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Key Takeaways:

1. The U.S. Supreme Court ruled that the federal government has under-funded Native American tribes' healthcare programs for 30 years and must now cover additional costs.
2. The decision could result in the U.S. Department of Health and Human Services paying between $800 million and $2 billion more annually.
3. The ruling is a significant victory for tribal sovereignty and the quality of healthcare on reservations.

U.S. Supreme Court Mandates Increased Healthcare Funding for Native American Tribes

By Samuel Lopez, USA Herald

[USA HERALD] - In a close 5-4 ruling, the Supreme Court determined that the federal government has been underfunding healthcare programs run by Native American tribes for decades. The court found that the U.S. Department of Health and Human Services (HHS) must cover the overhead costs that tribes incur when spending money from Medicare, Medicaid, and private insurers.

This decision marks a pivotal victory for the San Carlos Apache Tribe in Arizona and the Northern Arapaho Tribe in Wyoming, both of which had sued over the inadequate funding. Chief Justice John Roberts, joined by the court's three liberal justices and conservative Justice Neil Gorsuch, a staunch advocate for Native American rights, wrote the majority opinion. The ruling upheld previous decisions by the 9th and 10th U.S. Circuit Courts of Appeals.

Legal and Financial Implications

Carter Phillips, representing the San Carlos Apache Tribe, hailed the decision as "a huge win for Indian country and for the quality of healthcare provided on Indian reservations." Adam Unikowsky, who argued for the Northern Arapaho Tribe, emphasized that the ruling "will promote tribal sovereignty and provide resources for healthcare in under-served communities."

U.S. Secretary of Health and Human Services Xavier Becerra called on Congress to ensure stable and adequate funding for the Indian Health Service (IHS) division, which directly serves approximately 2.8 million Native Americans. The government had previously argued that the law did not require it to cover these costs, but the Supreme Court disagreed, potentially adding between $800 million and $2 billion annually to the federal budget.

Understanding the Indian Self-Determination Act (ISDA)

The case centers on the Indian Self-Determination Act (ISDA) of 1975, a law that empowers Native American tribes to administer their own healthcare programs under contracts with the IHS. These contracts require the IHS to provide the same amount of funding as if it were running the program directly, including covering administrative expenses.

An important amendment in 1994 clarified that payments from government and private insurance collected by the tribes supplement, rather than replace, IHS funding. The Supreme Court's decision reinforces this interpretation, ensuring that tribes are not financially penalized for administering their own programs.