This document summarizes health and health care issues for American Indians and Alaska Natives (AIANs) in the United States. It finds that while AIANs make up only 2% of the US population, they disproportionately experience poorer health outcomes and lower socioeconomic status compared to whites. The Indian Health Service provides some health services to AIANs but remains historically underfunded. The document also finds that Medicaid, CHIP, and private coverage play an important role in expanding access to care for AIANs, and that AIANs gained health insurance coverage under the Affordable Care Act, especially in states that expanded Medicaid.

1. Health and Health Care for American Indians
and Alaska Natives (AIANs) in the United States
Updated January 2018

2. Figure 1
As of 2016, over 5 million
individuals self-identify
as AIAN alone or in
combination with
another race.
Source: Kaiser Family Foundation analysis of the 2016 American Community Survey 1-Year Estimates.
Under treaties and laws,
the U.S. has a unique
responsibility to provide
certain rights,
protections, and services
to AIANs, including
health care.
AIANs account for 2% of the United States population.

3. Figure 2
CA
13%
OK
9%
AZ
7%
TX
6%
NM
4%WA
4%NY
4%
NC
4%
FL
3%
MI
3%
AK
3%
Remaining states
40%
Note: AIAN includes people of mixed race and of Hispanic origin.
Source: Kaiser Family Foundation analysis of the 2016 American Community Survey 1-Year Estimates.
AIANs live across the United States, but 60% reside in 11
states. The majority of AIANs live outside of tribal areas.
Total = 5.4 Million

4. Figure 3
58%*
28%*
73%*
50%
11%
85%
34 and Younger Family Income Below Poverty Full-Time Worker in Family
AIAN White
*Indicates statistically significant difference from the White population at the p<0.05 level.
Note: Whites and AIANs are non-Hispanic. Includes nonelderly individuals 0-64 years of age.
Source: Kaiser Family Foundation analysis of the 2016 American Community Survey 1-Year Estimates.
Nonelderly AIANs are younger, more likely to be poor, and
less likely to have a full-time worker in the family
compared to Whites.

5. Figure 4
22%*
46%*
39%*
31%*
14%* 12%* 12%*
9%
33%
29%
20%
10%
7% 8%
Reports Fair or
Poor Health
Status
Reports a
Physical
Limitation
Share Who are
Obese
Share Who
Smoke
Reports
Currently
Having Asthma
Told By Doctor
They Have
Diabetes
Substance Use
Disorder in Past
Year Among
Ages 12 or
Older
AIAN White
*Indicates statistically significant difference from White population at the p<0.05 level.
Note: Whites and AIANs are non-Hispanic.
Source: Kaiser Family Foundation analysis of CDC, National Health Interview Survey, 2016, Kaiser Family Foundation analysis of
CDC, Behavioral Risk Factor Surveillance System, 2016 and Results from the 2015 National Survey on Drug Use and Health: Detailed
Tables, http://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015/NSDUH-DetTabs-
2015.htm#toc.
AIANs fare worse than Whites across many health
measures.
Among Nonelderly Adults Ages 18-64

6. Figure 5
IHS is the primary vehicle through which the federal government
provideshealth services to AIANs.
IHS has historically been underfunded to meet the health care
needs of AIANs.
Enrolling AIANs in health coverage, including Medicaid or
Marketplace coverage, expands their access to services and
increases revenues to IHS and Tribal facilities.
Source: Kaiser Program on Medicaid and the Uninsured, Medicaid and American Indians and Alaska Natives, (Washington, DC:
Kaiser Family Foundation, September 2017), http://files.kff.org/attachment/issue-brief-medicaid-and-american-indians-and-alaska-
natives.
Although the Indian Health Service (IHS) provides services
to AIANs, health coverage is important for AIANs.

7. Figure 6
29%*
14%
55%*
27%
45%* 78%
31%*
69%
25%*
8%
14%*
4%
AIAN White AIAN White
Uninsured
Private
Medicaid/CHIP/Other Public
Medicaid and CHIP help fill gaps in private coverage for
AIANs, particularly AIAN children, but they remain more
likely to be uninsured than Whites.
Nonelderly Adults Children
* Indicates statistically significant difference from the White population at the p<0.05 level.
Note: Whites and AIANs are non-Hispanic. Includes nonelderly adults 19-64 years of age and children 0-18 years of age.
Source: Kaiser Family Foundation analysis of the 2016 American Community Survey 1-Year Estimates.

8. Figure 7
32% 38% 35%
43%
29% 30%
37%
40%
34%
37%
42% 45%
30%
22%
31%
20%
29% 25%
2013 2016 2013 2016 2013 2016
Medicaid/CHIP/Other Public Private Uninsured
Note: AIANs are non-Hispanic. Includes nonelderly individuals 0-64 years of age.
Source: Kaiser Family Foundation analysis of the 2013 & 2016 American Community Survey 1-Year Estimates.
AIANs have Gained Coverage Under the Affordable Care
Act, with Larger Gains in States that Expanded Medicaid
Overall Expansion States Non-Expansion States
Health Insurance Coverage for Nonelderly AIANs by Expansion Status, 2013-2016