Research Alert: January 15, 2026

Indian Health Service and Health Care Affordability Issues Among American Indian/Alaska Native People by Rurality

The Indian Health Service (IHS) provides comprehensive free health services to eligible individuals and may alleviate health care affordability issues for American Indian and Alaska Native (AI/AN) people; however, the IHS operates overwhelmingly in rural areas, and data on rural/urban differences in IHS use and health care affordability issues among AI/AN people are lacking. This policy brief examines rural/urban differences in rates of health care affordability and IHS use among AI/AN people, as well as within rural AI/AN residents.

Key Findings:

• AI/AN rural residents were more likely to receive Indian Health Service (IHS) care than AI/AN urban residents (47.3% vs 9.1%).
• Around 50% of AI/AN residents from both rural and urban areas reported worry about paying medical bills, with around 15% reporting problems paying medical bills and around 10% reporting being unable to pay medical bills entirely.
• AI/AN individuals who were both uninsured and not receiving IHS care were most likely to report worrying about paying medical bills when compared to any other health service provider/ insurer category, in both rural (80.0%) and urban (80.1%) areas. In rural areas, those privately insured and not receiving IHS care were least likely to report worry (41.1%), while in urban areas, those receiving IHS care were the least likely to report worry (36.8%).
• Rural AI/AN residents who were both uninsured and not receiving IHS care were most likely to report problems paying medical bills (24.1%) and being unable to pay medical bills entirely (16.7%), while those receiving IHS care were least likely to report problems paying medical bills (8.8%) or being unable to pay medical bills entirely (6.5%). Among urban AI/AN residents, there was no difference by health service provider/insurer status in reports of these issues.

Additional Resources of Interest:

• More FORHP-funded research on Poverty
• More information about the University of Minnesota Rural Health Research Center