The Supreme Court has ruled in favor of Native American tribes in their dispute with the federal government over the cost of health care. This decision means that the government will cover millions of dollars in overhead costs that two tribes faced when they took over running their health care programs under a law designed to give Native Americans more local control.
The Department of Health and Human Services had argued that it was not responsible for the potentially expensive overhead costs associated with billing insurance companies, Medicare, and Medicaid. The federal Indian Health Service has historically provided tribal health care under treaty obligations, but many facilities are inadequate and understaffed, as noted by the San Carlos Apache Tribe in Arizona.
Health care spending per person by the IHS is significantly lower than federal spending in other parts of the country, leading to Native American tribal populations having an average life expectancy nearly 11 years less than the U.S. average. The tribes in question had contracted with IHS to run their own programs, covering services from emergency care to substance abuse treatment.
While the agency paid the tribes the agreed-upon amount for running these services, the overhead costs associated with billing insurance companies or Medicare and Medicaid were not included in the contracts. This led to significant financial burdens for the San Carlos Apache Tribe and the Northern Arapaho Tribe.
Two lower courts had previously ruled in favor of the tribes, prompting the Department of Health and Human Services to appeal to the Supreme Court. The agency argued that tribes did receive some money for overhead costs but that
