One group that won’t be required to have health insurance when the Affordable Care Act’s individual mandate goes into effect next year is American Indians, of which Douglas County has a larger-than-average population.

The health reform law often known as Obamacare mandates that Americans carry some type of health insurance in 2014 or be fined. The 2010 law does, however, exempt certain people from that requirement: members of religious groups opposed to insurance, undocumented immigrants, prisoners, Americans who either don’t make enough money to file taxes or would have to spend more than 8 percent of their income on premiums, and American Indians eligible for care through the Indian Health Service.

The law’s online health care exchanges, through which people earning between 100 and 400 percent of the federal poverty level can purchase subsidized insurance, begin open enrollment Oct. 1.

Any American of Indian ancestry can, through treaty obligations, receive health care through the Indian Health Service, although service officials have complained of underfunding. Also, where American Indians can get care and how much they are able to utilize depends on factors like their tribe, where they live and what kind of resources their local health centers have. Those limitations explain why many choose to carry private insurance.

The Affordable Care Act originally only exempted from the mandate American Indians or Alaska Natives who could document being a member of one of the 560 federally recognized tribes. But since many tribes are only recognized at the state level, the Obama administration revised the rules this summer to exempt from the insurance-purchase mandate anyone who is able to get care through the Indian Health Service.

American Indians and Alaska Natives are still eligible for tax credits to pay for premiums on the health insurance exchanges, said Sheldon Weisgrau, the Lawrence-based director of the Health Reform Resource Project. The only people unable to receive subsidies on the exchanges, he noted, are undocumented immigrants.

Many American Indians would benefit from the more affordable premiums offered under Obamacare, said Dee Ann DeRoin, a Lawrence-based consultant on Indian health issues who practices family medicine once a week at the Kickapoo Nation Health Center in northeast Kansas.

“What I’m hoping is that Indian people who are eligible for the Indian Health Service or Indian health care will get insurance through the Affordable Care Act and use it at their local Indian health care facility,” she said.

Increased access to health care of particular significance to American Indians, who suffer from a disproportionate number of health problems, DeRoin noted.

According to the 2011 Behavioral Risk Factor Surveillance System survey in Kansas, American Indians and Alaska Natives report using cigarettes and smokeless tobacco, being diagnosed with depression, and having poor mental health at more than double the rate of all other racial and ethnic groups in the state. American Indians and Alaska Natives in Kansas also have shorter average lifespans than whites, and are more likely to die from conditions such as heart attacks, diabetes and liver disease. Part of the reason is the higher-than-average poverty among American Indians and Alaska Natives in Kansas, whose per capita income averages $17,331.

Kansas has four federally recognized tribes: the Kickapoo Tribe, Prairie Band Potawatomi Nation, Sac & Fox Nation and the Iowa Tribe. The Kickapoo Tribe and Prairie Band Potawatomi Nation have their own health centers, while the other two tribes use the Indian Health Service clinic in White Cloud. Douglas County’s estimated 5,000 American Indian or Alaska Native residents, meanwhile, are able to receive care at the Haskell Health Center in Lawrence, regardless of whether they are students or faculty at Haskell Indian Nations University.