SAN FRANCISCO (AP) — When Liz DeRouen needs any kind of health care services, from diabetes counseling to a dental cleaning, she checks into a government-funded clinic in Northern California's wine country that covers all her medical needs.
Her care and the medical services for her children and grandchildren are paid for as part of the government's treaty obligations to American Indian tribes dating back nearly a century.
The definition of Indian in the Affordable Care Act is roiling emotions on reservations and in native enclaves across the country, but U.S. Department of Health and Human Services spokeswoman Erin Shields said the agency is powerless to change it without an act of Congress.
The problem is so new that the federal government is still seeking to establish how many people might be affected, although Indian health advocacy groups estimate it could be up to 480,000.
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