IHS From the Beginning ...
The establishment of Indian Health Services dates back to the founding of the United States and the U.S. Constitution as well as subsequent statutes and case law. Case law, in particular the 1831 U.S. Supreme Court Cherokee Nation v. Georgia, defined the relationship among the Indian Nations, the federal government and state governments, and established the guardian/ward bond between the United States and the Indian Nations that is the basis of the trust relationship.
The trust relationship establishes a responsibility for a variety of services and benefits — including health care services — to American Indian people based on their political status as Indians and their time immemorial inherent rights as separate and distinct sovereign nations. It is through the organization of hundreds of treaties into law that form the basis of the federal governments’ health care provisions to American Indians. Treaty health care terms represented part of the government’s payment to Indian tribes for, among other things, giving up their ancestral homelands to the United States. These treaties were — still are — contracts by and between the sovereign federal government and sovereign tribal governments.
The 1921 Snyder Act provides for continued federal program authority; it identifies “the relief of distress and conservation of Indian health” as a federal function. In addition, numerous other laws, court cases, and Executive Orders reaffirm the unique relationship between tribal governments and the federal government.
During the 1950s the creation of basic health care services progressed under the jurisdiction of the newly formed Indian Health Service. Moving into the 1960s the emphasis shifted toward health program management, health planning, health professional and health occupational training for American Indians as well as health management training for Indian Health Service administrators. The Community Health Representative training initiative was established in 1965. The intent of this particular program was to bridge the existing gap between community member patients needing health care and the clinics and hospitals providing such care.
The 1970s were revolutionary for Indian Health Services. President Richard Nixon had introduced the concept of “Tribal Self-Determination,” that proposed tribal governments taking over the management of federal programs provided to them. Congress took formal action on this concept in 1975 by enacting PL 93-638, the Indian Self-Determination and Education Act.
In the 1980s there were vast increases in funding for Indian Health Service programs with special emphasis on professional excellence, construction of modern health facilities and movement toward greater tribal involvement. Throughout the 1990s a continual unfolding growth of the “self-determination” process was portrayed. Congress passed legislation extending tribal self-governance, allowing tribes to contract for the programs, services, functions, and activities within Indian Health Service and the Bureau of Indian Affairs.
The permanent reauthorization of the Indian Health Care Improvement Act — enacted in 2010 as part of the Patient Protection and Affordable Care Act (PL 111-148) — provide specific legislative authority for Congress to appropriate funds specifically for the health care of American Indian people. It also establishes the Indian Health Service as an agency of the U.S. Department of Health and Human Services.
Today the Indian health care system administers services through 46 hospitals, 296 health centers, 108 health stations, 164 Alaska village clinics, and 34 urban projects. It serves approximately 2.1 million American Indians and Alaska Natives residing on or near Indian reservations.
On the Flathead Indian Reservation the Confederated Salish and Kootenai Tribes’ Tribal Health and Human Services Department provides a wide range of services to a user population of more than 12,000 American Indians. Funding for this effort is increasingly constrained as the cost of health care continues to climb parallel to the escalating health care needs in our area. The federal per capita user population expenditure for the Indian Health Service is $2,741 per user while the general U.S. user population expenditure for health care services is $7,239 per user.
Tribal Health’s provision of quality, competent, and timely health care is of the highest priority. Tribal Health’s continuing efforts are geared toward efficient, effective and culturally sensitive service delivery, while exploring additional avenues to enhance funding levels and expand our health care systems.