An Indian Tribe is a self-governing entity and is acknowledged as such by the United States. In the landmark case Cherokee Nation v. Georgia, 30 U.S. 1 (1831), Chief Justice Marshall described Indian tribes as “domestic dependent nations” and their relationship with the United States as that of “a ward to his guardian.” These descriptions recognize 1) the nationhood of Tribes, 2) the fact that Tribes are subject to the United States as superior sovereign, and 3) the Federal government’s guardian-like trust role.
The unique “trust relationship” between the U.S. and federally-recognized Indian Tribes has long been recognized in the Constitution, statutes, regulations, case law, Presidential executive orders and agency policies, and the general course of dealings between Indian Tribes and the Federal government. In its role of “guardian,” the United States provides a variety of services, including health care, to Indian people.
The Indian Health Care Improvement Act (IHCIA), along with the Snyder Act of 1921, forms the statutory basis for the delivery of federally-funded health care and the direct delivery of care to American Indians and Alaska Natives (AI/ANs). Since its passage in 1976, the IHCIA has provided the programmatic and legal framework for carrying out the federal government’s trust responsibility for Indian Health.
To accomplish this goal, the Federal Government created Indian Health Service (IHS), an agency within the Department of Health and Human Services (HHS), whose sole mission is to deliver health care to AI/ANs. The IHS provides comprehensive health care services—using a public health model—to 1.9 million AI/ANs residing in tribal communities located in 35 States.
Throughout the United States, the IHS directly operates 27 hospitals, 59 health centers, 9 school health centers and 32 health stations. In addition, Tribes and Tribal organizations, through contracts and compacts under the Indian Self-Determination and Education Assistance Act (P.L. 93.638), operate over 56% of the IHS budget and provide health care in 18 hospitals, 284 health centers, 8 school health centers, and 79 health stations (including 163 Alaska Native village clinics). The IHS or Tribes/Tribal organizations also operate 12 regional youth substance abuse treatment center. In addition, the IHS provides funding for Indian health centers located in 34 urban areas.
For more information on Indian Health, please contact Devin Delrow, Director of Federal Relations at [email protected] or (202) 507-4072.
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