WASHINGTON – The Supreme Court sided with Native American tribes on Thursday in a dispute with the federal government over the cost of health care when tribes run programs in their own communities.
The 5-4 decision means the government will cover millions in overhead costs that two tribes faced when they took over management of their health programs under a law intended to give Native Americans more local control.
Covering these costs is “necessary to avoid a funding gap,” Chief Justice John Roberts wrote in the majority opinion. Not reimbursing them forces tribes to “pay a penalty for seeking self-determination.”
The Department of Health and Human Services has argued that it is not responsible for the potentially expensive indirect costs associated with billing insurance companies, Medicare and Medicaid.
Paying these costs for all tribes that run their own health programs could total between $800 million and $2 billion a year, the agency said.
“The extra federal money the Court greenlights today does not come for free,” Justice Brett Kavanaugh wrote in the dissent, joined by Justices Clarence Thomas, Samuel Alito and Amy Coney Barrett. “In my opinion, the court should leave these difficult appropriations and compensation decisions to Congress.”
The Federal Indian Health Service has provided tribal health care since the 1800s under treaty obligations, but facilities are often inadequate and understaffed, the San Carlos Apache Tribe of Arizona said in court documents.
IHS’s per-person health care spending represents just a third of federal spending in the rest of the country, the Northern Arapaho Tribe of Wyoming said in court filings. Native American tribal populations have an average life expectancy of about 65 years, nearly 11 years less than the U.S. as a whole.
The tribes contract with IHS to run their own programs, ranging from emergency services to substance abuse treatment. The agency paid the tribes the money it would have spent to perform these services, but the contract did not include the overall costs of billing insurance companies or Medicare and Medicaid, since other agencies handle this when the government is running the program. .
The tribes, however, had to do the billing themselves. It cost the San Carlos Apache Tribe nearly $3 million in overhead expenses over three years and the Northern Arapaho Tribe $1.5 million over a two-year period, they said. Two lower courts agreed with the tribes.
The Department of Health and Human Services appealed to the Supreme Court, arguing that tribes receive some money for overhead expenses, but the government is not responsible for costs associated with third-party income.
Most federally recognized tribes now contract with IHS to manage at least some of their own health care programming.
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