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Member Research and Reports

Member Research and Reports

UNC: Despite ACA Benefits, Some Native Populations Lack Health Insurance Coverage

Research from faculty at the University of North Carolina Gillings School of Global Public Health shows insurance coverage among American Indians and Alaska Natives in midwestern regions is still lacking, despite Affordable Care Act (ACA) provisions for these historically underserved populations.

Dr. Leah Frerichs, assistant professor of health policy and management at the Gillings School, is lead author of the paper “Regional Differences in Coverage Among American Indians and Alaska Natives Before and After the ACA,” published in the September 2019 issue of Health Affairs. Dr. Kristen Hassmiller Lich, associate professor of health policy and management, is co-author on the paper.

There are many barriers to health insurance coverage for American Indians and Alaska Natives, including low employment rates and a distrust of health care institutions. While a common misunderstanding persists that the Indian Health Service (IHS), the federally funded system of clinics and hospitals for American Indians and Alaska Natives, meets the health care needs of these populations, many individuals are not in areas covered by the IHS and experience significant gaps in insurance coverage.

Though the Affordable Care Act (ACA), enacted in 2010, has specific provisions for Native American populations, Dr. Frerichs could find very little post-ACA research that focused on the health coverage of those groups.

“Native American populations are often underrepresented across the spectrum of research. With specific reference to health services research, they have a very unique and complex health care system that deserves more attention,” she says. “As the nation continues to debate health care reform, data on American Indians and Alaska Natives need to be included in the conversation.”

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