WASHINGTON — The Supreme Court on Thursday sided with Native American tribes in a dispute with the federal government over the cost of health care when tribes administer 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 care programs under a law intended to give Native Americans more local control.
Covering these costs is “necessary to avoid a funding shortfall,” Chief Justice John Roberts wrote in the majority opinion. Not reimbursing them forces tribes to “pay a penalty for pursuing self-determination.”
The Department of Health and Human Services had argued that it is not responsible for the overhead costs associated with billing insurance companies, Medicare and Medicaid.
Paying these costs for all tribes running their own health care programs could amount to between $800 million and $2 billion per year, the agency said.
“The additional federal money the Court greenlights today does not come for free,” Justice Brett Kavanaugh wrote in the dissent, which was joined by Justices Clarence Thomas, Samuel Alito and Amy Coney Barrett. “In my view, the court should leave these difficult appropriations decisions and considerations to Congress.”
The federal Indian Health Service has provided tribal health care under treaty obligations since the 19th century, but facilities are often inadequate and understaffed, Arizona's San Carlos Apache Tribe said in court documents.
Per-person health care spending by the IHS is only one-third of federal spending in the rest of the country, the Northern Arapaho Tribe of Wyoming said in court documents. Native American tribal populations have an average life expectancy of about 65 years, almost 11 years less than the US as a whole.
Attorney Adam Unikowsky, who represented the Northern Arapaho Tribe, said the decision puts the tribes on an equal footing with the IHS in health care and “will promote tribal sovereignty and provide resources for health care in underserved communities.”
The tribes contracted 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 overhead costs of billing insurance companies or Medicare and Medicaid, since other agencies handle this when the government administers the program.
However, the tribes had to do the billing themselves. That cost the San Carlos Apache Tribe nearly $3 million over three years and the Northern Arapaho Tribe $1.5 million over two years, they said. Two lower courts agreed with the tribes.
The Department of Health and Human Services appealed to the Supreme Court, arguing that tribes get some money for overhead costs, but the government is not responsible for costs related to third-party revenues.
The majority of federally recognized tribes now contract with the IHS to administer at least part of their own health care program.
