Treaty and Trust Responsibility Funding Trends in Indian Country: Focus on the Indian Health Service

The federal government has a unique relationship with American Indians and Alaska Natives and part of this relationship is to provide support and protection as a treaty and trust responsibility. This study focused upon the federal commitment to health care delivery in the United States by examining total and program level funding overtime to the Indian Health Service. The study made comparisons with other health care spending priorities in the United States to understand how funding to the Indian Health Service ranks. Based upon the Department of Health and Human Services’ fiscal year congressional justifications, funding to the Indian Health Service has increased since 2007. However, the total spending amounts to a mere $2,485 per American Indian/Alaska Native person and total dollars allocated per American Indian/Alaska Native person was lowest among all groups examined. Low health care spending by the United States contributes to the disproportionally higher death rate among the American Indians and Alaska Natives population. The comparatively low level of fiscal appropriations to the Indian Health Service despite the high need raises questions about equality, democracy, and representation within the federal health care system and its ability to meet those needs.