Introduction

In 2017 there were approximately 774,000 American Indian and Alaska Native (AI/AN) children under age 19, comprising about 1 percent of the 78.1 million children nationwide.¹ AI/AN children are disproportionately poor, experience major health disparities, and are more than twice as likely to be uninsured as U.S. children overall. It goes without saying that they represent the future of Tribal nations that survived the Native American Removal and forced assimilation.² Precisely because this population of children is so small and so disadvantaged, it merits special attention.

In 2017, over 80,000 AI/AN children, or 14.1 percent, were uninsured. In contrast, only 5 percent of all U.S. children were uninsured that year.³ It is well established that uninsured children are at greater risk for health disparities and poor health outcomes.⁴ Reducing the rate of uninsurance among AI/AN children requires an understanding of the current sources of coverage in order to identify gaps and develop policies for addressing them.

This brief begins with a discussion of AI/AN children and the health disparities they face. It then updates and expands a previous Center for Children and Families (CCF) analysis of coverage trends for this population between 2008 and 2015, with a particular focus on three public sources of coverage: the Indian Health Service (IHS), Medicaid, and the Children’s Health Insurance Program (CHIP).⁵ There are, of course, other sources of coverage for AI/AN children, including a parent’s employer-sponsored insurance. But for AI/AN children whose families are disproportionately low income, the IHS, Medicaid, and, to a lesser extent, CHIP are the most important.⁶ The brief concludes with a set of recommendations for improving health care coverage for AI/AN children.

Full Report

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1. Georgetown University Center for Children and Families analysis of the U.S. Census 2017 American Community Survey data from American Fact Finder Table C27001C using 1-year estimates of AI/AN alone.
2. National Museum of the American Indian, “American Indian Removal: What Does it Mean to Remove A People” (Washington: Smithsonian National Museum of the American Indian), available at https://americanindian.si.edu/nk360/removal/pdf/related-facts.pdf
3. J. Alker and O. Pham, “Nation’s Progress on Children’s Health Reverses Course” (Washington: Georgetown University Center for Children and Families, November 2018), available at https://ccf.georgetown.edu/2018/11/21/nations-progress-on-childrens-healthcoverage-reverses-course/.
4. A. Chester, J. Alker, and K. Wagnerman, “Medicaid is a Smart Investment in Children” (Washington: Georgetown University Center for Children and Families, March 2017), available at https://ccf.georgetown.edu/2017/03/13/medicaid-is-a-smart-investment-in-children/.
5. J. Alker, K. Wagnerman, and A. Schneider, “Coverage Trends for American Indian and Alaska Native Children and Families” (Washington: Georgetown University Center for Children and Families, July 2017), available at https://ccf.georgetown.edu/2017/07/14/coverage-trendsfor-american-indian-and-alaska-native-children-and-families/.
6. Unposted data made available by CMS to its Tribal Technical Advisory Group indicate that in 2018 a total of 10,500 AI/AN children under age 17 were enrolled in the Federally-Facilitated Marketplaces. Source: CMS, Table 1: American Indian and Alaska Native Applicants and Enrollees (Active) in the Federally-Facilitated Marketplace, Coverage Year 2017-2018. Table 1 is available from the authors.