Table 1 Summary of study themes

Lack of Insurance as a Barrier to Healthcare

Lack of insurance norm for elders growing up

“Momma always paid for her doctor visits [out of pocket] until she got older and stuff like that. ….healthcare was just practically unheard of. We pretty much suffered our consequences with illnesses and that sort of thing.” (30)

Foregoing care because couldn’t afford to pay out of pocket

“They do the free care with the doctor but then I have to buy the medicine…I don't bother with medicine.” (6)

Seasonal work not providing healthcare benefits

“If they don't have insurance…that's the first question the doctors ask for…You know, even making an appointment, you know, so yeah….That's the barrier.” (30)

Stigma related to going to charity hospital

Even if visits are free, some patients are unable to afford medications

Pre-Paying for Childbirth when Uninsured

Older women reflected back on not having insurance when they gave birth

“They told us how much the bill was going to be, and we paid it. ‘Just make sure you have it paid before the baby’s born’” (21)

Extra cost if complications during childbirth

Access to Public Health Insurance Coverage

Importance of public assistance to meet health needs

“I’m thankful for Medicaid because I wouldn’t have been able to afford it” (29)

Need for education/training about forms of assistance and how to enroll

“I think that would be something good to have like a Medicaid and Medicare to let them know what's available for them and all. Because a lot of people in this community don't have insurance and they've never really had insurance, you know?” (25)

Younger tribal members age out of coverage and are left uninsured

“She's 19. Yeah, she aged out. So…she no longer has insurance” (2)