Society for Medical Anthropology
Oral Presentation Session
Cathleen Willging (Pacific Institute for Research and evaluation)
Although health care is a treaty-guaranteed right for members of federally-recognized tribes, decades of research describe persistent disparities in health outcomes and access to health care and insurance for American Indians. The 2010 Patient Protection and Affordable Care Act (ACA) expanded access to insurance for American Indiansby infusing the Indian Health Service and tribally-run healthcare programs with new funding, particularly in states that accepted the Medicaid expansion. However, continuing underfunding of the Indian Health Service combined with the ongoing national debate over the ACA and public insurance programs in general contributes to a pervasive atmosphere of fear and insecurity, especially among the majority of American Indians over the age of 65 who rely on Medicare and/or Medicaid. This mixed-methods paper considers the production of insecurity surrounding healthcare access and affordability, analyzing both its embodied and affective consequences for the health and wellbeing of American Indian elders (age 55 and older). Drawing on quantitative surveys, in-depth qualitive interviews, and concept mapping data collected among American Indian elders, we consider the sources and circulation of discourses of uncertainty around the cost, quality, and availability of health care among elders. We argue that this uncertainty presents a major barrier to wellbeing that remains unaddressed by existing health policy interventions for this population, which focus predominately on individual-level knowledge (i.e., health literacy) and behavior (i.e., insurance enrollment). We discuss policies, systems, and interventions that are necessary to counteract insecurity, cultivate wellbeing for elders, and eradicate health disparities in this underserved and underrepresented population.