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Impact of Affordable Care Act Repeal in Indian Country

Impact of Affordable Care Act Repeal in Indian Country

Report on the Impact of Affordable Care Act Repeal in Indian Country.


Washington, DC, Mar 27, 2017 — The National Indian Health Board (NIHB) and North Dakota State University (NDSU) released a report outlining the impact a full repeal of the Patient Protection and Affordable Care Act would have on Tribes and American Indians/Alaska Natives (AI/ANs) across the country.


During the ongoing debate about healthcare reform it’s important to bring attention to the serious consequences that American Indian and Alaska Natives may ultimately face. There is a great deal at stake for America’s Native American people, and their health care needs cannot and should not be ignored.

Dr. Don Warne,
Coauthor and Chair of the Department of Public Health at North Dakota State University


The report analyzed the ACA’s impact on Tribes and the consequences a repeal would have on the law’s impact in Tribal communities. Highlights from “The Impact of ACA Repeal on American Indians and Alaska Natives” include:

  • Third party billing at the Indian Health Service has increased by $240,000,000, 26%, since the Indian Healthcare
  • Improvement Act passed as part of the ACA, became law.
  • 51% of uninsured AI/ANs nationwide would be eligible for Medicaid if all states adopted expansion—550,000 people.
  • From 2013-2014, the AI/AN uninsured rate fell from 22.6% to 17.7%.
  • Repeal of the ACA would disrupt healthcare benefits for up to 90% of AI/ANs in Medicaid expansion states.
  • Full repeal would return Indian Country to the days when only specialty healthcare for “life and limb” threatening illness was funded, meaning that many patients had to forego services like cancer screenings, joint replacement surgery, and other critically needed procedures.

NIHB hopes that this analysis will provide a unique perspective to lawmakers as they debate changes to the ACA. While much work remains to be done, the ACA has caused the Indian healthcare delivery system to make real gains in the past few years, and a complete repeal would be devastating to Tribal communities.

This partnership between NIHB and NDSU is yet another example of advocates coming together and amplifying the Tribal voice to ensure the healthcare needs of our people are met and the trust responsibility to provide healthcare for AI/ANs is honored.

Support for the research and data collection associated with this report was provided by the Robert Wood Johnson Foundation and the Montana Healthcare Foundation.

You can read the full report HERE.