The Future of Coverage for American Indian and Alaska Native Children

As you may possibly have heard by now, the uninsured rate for children is heading in the wrong direction.  It increased from 5 percent in 2017 to 5.5 percent in 2018, which translates into an additional 425,000 uninsured children.  Among the children whom this trend likely affects are American Indians and Alaska Natives, but we won’t know for sure until we’ve had a chance to analyze more detailed data that the Census Bureau will release later this month. Here’s what we do know:  that the uninsured rate for AI/AN children in 2017 was 14.1 percent, nearly triple the uninsured rate of 5 percent for all children that year.

These and other data are presented in a new CCF brief, “Promoting Health Coverage of American Indian and Alaska Native Children.”  This brief is the eighth in our series on the Future of Children’s Health Coverage, which aims to develop federal and state policy ideas that will promote child and family health.  While the AI/AN child population is relatively small—774,000 in 2017, or about 1 percent of the 78.1 million children in the U.S.—they are a 1 percent to whom the federal government has a special legal and moral responsibility.

The brief focuses on the three main sources of coverage for low-income AI/AN children:  the Indian Health Service (IHS), Medicaid, and the Children’s Health Insurance Program (CHIP).  It cites research showing that AI/AN children are more likely than other American children to be in poor health and makes the case that these health disparities cannot be reduced unless coverage of AI/AN children improves.  The brief finds that reducing the uninsurance rate and improving health outcomes for AI/AN children will be difficult to achieve without much better national data than are currently available.

The weak quality of national data on coverage and health disparities among AI/AN children is just one of the problems they face.  Another is the chronic underfunding of the IHS, which limits its capacity to meet the needs of the AI/AN adults and children it serves and makes it more dependent on revenues from public health insurance programs like Medicaid. That, in turn, makes it even more important that AI/AN children who are eligible for Medicaid are actually enrolled in the program.  The brief makes recommendations for concrete steps that the IHS, the Center for Medicaid & CHIP Services, and the Congress can take to address both the data and funding gaps.

Hopefully this brief and its recommendations will support initiatives like First Kids 1st – Every Child Is Sacred, which seeks to “change national, tribal, and state policy to create conditions in which American Indian and Alaska Native children can thrive.”  Children—especially those like AI/AN children facing sharp health disparities—need coverage to thrive.  The responsible federal agencies—you know who you are—need to get on the case.

This paper was written jointly by Lauren Roygardner and Andy Schneider of Georgetown University Center for Children and Families and Doug Steiger, who was a counselor to the U.S. Secretary of Health and Human Services from 2012 to 2017.