As states move toward fulfilling all the requirements of the Affordable Care Act, glitches, loopholes and confusion have emerged including health coverage for Native Americans. Treaties signed by lawmakers more than a century ago ensure free health care to those from tribes recognized by the federal government. However, those from tribes unrecognized also have received care through the program.The care is somewhat limited in scope, but it has helped many. Now, the Affordable Care Act may change the rules. Above, a photo by Keith Durflinger of nurse practioner Debbie Bent, Nash Helm, 13, and his mother, Sunshine, at the American Indian Healing Center. I’d like to thank Garance Burke from the Associated Press for finding this issue that I was able to localize. From my story (L.A. Daily News, May 16, 2013):
It is one of two state licensed health facilities in Los Angeles County dedicated to serving urban-based Native Americans.
But these days, the Affordable Care Act is stirring up confusion and anger among the patients who visit the center and across the nation. That’s because President Barack Obama’s reform has raised a painful question: which tribes get free health care and which have to pay?
“There is a lot of controversy,” said John Andrews, executive director of the healing center. “The real issue is what defines a Native American? Are they only those from the federally recognized tribes?”
Native Americans have received some medical care for free as part of the government’s obligations to various tribes dating back nearly a century. But under Obama’s health care overhaul, tens of thousands of those who identify as Native American will face a new reality. They will have to buy their own health insurance policies or pay a $695 fine from the Internal Revenue Service unless they can prove they are “Indian enough” to claim one of the few exemptions allowed under the Affordable Care Act’s mandate that all Americans carry insurance.
The Affordable Care Act takes a narrow view of who is considered an American Indian, choosing to define it only as those who can document their membership in one of the 566 tribes that are recognized by the U.S. Bureau of Indian Affairs. Yet more than 100 tribes nationwide are recognized only by states and not the federal government. Those are the ones who may have to buy insurance, but it’s all still so unclear, some say.
In California alone, about 21,000 people who currently receive free health care through Indian clinics are not recognized as Native American by the federal government and would have to pay the penalty, according to the nonprofit California Rural Indian Health Board.
Among those who could be affected by the new health care laws are members of the Fernandeno Tataviam Band of Mission Indians, whose home once stretched across the San Fernando, Santa Clarita and Antelope valleys. Members have been seeking federal recognition for 30 years.
The Los Angeles Urban Indian Roundtable is anticipating a final policy brief that addresses the health status of American Indians in L.A. County, said Pamela Villasenor, director of special projects for the band.
“I would be interested to know whether the Affordable Care Act will in any shape, way, or form, change the status quo for our people.” Villasenor said. “In 2013 isn’t it a shame that the true people of what today is referred to as Los Angeles are not even included in the discussion of health care for American Indian and Alaska Natives?”
The problem is so new that the federal government is still seeking to establish how many people might be affected, although Indian health advocacy groups estimate it could be up to 480,000.
“The administration doesn’t even know what’s going on,” said Ron Andrade, director of the Los Angeles City/County Native American Indian Commission. “None of our agencies have any information. By now they should have given us piles of fact sheets. It’s a total mess from what I can see. The nuances of the Affordable Care Act are going to kill us.”