Census: Decennial and Annual American Community Survey

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 RatesMarch 14, 2012 Review of New Data from the 2008-2010 American Community Survey on rates of insurance for Alaska Natives and American Indians

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. 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. 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. References • U.S. Census Bureau. American Community Survey (ACS) 2008,2009, 2010, 3 year 2008-2010. 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 (2008-2010 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. 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