Since the first treaties between the United States and indigenous tribes were signed during the Revolutionary War, U.S. law has recognized Native American nations as sovereign governments. The fact that treaties with Native American peoples have been broken repeatedly does not change the fact that the governments of Native American tribes have been recognized as distinct legal entities, entitled to certain rights and protections not afforded other U.S. citizens. Among those rights and protections has been the guarantee of health care, provided by the Indian Health Service, based in historic recognition of the government-to-government obligations owed by the federal government to Native American tribes.
The governments of Native American tribes have been recognized as distinct legal entities
This arrangement is now under threat because of the refusal by the Trump administration’s Department of Health and Human Services to grant Native American tribes’ request for exemption from new state laws implementing work requirements for Medicaid. The core of the administration’s reasoning is that Native Americans constitute a “racial category” and that granting exemption would constitute racial discrimination (presumably against others). In refusing the exemption, the administration shows a lack of respect for the sovereignty of Native American nations and once again breaks the spirit of the treaties. Considering the ethnic cleansing and social marginalization native peoples have experienced in U.S. history, the status quo is already deeply unjust.
Unemployment on Native American reservations is far above the national average, just one of many symptoms of entrenched racial and economic inequality facing Native Americans. Implementing a work requirement for access to Medicaid will disproportionately hurt those in areas already suffering from lack of economic opportunity. Any reduction in Medicaid funds among Native American tribes could cripple the Indian Health Service. And as the Republican-held Congress eyes further welfare reform and pushes a farm bill that cuts SNAP benefits, the precedent of treating Native Americans simply as a racial category means this most marginalized of groups in the country is likely to go without critically needed aid.
It goes without saying this is not the way to ask forgiveness from native peoples and achieve reconciliation with them. The Trump administration should reverse course and continue to recognize the unique tribal sovereignty of Native American people and work with tribal governments to determine how best to tackle the severe economic, social and public health challenges facing Native Americans.