LAS VEGAS — On one hand, Angie Wilson said she’s looking forward to when the health care overhaul takes full effect in 2014 — it’ll allow the northern Nevada tribal health clinic she directs to maximize its limited resources.
But on the other hand, the director of the Reno Sparks Tribal Health Center is worried about the federal government’s plans to use a narrow definition of American Indian in the law — one that could mean an estimated one-third of her clinic’s 7,000 regular clients will be hit with a $695 annual fine for not carrying insurance, even if they continue to receive free care through the clinic.
“This is such a huge issue for us,” Wilson said. “The question that I can already see coming is that our folks are getting fined for not having health coverage, but we’re already born with the right to health care because of the treaties.”
Advocates across the country are raising concerns about the law’s proposal to define an American Indian as a member of a federally recognized tribe. People in that category will continue receiving free tribal health care and be exempt from the requirement to carry health insurance.
But clinics such as Wilson’s in Reno serve a much broader population that includes descendants of federally recognized tribal members, and Wilson said the clinic plans to continue serving those people when the law takes effect. The difference will be that descendants who don’t sign up for a separate insurance policy will face fines — ones that Wilson worries they won’t be able to afford.
It’s unclear exactly how many people in Nevada will be affected if federal officials adopt the narrower definition. The Census counts nearly 56,000 people in the state who self-identify as Indian, including 30,000 in Clark County and 11,000 in Washoe County.
But not all of them are official members of federally recognized tribes. Some don’t meet “blood quantum” levels set by tribes that require potential members prove a minimum quantity of Indian blood to join. Sometimes that happens when a child has parents from two separate tribes, but not enough blood from a single tribe to qualify.
Others, like the Pahrump Paiute Tribe, belong to entire groups that have never been federally recognized. It numbers about 150 people and is concentrated southern Nevada’s Pahrump Valley.
Tribal chairman Richard Arnold said his education was paid for through the Bureau of Indian Affairs, and the federal agency keeps track of the tribe. But the group’s application for federal recognition that was filed in 1982 is still pending. It could be years before it moves forward.
“We always have fallen through the cracks,” Arnold said. “One way or the other, we’re survivors. We’ve been able to keep going.”
While some Pahrump Paiute members use Indian Health Service because of intermarriage with members of federally recognized tribes, many are accustomed to living without the services that people who self-identify as American Indians enjoy.
As far as insurance, “it’s something that the majority of people don’t have, and the majority just go without,” Arnold said.
He’s concerned that the fines from the Affordable Care Act could be a burden for Pahrump Paiute families.
And Arnold questions whether certain tribal members want to take part in the modern health insurance system to begin with.
As a practitioner of traditional medicine, he responds to sick members with a holistic approach that blends physical and spiritual approaches passed down from his ancestors. Many Pahrump Paiutes don’t depend on hospitals as often as the general population.
“They believe in it, they rely on it,” Arnold said about traditional medicine. “Why go someplace else?”