As Congress begins debate on whether and how to repeal or replace the Patient Protection and Affordable Care Act (ACA or “Obamacare”), American Indians and Alaska Natives (AI/ANs) face considerable risk and uncertainty due to many special provisions in the ACA that were intended to address longstanding under funding and health disparities. AI/ANs have a unique political standing in the United States and are the only population born with a legal right to health services. These rights are based on numerous legal foundations, including treaties, laws, executive orders, and court decisions. However, the Indian Health Service (IHS)—the federal agency charged with providing health services to AI/ANs has been underfunded for decades, leaving the AI/AN population with among the worst health disparities and poorest access to services in the nation.
This report, authored by Dr. Donald Warne at North Dakota State University, in partnership with the National Indian Health Board, highlights the specific effects of an ACA repeal. Support for the research and data collection associated with this report was provided by the Robert Wood Johnson Foundation and MHCF.