How do Native Americans get health care?

NATIVE AMERICANS are now vaccinated against covid-19 at higher rates than any other racial or ethnic group in America, according to the Kaiser Family Foundation, a health-research outfit. Effective distribution and a high uptake drove this vaccine victory. But it is a rare success. Native Americans died of covid-19 at nearly twice the rate of white Americans. Their life expectancy is 4.4 years below the American average and they have the highest rates of pre-existing health conditions out of any ethnic or racial group in America. Unlike other groups, Native Americans are entitled to health care from the federal government, but the system is poorly run and funded. How does it work? And why is it failing?

During the 18th and 19th centuries, America’s federal government (and the British before it) signed treaties with Native American tribes. Many of them exchanged land for a commitment that the government would protect them, including by providing medical care. Rulings by the Supreme Court in the 1800s established that tribes are political bodies that control their internal affairs. But the tribes remain subject to federal law, and the federal government has a duty to provide for them, known as the “trust responsibility”. Congress affirmed the duty to provide health care in 1921 with the Snyder Act, which appropriated funds for Indian health care. This obligation covers enrolled members of federally-recognised tribes, which are political bodies, but does not apply to those who merely self-identify as Native American or belong to non-recognised tribes. Tribes themselves decide who qualifies as a member.