R E V I E W O F N E W D A T A F R O M T H E 2 0 0 8 - 2 0 1 0 A M E R I C A N C O M M U N I T Y S U R V E Y O N R A T E S O F I N S U R A N C E A N D I N C O M E

D I S T R I B U T I O N F O R A L A S K A N A T I V E S A N D A M E R I C A N I N D I A N S

3 3 S T A T E A C A A I A N D A T A P R O J E C T A C A / A I A N 1 2

W W W . E D F O X P H D . C O M

Health Care Reform: Measuring its impactin 33 States with IHS funded health programs

American Indians & Alaska Natives

July 26, 2012

33 State level impact analysis

1st step: How many AIANs are there?

4,095,371 (33 states) estimated AIAN alone & in combination4, 900,000 in all 50 states

2nd step: What is rate of private insurance?

45.6% 1.9 million AIANs have private insurance30% 1.2 million report access to IHS paid services27% 1.1. million have Medicaid

3rd step: What is number and rate of uninsured?

27% 1.1 million uninsured 4th step: Determine income distribution of uninsured across 3 income categories.*

36% under 138% of Federal Poverty Level (FPL), ** 42% 138 to 400% of FPL 21% over 400% of FPL

5th step: Use estimates to provide information needed for planning outreach & education, workforce, facilities, budgets for all.

6th step: Remember these are estimates, check with reality as it becomes known, make no assumptions, remember error rates.

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The American Community Survey

Three-year data2008-2010 surveys pooled data released 10/27/11, w/ add’l releases Dec.

’11

State, County, and Metropolitan Area data for areas w/ ≥ 20,000 AIAN alone & in comb.

Health Insurance data partially available

(most reliable data thus far for AIANs – question on health insurance first asked in 2008, allowing 1st time 3-yr data is avail.)

Current release does not report Medicaid or Medicare separately, but as public coverage

In addition it includes, for the first time, information on the perception of IHS ‘coverage’ and Income distribution for AIANs:

Questions on the ACS

The health insurance question asks the respondent to give a separate answer for each member of household regarding health insurance coverage, including:

1. Employer Sponsored Insurance (ESI)2. Private, paid by individual3. Medicare4. Medicaid 5. Tricare, Health care insure for military and families6. VA, Veteran’s Administration 7. IHS coverage-not used to compute rates of insurance

Question on insurance is ‘point in time’ or ‘current coverage’ not the coverage in the ‘past year’ asked in some surveys.

It is generally believed that Medicaid is underreported.

Limitations of ACS data

Estimates are based on survey samples: do not have calculated error rates to inform the range of uncertainty in

the estimates However, three years of data for Oklahoma have over 10,000 responses

and Washington’s data includes more than 6300 responses from self-identified AIANs

As the first set of 3-year estimates, it is relatively new and little research has examined its relative accuracy.Example: there is some evidence that it underestimates Medicaid coverage by a couple points

Uninsured is calculated when a respondent answers: no to all 6 types of health insurance coverage Note: IHS is not considered coverage

ACS and Urban Indians

Arizona, Alaska, California, Oregon, Oklahoma, Minnesota, New Mexico, and Washington all have very large Urban Indian populations.

ACS has income and insurance data for metropolitan areas in each of these states. In addition, County level, data is available for Arizona, California, Oklahoma, New Mexico, and Washington.

% of All Respondents IHS Uninsured Medicaid Medicare Private InsAlabama 3% 21% 20% 15% 59%Alaska 81% 36% 29% 8% 35%Arizona 53% 30% 38% 9% 32%California 9% 20% 26% 11% 54%Colorado 9% 23% 22% 9% 54%Connecticutt 13% 26% 13% 61%Florida 4% 28% 21% 13% 50%Idaho 33% 30% 24% 13% 44%Iowa 11% 26% 21% 10% 55%Kansas 18% 23% 24% 9% 54%Louisiana 4% 24% 27% 11% 49%Maine 21% 18% 42% 15% 43%Massachusetts 2% 8% 34% 13% 61%Michigan 17% 16% 30% 11% 56%Minnesota 28% 22% 37% 8% 43%Mississippi 28% 32% 25% 12% 45%Montana 68% 40% 29% 9% 28%Nebraska 19% 21% 25% 11% 52%Nevada 33% 28% 16% 10% 55%New Mexico 63% 39% 29% 9% 30%New York 10% 19% 30% 12% 52%North Carolina 6% 25% 28% 11% 45%North Dakota 69% 33% 26% 6% 41%Oklahoma 59% 28% 24% 10% 48%Oregon 20% 27% 26% 9% 48%Rhode Island 28% 32% 25% 12% 45%South Carolina 4% 24% 25% 12% 51%South Dakota 77% 38% 39% 7% 22%Texas 5% 27% 18% 11% 55%Utah 19% 27% 28% 21% 47%Washington 26% 22% 29% 10% 50%Wisconsin 31% 20% 33% 12% 48%Wyoming 40% 31% 28% 8% 41%

MassachusettsAlabama

LouisianaSouth Carolina

FloridaTexas

North CarolinaColorado

CaliforniaNew York

IowaMichigan

KansasUtah

NebraskaOregonMaine

WashingtonMinnesota

Rhode IslandMississippiWisconsin

IdahoNevada

WyomingArizona

OklahomaNew Mexico

MontanaNorth DakotaSouth Dakota

Alaska

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

2%3%4%4%4%5%6%

9%9%10%11%

17%18%19%19%20%21%

26%28%28%28%

31%33%33%

40%53%

59%63%

68%69%

77%81%

Access to IHS

MassachusettsConnecticutt

MichiganMaine

New YorkCaliforniaWisconsinNebraskaAlabama

MinnesotaWashington

KansasColoradoLouisiana

South CarolinaNorth Carolina

IowaTexas

OregonUtah

OklahomaFloridaNevada

IdahoArizona

WyomingMississippi

Rhode IslandNorth Dakota

AlaskaSouth DakotaNew Mexico

Montana

0% 5% 10% 15% 20% 25% 30% 35% 40%

8%13%

16%18%

19%20%20%21%21%

22%22%23%23%

24%24%25%

26%27%27%27%

28%28%28%

30%30%

31%32%32%33%

36%38%39%40%

Uninsured

NevadaTexas

AlabamaFlorida

IowaColorado

OklahomaIdaho

KansasMississippi

Rhode IslandSouth Carolina

NebraskaOregon

CaliforniaConnecticutt

North DakotaLouisiana

UtahNorth Carolina

WyomingWashingtonNew Mexico

AlaskaMontana

New YorkMichigan

WisconsinMassachusetts

MinnesotaArizona

South DakotaMaine

0% 5% 10% 15% 20% 25% 30% 35% 40% 45%

16%18%

20%21%21%

22%24%24%24%25%25%25%25%26%26%26%26%

27%28%28%28%29%29%29%29%30%30%

33%34%

37%38%

39%42%

Medicaid

North DakotaSouth Dakota

MinnesotaAlaska

WyomingColorado

ArizonaMontana

OregonKansas

New MexicoWashington

NevadaOklahoma

IowaNebraska

TexasCaliforniaMichigan

North CarolinaLouisianaNew YorkWisconsin

Rhode IslandMississippi

South CarolinaConnecticutt

MassachusettsIdaho

FloridaMaine

AlabamaUtah

0% 5% 10% 15% 20% 25%

6%7%8%8%8%9%9%9%9%9%9%10%10%10%10%11%11%11%11%11%11%12%12%

12%12%12%13%13%13%13%

15%15%

21%

Medicare

South DakotaMontana

New MexicoArizonaAlaska

North DakotaWyoming

MaineMinnesota

IdahoNorth Carolina

MississippiRhode Island

UtahOklahoma

OregonWisconsinLouisiana

FloridaWashington

South CarolinaNebraskaNew YorkColorado

CaliforniaKansas

TexasIowa

NevadaMichiganAlabama

ConnecticuttMassachusetts

0% 10% 20% 30% 40% 50% 60% 70%

22%28%

30%32%

35%41%41%

43%43%44%45%45%45%

47%48%48%48%49%50%50%

51%52%52%

54%54%54%55%55%55%56%

59%61%61%

Private Insurance

Income Categories and Insurance Status

Source: American Community Survey 2008-2010

  33 state Average    Total

1,494,529 36% under 138   1,738,858 42% 138-400   861,984 21% over 400   4,095,371 100% Total          IHS Access 30%     495,893 41% under 138   532,423 44% 138-400   186,626 15% over 400   1,218,539 100% Total     %   Uninsured 27%   of Total    487,641 45% under 138   463,275 43% 138-400   151,286 14% over 400   1,102,202 101% Total    

 Medicaid  27%

 % of Total

   742,621 66% under 138   326,250 29% 138-400   48,820 4% over 400   1,117,691 100% Total     % of Total   Medicare 11%      158,043 37% under 138   190,131 44% 138-400   78,336 18% over 400   430,437 99% Total     % of Total   Private 47%      270,342 14% under 138   949,506 49% 138-400   703,054 37% over 400   1,922,902 100% Total