Regional Differences In Coverage Among American Indians And Alaska Natives Before And After The ACA.

Understanding regional variation in the effect of the Affordable Care Act (ACA) on health insurance coverage among vulnerable populations such as American Indian and Alaska Native adults has important policy implications. We used American Community Survey data for the period 2010-17 to examine unadjusted trends in health insurance coverage among American Indians and Alaska Natives across ten US regions. In each region we also used multivariate regression to evaluate the effects of the ACA on insurance coverage among American Indians and Alaska Natives and differences in effects between that group and non-Hispanic whites. In the West we observed significant improvements in public insurance among American Indians and Alaska Natives, and disparities compared to non-Hispanic whites were reduced following the ACA. Although there were unadjusted increases in insurance coverage across most regions, regression analyses suggested that there were no significant post-ACA changes in public or private health insurance coverage among American Indians and Alaska Natives in the Oklahoma, Bemidji, or Alaska regions. In sum, health insurance among American Indians and Alaska Natives increased after the ACA, but improvements were not consistent across regions. More attention is needed to improve insurance coverage among American Indians and Alaska Natives in midwestern regions.