The U.S. Supreme Court has yet to issue a decision affecting the landmark Affordable Care Act.

The law includes a permanent reauthorization of the Indian Health Care Improvement Act. If the court invalidates the entire law, Congress will have to redo the IHCIA.

Members of Congress have already introduced bills to reauthorize the IHCIA in the event that happens. But passage is no easy prospect -- tribes started working on an update to the law in 1999 and it took over 10 years for the effort to bear fruition amid opposition from Republican lawmakers and then-president George W. Bush (R).

Even if the court leaves the IHCIA intact, other ACA provisions that benefit Indian Country are at risk. Tribes can participate in the Federal Employee Health Benefits Program for the first time. The law also exempts health benefits provided by tribes from being treated as income tax.

"Tribes have a lot at stake in this Supreme Court decision," John Dossett, the general counsel for the National Congress of American Indians, said in March as tribal leaders met in Washington, D.C., for their winter summit. NCAI submitted a brief to the high court to outline tribal concerns.

The most controversial provision of the ACA requires all Americans to obtain health insurance. But a decision striking down the individual mandate may not have a big effect in Indian Country.

American Indians and Alaska Natives who receive care through the Indian Health Service, tribes, Alaska Native entities and urban Indian organizations are exempt from the mandatory health coverage requirement. So a negative ruling on the provision would not affect most tribal members.

The Supreme Court's decision is expected this week.

Related Stories:
Native Sun News: IHCIA at stake in Supreme Court ruling (04/12)
Supreme Court to debate health care reform law next week (03/20)