Unfortunately, the U.S.  health insurance system does not serve everyone due to issues of accessibility and systemic inequities, contributing to health disparities. One population most hurt by these inequities is the Indigenous communities. 

This is in part a problem because the health care system in Indigenous communities has gone through a lot of shifting over the years. It started as a system of providing medical and food assistance to Indigenous populations in America in exchange for them to stay within their reservations, which has been written into the Constitution. However, those services usually were of low quality and arrived late to the communities. This prevented the development of health care systems for Indigenous people. Forced assimilation into white health practices also proved harmful as medical care was eventually removed from the reservations and Indigenous people had to travel to receive life-saving care. 

Eventually, the current service working to provide accessible health care to Indigenous populations came into effect. The Indian Health Services (IHS), now under the Department of Health and Human Services, is a coverage plan that works to improve the health of Indigenous people. The IHS started to implement improvements by establishing medical facilities in reservations, making healthcare more accessible and creating jobs. Any person who is  part of the 574 federally recognized tribes can utilize the IHS for their health care needs as it is the primary provider and advocate for the health of Indigenous people. While this progress has been made for the advancement of Indigenous healthcare, there are still problems with the IHS. 

For example, there are tribes who still do not have federal recognition, meaning they are not eligible to receive the affordable care that the IHS provides. Additionally, the IHS has its care focused on rural areas even though about 78% of the Indigenous population live in urban areas. This leads to longer travel times for those seeking IHS care. 

The IHS is also severely underfunded. The amount spent per patient within the IHS is about ¼ of what is spent in the Veterans Health Care System and about ⅙ of what is spent for Medicare. Finally, the IHS is understaffed, leading to longer wait times in clinics and an overall decrease in the quality and efficiency of care, contributing to disparities in the health of Indigenous populations compared to other groups. 

Even though the IHS provides care, Indigenous people need to see other providers in case the IHS is not an option for them. For this reason, Indigenous people still need insurance to be able to see other providers without having to pay the full price. 

But while Medicaid provides insurance to Indigenous people who qualify for its benefits, regardless of their eligibility to receive treatment from the IHS, this hasn’t helped many Indigenous people. While the Affordable Care Act expanded Medicaid nationally, many states did not expand it, limiting access for  Indigenous people who need it. 

Given that the IHS is not completely accessible to all Indigenous people due to being underfunded and understaffed, and that Medicaid is not always an option, many Indigenous people need to  see other providers. But healthcare is expensive without insurance – and currently, about 19% of Indigenous people remain uninsured, compared to 6.6% of white people.  

Due to all these factors, almost a fifth of the Indigenous population does not have access to affordable health care. Although the Indian Health Service is supposed to provide health care infrastructure for Indigenous communities, gaps in accessibility and health care coverage contribute to troubling health inequities and disparities for these communities.