The U.S. Supreme Court today issued its long-awaited decision on the landmark Affordable Care Act.

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.

"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.

Supreme Court Decision:
NFIB v. Sebelius (June 28, 2012)

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