(1) IN GENERAL.—Section 1304 of the Patient 
Protection and Affordable Care Act (42 U.S.C. 
18024) is amended by adding at the end the fol-
lowing new subsection: 
‘‘(f) INDIAN.— 
‘‘(1) IN GENERAL.—In this title, the term ‘In-
dian’ means any individual— 
‘‘(A) described in paragraph (13) or (28) 
of section 4 of the Indian Health Care Improve-
ment Act (25 U.S.C. 1603); 
‘‘(B) who is eligible for health services pro-
vided by the Indian Health Service under sec-
tion 809 of the Indian Health Care Improve-
ment Act (25 U.S.C. 1679); 
‘‘(C) who is of Indian descent and belongs 
to the Indian community served by the local fa-
cilities and program of the Indian Health Serv-
ice; or 
‘‘(D) who is described in paragraph (2). 
‘‘(2) INCLUDED INDIVIDUALS.—For purposes of 
this title, the following individuals shall be consid-
ered to be an ‘Indian’: 
‘‘(A) A member of a Federally recognized 
Indian tribe. 
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‘‘(B) A resident of an urban center who 
meets one or more of the following four criteria: 
‘‘(i) Membership in a Tribe, band, or 
other organized group of Indians, including 
those Tribes, bands, or groups terminated 
since 1940 and those recognized by the 
State in which they reside, or being a de-
scendant, in the first or second degree, of 
any such member. 
‘‘(ii) Is an Eskimo or Aleut or other 
Alaska Native. 
‘‘(iii) Is considered by the Secretary of 
the Interior to be an Indian for any pur-
pose. 
‘‘(iv) Is determined to be an Indian 
under regulations promulgated by the Sec-
retary. 
‘‘(C) An individual who is considered by 
the Secretary of the Interior to be an Indian for 
any purpose. 
‘‘(D) An individual who is considered by 
the Secretary to be an Indian for purposes of 
eligibility for Indian health care services, includ-
ing as a California Indian, Eskimo, Aleut, or 
other Alaska Native.’’. 
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(2) CONFORMING AMENDMENTS.— 
(A) AFFORDABLE CHOICES HEALTH BEN-
EFIT PLANS.—Section 1311(c)(6)(D) of the Pa-
tient Protection and Affordable Care Act (42 
U.S.C. 18031(c)(6)(D)) is amended by striking 
‘‘section 4 of the Indian Health Care Improve-
ment Act’’ and inserting ‘‘section 1304(f)’’. 
(B) REDUCED
COST-SHARING
FOR
INDI-
VIDUALS
ENROLLING
IN
QUALIFIED
HEALTH 
PLANS.—Section 1402(d) of the Patient Protec-
tion and Affordable Care Act (42 U.S.C. 
18071(d)) is amended— 
(i) in paragraph (1), in the matter 
preceding subparagraph (A), by striking 
‘‘section 4(d) of the Indian Self-Deter-
mination and Education Assistance Act 
(25 U.S.C. 450b(d))’’ and inserting ‘‘sec-
tion 1304(f)’’; and 
(ii) in paragraph (2), in the matter 
preceding subparagraph (A), by striking 
‘‘(as so defined)’’ and inserting ‘‘(as de-
fined in section 1304(f))’’. 
(C) EXEMPTION FROM PENALTY FOR NOT 
MAINTAINING
MINIMUM
ESSENTIAL
COV-
ERAGE.—Section 5000A(e) of the Internal Rev-
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enue Code of 1986 is amended by striking para-
graph (3) and inserting the following new para-
graph: 
‘‘(3) INDIANS.—Any applicable individual who 
is an Indian (as defined in section 1304(f) of the 
Patient Protection and Affordable Care Act).’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply with respect to plan 
years beginning on or after January 1, 2021. 
(b) TECHNICAL AMENDMENTS.—Section 4 of the In-
dian Health Care Improvement Act (25 U.S.C. 1603) is 
amended— 
(1) in paragraph (13), by striking ‘‘as defined 
in subsection (d) hereof’’ and inserting ‘‘as defined 
in paragraph (14)’’; and 
(2) in paragraph (28)— 
(A) by striking ‘‘as defined in subsection 
(g) hereof’’ and inserting ‘‘as defined in para-
graph (27)’’; and 
(B) by striking ‘‘subsection (c)(1) through 
(4)’’ and inserting ‘‘subparagraphs (A) through 
(D) of paragraph (13)’’. 
Æ 
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