Rights and Privileges of Indian Health Care

Julianne Jennings

State-recognized tribes are Native American Indian Tribes and Heritage Groups that are recognized by individual states for their various internal government purposes. State recognition confers, in some cases but not all, limited benefits and funding under state and federal law and is not the same as federal recognition. Federal recognition does not acknowledge sovereignty of an Indian Tribe/Nation/Band or community. The Supreme Court already decided that [all] Tribes were sovereign. It establishes eligibility for BIA services and/or benefits...subjugation and that is all. To be acknowledged, a tribe must cede aboriginal sovereignty for the benefit of limited autonomy at the convenience of the federal President. Aboriginal sovereignty is a right whereas limited autonomy is a privilege.

Why the need for federal and state clarification? Recently, I sought medical care at a local Native Health Care Center. Their mission statement is defined as, A tradition of wellness?to continually strive to improve the lives of American Indian families by offering high quality, culturally competent health-related services that enhance the well-being of the whole person and the Native American community. My physical examination revealed I had high blood pressure, 167/96. Native American Health Center then referred me to the Indian Medical Center to register as an American Indian patient and have my prescription filled for hypertension medication.

Soon, it was determined services would not be rendered because my state status; even though my Rhode Island birth certificate identifies me as an “American Indian.” The federal government uses my birth record for statistical purposes to provide funding for native programs based upon that information. The Indian Medical Center could have, but did not, offer me a few pills to hold me over, giving me time to find a doctor or a health care facility willing to treat me. Shame on them.

Many states impose restrictions on who can practice medicine and/or healthcare in their state. This activity precludes a tribe from determining who and what competencies can be utilized in their health care provision. Essentially it is a method to deny free or low cost health care to tribal members through the denial of services for failure to meet state or, in this case, federal requirements. This constructive denial is tantamount to creating conditions of life designed to destroy groups.

California Indian Health Services provides further definition of terms as, Urban Indian eligible for services is defined as any individual who: Resides in an urban center, which is any community that has a sufficient urban Indian population with unmet health needs to warrant assistance under Title V, as determined by the Secretary of the Department of Health and Human Services (HHS); and who meets one or more of the following criteria: Irrespective of whether s/he lives on or near a reservation, is a member of a tribe, band, or other organized group of Indians, including: those tribes, bands, or groups terminated since 1940, and those recognized now or in the future by the State in which they reside; or is a descendant, in the first or second degree, of any such member described in (A); or is an Eskimo or Aleut or other Alaska Native; or is considered by the Secretary of the Department of the Interior to be an Indian for any purpose; or is determined to be an Indian under regulations pertaining to the Urban Indian Health Program that are promulgated by the Secretary of HHS.

The eligibility requirement for Contract Health Services (CHS) delivered by referral to a non-tribal facility or provider is stricter than for direct healthcare. To be eligible for CHS, an individual must reside within a CHS Delivery Area (CHSDA) and be member of a federally recognized tribe or descendant of an Indian who was living in California on June 1, 1852 and live on or near the established CHSDA.

My confusion. If a state acknowledged Indian resided in Rhode Island s/he would qualify in the boundaries of the state. Acknowledgement is not an acknowledgement of a tribe as a sovereign; it is a qualification for services and benefits of the BIA. Moreover, the true intension of the law pits federal tribes against state tribes; a strategy that will promote “political racism.”

Have we lost our sense of priority by allowing the Circle of Life to be regulated by state and federal laws? No one should be denied medical care. Our sovereignty has taken away our humanity and we are becoming a bureaucracy too blind to see the people we are mandated to serve.

Lucky for me, I am now receiving health services provided by my university— in a sense, my academic tribal family concerned with healing my body and strengthening my mind.

To better understand the details of the story, history, and effects of the policies administered by the BIA, the best current information available is by Dr. Donald L. Fixico, Bureau of Indian Affairs, newly released by Greenwood Press.

Julianne Jennings, E. Pequot-Nottoway, is a Ph.D. student at Arizona State University.

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tmsyr11's picture
The equivalent to so-called 'rights and privileges' in the IHS today is come back tomorrow or take two tylenols, or two aspirins and call the clinic back in the morning. R U serious to rights and privileges? What good are 'rights and privileges' if the IHS cannot handle the current influx of reservation-bound patients or the movement of indian people around the United States? Do you think throwing more money and resources at indian healthcare will improve the quality of services right now?
hontasfarmer's picture
As someone who is not a member of a federally recognized tribe myself I feel what you are saying. I do not have enough blood quantum from either of my recent ancestral nations to be a part of one of them. As it stands in many minds and the legal structure that makes me non-NDN for many purposes. Even though I am about 1/4 Indian in total. Why that extends to healthcare which is not linked to a specific tribe but provided to all NDN's based on tribal membership is a mystery. The only possible reason that is done is to protect the sovereign rights of the federally recognized nations in every way. That concept has preserved hundreds of peoples and cultures that might otherwise have been totally destroyed. Getting our healthcare from the general resources available to all Americans is a small price to pay for that. Just one thing should we ask in return. When a state recognized tribe is seeking federal recognition don't stand in their way.