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.
