The following story was written and reported by Karin Eagle, Native Sun News Staff Writer. All content © Native Sun News.

WASHINGTON, DC –– Looming over the nation, a decision made by the United States Supreme Court June 28 has settled for now the question of “Obamacare” that had many citizens waiting with bated breath.

What this decision means for Native American citizens is one of the least understood portions of the Patient Protection and Affordable Care Act.

With the Supreme Court’s opinion that the act, informally known as Obamacare, is constitutionally sound, the battle over its validity as a law and policy is just now beginning between the political parties that take center stage in America.

However, it is the tribes of the country who have the greatest to lose or to gain, depending on the outcome of that battle. One of the provisions in the act directly addresses Native Americans, and has been left intact by the nation’s highest court.

Health care reform was a major topic of discussion during the 2008 Democratic presidential primaries. As the race narrowed, attention focused on the plans presented by the two leading candidates: New York Sen. Hillary Clinton and the eventual nominee, Illinois Sen. Barack Obama.

At the time, each candidate proposed a plan to cover the approximately 45 million Americans estimated by the U.S. Census to be without health insurance.

During the general election campaign between Obama and the Republican nominee, Arizona Sen. John McCain, Obama said that fixing health care would be one of his four priorities if he won the presidency. After his January 2009 inauguration, the brand-new president announced to a joint session of Congress the next month that he would begin working with the country’s legislative body to construct a plan for health care reform.

The result of that plan is what is now called “Obamacare.” Lawsuits brought by 26 state attorneys general – South Dakota’s being one of them – against the federal government claimed that mandatory participation was a violation of Americans’ freedom.

This led to the Supreme Court hearing at the end of March, which resulted in the 5-4 decision June 28 that the mandate is indeed constitutional.

The National Congress of American Indians, via its president, Jefferson Keel, responded to the decision with the following prepared statement – which also includes some of the answers to the question of how this decision will impact Native people:

"In a 5-4 decision the Supreme Court has upheld the constitutionality of the Affordable Care Act (ACA), affirming the permanent reauthorization of the Indian Health Care Improvement Act (IHCIA), which passed along with the ACA.

This is an important step for health care in Indian country; the permanence of the Indian Health Care Improvement Act has been affirmed and NCAI will stay focused on working with all members of Congress to uphold the trust responsibility to tribes. Moving forward, we are focused on improving health care for Indian country, while ensuring the Indian Health Care Improvement Act remains protected and implemented as enacted.

The IHCIA permanently authorizes daily health care delivery to nearly 2 million American Indians and Alaska Natives served by the Indian Health Service, who are in critical need of improved health care services. A snapshot of health conditions highlights the critical need for improving health care in Indian country. Native people suffer from higher rates of diabetes and related illness, heart disease and substance abuse than any other group.

The IHCIA authorizes new programs within the IHS to ensure the service is more equipped to meet its mission to raise the health status of American Indians and Alaska Natives to the highest level.

For example, it includes authorities for new and expanded programs for mental and behavioral health treatment and prevention; expanded authorities for long-term care services, including home health care, assisted living and community-based care; new authorities for development of health professional-shortage demonstration programs; expanded authorities for funding of patient travel costs; new authorities for demonstration projects for innovative health care facility construction; new authorities for the provision of dialysis services; improvements in the Contract Health Services program, which pays for referrals; new authorities for facilitation of care for Indian veterans; and new authorities for urban Indian health programs.

The passage of the IHCIA on March 23, 2010, represented a 14-year-long effort by NCAI, tribal leaders and advocates to make permanent the legislative commitment by the federal government to deliver health care for American Indian and Alaska Natives. The IHCIA was originally passed in 1976 and last reauthorized in 2000."

Keel also serves as lieutenant governor of the Chickasaw Nation of Oklahoma. Founded in 1944, NCAI is the nation’s oldest and most representative American Indian and Alaska Native advocacy organization.

A news posting on Indianz.Com immediately following the announcement reads:

“By a 5-4 vote, a majority of the court upheld the law’s requirement for all Americans to obtain health insurance. Chief Justice John G. Roberts Jr. provided the key vote in backing the individual coverage mandate.”

The decision addresses one of the most controversial provisions of the health reform law. But it won’t necessarily affect Native Americans who receive care through the Indian Health Service, tribes, Alaska Native entities and urban Indian organizations because they are exempt from the mandatory requirement that all Americans obtain health insurance by 2014.

“And some individuals who are subject to the mandate are nonetheless exempt from the penalty – for example, those with income below a certain threshold and members of Indian tribes,” Roberts noted in the majority opinion.

The court’s decision nonetheless has a big impact in Indian country. The ACA includes the Indian Health Care Improvement Act, which was left undisturbed by the justices as tribal advocates had hoped.

Other provisions that benefit tribes and tribal members were left intact as well. Tribes can participate in the Federal Employee Health Benefits Program for the first time, so their employees can receive coverage.

The law also ensures that health benefits provided by tribes won’t be subject to the federal income tax. The Internal Revenue Service had been raising concerns about such benefits."

In South Dakota, the reaction to the June 28 decision was split along Republican and Democratic party lines.

Republican Congresswoman Kristi Noem said, in a written response following the announcement, “I have voted 30 times to repeal, defund or dismantle this law and will not stop fighting for full repeal. This law tells South Dakotans that the government knows what’s best for their health care. I believe South Dakotans know what’s best for their health care, and I will keep fighting to repeal this law and replace it with reforms that will increase quality, choices and affordability for the American people.”

Republican Sen. John Thune said in his written response, “While today’s decision by the U.S. Supreme Court is disappointing, congressional Republicans will not rest until Obamacare is fully repealed. Rather than jam a nearly 3,000-page bill through Congress using political favors and backroom deals, as was the case with Obamacare, congressional Republicans are committed to working across the aisle in a step-by-step manner to improve and expand access to health care, while reducing costs for Americans.”

On the other side of the arena is the lone Democratic voice for South Dakota, Sen. Tim Johnson:

"I applaud today’s Supreme Court decision to uphold the health care reform law. This is a huge win for South Dakotans and the nation. I have always believed health care reform was constitutional. Critically, the Supreme Court upheld the individual mandate.

From kids to seniors, health care reform seems to have made a difference in the lives of tens of thousands of South Dakotans. More than 9,000 young adults in South Dakota have been covered under their parent’s health insurance policies since the beginning of the year.

Nearly 100,000 South Dakotans on Medicare received free preventive services like mammograms and colonoscopies as a result of health reform. Already this year, beneficiaries reaching the donut hole (health insurance coverage gap) have saved an average of $690 on prescription drugs with the help of health reform.

I look forward to continue working with members of both parties to reduce health care costs and increase health insurance coverage. The Supreme Court decision upholding the health care reform law gives us the foundation to do just that."

The Obamacare Facts website offers factual interpretations of the mandate. The website’s address is http://obamacarefacts.com.

(Contact Karin Eagle at staffwriter2@nsweekly.com)

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