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Self-governance in Indian Health Care is a good thing

blog | | By Ron Shaw

What is Self-governance in terms of health care and why should I know about it?

The term self-governance does not clearly convey its meaning as regards to the relationship between a federally recognized tribe and the United States government.

The Osage Nation indeed governs itself with an elected Principal Chief, Congress and Judicial Branches. These branches enforce and adjudicate laws, administer Tribal programs and represent Tribal citizens. When “self-governance” is used to describe the relationship between the Osage Nation and the U.S. government the term is used to convey a different framework of self-governance.

Based on previously established treaties, the federal government has a legal trust responsibility to provide services to the Nation, including services provided by the Bureau of Indian Affairs (BIA) and the Indian Health Service (IHS). Hence, the federal government through these two federal agencies has administered services without any direct control by the Osage people or our elected officials.

It has been a paternalistic relationship where funds were obligated and spent on our behalf with decisions on where those funds should be spent and the priorities for these funds set by those agencies. The priorities for the spending of these funds were frequently part of a regional or national initiative and not necessarily in the best interests of the citizens of the Osage Nation. (It’s important to note that these funds aren’t gifts from the U.S. government but money obligated to provide certain services – including health and law enforcement – based on treaty language and are prepaid by Tribes through the ceding of millions of acres of land and natural resources.)

Self-governance in Indian Health Care

Should a federally recognized Tribe desire to receive and administer these funds and therefore directly provide services under the auspices of Public Law 93-638, the Indian Self Determination and Education Assistance Act (ISDEAA), passed in 1975, forms the legal framework that obligates the federal government and its agencies to contract with federally recognized Tribes to either contract or compact for those services. The Act empowers Tribes to assume administrative control of federal programs without extinguishing the trust relationship and allows them to retrocede (or give back) programs should they want to do so with no penalties.

Self-determination should not, however, be confused with sovereignty. Rather, self-determination policy is ideally a means by which a Tribe may realize the full potential of their sovereign powers. Sovereignty may also be viewed in terms of political, cultural, and economic autonomy. Self-determination is the potential means to that end.

In general, a Tribe that has a “638 contract” with the Indian Health Service might be referred to as a “self-determination Tribe.” A Tribe that has a Compact with the federal government to receive and administer its allotted monies for health care may be referred as a “self-governance Tribe,” this is the method chosen by Tribes to delineate the specific trust responsibility they acquired.

Currently the Osage Nation has Compacted most of its formerly provided BIA services except the administrative oversight of our realty and mineral interests. We have 638 contracts for some of our health services including community health representatives, public health nursing and substance abuse services.

The majority of our current health services continue to be under the direct control of the Indian Health Service and this means we are considered a direct services tribe. Some of the Oklahoma Tribes that currently Compact with the Indian Health Service include the Cherokees, Choctaws, Chickasaws, Kaws, Poncas and Citizen Potawatomi.

These Oklahoma self-governance Tribes have enjoyed much success from their Compacting efforts and have more freedom and flexibility to create a health program unique to their cultural and community based needs and have the opportunity to increase their health services through grants and third party billing.

It’s my opinion as a Tribal citizen and that of others that the Osage Nation should proceed toward self-governance with the Indian Health Service for the benefit and improved health care of Osage Citizens.

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