Native Americans and the Affordable Care Act

By:  Ryan Borger

Due to treaties between Indian tribes and the United States, tribal Indians are guaranteed free health care at any Indian Health Service (“IHS”) or tribal-run facility.  Despite this, in the United States in 2011, nearly 1.2 million (approximately 25%) American Indians and Alaska Natives did not have health insurance.  That’s roughly 10% higher than the total number of Americans countrywide that were uninsured at that time.  This was attributable, at least in part, to some glaring deficiencies in the IHS system.  First, “urban Indians,” which are those who do not live on tribal lands, typically do not have access to IHS facilities.  According to the 2010 census, nearly 78% of all Native Americans were urban Indians.  Second, insufficient funding results in Native Americans who do have access to IHS facilities facing difficulties in getting the care they need.  Their answer may be the Affordable Care Act.

If Tribal Indians buy insurance through the ACA’s marketplace exchange, their access to health care is much more obtainable.  It would make no difference whether they live on tribal lands or whether they are urban Indians; each would have equal access to care.  Moreover, if they sign up, Native Americans falling below a certain income level would have their health care costs covered for them, regardless of the facility they choose to attend.  Those above the income level would have their costs covered for them if they attend an IHS or tribal-run facility.  This generates more money for these facilities and allows them to provide care to those who remain uninsured.

The ACA could possibly be the answer to the Native American health care problem the IHS was once thought to be.  In the years since the ACA’s inception, the IHS has been providing training and education to IHS and tribal-run facilities on the ACA.  As this continues in the years to come, the IHS expects the number of uninsured Native Americans to drop significantly from where it was just four years ago.  As the goal of the IHS is “to raise [Native Americans and Alaska Natives’] health status to the highest possible level,” perhaps the ACA is just the way to accomplish it.

Source:  Taylor Kubota, How the Affordable Care Act Applies to Native Americans, (November 5, 2013), http://

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