3 Key Takeaways From Yale’s ‘Ensuring Sovereignty In Healthcare’

Understanding tribal healthcare agreements provides vital lessons for navigating underfunded medical systems.

A recent Yale Law Journal article explores the stark differences in federal funding between tribal healthcare and state Medicaid programs.

IHS Spends $4,078 Per Person While Other Federal Programs Spend Almost 3x More

The Indian Health Service (IHS) operates with significantly less financial support compared to other federal health systems, spending only $4,078 per capita in 2017 while Medicaid spent $8,109 and the Veterans Health Administration spent $10,692. Trudel Pare’s analysis in the Yale Law Journal, Ensuring Sovereignty in Healthcare, highlights how tribes have utilized Title V compacts to maximize these limited resources through Native practitioners and culturally competent public health initiatives.

Without Medicaid Reimbursements Indian Health Service Facilities Cannot Survive

Medicaid remains heavily intertwined with Native health, covering one-third of the total American Indian and Alaska Native population. Because the federal government matches 100 percent of Medicaid costs for services provided to Native populations at Indian Health Service facilities, Medicaid serves as a vital financial lifeline. In fiscal year 2019 alone, Indian Health Service facilities collected over $800 million in Medicaid reimbursements. Federal funding for Medicaid is typically massive, accounting for about 10 percent of the total federal budget, with the federal government spending approximately $606 billion out of a total $880 billion program cost in fiscal year 2023.

65% of Tribes Now Self-Govern Their Own Healthcare Through Title V Compacts

Tribal self-governance programs have grown significantly despite these financial hurdles. As of 2020, 65 percent of federally recognized tribes participated in Title V self-governance compacts, managing programs that account for roughly half of the entire Indian Health Service budget. To protect these operations from federal delays, these tribal compacts stipulate strict negotiation timelines, requiring the federal government to begin funding discussions 120 to 150 days before an existing agreement expires. This legal framework guards against the historical failures of the federal government, such as the 1970s forced sterilization campaigns that unethically impacted 25 to 50 percent of all Native individuals with the capacity for pregnancy.

We at Ellsworth appreciate comprehensive academic studies that allow the broader public to understand the nuances of IHS healthcare delivery to Indigenous populations in the United States. As a trusted Native owned small business and recognized ISBEE, we understand the unique challenges facing Indian Country firsthand. We proudly supply highly qualified medical professionals who deliver exceptional, culturally competent care to vulnerable communities.