Falling Short: Examining Medical Debt and Cost Avoidance in American Indian and Alaska Native Households

Sean Hubbard, Patricia M. Chen

Research output: Contribution to journalArticlepeer-review


The Affordable Care Act (ACA) expanded access and assistance to many Ameri-cans, but health care remains prohibitively expensive for some, including people with insurance. The COVID-19 pandemic brought to the forefront the precarious conditions of those facing financial and health crises, including American Indians and Alaska Natives (AI/ANs). Theoretically, AI/ANs should have some insulation because of their health care access through Indian Health Service (IHS) and ACA Tribal health insurance options. We use 2018 National Financial Capability Study’s survey data to examine household medical debt and cost avoidance behaviors. Findings show AI/ ANs are more likely to have medical debt and skip filling prescriptions due to costs than non-Hispanic Whites. Implications are AI/ANs may face financial and health burdens due to insufficient health coverage, possibly exacerbated by the shortcomings of IHS or other underlying factors. Future research should use a qualitative approach to elucidate factors influencing health care finances and behaviors of AI/AN communities.

Original languageEnglish (US)
Pages (from-to)1757-1771
Number of pages15
JournalJournal of Health Care for the Poor and Underserved
Issue number4
StatePublished - Nov 2022


  • American Indians and Alaska Natives
  • cost avoidance
  • Health care
  • medical debt

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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