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Robert Ruise, a member of the La Jolla Indian Reservation Fire Department, checks on cattle after the fire devastated most of the land on the reservation October 28, 2007 in La Jolla, California.
The Affordable Care Act has faced plenty of criticism, some say it's a breach of the federal government's power. Others say it's too much of a financial burden for businesses and will kill jobs.
Then there are the concerns raised by Native Americans. The ACA takes a rather narrow view of who can be considered American Indian, and therefore be exempt from the requirement to have health insurance.
Currently, the Affordable Care Act is defined to only include those who can document their membership in one of the 566 tribes recognized by the U.S. Bureau of Indian Affairs. There are still hundreds of tribes solely recognized by states, not the federal government. Where they stand in the health care reform plan is unclear.
According to the California Rural Indian Health Board, California alone has 21,000 people who receive free health care through Indian clinics, and who are not recognized by the federal government.