Indian Health Service and Health Care Affordability Issues Among American Indian/Alaska Native People by Rurality
Link
Date
01/2026
Description
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.
Center
University of Minnesota Rural Health Research Center
Authors
Ingrid Jacobson, Katie Rydberg, Alexis Swendener, Kyle Hill, Katy Kozhimannil, Carrie Henning-Smith