This story is part of our new Quick Hits series. This series will bring you breaking news and short updates from throughout the state.
The U.S. Supreme Court issued a ruling on June 6 on Becerra v. San Carlos Apache Tribe, a case centered on questions about funding for tribally-run health care from the Indian Health Service (IHS). The 5-4 ruling affirms that the IHS is required to fully reimburse tribes for administrative expenses connected to running their own health care.
The case consolidated arguments from two previous lower circuit cases, one of which was brought by the Northern Arapaho Tribe.
Some tribal members go to IHS-run health care programs that bill Medicare, Medicaid or third-party private insurance for those services. To enhance tribal sovereignty, Congress passed the Indian Self-Determination and Education Assistance Act (ISDA) in 1975, which allows tribes the choice to administer health care programs themselves rather than go through the IHS.
In the majority opinion, Chief Justice John Roberts wrote that if the IHS did not reimburse the contract support costs necessary for tribes to run their own health care programs, that would “impose a penalty on tribes for opting in favor of greater self-determination.” Justices Sonia Sotomayor, Elena Kagan, Ketanji Brown Jackson and Neil Gorsuch joined in the majority opinion.
In the dissenting opinion, Justice Brett Kavanaugh wrote that “the extra federal money that the Court today green-lights does not come free.” He stated that the federal government estimates that paying the contract support costs could amount to between $800 million and $2 billion annually – a significant portion of the $8 billion that Congress appropriates for Indigenous health care every year. He wrote, “the Court’s decision will divert funding from poorer tribes to richer tribes” and was joined by Justices Clarence Thomas, Samuel Alito and Amy Coney Barrett.
A statement from the Northern Arapaho Business Council called the decision a “momentous victory for the Northern Arapaho people and the sovereignty of all tribes,” adding that an opposite ruling would have “cost our Tribe alone millions of dollars, leading to reduced services and programs that our community relies upon.”
Native American Rights Fund Executive Director John Echohawk said the decision “honors the commitment Congress made to Tribal Nations’ rights to self-determination” in a statement on the organization’s website.
In a statement following the decision, U.S. Department of Health and Human Services Secretary Xavier Becerra wrote, “We remain firmly committed to executing our obligations under federal law and supporting tribal self-determination and sovereignty.”
In anticipation of the potential budgetary impacts of the decision, he urged Congress to shift the IHS budget from discretionary to mandatory funding starting in the 2026 fiscal year to “protect the overall appropriation for the Indian Health Service and create more adequate and stable funding into the future.”
