The Obama administration on Wednesday broadened an exemption for American Indians from the new health care law's requirement that virtually every U.S. resident has health insurance starting next year.
New rules clarify that people who are eligible to receive medical care through the federal Indian Health Service will be exempt from the requirement to have health insurance or face fines from the Internal Revenue Service. The Indian Health Service, a division of U.S. Health and Human Services, oversees a network of clinics that are required through treaty obligations to serve all patients of Indian ancestry, even if they cannot document their federal tribal status.
"Today, we continue to fulfill our responsibility to consult and work with tribal communities," Health and Human Services Secretary Kathleen Sebelius said in a statement.
Last month, The Associated Press reported that the Affordable Care Act exempted only American Indians and Alaska Natives who can document their membership in one of about 560 tribes 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.
That meant thousands of people who consider themselves Native Americans would have to buy their own health insurance policies or pay a $695 fine to the Internal Revenue Service unless they could prove they were eligible to claim an exemption under the Affordable Care Act. The health care law mandates that all Americans carry insurance, with just a few exemptions.
Caitrin McCarron, manager of congressional relations at the National Indian Health Board, said tribal advocates are pleased that the administration added an exemption for Native Americans who are eligible for services through an Indian health care provider. But the board is still pushing for Congress to change that section of the federal law.
"We are really pleased that HHS decided to move forward with this exemption," McCarron said. "However, we still believe that this was a stop-gap measure. Because it's not a legislative fix and it's the secretary's exemption waiver, a future secretary could reverse the policy."
While the exemption provides Native Americans who aren't part of a federally recognized tribe with some financial relief, other discrepancies remain. Jay Stiener, an analyst with the National Council of Urban Indian Health in Washington, D.C., said some Native Americans could be on the hook for co-pays, deductibles and other cost-sharing requirements.
Also, he said members of federally recognized tribes are eligible to enroll throughout the year but not others.
The 2010 Census found that nearly one-third of the 6.2 million people who self-identify as American Indian or Alaska Native lack health insurance and that 28 percent live in poverty.
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.