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Supreme Court sides with tribal nations, mandates federal agency cover health care services costs

In a decision that applies to tribal nations across the U.S., the Supreme Court has mandated that the federal government reimburse tribes for costs associated with certain health care programs.

At issue were programs previously overseen by the Indian Health Service, a federal agency. Advocates have called the decision a victory for tribal sovereignty.

“The dispute was basically over how much was owed and what was owed for those overhead costs,” said Morgan Saunders, an attorney with the Native American Rights Fund.

Tribes’ sovereignty over their own health care services, she said, is at the heart of the matter.

“Tribal governments know what their people need,” said Saunders. “They're able to make decisions close to these populations, on the ground, and exercise their key functions as governments and as sovereigns. This is really about the government, the tribal nation that knows about the needs of its citizens, providing for those needs directly.”

Now, the Indian Health Service will foot the bill for health care services with third parties like Medicare, Medicaid, and private insurers.

Saunders said the win comes after years of legal action and opposition from the federal government, which she added must uphold its trust doctrine with tribal nations to support their self-government and prosperity.

The San Carlos Apache Tribe is one of the parties in the case.

Chairman Terry Rambler said those costs were largely unavoidable, and have left on-reservation providers little option but to refer people, sometimes hundreds of miles away.

“Because we live out in a rural area,” Rambler said, “because of our situation, these type of things really means a lot to us.”

Rambler said the court's decision helps put their programs on equal footing with IHS ones, in alignment with agreements between tribal nations and the federal government.

“It will help change the game for us, where it will be able to provide more direct care services for our people,” he said. “More of the funding and the services attached to that funding will trickle down to our people.”

He looks forward, he said, to the precedent this decision will set and the future of tribal health care, with plans to expand services already in the works.

Kirsten Dorman is a field correspondent at KJZZ. Born and raised in New Jersey, Dorman fell in love with audio storytelling as a freshman at the Walter Cronkite School of Journalism and Mass Communication in 2019.