Access to quality healthcare remains a pressing issue for American Indian and Alaska Native (AI/AN) communities. Rooted in history and shaped by systemic barriers, Native American health access depends on a complex structure that includes sovereign tribes, reservations, and the Indian Health Service (IHS).
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Key Takeaways
Native American healthcare access is shaped by historical inequalities, geographic isolation, and underfunded systems. While the Indian Health Service (IHS) plays a vital role in providing healthcare, gaps in funding and staffing continue to limit care. Solutions to broaden healthcare access must go beyond basic outreach and use reflective messaging and community centered approaches to build trust.
Who Are American Indians and Alaska Natives?
It’s important to know the meaning of American Indian and Alaska Native (AI/AN) can change depending on the context. For the U.S. Census, it includes anyone with origins in the original peoples of North and South America who has a tribal affiliation or community connection. For healthcare or federal programs, eligibility often depends on being enrolled in a federally recognized tribe or meeting certain legal criteria. But identity goes beyond paperwork. Many people who are not “enrolled” still identify as Native, stay connected to their culture, and are active in their communities. Being AI/AN is not only about legal definitions but also heritage, relationships, and lived experiences.
In 2023, more than 8.8 million people in the U.S. identify as AI/AN alone or in combination with one or more races. There are currently 574 federally recognized tribes, each with its own government, culture, and traditions. Despite this diversity, Native American healthcare access remains limited in many communities. Common barriers include geographic isolation, economic inequity, and underfunded systems.
What is the Indian Health Service (IHS)?
The Indian Health Service (IHS) is a federal agency under the U.S. Department of Health and Human Services (HHS) responsible for delivering health services to all 574 federally recognized American Indian tribes. According to IHS, “The goal of the IHS is to ensure that comprehensive, culturally acceptable personal and public health services are available and accessible to all American Indian and Alaska Native people.” The IHS plays a central role in Native American healthcare access, especially in rural and reservation based communities.
Although the IHS provides an array of medical services, it is not health insurance. Even with the IHS, it is recommended that AI/AN have health insurance.
Key Facts About IHS
- Serves approximately 2.56 million of the nation’s estimated 5.2 million American Indians and Alaska Natives
- Operates through a network of IHS-operated, tribal-operated, and Urban Indian health programs
- Provides primary care, behavioral health, dental, and public health services
- Funded by Congress, but at a fraction of per capita national health spending
5 Barriers to Native American Healthcare Access
Even with the presence of the IHS, Native American healthcare access continues to face multiple challenges which include:
1. Geographic Isolation
- According to the National Rural Health Association 40% of AI/AN people live in rural areas.
- Lack of reliable transportation infrastructure compounds the issue. A study done by the Minnesota Healthcare program found that 39% of American Indians reported transportation barriers compared to 18% of non-Hispanic whites.
2. Workforce Shortages
- Tribal health facilities, especially in remote areas, struggle to hire and retain staff. According to the Indian Health Service in 2024, the physician vacancy rate was 38% and average vacancy rate was 30% across all IHS facilities
3. Underfunding
- In 2017 IHS spending per person was $4,078 compared with per-person spending of $8,109 in Medicaid, $10,692 in the Veterans Health Administration, and $13,185 in Medicare, respectively.
- Urban Indian Health programs are especially underfunded at just $672 per person of AI/AN served compared to the national average of $11,172 per person.
4. Cultural and Language Barriers
- AI/AN communities have deep rooted mistrust of the federal government and healthcare systems due to historical and systemic inequities. Barriers include lack of cultural awareness, and exclusion of AI/AN voices in healthcare design.
- About a quarter of AI/AN people report experiencing bias and discrimination in healthcare settings.
5. Limited Insurance Coverage
- Many tribal members live outside reservation areas and may not have access to IHS facilities or qualify for Medicaid or private insurance. On average, 16% of AI/AN people are uninsured compared with 7% of white Americans.
How Native Reach™ Supports Healthcare Access
Native Reach™ is dedicated to supporting Native American health equity and access through GoodhealthTV®, our nationwide health education network, as well as digital outreach and culturally aligned campaigns. By placing trusted health messages where they matter most, we help bridge communication gaps and improve awareness and prevention.
We can help you connect with American Indian and Alaska Native communities in a respectful and effective way. Explore how we can support your outreach.
Frequently Asked Questions
Do Native Americans get free healthcare?
Yes, members of federally recognized tribes typically receive care at IHS facilities at no cost. However, due to limited services, especially in speciality care, it is recommended that individuals have additional health insurance.
Can Native Americans go to any hospital?
Yes, as U.S. citizens, all Native Americans are eligible to use public and private hospitals. For federally funded care through IHS, they must be members of a federally recognized tribe and live in the service area.
What Are Native American Reservations?
A Native American reservation is federal land managed by a tribal nation under the U.S. Bureau of Indian Affairs (BIA). According to the BIA, reservation lands have been established through treaties or other agreements with the United States, executive order, federal statutes, or administrative actions and are meant to serve as permanent homelands for tribal communities.
What is the number one health problem for Native Americans?
According to the U.S. Department of Health and Human Services (HHS) the leading cause of death for AI/AN people are chronic conditions such as heart disease, diabetes, cancer, and chronic liver disease. Learn more about Native American Health Disparities here.