II 114th CONGRESS 1st Session S. 2114 IN THE SENATE OF THE UNITED STATES October 1, 2015 Ms. Murkowski (for herself, Mr. Sullivan , and Mr. Schatz ) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To correct inconsistencies in the definitions relating to Native Americans in the Patient Protection and Affordable Care Act.

1. Technical corrections to PPACA (a) Definition of Indian Section 1304 of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18024 ) is amended by adding at the end the following: (f) Indian (1) In general In this title, the term Indian means any individual— (A) described in paragraph (13) or (28) of section 4 of the Indian Health Care Improvement Act ( 25 U.S.C. 1603 ); (B) who is eligible for health services provided by the Indian Health Service under section 809 of the Indian Health Care Improvement Act ( 25 U.S.C. 1679 ); (C) who is of Indian descent and belongs to the Indian community served by the local facilities and program of the Indian Health Service; or (D) who is described in paragraph (2). (2) Included individuals The following individuals shall be considered to be an Indian : (A) A member of a Federally-recognized Indian tribe. (B) A resident of an urban center who meets 1 or more of the following 4 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 now or in the future by the State in which they reside, or being a descendant, 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 purpose. (iv) Is determined to be an Indian under regulations promulgated by the Secretary. (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, including as a California Indian, Eskimo, Aleut, or other Alaska Native. . (b) Conforming amendments (1) Affordable choices health benefit plans Section 1311(c)(6)(D) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18031(c)(6)(D) ) is amended by striking section 4 of the Indian Health Care Improvement Act and inserting section 1304(f) . (2) Reduced cost-sharing for individuals enrolling in qualified health plans Section 1402(d) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18071(d) ) is amended— (A) in paragraph (1), in the matter preceding subparagraph (A), by striking section 4(d) of the Indian Self-Determination and Education Assistance Act ( 25 U.S.C. 450b(d) ) and inserting section 1304(f) ; and (B) in paragraph (2), in the matter preceding subparagraph (A), by striking (as so defined) and inserting (as defined in section 1304(f)) . (3) Exemption from penalty for not maintaining minimum essential coverage Section 5000A(e) of the Internal Revenue Code of 1986 is amended by striking paragraph (3) and inserting the following: (3) Indians Any applicable individual who is an Indian (as defined in section 1304(f) of the Patient Protection and Affordable Care Act). .