For years, the federal government has failed to uphold its promises to provide health care to Native Americans. These promises are echoed in treaties, the Constitution, and judicially-created law. As a result of this breach of promise and chronically underfunding, there are significant health disparities between indigenous populations and other Americans. In a recent 2020 case, McGirt v. Oklahoma, the U.S. Supreme Court held that both the federal government and individual states must follow the terms of a treaty made with a tribe, encouraging the possibility of direct health care funding. This reform, however, means little without tribal sovereignty and self-determination, which give dignity and decisionmaking capabilities back to a group that has long been without them. This Note explores two examples of self-determination in Native American health care, the Alaskan Native health care system and the recent vaccine rollout, proposing a framework for increasing self-determination in health care to provide support for funding reform, which becomes increasingly necessary as Native Americans continue to struggle to access health care.

多年来，联邦政府未能兑现为美洲原住民提供医疗保健的承诺。这些承诺在条约、宪法和司法制定的法律中得到回应。由于这种违背承诺和长期资金不足的情况，土著居民和其他美国人之间存在着巨大的健康差异。美国最高法院在最近的 2020 年 McGirt v. Oklahoma 案中裁定，联邦政府和各州都必须遵守与部落签订的条约条款，鼓励直接提供医疗保健资金的可能性。然而，如果没有部落主权和自决权，这项改革就没有什么意义，因为它们将尊严和决策能力还给了一个长期没有他们的群体。