Is another challenge in its future?
While I’m neither a lawyer nor a legal scholar I do have an interest in things legal. I also have an interest in the healthcare issue and have posted many original articles and op-eds on this blog. So when I noticed something at Healthcare.gov that seemed weird and just not right it stuck in my mind. I bounced my thoughts around with friends and organizations via social media. Finally when Pacific Legal Foundation tweeted that they were combing through the issue and would address it in a weekly podcast, I felt validated, humbled and eagerly await their opinion.
So what is the issue and could it eventually provoke a fourth (more on that later) Obamacare challenge to reach the Supreme Court? From the home page of Healthcare.gov, rolling over “Get Answers”, then under “Coverage for…”, finally clicking “American Indians and Alaska Natives” a story of unequal special treatment for one group over others unfolds.
The level of special treatment is shocking in regard to our Constitution’s 14th Amendment which requires equal protection under the law for all citizens. Qualification comes with membership in a Federally recognized tribe or being an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder.
American Indians and Alaska Natives most favorably have no closed season under the ACA. They can sign up for a health plan on the exchange anytime they want and even change plans once per month. They can choose to have no insurance at all without paying the tax penalty. On top of that, up to 300% of federal poverty level (up to around $70,650 for a family of 4) they pay ZERO copay or deductible. How is this equal treatment under the law?
Every other group not exempted from the law by provisions in the law, generally based on religious beliefs, is subject to the same rules governing the exchanges as anyone else. This includes a closed season three quarters of the year, a hefty tax for choosing to go uninsured, and reduced copays and deductibles only up to 250% of the federal poverty level on silver plans.
Closed seasons, when there’s guaranteed issue as with the ACA, prevent gaming the system exactly as the special provisions for American Indians and Alaska Natives allow. No closed season opens the door to only signing up for insurance after the discovery of a serious illness. This is precisely why employer provided health benefits, which have long been guaranteed issue, have an annual open season for about a month each year, barring specified life event exceptions. For such plans to work time commitment at all times must be required of everyone.
There is an Indian Health Service already on reservations where Indians can get free healthcare from Indian healthcare providers or others if referred by one, but Healthcare.gov discusses advantages of additionally obtaining plans in the exchanges, suggesting better access to programs not provided by other Indian health programs. They also suggest this will help the tribe by allowing more services to others, suggesting tribal programs run on a globally limited budget. Think rationing of services or extended waiting times that accompany such approaches and perhaps the ineptitude of the Veterans Administration as well.
This raises questions of possible reasons if American Indians and Alaska Natives could or should be treated unlike ordinary citizens under the Constitution. Are they citizens at all? Aren’t Indians sovereigns within our country, nations within a nation? The answer seems to be to a point. The “FAQ” section of the Bureau of Indian Affairs website provides many clues and answers.
First let’s consider eligibility. Described in the FAQ, membership in a federally recognized tribe is determined by each tribe. It makes clear that “there is no single federal or tribal criterion or standard” and eligibility for membership “will differ from tribe to tribe”.
If this doesn’t seem loose enough, the FAQ tells us that “blood quantum” is not the only means by which a person is considered, including “how strongly a person identifies himself or herself as an American Indian or Alaska Native”. As it’s becoming popular to identify outside one’s race or even gender, it appears any of the 561 recognized tribes could open membership to anyone willing to learn the history and customs and believe enough, perhaps even paying a hefty entry fee in the process, thereby granting them special benefits under Obamacare too!
Even among those with sufficient blood quantum, estimated by the Census Bureau to be 4.5 million in 2007, enrolled tribal members are around 2 million, less than one half. Of the total population more than half do not live on reservations, and can be integrated into the larger society to any degree, while still maintaining tribal membership.
It’s worth noting some of the other facts provided in the FAQ as follows:
American Indians are citizens of the United States and the states in which they reside, and have been so, generally, since 1924.
American Indians have the right to vote.
American Indians can run for and hold any public office as any other US citizen.
American Indians do not have special rights different from other US citizens unless based on treaties or other arrangements.
American Indians do pay taxes like everyone else with the exception of state taxes when living or conducting business on a reservation.
Laws that apply to non Indians also apply to Indians except on reservations where only federal and tribal laws apply to members. Only state laws do not apply to members when living on a reservation.
American Indians do serve in the armed forces of the United States.
So what is the takeaway of all this? It seems proper application of the 14th Amendment would back and provide standing for any uninsured non Indian to be exempt from the individual mandate and its tax or require American Indians and Alaskan Natives to be subject to it.
It also seems that any uninsured non Indian tribal member who encounters a serious illness outside the open season without a qualifying event, would have standing to claim harm by being denied immediate access to insurance on an exchange as is afforded American Indians or Alaskan Natives primarily as a result of their ethnicity. It’s with this I await what the legal minds at Pacific Legal have to say.
Pacific Legal Foundation, which has been defending against government impositions on property rights and liberty since 1973, is involved with another Obamacare case, Sissel vs HHS, that could invalidate the entire law as a violation of the origination clause, and is now under appeal to the Supreme Court. If accepted it will be the 3rd challenge, hence the chance a possible violation of the 14th Amendment outlined here could eventually become number four.
Pacific Legal produces a weekly podcast each Wednesday and maintains an informative website, both with stories and updates on the many fascinating cases they agree to accept. Importantly and impressively they represent every client and every case at no charge. Liberty minded individuals would do well to consider supporting them with a donation.