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Context: American Indian Elders have a lower life expectancy than other aging populations in the United States, due to inequities in health and access to health care. To reduce such disparities, the 2010 Affordable Care Act included provisions to increase insurance enrollment among American Indians. While the Indian Health Service remains underfunded, increases in insured rates have had significant impacts among American Indians and their health care providers. Methods: From June 2016-March 2017, we conducted qualitative interviews with 96 American Indian Elders (age 55+) and 47 professionals (including health care providers, outreach workers, public-sector administrators, and tribal leaders) in two Southwestern states. Interviews focused on Elders’ experiences with health care and health insurance. Transcripts were analyzed iteratively using open and focused coding techniques. Findings: Although tribal health programs have benefitted from insurance payments, the complexities of selecting, qualifying for, and maintaining health insurance are often profoundly alienating and destabilizing for American Indian Elders and communities. Conclusions: Findings underscore the inadequacy of health-system reforms based on the expansion of private and individual insurance plans in ameliorating health disparities among American Indian Elders. Policymakers must not neglect their responsibility to directly fund health care for American Indians.

Experiences of Health Insurance among American Indian Elders and Their Health Care Providers