Addressing Determinants of Health and Barriers to Care for Native Americans

Native Americans experience a variety of health determinants in their everyday lives, and agencies like the Alaska Native Tribal Health Consortium (ANTHC) and the Indian Health Service (IHS), along with insurance company Premera Blue Cross, have prioritized American Indian and Alaska Native health.

The size and terrain of Alaska make it extremely difficult for patients living in remote areas to receive adequate healthcare. Travelling to a physician or specialist may require hours of driving or even a plane flight depending on the distance of the location. Because of this, many Alaska Natives avoid annual wellness visits and over time develop a variety of severe physical and mental health issues that arise in the absence of preventative care.

IHS is an agency under the HHS that offers affordable or free healthcare to members of the 567 federally recognized tribes in the United States. The agency has calculated the disparities between American Indians and the rest of the American population for a variety of medical conditions.

According to IHS, American Indians and Alaska Natives have a life expectancy that is 4.4 years less than the rest of the American population. This community continues to have higher rates of death than the average American for medical conditions, including chronic liver disease, diabetes, unintentional injuries, assault, suicide, and chronic lower respiratory diseases. These disparities are a result of behavior issues—for example, substance abuse/addiction and depression—that are not being addressed in American Indian or Alaska Native communities.

In 2016, IHS entered an Interagency Agreement with the Bureau of Indian Affairs and the Bureau of Indian Education with the mission of increasing mental and behavioral health service access for American Indian students. This partnership is one of the many ways IHS promotes preventive care among the community.

"The Indian Health Service is dedicated to addressing behavioral health issues across Indian Country with a special focus on Native youth," said IHS Principal Deputy Director Mary L. Smith in a press release. "This Agreement is another major step we have taken to increase access to quality health care in tribal communities. This is a great partnership and key to caring for our Native youth."

According to the United States Census Bureau, the median household income for Alaska Natives was only $36,252 compared to the United States median household income at $52,176. In addition, 29.2% of the American Indian and Alaska Native population live below the poverty level, making the community the most impoverished race in America. These statistics correlate with the lack of American Indians enrolled in insurance programs due to their inability to afford coverage.

Premera, Alaska’s main health insurer, has noted that its insurance rates will experience a significant decrease for the 2018 calendar year. The company expects that this decrease will entice more American Indians and Alaska Natives in purchasing health insurance for their families.

Melanie Coon, a media representative for Premera, wrote in an email that, “the increased stability of the state’s individual insurance market provided by the state’s reinsurance program as well as a significant reduction in the use of medical services by the health plan’s customers resulted in an unprecedented average rate decrease of 22.4 percent on Premera’s 2018 individual metallic plans.” Since 2017, gold plans went down 26.7%, silver plans decreased 20.6%, and bronze plans were reduced 23.9%.

Coon continued with the example that a 40-year-old nonsmoker on the Preferred Plus Silver 3000 Health Savings Account plan who lived in Anchorage paid $879 in 2017. In 2018, that price would be reduced to $709 unless further financial assistance was needed to pay their monthly premium, making the already reduced price even lower.

Patients who are registered with a Federally Recognized Tribe in Alaska and Washington who are under the 300% poverty level pay zero out-of-pocket costs, including deductibles, copays, and coinsurance, when signed up for Premera Blue Cross.

In 2017, the insurance company added 100 new doctors and specialists to their insurance plan, making Premera the largest provider network in Alaska. Coon explained that this expansion—along with the health coverage plans specialized for Alaska Natives—will increase healthcare opportunities for this community. More access to in-network doctors translates to lower, more predictable costs for Premera customers.

ANTHC has also made healthcare more accessible for its patients. Despite long drives and flights that limit healthcare access for Alaska Natives, physicians and specialists are using technology to serve their patients who may be hours afway. ANTHC has been using telehealth services since 2001, a video conferencing communication system where patients receive the highest quality care in their own homes.