Some American Indians in Illinois may have to pay a fine if they're uninsured under the nation's health care law, even if they're entitled to free or subsidized health care under other federal obligations.
It's unclear how many of the more than 100,000 Illinois residents who are American Indians and Alaska Natives would have to buy insurance or pay a fine. But it will likely affect some Chicago residents who may have been disconnected from their tribes for years and may face steep hurdles to tribal membership, said Jay Stiener of the National Council of Urban Indian Health.
"A lot of folks are going to get stuck with the bill," he said. The minimum annual tax penalty for an uninsured individual, when fully phased in, will be $695.
The confusing situation hinges on conflicting definitions of who qualifies as American Indian. The health care law exempts enrolled members of approximately 560 federally recognized tribes from financial penalties.
But a broader definition is used for the free or subsidized care provided by urban Indian health organizations such as the American Indian Health Service of Chicago, which are partially funded by federal dollars.
Urban Indian health centers provide free or reduced-cost care to the children and grandchildren of those who are eligible for services from an Indian Health Services facility, Stiener said. Documentation must be provided, but it could be as simple as a receipt for a prescription in a grandparent's name.
A grandparent's receipt wouldn't be enough for an exemption from the tax penalty under the health overhaul law.
"Those American Indians who moved to Chicago in search of better opportunities, they and their children may be subject to penalties that those folks who live on tribal lands may not be subject to," Stiener said.
He noted that the definition of "Indian" used to receive care at urban Indian health programs is no broader than the definition the federal government already uses for the purposes of exempting American Indians from cost-sharing for Medicaid services.
There are no federally recognized Indian reservations in Illinois and no Indian Health Service facilities, although the land was once home to many tribes that the government relocated to reservations in other states. During the 1940s and '50s, the government ended services to some tribes and encouraged Indians to relocate to cities such as Chicago and to assimilate.
Urban Indian health centers were granted federal funding during the 1970s to address the poor health status of urban Indians. They now operate in 38 cities, including Chicago.
American Indians who moved to cities "lost contact with their community, their elders, their relatives," but they still qualify for free or subsidized care at urban Indian health centers because their ancestors gave up millions of acres of land to the U.S. government, Stiener said.
Chicago's American Indian Health Service has been providing care for almost 40 years.
"We see many people who are unemployed and uninsured, and many are working poor," said executive director Ken Scott. The clinic serves about 700 people per year, Scott said.
Native Americans who make more than 200 percent of federal poverty guidelines are asked to pay an amount they can afford on a sliding fee scale, Scott said.
"Free care went out with the Johnson era," Scott said. "It doesn't work."