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Self-Determined Health: Reevaluating Current Systems and Funding for Native American Health Care
Published online by Cambridge University Press: 11 July 2022
Abstract
For years, the federal government has failed to uphold its promises to provide health care to Native Americans. These promises are echoed in treaties, the Constitution, and judicially-created law. As a result of this breach of promise and chronically underfunding, there are significant health disparities between indigenous populations and other Americans. In a recent 2020 case, McGirt v. Oklahoma, the U.S. Supreme Court held that both the federal government and individual states must follow the terms of a treaty made with a tribe, encouraging the possibility of direct health care funding. This reform, however, means little without tribal sovereignty and self-determination, which give dignity and decisionmaking capabilities back to a group that has long been without them. This Note explores two examples of self-determination in Native American health care, the Alaskan Native health care system and the recent vaccine rollout, proposing a framework for increasing self-determination in health care to provide support for funding reform, which becomes increasingly necessary as Native Americans continue to struggle to access health care.
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- Student notes
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- © 2022 The Author(s)
Footnotes
†
J.D. Candidate,. Olivia Meadows has a concentration in Health Law and B.A. in Anthropology and Philosophy, University of Florida. The author can be contacted at omeadows@bu.edu
Thank you to Professor Nicole Huberfeld for providing invaluable feedback on various drafts of this paper and to my family for encouraging me throughout my writing process.
References
1 In this Note, the term “Native American” is used interchangeably with the term AI/AN (“American Indian/Alaska Native”) unless indicated otherwise. When the term “Indian” is used, it is necessary as a part of either a title or a quotation.
2 U.S. Comm’n on Civil Rights, Broken Promises: Continuing Federal Funding Shortfall for Native Americans 66 (2018).
3 U.S. Const. art. I, § 8, cl. 3.
4 25 U.S.C. § 1602 (2006); Snyder Act of 1921, ch. 115, 42 Stat. 208 (1921) (codified as amended at 25 U.S.C. § 13 [2004]); see National Academies of Sciences, Engineering, and Medicine, Communities in Action: Pathways to Health Equity app. 509-10 (James N. Weinstein, Amy Geller, Yamrot Negussie, et. al. eds., 2017) (Native American Health: Historical and Legal Context), https://www.ncbi.nlm.nih.gov/books/NBK425854/ [https://perma.cc/C7TS-4H4A].
5 Mark Walker, Fed Up With Deaths, Native Americans Want to Run Their Own Health Care, N.Y. Times (Jan. 3, 2021), https://www.nytimes.com/2019/10/15/us/politics/native-americans-health-care.html?smid=nytcore-ios-share [https://perma.cc/D86D-U5D9].
6 25 U.S.C. § 5303 (2020); see Megan J. Renfrew, The 100% Federal Medical Assistance Percentage: A Tool for Increasing Federal Funding for Health Care for American Indians and Alaska Natives, 40 Colum. J.L. & Soc. Probs. 173, 178–79 (2006).
7 McGirt v. Oklahoma, 140 S. Ct. 2452 (2020).
8 National Conference of State Legislatures, An Issue of Sovereignty (Jan. 2013) [hereinafter An Issue of Sovereignty], https://www.ncsl.org/research/state-tribal-institute/an-issue-of-sovereignty.aspx#:~:text=Tribal%20sovereignty%20refers%20to%20the,to%20regulate%20their%20internal%20affairs [https://perma.cc/9NX3-HQNB].
9 U.S. Const. art. I, § 8, cl. 3 (regulating commerce with Indians); U.S. Const. art. II, § 2, cl. 2 (giving President and Senate power to make treaties).
10 An Issue of Sovereignty, supra note 8.
11 Snyder Act of 1921, Ch. 115, 42 Stat. 208 (1921) (codified as amended at 25 U.S.C. § 13 [2004]).
12 Patrice H. Kunesh, Tribal Self-Determination in the Age of Scarcity, 54 S.D. L. Rev. 398, 401 (2009).
13 Id. (citing Felix S. Cohen, Handbook of Federal Indian Law § 402 (Nell Jessup Newton et al. eds., LexisNexis 2005)).
14 Kunesh, supra note 12, at 401 (citing Cherokee Nation v. Georgia, 30 U.S. 1, 13 (1831)).
15 Cherokee Nation v. Georgia, 30 U.S. 1, 12-13 (1831).
16 Kunesh, supra note 12, at 401.
17 Id. (citing United States v. Wheeler, 435 U.S. 313, 326 (1978) (“[T]he dependent status of Indian tribes within our territorial jurisdiction is necessarily inconsistent with their freedom independently to determine their external relations.”) (superseded by statute as stated in United States. v. Lara, 541 U.S. 193 (2004).
18 Id. (citing Felix S. Cohen, Handbook of Federal Indian Law § 402, 123 (Nell Jessup Newton et al. eds., LexisNexis 2005)).
19 United States v. Lara, 541 U.S. 193, 206 (2004).
20 Kunesh, supra note 12, at 401.
21 Id. at 401-2.
22 Walker, supra note 5.
23 U.S. Const. art I, § 8, cl. 3.
24 Holly Miller & Michael Reese, A History of Treaty Making and Reservations on the Olympic Peninsula, Ctr. for Study Pac. Nw., https://depts.washington.edu/cspn/resources/curriculummaterials/treaties-reservations/#1510354839889-e3d2a8f4-0398 [https://perma.cc/QBX4-LLCA] (“In retrospect, these treaty negotiations seem highly suspect: They were carried out in a language that was understood by few of the participants and inadequate to convey the complexities of the treaties; they were held between two cultures that had conflicting ideas about land ownership, contractual obligations, and even basic social courtesies; and, ultimately, the terms were virtually dictated by Americans negotiators who had little inclination to bargain. In the end it is never clear whether the whites or the Indians ever understood the other during these negotiations.”).
25 Treaty with the Makah, 12 Stat. 939, art. 11 (Jan. 31, 1855) (“And the United States further agrees to employ a physician to reside at the said central agency, or as such other school should one be established, who shall furnish medicine and advice to the sick, and shall vaccinate them; the expenses of said school, shops, persons employed, and medical attendance to be defrayed by the United States and not deducted from the annuities.”); Treaty with the Klamath, 16 Stat. 707, art. 5 (Oct. 14, 1864) (“The United States further engages to furnish and pay for the service and subsistence … for the term of twenty years of one physician … .”); Treaty with the Kiowa and Comanche, 15 Stat. 581, art. 14 (Oct. 21, 1867) (“The United States hereby agrees to furnish annually to the Indians the physician … and that such appropriations shall be made from time to time, on the estimates of the Secretary of the Interior, as will be sufficient to employ such [person].”).
26 The federal government’s trust responsibility to tribes is discussed by Chief Justice John Marshall in the United States Supreme Court’s decision in Cherokee Nation v. Georgia, 30 U.S. 1, 11-12 (1831).
27 Seminole Nation v. United States, 316 U.S. 286 (1942).
28 Everett Rhoades & Dorothy Rhoades, The Public Health Foundation of Health Services for American Indians Alaska Natives, 104 Am. J. of Pub. Health s3, s279 (Sep. 3, 2014).
29 Id.
30 Id. at s279-80.
31 Brett Lee Shelton, Legal and Historical Roots of Health Care for American Indians and Alaska Natives in the United States, KISER Fam. Found. 7 (Feb. 2014).
32 Timeline, Native Voices, https://www.nlm.nih.gov/nativevoices/timeline/432.html [https://perma.cc/X5NW-F2X2].
33 Pub. L. No. 568 (42 U.S.C. 2001) (Aug.5,1954).
34 Id.
35 About IHS, Indian Health Serv., https://www.ihs.gov/aboutihs/ [https://perma.cc/X4XQ-RG7D].
36 U.S. Comm’n on Civil Rights, Broken Promises: Continuing Federal Funding Shortfall for Native Americans 65 (2018).
37 Id.
38 Id. at 66.
39 Id. at 65.
40 See Cindy L. Ehlers et al., Measuring Historical Trauma in an American Indian Community Sample: Contributions of Substance Dependence, Affective Disorder, Conduct Disorder and PTSD, 133 Drug and Alcohol Dependence 1, 2 (2013).
41 Risk for COVID-19 Infection, Hospitalization and Death by Race/Ethnicity, Ctrs for Disease Control and Prevention (June 17, 2021), https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigationsdiscovery/hospitalization-death-by-race-ethnicity.html [https://perma.cc/W9A2-P5X7].
42 Gloria Oladipo, Native American communities lashed by Covid, worsening chronic inequities, Guardian (Dec. 13, 2021), https://www.theguardian.com/us-news/2021/dec/13/pandemic-challenges-native-american-communities [https://perma.cc/Z6V4-DVUZ].
43 A Quick Look, Indian Health Serv., https://www.ihs.gov/newsroom/factsheets/quicklook/ [https://perma.cc/AB7N-SNL4].
44 IHS Profile Fact Sheet, Indian Health Serv. (Aug. 2020), https://www.ihs.gov/newsroom/factsheets/ihsprofile/ [https://perma.cc/X5W8-UC8F].
45 Id.
46 Indian Health Care Improvement Act, Pub. L. No. 94-437 § 3 (“It is the policy of the Nation, in fulfillment of its special responsibilities and legal obligations to the American Indian people, to ensure the highest possible health status for Indians and urban Indians.”); Urban Indian Health Program Fact Sheet, Indian Health Serv. (Oct. 2018), https://www.ihs.gov/newsroom/factsheets/uihp/ [https://perma.cc/66XF-Y749].
47 IHS Profile, Indian Health Serv. (Aug. 2020), https://www.ihs.gov/newsroom/factsheets/ihsprofile/ [https://perma.cc/SD2Y-63X9].
48 Megan J. Renfrew, The 100% Federal Medical Assistance Percentage: A Tool for Increasing Federal Funding for Health Care for American Indians and Alaska Natives, 40 Colum. J. L. & Soc. Probs. 173, 182 (2006).
49 Jennie R. Joe, The Rationing of Healthcare and Health Disparity for the American Indians/Alaska Natives532 (2003), https://www.ncbi.nlm.nih.gov/books/NBK220367/ [https://perma.cc/ VBU8-QQUW].
50 Id.
51 See Arica L. Coleman, From the ‘Pocahontas Exception’ to a ‘Historical Wrong’: The Hidden Cost of Formal Recognition for American Indian Tribes, Time (Feb. 9, 2018), https://time.com/5141434/virginia-indian-recognition-pocahontas-exception/ [https://perma.cc/V6A6-SH6Q].
52 Indian country includes: 1) all land within the limits of an Indian reservation under the
jurisdiction of the United States government; 2) all dependent Indian communities, such as the New Mexico Pueblos; and 3) all Indian allotments still in trust, whether they are located within reservations or not. It is generally within these areas that tribal sovereignty applies, and state power is limited.
53 Starla Kay Roels & Liz Malerba, New Opportunities for Innovative Healthcare Partnerships with Indian Tribes and Tribal Organizations, 28 Health Lawyer 1, 25 (Oct. 2015).
54 See id.
55 25 U.S.C. § 1602 (2006).
56 See id.
57 Rosebud Sioux Tribe v. United States, 450 F.Supp.3d 986, 996-97 (D.S.D. 2020).
58 Roels & Malerba, supra note 53, at 26.
59 Indian Self-Determination and Education Assistance Act, Pub. L. No. 93-638 (Jan. 4, 1975).
60 Cherokee Nation v. Leavitt, 543 U.S. 631, 639 (2005).
61 Office of Direct Service and Contracting Tribes, Title I, Indian Health Serv., https://www.ihs.gov/odsct/title1/ [https://perma.cc/RS7C-TKZN] (last visited Feb. 9, 2022).
62 25 U.S.C. §§ 450-458 (2020).
63 Roels & Malerba, supra note 53, at 25.
64 Id.
65 Id.
66 25 U.S.C. §§ 450-458 (2020); 25 C.F.R. § 900; 25 C.F.R. § 1000; 42 C.F.R. § 137.
67 See, e.g., Dep’t of Health & Hum. Servs., Fiscal Year (FY) 2015 Report to Congress on Contract Funding of Indian Self-Determination and Education Assistance Act Awards (Includes Fiscal Year 2012 – 2015 Data), https://www.ihs.gov/sites/newsroom/themes/responsive2017/display_objects/documents/RepCong_2016/CSC_Report.pdf [https://perma.cc/HSA2-4VBD]
68 Joe, supra note 49, at 534.
69 Id.
70 Tribal Self-Governance Fact Sheet, Indian Health Serv., https://www.ihs.gov/newsroom/factsheets/tribalselfgovernance/ [https://perma.cc/HX9D-6ZRT] (last visited Feb. 10, 2022).
71 Id.
72 See Off. Minority Health, Profile: American Indian/Alaska Native, U.S. Dept. Health & Hum. Servs. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=62 [https://perma.cc/MWR4-Y7NR] (last visited Feb. 10, 2022).
73 Id.
74 Id.
75 Cara James, Karyn Schwartz & Julia Berndt, Race, Ethnicity, & Health Care Issue Brief: A Profile of American Indians and Alaska Natives and Their Health Coverage 6 (2009).
76 H.R. Rep. No. 94-1026 at 107.
77 Megan J. Renfrew, The 100% Federal Medical Assistance Percentage: A Tool for Increasing Federal Funding for Health Care for American Indians and Alaska Natives, 40 Colum. J.L. & Soc. Probs. 173, 178–79 (2006).
78 Id.
79 Id. at 819.
80 Id. at 174.
81 Ross Kenneth Urken, Poor Cancer Care for Native Americans Might Be a Treaty Violation, Newsweek Magazine (July 19, 2016, 9:10 AM), https://www.newsweek.com/2016/07/29/colorectal-cancer-indian-health-services-native-americans-481524.html [https://perma.cc/D6FZ-P6M4].
82 Id.
83 Id.
84 Id.
85 Urban Indian Health Program Fact Sheet, Indian Health Serv. (Oct. 2018), https://www.ihs.gov/newsroom/factsheets/uihp/ [https://perma.cc/PPL2-6QL5].
86 FY 2021 Budget & Performance, U.S. Dept. of Health and Human Servs., https://www.hhs.gov/about/budget/index.html [https://perma.cc/3Z4K-JGJZ]; Susannah Luthi, Indian Health Service Urban Programs Threatened by Government Shutdown, Modern Healthcare (Jan. 7, 2019), https://www.modernhealthcare.com/article/20190107/NEWS/190109933/indian-health-service-urban-programs-threatened-by-government-shutdown [https://perma.cc/M9SZ-MCSW].
87 Dana Ferguson, In Tense Meeting, Tribal Leaders, IHS Head Talk Solutions, Argus Leader (Apr. 5, 2016, 5:39 PM), https://www.argusleader.com/story/news/2016/04/05/tense-meeting-tribal-leaders-ihs-head-talk-solutions/82648032/ [https://perma.cc/S2FQ-6948].
88 Martha Salazar, State Recognition of American Indian Tribes, Nat’l Conf. State Legislatures (Oct. 2016), https://www.ncsl.org/research/state-tribal-institute/state-recognition-of-american-indian-tribes.aspx [https://perma.cc/6FQC-87M7].
89 Urken, supra note 81.
90 U.S. Dep’t Health & Hum. Servs., FY 2021 Budget in Brief 41, https://www.hhs.gov/about/budget/fy2021/index.html [https://perma.cc/9K2D-GV77].
91 Joe, supra note 49, at 541.
92 Id.
93 Id. at 535 (citing A.B. Bergman et al, A Political History of the Indian Health Service, 77 The Milbank Quarterly 571, 601 (1999)).
94 Id. at 544.
95 See id.
96 Id.
97 Treaty with the Makah, Makah-U.S., art. 11, Jan. 31, 1855, 12 Stat. 939.
98 Kiowas: Treaty between the United States of America and the Kiowa and Comanche Tribes of Indians art. 14, 15 Stat. 581 (Oct. 21, 1867).
99 Treaty between the United States of America and different tribes of Sioux Indians art. 13, 15 Stat. 635 (May 25, 1868).
100 McGirt, 140 S. Ct. 2452, 2453 (2020).
101 Id. at 2462 (“So it’s no matter how many other promises to a tribe the federal government has already broken. If Congress wishes to break the promise of a reservation, it must say so.”).
102 Id.
103 Solem v. Bartlett, 465 U.S. 463, 470 (1984).
104 McGirt, 140 S. Ct. 2468; Montana v. U.S., 450 U.S. 544, 545 (1981).
105 Transcript of Oral Argument at 19, Oklahoma v. Castro-Huerta, No. 21-429 (U.S. argued Apr. 27, 2022).
106 Id. at 17.
107 The Snyder Act of 1921, ch. 115, 42 Stat. 208 (1921) (codified as amended at 25 U.S.C. § 13 (2018)).
108 McGirt, 140 S. Ct. at 2452.
109 Samantha Artiga et al., Medicaid and American Indians and Alaska Natives, Kaiser Fam. Found. (Sep. 2017), https://www.kff.org/medicaid/issue-brief/medicaid-and-american-indians-and-alaska-natives/ [https://perma.cc/CHV9-YCL3].
110 Eric Whitney, Native Americans Feel Invisible in U.S. Health Care System, NPR (Dec. 12, 2017, 5:00 AM), https://www.npr.org/sections/health-shots/2017/12/12/569910574/native-americans-feel-invisible-in-u-s-health-care-system [https://perma.cc/DYS9-755G].
111 Larisa Antonisse, Rachel Garfield, Robin Rudowitz & Samantha Artiga, The Effects of Medicaid Expansion under the ACA: Updated Findings from Literature Review—Issue Brief, Kaiser Fam. Found., (Mar. 2018), https://files.kff.org/attachment/Issue-Brief-The-Effects-of-Medicaid-Expansion-Under-the-ACA-Updated-Findings-from-a-Literature-Review [https://perma.cc/FYM4-4T4Q].
112 U.S. Comm’n on Civil Rights, Broken Promises: Continuing Federal Funding Shortfall for Native Americans, 91 (2018), https://www.usccr.gov/files/pubs/2018/12-20-Broken-Promises.pdf [https://perma.cc/9LXK-5X9N].
113 Molly Frean et al., Health Reform and Coverage Changes Among Native Americans, 176 JAMA Internal Med. 858, 859 (2016).
114 See id.
115 Id.
116 Id.
117 Press Release, U.S. Dep’t. of Health & Hum. Servs., Oklahoma’s Medicaid Expansion Will Provide Access to Coverage for 190,000 Oklahomans (July 1, 2021), https://www.hhs.gov/about/news/2021/07/01/oklahomasmedicaid-expansion-will-provide-access-to-coverage-for-190000-oklahomans.html [https://perma.cc/D7S2-QGQD].
118 Press Release, U.S. Dep’t. of Health & Hum. Servs., Health Insurance Coverage and Access to Care for American Indians and Alaska Natives: Current Trends and Key Challenges (July 22, 2021), https://aspe.hhs.gov/sites/default/files/2021-07/aspe-aian-health-insurance-coverage-ib.pdf [https://perma.cc/ ZN85-4KGH].
119 See Press Release, U.S. Dep’t of Health & Hum. Servs., supra note 117.
120 U.S. Dep’t Health & Hum. Servs., FY 2021 Budget in Brief, supra note 90.
121 25 U.S.C.A. §5301 (West).
122 Overview, Alaska Native Tribal Health Consortium, https://anthc.org/who-we-are/overview/ [https://perma.cc/F35E-PNGW] (last visited Feb. 10, 2022).
123 Id.
124 Magnet Recognition Program, American Nurses Credentialing Ctr., https://www.nursingworld.org/organizational-programs/magnet/ [https://perma.cc/9XM6-J2PR] (last visited Feb. 10, 2022).
125 Joe, supra note 49, at 543-44.
126 David A. Nash and Ron J. Nagel, Confronting Oral Health Disparities Among American Indian/Alaska Native Children: The Pediatric Oral Health Therapist, 95 Am. J. Pub. Health 1325, 1325 (2005).
127 Id.
128 Id.
129 Connie Mobley et al., The Contribution of Dietary Factors to Dental Caries and Disparities in Caries, 9 Acad. Pediatrics 410, 410 (2009).
130 Agency for Healthcare Research and Quality, supra note 120.
131 Id.
132 Id.
133 Id.
134 Id.
135 Id.
136 H.R. Rep. No. 113-248 at 2 (2013).
137 Press Release, Senator Lisa Murkowski, Delegation Land Transfer Passes Congress, Benefitting Native Health Effort (Dec. 20, 2013).
138 Alaska Native Tribal Health Consortium, Health Within Reach Alaska Native Tribal Health Consortium 2019 Annual Report, (2019), https://anthc.org/wp-content/uploads/2019/12/2019-ANTHC-Annual-Report-web-1.pdf [https://perma.cc/A7PS-6DZT].
139 Joaqlin Estus, Alaska Native Corporations Dominate List of State’s Top Businesses, Indian Country Today (Oct. 5, 2020), https://www.indianz.com/News/2020/10/05/indian-country-today-alaska-native-corporations-mean-business/ [https://perma.cc/SC7P-D5TA].
140 Joanne Silberner, Covid-19: How Native Americans Led the Way in the US Vaccination Effort, 374 BMJ (2021).
141 COVID data tracker, Ctrs for Disease Control & Prev., https://covid.cdc.gov/covid-data-tracker/#vaccination-demographics-trends [https://perma.cc/K6AE-2SS2] (last visited Feb. 10, 2022).
142 Raymond Foxworth et al., Covid-19 Vaccination in American Indians and Alaska Natives — Lessons from Effective Community Responses, 385 New Eng. J. Med. 2403, 2405 (2021).
143 Id.
144 Silberner, supra note 140, at 1.
145 Id. at 2.
146 Id. at 1.
147 Foxworth, supra note 142, at 2405-06.
148 See 2020 CARES Act, U.S. Dep’t of the Interior, https://www.bia.gov/covid-19/cares-act [https://perma.cc/F3KT-SRDU] (last visited Feb. 10, 2022).
149 Urken, supra note 81.