1. Health Care Reform: Measuring its impact on American Indians & Alaska Natives in Oregon and Washington Comparison of Areas with large Indian reservations to State-wide Rates March 14, 2012
Review of New Data from the American Community Survey on rates of insurance for Alaska Natives and American Indians
ef, vfb

2. Census: Decennial and Annual American Community Survey
2010 Census is official census:
WA 198,998 AIAN alone and in combination
OR 109,223 alone and in combination
2010 ACS estimates:
192,000 estimate by ACS for Washington 2010
Roughly 80,000 live on or near reservations
105,000 estimate by ACS for Oregon 2010
About 40,000 live on or near reservations
Little is known about variations in health insurance status between reservation areas and urban areas.
Comparing Eastern OR Eastern WA to statewide insurance status

3. Comparing Eastern OR Eastern WA to statewide insurance status
Eastern OR and WA
Largest reservations in both states are on the East side of Cascades
WA, Yakama and Colville have largest tribal membership in the State
Over 20,000 members of WA tribes live in Eastern WA of over 40,000 AIANs who live in Eastern Washington.
Klamath, Warm Springs, and Umatilla each have about 4,000 tribal members, many live on reservations, with exception of Klamath, a terminated tribe, who lost 1 million acre reservation in the 1950s.
Over 12,000 members of OR tribes live in Eastern OR over population of over 20,000 AIANs in Eastern Oregon.
Comparing Eastern OR Eastern WA to statewide insurance status

4. Comparing Eastern OR Eastern WA to statewide insurance status

5. 12 % difference in Access to IHS
Comparing Eastern OR Eastern WA to statewide insurance status

6. Comparing Eastern OR Eastern WA to statewide insurance status
3% Difference in Medicaid Coverage: Unknown Difference in Take-up rates
Comparing Eastern OR Eastern WA to statewide insurance status

7. 10% Difference in Private Insurance Coverage
Comparing Eastern OR Eastern WA to statewide insurance status

8. Uninsurance Rate: 10% difference between Eastern WA and Statewide Rate
Comparing Eastern OR Eastern WA to statewide insurance status

9. Comparing Eastern OR Eastern WA to statewide insurance status

10. 22% difference in access to IHS services: 42% in Eastern Oregon
Comparing Eastern OR Eastern WA to statewide insurance status

11. 3% difference in Medicaid coverage: 29% in Eastern Oregon
Comparing Eastern OR Eastern WA to statewide insurance status

12. 5% difference in Private Insurance: 43% in Eastern Oregon
Comparing Eastern OR Eastern WA to statewide insurance status

13. 2% difference in rate of uninsurance
Comparing Eastern OR Eastern WA to statewide insurance status

14. Comparing Eastern OR Eastern WA to statewide insurance status

15. Overall Assessment: Variation Across OR and WA
The impact of Health Care Reform On or Near Oregon’s and Washington’s Indian Reservations
Great variation between State-wide and Eastern areas
Uninsured and IHS access vary widely, but Medicaid keeps rates lower in areas with lower private insurance
Medicaid high (and similar to statewide) in all areas, but may have lower take up rates given poverty rates
IHS access higher in rural areas near reservations.
Private insurance low in eastern parts of both states.
Outreach and education should consider differences.
Comparing Eastern OR Eastern WA to statewide insurance status

16. Comparing Eastern OR Eastern WA to statewide insurance status
References
U.S. Census Bureau. American Community Survey (ACS) 2008,2009, 2010, 3 year American Community Survey accessed through Factfinder2 for 3 year reports for years 2008, 2009, 2010
Comparing Eastern OR Eastern WA to statewide insurance status

17. ACS question on insurance coverage
Comparing Eastern OR Eastern WA to statewide insurance status

18. The American Community Survey Notes
3-year data ( surveys pooled data) released October 27, 2011
State, County and Metropolitan Area data for areas w/ ≥ 20,000 AIAN alone and in combination
Health Insurance data partially available:
first time including 3-year data as question on health insurance first asked in 2008
PUMAs are areas with about 100,000 persons, raw data, at the individual level available, but number of AIANs is so small that error rates are high and should be used with understanding of their ‘wide’ confidence intervals.
Ed Fox, Verne Boerner, Sonciray Bonnell

19. PUMAs in this presentation
Oregon
Includes all PUMAs east of the Cascades
Washington
Includes all PUMAs except those for City of Spokane, Spokane Valley and rest of Spokane County
That is it includes all counties East of the Cascades except Spokane County.
Spokane county has more AIANs from other states than the counties included in Eastern WA analysis presented here.
Comparing Eastern OR Eastern WA to statewide insurance status

20. Comparing Eastern OR Eastern WA to statewide insurance status
Eastern Oregon Pumas
Comparing Eastern OR Eastern WA to statewide insurance status

21. INDIAN RESERVATIONS WASHINGTON
Comparing Eastern OR Eastern WA to statewide insurance status

22. Comparing Eastern OR Eastern WA to statewide insurance status

23. Comparing Eastern OR Eastern WA to statewide insurance status

24. Comparing Eastern OR Eastern WA to statewide insurance status