S.E. Ruckman: Series on health care law and Indian Country

Finding the exact number of American Indians enrolled for federal health care insurance seemed like a natural question. One federal agency reports point out that many minorities defer from self-identifying on their Affordable Care Act (ACA) application, so totals are not an easy assumption even with numbers attached. In short, the practice of omitting race information is common across federal agencies and occurs in just over 31 applications per 100, according to a U.S. Department of Health and Human Services (HHS) report on ACA enrollment data. With this in mind, experts say that roughly 1.3 percent of federal ACA applicants were classified as “multi-racial” when race was disclosed, muddying the waters even further.

In a federally-facilitated marketplace (FFM), determining American Indian/Alaska Natives (AI/AN) ACA numbers are inexact and exclude Indians who live in state-based marketplaces in 14 states. In the federal market, Indians who enrolled in ACA markedly trail behind other minorities like Blacks, Latinos and Asians although some 2.7 million Americans identify as AI/AN in U.S. Census figures. Hawaiian/Pacific Islanders are an even smaller group and have an ACA enrollment figure of 3,282, the same report shows. Both Indian and Hawaiian ACA enrollment is below one percent of all Americans.

Zeroing in on official Indian ACA enrollment numbers (FFM or otherwise) did not divulge any extra ethnic information. Tribal diversity, for example, was a statistic that was not calculated. Numbers for the state of Oklahoma, while giving AI/AN enrollment tallies (listed at just over 1,300), did not include any insight into tribal affiliation for the state’s 38 federally recognized tribes. This is typical for Oklahoma (a non-Medicaid expansion state) since their version of “Indian country” involves varying tribal jurisdictions and allotment parcels rather than official reservations that exist in states like New Mexico, South Dakota and Arizona where reservation names can provide clues about specific cultural specificity.