As of 2017, over 5 million individuals identify as American Indian and Alaska Native (AIAN), representing 2% of the U.S. population. AIANs face significant health disparities compared to whites, including higher rates of poverty and poorer health outcomes, while the Indian Health Service (IHS) is historically underfunded, necessitating health coverage to improve access to care. Medicaid and the Affordable Care Act have helped increase coverage among AIANs, particularly in states that expanded Medicaid.

1. Health and Health Care for
American Indians and Alaska
Natives (AIANs) in the United
States
Updated May 2019

2. Figure 1
As of 2017, over 5 million
individuals self-identify as
AIAN alone or in combination
with another race.
AIANs account for 2% of the United States
population.
Source: Kaiser Family Foundation analysis of 2017 American Community Survey (ACS), 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.

3. Figure 2
AIANs live across the United States, but 60% reside in 11
states. The majority of AIANs live outside of tribal areas.
Note: AIAN includes people of mixed race and of Hispanic origin.
Source: Kaiser Family Foundation analysis of 2017 American Community Survey (ACS), 1-Year Estimates.
SHARE OF AIAN POPULATION BY STATE, 2017
CA
14%
OK
10%
AZ
7%
TX
6%
NM
4%WA
4%NY
4%
NC
3%
FL
3%
AK
3%
MI
3%
Remaining States
40%
Total: 5.4 Million

4. Figure 3
Nonelderly AIANs are younger, more likely to be
poor, and less likely to have a full-time worker in the
family compared to Whites.
Note: AIANs and Whites are non-Hispanic. Excludes individuals of mixed race. Includes nonelderly individuals 0-64 years of age. All
values have a statistically significant difference from the White population at the p<0.05 level.
Source: Kaiser Family Foundation analysis of 2017 American Community Survey (ACS), 1-Year Estimates.
57%
23%
70%
49%
8%
84%
34 and Younger Family Income
Below Poverty
Full-Time Worker
in Family
AIAN White

5. Figure 4
AIANs fare worse than Whites across many health
measures.
* Indicates statistically significant difference from the White population at the p<0.05 level.
Note: AIANs and Whites are non-Hispanic. Excludes individuals of mixed race. Includes nonelderly adults 18-64 years of age.
Source: Kaiser Family Foundation analysis of 2017 National Health Interview Survey (NHIS), 2017 Behavioral Risk Factor Surveillance
System (BRFSS), and 2017 National Survey on Drug Use and Health.
17%*
37%
40%*
31%*
15%* 14%* 15%*
9%
32% 30%
20%
10% 7% 10%
Fair or Poor
Health Status
Physical
Limitation
Obese Current
Smoker
Currently
Has Asthma
Told By Doctor
They Have
Diabetes
Substance Use
Disorder Among
Ages 12+
AIAN White

6. Figure 5
Although the Indian Health Service (IHS) provides services
to AIANs, health coverage is important for AIANs.
Source: Kaiser Family Foundation 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.
IHS is the primary vehicle through which
the federal government provides health
services to AIANs.
IHS has historically been underfunded to
met 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.

7. Figure 6
32%
16%
42% 75%
26%
8%
AIAN White
Medicaid and CHIP help fill gaps in private coverage for
AIANs, particularly AIAN children, but they remain more
likely to be uninsured than Whites.
Note: AIANs and Whites are non-Hispanic. Excludes individuals of mixed race. Includes nonelderly adults 19-64 years of age and
children 0-18 years of age. Totals may not sum to 100% due to rounding. All values have a statistically significant difference from the
White population at the p<0.05 level.
Source: Kaiser Family Foundation analysis of 2017 American Community Survey (ACS), 1-Year Estimates.
56%
28%
30%
68%
14%
4%
AIAN White
Uninsured
Employer/
Other
Private
Medicaid/
Other
Public
Nonelderly Adults (19-64) Children (0-18)

8. Figure 7
AIANs have Gained Coverage Under the Affordable Care
Act, with Larger Increases in States that Expanded Medicaid.
Note: AIANs are non-Hispanic. Excludes individuals of mixed race. Includes nonelderly individuals 0-64 years of age.
Source: Kaiser Family Foundation analysis of the 2013 & 2017 American Community Survey (ACS), 1-Year Estimates.
HEALTH INSURANCE COVERAGE FOR NONELDERLY AIANs BY EXPANSION STATUS, 2013 & 2017
36%
45%
30% 31%
33%
35%
40% 43%
31%
20%
29% 26% Uninsured
Employer/
Other
Private
Medicaid/
Other
Public
Expansion States
2013 2017
Non-Expansion States
2013 2017