OKLAHOMA CITY —
As a policy advisor for the Choctaw Nation Health Services Authority, Melanie Fourkiller knows that documented Native Americans can access the tribe’s health care services even if they are not members of the Choctaw Nation or any other federally recognized tribe.
But changes in how the government defines a Native American that are part of the Affordable Care Act could force some who are served by the Choctaw Nation to either purchase private insurance or pay an annual $695 penalty to the Internal Revenue Service, once it’s fully phased in.
“It causes all kind of chaos,” Fourkiller said. “Members of my family would fall into the category. It just would be very confusing.”
Tribal leaders from across Oklahoma are working with federal officials to restore the definition of which American Indians and Alaska Natives are exempt from the penalty to the one that has been used by the Indian Health Service for decades.
“There are different definitions of Indians floating around out there,” said Dr. Charles Grim, deputy executive director of health services for the Cherokee Nation, which operates a hospital and eight outpatient clinics that serve about 150,000 people in northeastern Oklahoma.
Grim said there is concern among tribal governments that some people eligible to receive health care services through the IHS will not meet the ACA’s definition for which American Indians are exempt from the penalty.
In Oklahoma, almost 483,000 of the state’s 3.75 million residents identify themselves as Native Americans, or nearly 13 percent of the state’s population, according to figures from the U.S. Department of Health and Human Services. Only California has a higher number.
Tulsa County has the largest number of residents who identify themselves as Native American — 61,000. Oklahoma County is home to almost 46,000 people who self-identify as Native American.
There are approximately 560 federally recognized tribes in the U.S., and 39 of them are based in Oklahoma. Tribal officials said Native Americans who are not citizens of one of the tribes could potentially be required to enroll in health insurance exchanges and carry insurance.
“It is a potential problem,” Grim said.
Republican Rep. Tom Cole, a member of the Chickasaw Nation in Oklahoma, said he was aware of the concerns.
“This could lead to some tribal citizens being required to purchase insurance or face penalties even though they are covered by IHS,” he said in a statement to The Associated Press. Cole is one of two federal legislators who are members of a federally recognized tribe. He would not say whether he would sponsor a bill to address the issue.
Mickey Peercy, executive director of health for the Choctaw Nation, said the solution involves making the new health care law’s definition of American Indian consistent.
“They’re messing with the definition of who’s an Indian,” Peercy said. “It needs to stay what it is.”
Peercy said the Choctaw Nation, which serves about 50,000 people with a hospital and outpatient clinics in southeastern Oklahoma, will be able to adapt to the ACA’s provisions.
“We can bend and roll with the Affordable Care Act,” he said. But the changes could be costly for non-tribal patients who have been receiving tribal health care services.
“It negatively impacts lots and lots of folks with uncompensated care,” he said.