Edward J. Fox, PhD

These tables come from the U.S. Census Bureau’s American Community Survey Public Use Microdata Sample (PUMS), tabulated for this site. Each entry lists the key figures in plain text, explains what the numbers can and cannot tell you, and links to a spreadsheet with every figure traced back to the Census export. AI/AN is counted alone or in combination with other races throughout. PUMS estimates come from a sample, and margins of error are not shown.

Last updated October 13, 2026.

At a Glance

A note on comparing years: the 2020 race question change added AI/AN respondents in large numbers, mostly people with no reported IHS connection. Compare rates, not raw AI/AN counts, across 2020. The papers on this change are listed on Other Indian Health Finance Papers.

The 2020 Race Question Change

Who Was Added to the AI/AN Count, 2019–2021: IHS Coverage, Hispanic Origin, and Nativity

National AI/AN counts for 2019 and 2021, the two standard 1-year ACS releases on either side of the 2020 race question change, broken down by IHS coverage reporting, detailed Hispanic origin, and place of birth.

• The AI/AN count rose from 5.65 million to 8.73 million (+55 percent) while the total U.S. population grew about 1 percent.
• The entire increase was among people reporting no IHS coverage. The number reporting IHS coverage fell from about 1.51 million to 1.32 million.
• Hispanic respondents account for 56 percent of the increase, led by people of Mexican and Central American origin.
• Most added respondents were born in the United States; foreign-born respondents account for about one-fifth of the increase.
• Hispanic origin and foreign birth do not place anyone outside the IHS population: about 122,000 Hispanic AI/AN people and about 5,400 foreign-born AI/AN people reported IHS coverage in 2021.

Source: ACS 1-Year PUMS, 2019 and 2021 (RACAIAN, HINS7, HISP, NATIVITY). No standard 1-year ACS was released for 2020.

Download the spreadsheet (.xlsx) → · Read the paper

AI/AN Counts and IHS Coverage by State, 2019–2024

AI/AN counts and IHS coverage reporting for every state, 2019 and 2021–2024, with a focus on the 39 states where more than 1,500 AI/AN people reported IHS coverage in 2024. States are grouped by the share of AI/AN residents reporting IHS coverage in 2019, before the question change: high-IHS states (25 percent or more) and low-IHS states (under 25 percent).

• From 2019 to 2021 the AI/AN count rose 7 percent in states where half or more of AI/AN residents reported IHS coverage, 33 percent where a quarter to a half did, and 80 percent where fewer than a quarter did.
• The jump happened once, at 2020, and held through 2024.
• Low-IHS states held 17 percent of AI/AN people reporting IHS coverage in 2019 but absorbed about three-quarters of the national increase.
• California, Texas, Illinois, Florida, and New York account for half of the increase across the 39 states.
• The number reporting IHS coverage fell in 30 of the 39 states between 2019 and 2024.

Source: ACS 1-Year PUMS, 2019, 2021, 2022, 2023, and 2024 (RACAIAN, HINS7). Single-year figures for states with small AI/AN samples are approximate.

Download the spreadsheet (.xlsx) → · Read the paper

Who Was Added, by Income: AI/AN Income Bands With and Without IHS Coverage, 2019 and 2024

AI/AN people in 2019 and 2024, the 1-year ACS releases on either side of the 2020 race question change, grouped by income as a percent of poverty: 0–138 percent (the Medicaid expansion limit), 139–400 percent (the Marketplace premium tax credit range), and above 400 percent. Each group is shown separately for AI/AN people with and without reported IHS coverage, with non-AI/AN figures for comparison.

• AI/AN people without IHS coverage rose by about 3.57 million between 2019 and 2024. Only 18 percent of the increase had incomes within the Medicaid expansion limit; 46 percent were in the Marketplace range and 36 percent above 400 percent.
• The income profile of AI/AN people reporting IHS coverage barely changed: 33.5 percent within the Medicaid expansion limit in 2019 and 31.9 percent in 2024.
• Across all AI/AN people, the share within the Medicaid expansion limit fell from 28.6 to 24.0 percent, a shift driven by who was added to the count, not by rising incomes among the IHS-connected population.

Shares are within each group. The two years are separate cross-sections, so the change describes the composition of the count, not individual income gains. Source: ACS 1-Year PUMS, 2019 and 2024 (RACAIAN, HINS7, POVPIP).

Download the spreadsheet (.xlsx) → · Read the paper

Health Coverage

Medicare, Medicaid, and IHS Coverage Among American Indians and Alaska Natives, 2024

How AI/AN people report Medicare, Medicaid, and Indian Health Service coverage, alone and in combination, with all eight coverage combinations and both 5-year and 1-year 2024 estimates. These overlaps show where IHS-funded programs can bill Medicaid or Medicare and where IHS is the only source.

• In the 5-year data (2020–2024), 31 percent of AI/AN people report Medicaid, 13 percent report Medicare, and 16 percent report IHS coverage (about 1.29 million).
• About 683,000 AI/AN people report IHS coverage with neither Medicare nor Medicaid; about 496,000 report both IHS and Medicaid.
• About 328,000 AI/AN people have both Medicare and Medicaid.
• The 1-year 2024 estimates are similar: 31 percent Medicaid, 14 percent Medicare, and 15 percent IHS.

IHS coverage here is self-reported, and the Census Bureau does not count IHS alone as health insurance. Many people served by IHS-funded programs don’t report IHS on the survey, so these figures are not a count of IHS users. Compare the 5-year and 1-year figures by percentage only; the 1-year AI/AN total is higher because the 5-year still includes years before the 2020 race question change. Source: ACS PUMS, 5-Year (2024 release) and 1-Year (2024).

Download the spreadsheet (.xlsx) →

Income Relative to Poverty Among American Indians and Alaska Natives, by IHS Coverage, 2024

AI/AN people grouped by family income as a percent of the federal poverty level, in bands that match federal coverage programs: 0–138 percent (the Medicaid expansion income limit), 139–400 percent (the Marketplace premium tax credit range), and 401 percent and above. Each group is shown separately for AI/AN people who report IHS coverage and those who do not, with non-AI/AN figures for comparison.

• About 434,000 AI/AN people reporting IHS coverage, 34 percent, have incomes at or below 138 percent of poverty.
• About 567,000 (45 percent) fall in the 139–400 percent range, and about 263,000 (21 percent) are at 401 percent or above.
• AI/AN people reporting IHS coverage are more likely to be within the Medicaid expansion limit than other AI/AN people (24 percent) or non-AI/AN people (18 percent).
• Compared with 2015–2019, before the 2020 race question change, the share of IHS-connected AI/AN people within the Medicaid expansion limit fell modestly (36.9 to 34.3 percent), about as much as for non-AI/AN people (20.0 to 18.1 percent). Across all AI/AN people it fell much more (30.9 to 25.3 percent), because the people added to the count after 2020 are higher-income.

Shares are within each group. Income bands describe likely eligibility ranges, not enrollment. IHS coverage is self-reported. Source: ACS 5-Year PUMS, 2024 release (2020–2024) and 2019 release (2015–2019) (RACAIAN, HINS7, POVPIP). The spreadsheet includes both periods and a comparison sheet.

Download the spreadsheet (.xlsx) → · Read the paper

Veterans and Military Service

American Indian and Alaska Native Veterans by Period of Service, 2024

How many AI/AN people have served in the U.S. military, by period of service.

• About 402,800 AI/AN veterans, 2.3 percent of the nation’s 17.4 million veterans. AI/AN people are 2.4 percent of the total population.
• AI/AN people are 3.0 percent of veterans who served only after September 2001.
• Two in five AI/AN veterans (about 161,800) have post-9/11 service, alone or combined with earlier periods.
• About 90,000 AI/AN veterans served in the Vietnam War only.

Source: ACS 5-Year PUMS, 2024 release (2020–2024) (RACAIAN, VPSP).

Download the spreadsheet (.xlsx) →

American Indian and Alaska Native Military Service, 2019 and 2023

Military service status for AI/AN and non-AI/AN adults from two 5-year ACS releases, with service rates among persons 17 and older.

• Veterans (past active duty) were 6.5 percent of AI/AN adults in 2023, compared with 6.3 percent of non-AI/AN adults. In 2019 the rates were 7.8 and 7.1 percent.
• About 350,000 AI/AN people reported past active duty in 2023, and about 30,000 were on active duty.

The AI/AN count rose from 5.6 million to 7.3 million between these releases, mostly because of the 2020 race question change, so compare rates, not counts, across the two years. This table asks whether someone ever served (MIL); the table above asks when (VPSP), so their veteran totals differ. Source: ACS 5-Year PUMS, 2019 and 2023 releases.

Download the spreadsheet (.xlsx) →

---

For earlier charts from the National Indian Health Board years, see Data Visualizations from NIHB, 2015–2022. Suggested citation for any table: U.S. Census Bureau, American Community Survey PUMS; tabulated by Edward J. Fox, PhD, edfoxphd.com.