Indian Health Service

Funds for Health Care

In 1819, the U.S. Congress appropriated $10,000 to several missionary groups to “civilize” Indians. Although the emphasis was on “civilizing,” which meant Christianization, agriculture, and assimilation of American Indians, some of those funds were used by these groups to provide basic health services. During this time, Indian health and Indian affairs were under the jurisdiction of the U.S. War Department. Health care was provided by military physicians stationed at forts who were commissioned to provide service to military personnel. This often meant that health care for American Indians near military forts was at best unorganized and limited.

Access to health care was often written into treaty rights signed by tribes and the U.S. government. For example, in Article 5 of the 1837 Sioux treaty, the U.S. government agreed to pay $8,250 a year for 20 years to provide medicine and a physician for the Sioux. Like the 1837 Sioux treaty, the 1854 treaty with the Oto and Missouri obligated the U.S. government to set aside funds for similar health care services. In Article 13 of the 1868 treaty with the Sioux-Brule, Oglala, Miniconjou, Yankto-nai, Hunkpapa, Blackfeet, Cuthead, Two Kettle, Sans Arcs, Santee, and Arapaho, the United States again agreed to provide a physician. Such examples indicate that the U.S. government well understood the importance of a health policy for Native peoples.

The administration of Indian affairs was transferred from the War Department to the Department of the Interior (DOI) in March 1849. With the change, Congress authorized the expenditure of $12,000 for public health. Yet, it wasn't until 1873 that the U.S. government developed a Division of Education and Medicine in the hope of centralizing administrative duties and to coordinate medical services. Four years later, the medical section of the division was closed because of a lack of funding. By 1880, the DOI employed 77 physicians to work in Indian country. From 1880 until the Snyder Act of 1921, the U.S. policy on American Indian health moved increasingly toward approaches based on public health models of disease prevention and health promotion. From the late 1880s through the 1930s American Indian health was greatly impacted not only by the conditions found on reservations but also by the lack of funding.

In 1921, the Congress, via the Snyder Act, authorized funding for physicians and for health/medical services. Funding for American Indian health was at the discretion of Congress; as a result, Indian health policy was largely dependent on funding levels. The Snyder Act is considered the beginning of modern U.S. Indian health policy. With the legislation, the U.S. government gave formal authorization for Indian health services. From the 1920s to 1954, the Bureau of Indian Affairs managed Indian health. In 1955, [Page 1177]the Indian Health Service, under the Department of Health and Human Services, took responsibility for Indian health.

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