Indian+Health+Services+Aff Pointer Kelly Corrigan GDI09

Gonzaga Debate Institute 2009
Pointer/Kelly/Corrigan
1
I.H.S. Affirmative
Indian Health Service Affirmative

Indian Health Service Affirmative............................................................................................... 1
Indian Health Service 1ac.............................................................................................................8
Indian Health Service 1ac.............................................................................................................9
Indian Health Service 1ac...........................................................................................................10
Indian Health Service 1ac........................................................................................................... 11
Inherency Reauthorizing the IHCIA...................................................................................... 24
Inherency Reauthorizing the IHCIA...................................................................................... 25
Inherency Lack of Funding......................................................................................................26

2
I.H.S. Affirmative

AT: Medicaid Solves.................................................................................................................... 42
AT: Medicaid Solves.................................................................................................................... 43
Inherency Health Care Costs...................................................................................................44
Inherency Lack of Coverage....................................................................................................45
Inherency Coverage Denial......................................................................................................50
Inherency Lack of Services......................................................................................................51
Inherency Lack of Services (Urban)....................................................................................... 55
Inherency Lack of Services (Elderly)......................................................................................56
Inherency Lack of Services (Elderly)......................................................................................57
Health Impacts Disease/Death.................................................................................................58
Health Impacts - Diabetes...........................................................................................................61
Health Impacts - Diabetes...........................................................................................................62
Health Impacts - Tuberculosis....................................................................................................63
Health Impacts Heart Disease................................................................................................. 64
Health Impacts - Cancer............................................................................................................. 65
Health Impacts Infant Mortality.............................................................................................66
Health Impacts Pandemics.......................................................................................................67
Health Impacts Pandemics.......................................................................................................68
Health Impacts Alcoholism......................................................................................................69
Health Impacts Mental Health................................................................................................ 70

3
I.H.S. Affirmative

Health Impacts Mental Health (Suicide)................................................................................76
Health Impacts Sexual Abuse/Reproductive Rights..............................................................77
Health Impacts Sexual Abuse/Reproductive Rights..............................................................78
Health Impacts - Genocide..........................................................................................................79
Health Impacts - Racism.............................................................................................................80
Health Impacts Moral Obligation...........................................................................................81
Health Solvency Reauthorization............................................................................................82
Health Solvency I.H.S. Funding.............................................................................................. 85
Health Solvency I.H.S. Empirically Solves.............................................................................90
Health Solvency Cultural Programs.......................................................................................91
Health Solvency Cultural Programs.......................................................................................92
Health Solvency I.H.S. Reforms..............................................................................................93
Health Solvency Exemptions/Subsidies.................................................................................. 94
Health Solvency Urban Indians...............................................................................................95
Health Solvency Urban Indians.............................................................................................100
Health Solvency Mental Health.............................................................................................101
A2: I.H.S. is Racist.....................................................................................................................102
A2: Transportation.................................................................................................................... 103
A2: Transportation.................................................................................................................... 104
A2: Structural/Distribution Barriers...................................................................................105
A2: No Qualified Professionals.................................................................................................106

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I.H.S. Affirmative
A2: Bureaucrats.........................................................................................................................107
A2: IHS doesnt use traditional medicine................................................................................108
A2: IHS has arbitrary eligibility standards.............................................................................109
A2: Blood Quantum...................................................................................................................110
A2: Medicaid Solves...................................................................................................................111
A2: Medicaid Solves...................................................................................................................112
Tribal Economy Internals Poor Health..................................................................................113
Tribal Economy Internals Poor Health..................................................................................114
Tribal Economy Internals Trust Doctrine............................................................................. 115
Tribal Economy Internals Trust Doctrine............................................................................. 116
Tribal Economy Impacts - Gangs.............................................................................................117
Tribal Economy Impacts Waste..............................................................................................118
Waste Impacts Health.............................................................................................................119
Waste Impacts Sovereignty/Culture......................................................................................120
Waste Impacts Genocide........................................................................................................121
Waste Impacts Exterminating the Periphery.......................................................................124
Waste Impacts Exterminating the Periphery.......................................................................125
AT: Casinos Solve Tribal Economies........................................................................................128
Trust Doctrine Internals Legal Obligation...........................................................................129
Trust Doctrine Internals - Poverty...........................................................................................135
Trust Doctrine Internals Poverty.......................................................................................... 136
Trust Doctrine Internals Congressional Backsliding.......................................................... 137
Trust Doctrine Impacts Modeling/Human Rights...............................................................140
Trust Doctrine Impacts Modeling/Human Rights...............................................................141

5
I.H.S. Affirmative
Trust Doctrine Impacts US Leadership................................................................................142

Trust Doctrine Impacts International Law..........................................................................143
Trust Doctrine Impacts Internal Self-determination.......................................................... 144
A2: SQ model solves.................................................................................................................. 147
A2: SQ model solves.................................................................................................................. 148
Trust Doctrine Impacts Waste...............................................................................................149
Trust Doctrine Impacts Water Rights...................................................................................150
Trust Doctrine Impacts Assimilation Bad............................................................................ 151
Self-determination Impacts - Kashmir....................................................................................152
Trust Doctrine Solvency............................................................................................................157
A2: Paternalism I.H.S. Turns.................................................................................................158
A2: Paternalism - General........................................................................................................ 162
A2: Paternalism - General........................................................................................................ 163
A2: Paternalism Trust Doctrine Turns................................................................................. 164
A2: Topicality Social Service.................................................................................................171
A2: Topicaltiy In means throughout.................................................................................... 174
A2: Politics (Obama Good).......................................................................................................175

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I.H.S. Affirmative
A2: Politics (Obama Good).......................................................................................................176

A2: Politics (Obama Bad)......................................................................................................... 177
A2: Politics (Obama Bad)......................................................................................................... 178
A2: Spending DA....................................................................................................................... 179
A2: States CP..............................................................................................................................180
A2: States CP..............................................................................................................................181
A2: States CP..............................................................................................................................182
A2: States CP..............................................................................................................................183
A2: States CP..............................................................................................................................184
A2: States CP..............................................................................................................................185
A2: States CP..............................................................................................................................186
A2: Federalism...........................................................................................................................188
A2: Medicaid CP........................................................................................................................189
A2: Medicaid CP........................................................................................................................190
A2: Medicaid CP........................................................................................................................191
A2: Private Actor CP.................................................................................................................192
A2: Private Actor CP.................................................................................................................193
A2: Tribal Delegation CP..........................................................................................................194
A2: Courts CP............................................................................................................................197
A2: Courts CP............................................................................................................................198
A2: Courts CP............................................................................................................................199
A2: Courts CP............................................................................................................................200
A2: Tribal Devolution CP / K alternative................................................................................203
A2: Gifts K..................................................................................................................................204
A2: Capitalism........................................................................................................................... 205
A2: Capitalism........................................................................................................................... 206
A2: Capitalism........................................................................................................................... 207
A2: Capitalism........................................................................................................................... 208
A2: Capitalism........................................................................................................................... 209
A2: Representation Ks............................................................................................................. 210
A2: Statism/Biopower................................................................................................................211
A2: Statism/Biopower................................................................................................................212

7
I.H.S. Affirmative
A2: US out of Indian Country.................................................................................................. 213

A2: Nuclear War Impacts (Kato)............................................................................................. 216
Rhetorical Exclusion K..............................................................................................................223

8
I.H.S. Affirmative
Indian Health Service 1ac

Contention 1: Health
American Indians receive the worst health care of any U.S. population death rates in
Indian Country from preventable disease are skyrocketing
Warne, President and CE0 of American Indian Health Management & Policy, 08
(Donald, Indian Country Today, Indian Health a legal right, 6/13/08,
http://www.indiancountrytoday.com/archive/28397974.html, Accessed 6/28/09, CAF)
The media recently shined a spotlight on life expectancy rates in the United States. One obvious but unstated
element in most news stories is that longevity correlates with health status, which directly correlates with
economic status. American Indians suffer alarming gaps in life expectancy. Death rates from
preventable causes like diabetes, alcoholism and mental illness are dramatically higher among
American Indians than the rest of the population. Nearly one-third of our people live in poverty,
compared to approximately 12 percent of the rest of the country. In Arizona, where I live, the average
age at death is 72.2 years for the general population and 54.7 years for American Indians. Even people in
Bangladesh and Ghana live longer. Despite this gross inequality, American Indians are the only population born with a legal right to
health care in this country.The treaties between the tribal nations and the federal government - involving exchanges of vast amounts of
Indian land and natural resources - resulted in federal guarantees for social services including housing, education and health care. The
BIA and IHS were established to administer the federal government;s trust responsibility to provide health care and other vital services
to American Indians. In the 2005 federal budget, per capita expenditures for IHS were $2,130, a fraction of
the federal funding for other health care programs like Medicare ($7,631), Veterans Administration ($5,234)
and Medicaid ($5,010). Even the Bureau of Prisons allocation is higher, at $3,985.So what would it take to
fix the funding shortfalls in the IHS budget? The number of American Indians actively using IHS services
is about 1.5 million, and clinical services for the IHS are funded at approximately $3 billion per year.
Several studies have shown that the IHS is funded at approximately 60 percent of need.
Without adequate funding for the Indian Health Service, American Indians are up to 600
percent more likely to die from preventable disease
Garcia, President of the National Congress of American Indians, 2006
(Joe, The Native Voice, NCAI President Joe Garcia Delivers Fourth Annual State of Indian
Nations Address 2-20-06, http://proquest.umi.com/pqdweb?index=3&did=1054628221&
SrchMode=2&sid=1&Fmt=3&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=12
46255456&clientId=10553, 6-29-09, ESM)
Number Two: Healthcare Second of the Steps is healthcare: Because of inferior healthcare, the quality and
length of life for American Indians falls well below the rest of the US American Indians have a life
expectancy five years less than the rest of the country. A typical American Indian is 650 percent more
likely to die from tuberculosis, 420 percent more likely to die from diabetes, 280 percent more likely to
die in an accident, and 52 percent more likely to die from pneumonia or influenza than the rest of the
US population. Native American healthcare is often no more than emergency treatment, which means that
our people are getting care only when they can't wait anymore. There's little preventive healthcare and
little education for healthier living. Healthcare expenditures for Indian are less than half what America spends for federal
prisoners. Let me repeat that: Healthcare expenditures for Indian are less than half what America spends for federal prisoners. And
remember that there are real people behind these numbers. The Ute Mountain Ute tribe in Towaoc, Colorado, recently lost three tribal
elders in a van accident because the only way these elders could get dialysis was to drive two-and-a-half hours each way to the nearest
hospital with the right equipment. What they needed wasn't close enough. Because of this , I call upon Congress and the
President to uphold their historic and contractual obligation by reauthorizing the tribally proposed
Indian Health Care Improvement Act during this session of Congress. This legislation is no less than the
framework for the Indian healthcare system. It will bring our outdated and inadequate system into the
21st Century - addressing mental health, substance abuse and youth suicide, and support for attracting
and retaining qualified healthcare professionals. Basic things such as in-home healthcare are becoming
commonplace. But they are not yet a common part of the system of Indian healthcare. They ought to be.

9
I.H.S. Affirmative

Without treatment, diabetes alone will cause American Indian extinction
Couto and Eken 02
(Richard & Stephanie, Professor of Leadership Studies at Antioch College and Stephanie C. Eken, Adolescent
Psychiatry & Pediatric Psychiatry, To Give their Gifts: Health, Community, and Democracy, p. 28-29).
Diabetes afflicts Native Americans at an alarming rate. Twenty-six out of every 1,000 people in the
United States had diabetes in 1987. The United States Public Health Service hoped to lower this incidences to
25 per 1,000 by the year 200. However, the rate of diabetes actually increased to 31 per 1,000 by 1996. The
rate among Native Americans served by IHS increased from 69 to 90 cases per 1,000 during the same
period. This conservative estimate is almost three times the corresponding rate of the general
population (Public Health Service 2001b:245; 1999). Diabetes occurred in epidemic portions in the Rosebud
community, yet the community remained far too complacent in DeCoras view, as the disease killed relatives
and friends: I didnt know whether or not Indian people even knew that they were in the midst of an
epidemic, despite the fact that probably everybody had at least one relative or friend that had diabetes or they
had it themselves. I worked in IHS, living in this comfort zone; inside I was dying because I didnt feel like I
was using my potential to really make some long-term positive change[in] our peoples health. I felt like
my time in IHS was spent applying Band-Aids and really not getting to the root problem of the disease. I
believed then, as I believe not, that if we dont come up with creative ways to combat this diseases, were
going to be extinct as a people by the middle of the next century. With the time I have left, I need to be
working on the way I believe this disease should be approached amongst our people and that is through our
culture. The answer to this disease and other disease, including social ills, lie in our tradition.
Denying Indian health care furthers an ongoing policy of American Indian genocide
Valentine, PhD Candidate, Sociology, Texas A&M, 08
(Shari, The Genocide that Never Ends: Bush to Veto Indian Health Services Bill, Racism Review,
http://www.racismreview.com/blog/2008/02/03/the-genocide-that-never-ends-bush-to-veto-indian-health-servicesbill/)
The headline on the New York Times Editorial on January 28 reads Vetoing Historys Responsibility. The
story unfortunately is not about history, but the entirely too current engagements in the 400 year old
American Holocaust against American Indians. The latest strategic strike is a Presidential Veto of Indian
Health Services Legislation. Heres the opening paragraph from the NYTimes editorial: President Bushs
threat to veto a bill intended to improve health care for the nations American Indians is both cruel
and grossly unfair. Five years ago, the United States Commission on Civil Rights examined the governments centuries-old treaty
obligations for the welfare of Native Americans and found Washington spending 50 percent less per capita on their health care than is
devoted to felons in prison and the poor on Medicaid. The NYTimes piece goes on to make note the fact that: Studies have established
that Native Americans suffer worse than average rates of depression, diabetes and cardiovascular disease. The Senate bill would improve
treatment for these problems, as well as address alcohol and substance abuse, and suicide among Indian youth. It would expand
scholarship help so more American Indians could pursue careers in health care. Actually according to Indian Health Service and the
National Center for Health Statistics worse than average is a gross understatement. American Indians have:
Infant mortality rate 300% higher than the national average
Tuberculosis rates 500% higher than the national average
Diabetes 200% higher than the national average
Cervical Cancer 170% higher than the national average
Maternal death in childbirth 140% higher than the national average
Influenza and pneumonia 150% higher than the national average
Teenage suicide rates 150% higher than the national average
Overall suicide rates 60% higher than the national average
These rates have increased over the rates reported by the IHS in 1996. Only diabetes has declined and that only slightly. These are
diseases that are highly preventable and treatable, unless you are a Native American held hostage to a
centuries old policy of genocide. Native American health expenditures are half as much as that spent on
prisoners and Medicaid patients and we are all too familiar with the intolerable health care provided to those
groups. Federal appropriations are the only source of health care funds available to Native Americans.
Outside philanthropy is bureaucratically prohibited. Some years ago I worked with an organization that donates
medical equipment and supplies to underserved populations. A retiring doctor wanted to donate cutting edge mammogram, catscan and
MRI machines as well as some other equipment to serve Native Americans. A national corporation agreed to transport the equipment
free of charge and a medical supply company agreed to set it up and service it. The appraised value of the equipment was over 3 million

10
I.H.S. Affirmative

Valentine 2008 (Continued)
dollars. For months working with then Senator Ben Nighthorse Campbell, we waded through red tape and forms to get permission for
the equipment. In the end, the equipment was sent abroad because the Bureau of Indian Affairs would not approve the $575 necessary to
build a pad for the MRI machine and $700 to upgrade a room for the catscan. When we raised the money to pay for these items, we were
told that the individual clinics could not accept contributions and the BIA would need more than 9 months to process the contributions
and could not guarantee expenditure of the funds on the purpose for which we were raising them. In spite of the investigation and
recommendation of the Civil Rights Commission the President will continue this long tradition. Native Americans have only
the Indian Health Service. No amount of public concern or private philanthropy can even be offered to
mitigate the health effects of the governments centuries of racist policy. The American public likes to
think that tactics like giving smallpox infested blankets to native people are history. The centuries
old oppression and systematic extermination of Native Americans continues and remains invisible to
most Americans. In Germany, Turkey, Sudan, we call that genocide.

11
I.H.S. Affirmative

Contention 2: Reservation Economies
Poor health care creates systematic cycles of economic depression and federal dependence
I.H.S. funding is necessary to improve social and economic development
Barry et. Al., Chairwoman of the U.S. Commission of Human Rights, 2004
(Mary, U.S. Commission on Human Rights, Broken Promises: Evaluating the Native American Health Care
System, September. Pages 7-8, MAG)
Consequently, not only is reduced health status a burden to Native Americans, but a cumulative drain
on the entire Native American existence. Poor health inhibits the economic, educational, and social
development of Native Americans and establishes an inescapable cycle of disparity. Nevertheless, not all
news regarding health status is bad news. The IHS, which has been given primary responsibility for
eliminating this disproportionate health status, has been largely successful in reducing mortality rates,
while making significant improvements in other areas.5 Dr. Perez explained that the incidence and
prevalence of many infectious diseases have been dramatically reduced through increased clinical care and
public health efforts such as vaccination for infectious diseases and the construction of sanitation facilities.
Today, Native Americans continue to experience significant rates of diabetes, mental health disorders,
cardiovascular disease, pneumonia, influenza, and injuries. Specifically, Native Americans are 770 percent
more likely to die from alcoholism, 650 percent more likely to die from tuberculosis, 420 percent more likely
to die from diabetes, 280 percent more likely to die from accidents, and 52 percent more likely to die from
pneumonia or influenza than the rest of the United States, including white and minority populations.7 As a
result of these increased mortality rates, the life expectancy for Native Americans is 71 years of age, nearly
five years less than the rest of the U.S. population.8 A comparison of earlier life expectancy data illustrates
one of the problems facing IHS in eliminating disparities. In 1976, the life expectancy for Native Americans
was 65.1 years, compared with 70.8 years for other Americans.9 Consequently, while life expectancy for
Native Americans has improved by six years, the difference in life expectancy relative to other
Americans has changed very little. Another problem facing health care providers is the increasing
importance of the behavioral component of health status. During the October briefing, Dr. Perez explained
that fully seven of the top 10 causes of high morbidity and mortality rates are directly related to, or
significantly affected by individual behavior and lifestyle choices.

12
I.H.S. Affirmative

Slashing health care budgets sustains false perceptions that tribal gaming has created
economic wealth leading to the withdraw of programs that support self-sufficiency
Pfefferbaum et al., Ph.D, Director of Gerontology, Phoenix College, 1997
(Rose L., Providing for the Health Care Needs of Native Americans: Policy, Programs, Procedures, and Practices,
American Indian Law Review, V. 21, pp. 214-5)
Despite the establishment of a legal foundation for the public provision of Indian health services a process
that began early in the nineteenth century the health of Indians has not yet been secured. Despite
remarkable progress in recent decades, the health status of Indians remains below that of other U.S. citizens
with respect to virtually all health measures. Furthermore, the Indian health care delivery system that has
developed gradually over two centuries is threatened by budget constraints at all levels of government, a
growing perception that Indians are beneficiaries of significant economic gains as a result of business
enterprises such as gaming, and a precipitous rush to dismantle the program through the otherwise
attractive doctrines of tribal self-sufficiency and self-governance. Therefore, there remains much to be
done if the health of Indian people is to be secured into the next millennium. Ongoing health care reform
efforts - public and private, deliberate and inadvertent - promise to affect virtually every aspect of the health
care industry. For whatever reason, consideration of Indian health care has been striking in its absence
from the national debate. Health care for Indians will, nonetheless, be severely impacted by changes - good
and bad - that come about in the context of reform.
And, those programs are required for long-term tribal economic autonomy
Cobb, Assistant Professor of History, Miami University, 2004
(Daniel, Poverty in the United States: An Encyclopedic History, Gwendolyn Mink & Alice O'Connor (eds.) p. 492).
In order to alleviate poverty in Native America, the federal government will need to continue to
support on- and off-reservation Indian communities with sustained social services. Meanwhile, tribes
will continue to explore new strategies to promote long-term economic development and seek ways to
diversity their economies. The long history of poverty and social welfare among Indians has shown,
however, that tribes will not sacrifice their rights as sovereign nations in order to gain economic parity.
Therefore, the continued shift toward compacting and self-governance, in addition to the retention of
tribes federal trust status, will play a crucial role in creating an administrative structure reflective of
these larger economic aspirations.

13
I.H.S. Affirmative

Collapsing economies make reservation targets for nuclear waste disposal the impact is
radioactive genocide
Brook, Contributer to Harpers and Boston Globe, 1998
(Daniel, Contributer to Harpers and Boston Globe, Environmental Genocide: Native Genocide: Native Americans
and Toxic Waste. American Journal of Economics and Sociology 1998 Vol. 37, No. 1 7/1/09, M.E)
GENOCIDE AGAINST NATIVE AMERICANS continues in modern times with modern techniques.
In the past, buffalo were slaughtered or corn crops were burned, thereby threatening local native populations;
now the Earth itself is being strangled, thereby threatening all life. The government and large
corporations have created toxic, lethal threats to human health. Yet, because "Native Americans live at
the lowest socioeconomic level in the U.S." (Glass, n.d., 3), they are most at risk for toxic exposure. All
poor people and people of color are disadvantaged, although for Indians, these disadvantages are
multiplied by dependence on food supplies closely tied to the land and in which [toxic] materials . ..
have been shown to accumulate" (ibid.). This essay will discuss the genocide of Native Americans through environmental
spoliation and native resistance to it. Although this type of genocide is not (usually) the result of a systematic plan with malicious intent
to exterminate Native Americans, it is the consequence of activities that are often carried out on and near the reservations with reckless
disregard for the lives of Native Americans.1 One very significant toxic threat to Native Americans comes from
governmental and commercial hazardous waste sitings. Because of the severe poverty and extraordinary
vulnerability of Native American tribes, their lands have been targeted by the U.S. government and the
large corporations as permanent areas for much of the poisonous industrial by-products of the
dominant society. "Hoping to take advantage of the devastating chronic unemployment, pervasive
poverty and sovereign status of Indian Nations", according to Bradley Angel, writing for the international
environmental organization Green- peace, "the waste disposal industry and the U.S. government have
embarked on an all-out effort to site incinerators, landfills, nuclear waste storage facilities and similar
polluting industries on Tribal land" (Angel 1991, 1). In fact, so enthusiastic is the United States government to dump its most
dangerous waste from "the nation's 110 commercial nuclear power plants" (ibid., 16) on the nation's "565 federally recognized tribes"
(Aug 1993, 9) that it "has solicited every Indian Tribe, offering millions of dollars if the tribe would host a
nuclear waste facility" (Angel 1991, 15; emphasis added). Given the fact that Native Americans tend to be
so materially poor, the money offered by the government or the corporations for this "toxic trade" is
often more akin to bribery or blackmail than to payment for services rendered.2 In this way, the Mescalero
Apache tribe in 1991, for example, became the first tribe (or state) to file an application for a U.S. Energy Department grant "to study the
feasibility of building a temporary [sic] storage facility for 15,000 metric tons of highly radioactive spent fuel" (Ak- wesasne Notes
1992, 11). Other Indian tribes, including the Sac, Fox, Yakima, Choctaw, Lower Brule Sioux, Eastern Shawnee, Ponca, Caddo, and the
Skull Valley Band of Goshute, have since applied for the$100,000 exploratory grants as well (Angel 1991, 16-17). Indeed, since so many
reservations are without major sources of outside revenue, it is not surprising that some tribes have considered proposals to host toxic
waste repositories on their reservations. Native Americans, like all other victimized ethnic groups, are not passive populations in the face
of destruction from imperialism and paternalism. Rather, they are active agents in the making of their own history. Nearly a century and
a half ago, the radical philosopher and political economist Karl Marx realized that people "make their own history, but they do not make
it just as they please; they do not make it under circumstances chosen by themselves, but under circumstances directly found, given and
transmitted from the past" (Marx 1978, 595). Therefore, tribal governments considering or planning waste facilities", asserts Margaret
Crow of California Indian Legal Services, "do so for a number of reasons" (Crow 1994, 598). First, lacking exploitable subterranean
natural resources, some tribal governments have sought to employ the land itself as a resource in an attempt to fetch a financial return.
Second, since many reservations are rural and remote, other lucrative business opportunities are rarely, if ever, available to them. Third,
some reservations are sparsely populated and therefore have surplus land for business activities. And fourth, by establishing waste
facilities some tribes would be able to resolve their reservations' own waste disposal problems while simultaneously raising muchneeded revenue. As a result, "[a] small number of tribes across the country are actively pursuing commercial hazardous and solid waste
facilities"; however, "[t]he risk and benefit analysis performed by most tribes has led to decisions not to engage in commercial waste
management" (ibid.). Indeed, Crow reports that by "the end of 1992, there were no commercial waste facilities operating on any Indian
reservations" (ibid.), although the example of the Campo Band of Mission Indians provides an interesting and illuminating exception to
the trend. The Campo Band undertook a "proactive approach to siting a commercial solid waste landfill and recycling facility near San
Diego, California. The Band informed and educated the native community, developed an environmental regulatory infrastructure,
solicited companies, required that the applicant company pay for the Band's financial advisors, lawyers, and solid waste industry
consultants, and ultimately negotiated a favorable contract" (Haner 1994, 106). Even these extraordinary measures, however, are not
enough to protect the tribal land and indigenous people from toxic exposure. Unfortunately, it is a sad but true fact that "virtually every
landfill leaks, and every incinerator emits hundreds of toxic chemicals into the air, land and water" (Angel 1991, 3). The U.S.
Environmental Protection Agency concedes that even if the . . . protective systems work according to plan, the landfills will
eventually leak poisons into the environment" (ibid.). Therefore, even if these toxic waste sites are safe
for the present generation-a rather dubious proposition at best-they will pose an increasingly greater
health and safety risk for all future generations. Native people (and others) will eventually pay the costs
of these toxic pollutants with their lives, "costs to which [corporate] executives are conveniently immune"
(Parker 1983, 59).

14
I.H.S. Affirmative

Contention 3: Trust Doctrine
Failure to provide adequate health care violates the federal governments legal obligation
to American Indians under the federal trust doctrine eroding federal protections for
tribal sovereignty
System September. Pages 120 & 121. MAG)
The Commission finds that IHS funding levels are inadequate by every applicable standard of
measurement and in every area of health service delivery within IHS. The lack of funding is, however,
particularly acute for contract health services and urban Indian programs. Federal policy, as expressed
in numerous documents and declarations over the past century, reflects congressional intent to maintain
credibility and to fully fund health care for Native Americans. Nevertheless, Myra Munson reminded us, the
ultimate policy document is always the budget document. Unfortunately, the budget has clearly failed to
reflect the stated policy objectives of providing adequate health care and erasing disparities. As a result,
the federal government has defaulted on its obligation and responsibility to Native Americans.
Considering the degree of inadequacy, the length of time over which it has been recognized, and the
obstinate refusal to take concrete action to remedy the situation, the only possible explanations are
either discrimination or gross neglect on the part of the federal government. The Commission has also
determined that the current regulatory framework needlessly restricts IHS officials from making minor
modifications to IHS facilities and structures, forcing inadequate facilities to remain in an unsatisfactory
condition while waiting for increased appropriations specifically designated for that facility. In
addition, current regulations requiring residence within defined Contract Health Service Delivery Areas allow
the denial of access to health care for many Native Americans living off-reservation for the simple reason
that they have exercised their right to live somewhere besides their home reservation.
A continued trend of devolution of I.H.S. responsibilities will provide Congress with a

rationale to wholesale abandon the trust doctrine
Trombino, NYU School of Law, 2005
(Caryn, CHANGING THE BORDERS OF THE FEDERAL TRUST OBLIGATION: THE
URBAN INDIAN HEALTH CARE CRISIS, NYU Law Review, Vol. 18, p. 133)
Inadequate funding has plagued federal programs for Indian health care since their inception in 1832. Despite
congressional recognition of the desperate state of federal Indian health care services, Congress remains
unwilling to allocate the funds necessary to meet the extraordinary demand for services.29 However,
beneath the persistent lack of financial resources is an emerging policy trend that threatens to
structurally undermineand perhaps ultimately eliminatethe federal governments obligation to
finance American Indian health care. This Note argues that the trend towards greater tribal selfgovernance and self-determination opens the door for the federal government to retreat from its
historical trust obligation to American Indians. Furthermore, as resource allocation is increasingly left
to the discretion of individual tribes, health care services for off-reservation urban American Indians
may be worse than they are under the current system. Tribes will be forced to make the ethically and
politically difficult choice between allocating funds for Indian Country or for offreservation tribal
members.

15
I.H.S. Affirmative

Reinstituting federal funding for the I.H.S. strengthens federal protections and stops
Congressional backsliding in all areas of the trust doctrine
The slow but steady movement towards the elimination of the IHScombined with congressional
failure to allocate more resources for either form of Indian health caresignals a retreat from the
federal trust obligation towards Indian health care. Dr. Rhoades and his co-authors surmise that some
tribes fear that self-determination and self-governance will lead to the dissolution of the IHS and, with
it, dissolution of federal responsibility for Indian health care.117 In the seven years since the publication
of Dr. Rhoades article, such dissolution is visible. Although compacts with local and tribal agencies can
lead to services greater and more efficient than the IHS delivery system, it is necessary to keep a watchful
eye on the backward creeping of the federal governments fulfillment of its trust obligation. Tribes have
not yet received the funding necessary to improveand oftentimes simply maintaintheir health care
systems, and congressional funding has even failed to keep up with the rate of inflation. The Bush
administration has already moved to collapse the IHS into the greater organizational structure of the
HHS in the One-department or One-HHS initiative, which will be explored more thoroughly in Part IV
of this Note. To the extent that the IHS is reduced and heath care is administered by tribes themselves, urban
Indian heath care will suffer a tremendous blow. The interests of urban Indians will necessarily be in conflict
with on reservation Indians with respect to the allocation of dangerously scarce resources.
Upholding the trust doctrine through improving I.H.S. services provides a model for
internal self-determination and tribal self-governance
Pfefferbaum et al., Ph.D. Director of Gerontology, Phoenix College, 1997
American Indian Law Review, Volume 21, p. 248)
A number of basic and complex forces have converged in the establishment of the IHS as a unique
health care delivery system. These factors include: (1) the special legal and sovereign relationship
between the federal government and tribes, marked by the continuing conflict between selfdetermination and self governance and maintenance of the trust responsibilities of the federal
government; (2) the genetic, social, cultural, and demographic attributes of the American Indian population; (3) the operation of a
comprehensive, community based health care program; (4) the Congress as the central policy determining agency; (5) historic factors
that have often required diametrically opposite and often conflicting policies on the part of the federal government; (6) the genuine effort
of the IHS to engage fundamental questions such as the universal cap on resources, determination of eligibility for services, the very
definition of "Indian," the most equitable allocation of scarce resources, and determination of the most appropriate array of services; and
(7) the overriding goal to which the system aspires, raising the health status of a given population to the highest possible level. Against
these social, legal, historic, political, and administrative determinants, there are modern pressures facing the entire nation. These include
a desire for universal access to health care; an ultimate cap on available resources in the face of continually growing demand; the need to
place the rationing of care on as reasonable and humane a basis as possible - preferably driven by health, rather than cost, considerations;
the reciprocal relationship between the number of persons who can be served versus the number of services that can be provided. In the
IHS, the complexity of these basic elements is compounded by the far more fundamental, difficult, and competing questions of tribal
sovereignty on the one hand and the federal trust responsibility on the other. Just as the operation of this community-based health care
delivery system serves as a very useful model for study, so too do the special governmental and political considerations. At the heart
of much of the health care debate in America are questions of the authorities and responsibilities of the
federal government relative to other levels of government, especially the states. The IHS provides a model
in which these questions may be examined. In spite of its now rather large bureaucracy, with its attendant
adverse effects, the IHS has often led the nation in the application of new and innovative health
concepts and interventions. The development of rural emergency medical services; the effective implementation of community
involvement in the planning and execution of health care practices; the development of community health lay workers; advances in
application of principles of resource allocation; efforts to address the conflict between the number of services available and the number
of persons to be served; attempts to base necessary health care rationing on indices of health status; and a number of other
innovations are examples of pioneering efforts by the IHS. The value placed on the synthesis of these and
other disparate elements into a coherent whole by the Congress and the tribes is now being tested
through downsizing of the government and division of the program among individual tribes. These
movements do, however, provide an opportunity to correct many of the deficiencies for which the IHS is
often criticized, including the problems inherent in federal bureaucracy, the intrinsic paternalism in serving

16
I.H.S. Affirmative

Pfefferbaum 1997 (continued)
as a trustee, the too-often absence of a concern for service to customers, the perception of a bloated and
unresponsive central bureaucracy, and failure to respond to the expressed wishes of individual tribes. The
IHS has attempted to respond to these criticisms, but many of the criticisms directed at the IHS arise from
fundamental elements beyond the ability of the IHS to correct. Nonetheless, for many issues, the IHS in
cooperation with the tribes themselves, has often led the nation. It is unclear whether the changes
underway for both the tribes and the federal government will correct current deficiencies in the system. There
seems to be little effort to examine potential adverse effects on either health care delivery or the underlying federal-Indian relationship.
Whether the results prove to be a benefit or a loss should become clear relatively quickly. In the meantime, the IHS remains a largely
unknown and misunderstood health care system. It provides the nation with a unique and important opportunity
to examine fundamental questions as they are worked out within a system charged with providing for
the health care needs of Native Americans. More than five hundred years ago, concepts of world medicine
were revolutionized by the introduction of techniques and drugs from Native Americans. The entire health
care delivery system may soon find itself drawing upon the lessons - good and bad - of the Native Health
Care Delivery System. As it struggles to adapt to changing medical needs, the United States has a
unique laboratory of more than two hundred years of public health care policy, programs, procedures,
and practices to use in examining many fundamental questions.
U.S. self-determination policies are modeled by other countries encouraging global

accommodation of indigenous rights
Morris, Associate professor of political science at the University of Colorado, Denver, 1999
(Glenn T., International Law and Politics: Toward a Right to Self-Determination for Indigenous Peoples,
http://cwis.org/fwdp/International/int.txt)
Although this chapter has implications for the status of all indigenous peoples, its concentration is primarily
within the United States. This is because, in several ways, the status of indigenous nations within the U.S.
is unique, and the policy of the United States toward indigenous nations has frequently been emulated
by other states. The fact that a treaty relationship exists between the United States and indigenous
nations, and the fact that indigenous nations within the U.S. retain defined and separate land bases and
continue to exercise some degree of effective self-government, may contribute to the successful
application of international standards in their cases. Also, given the size and relative power of the
United States in international relations, and absent the unlikely independence of a majorityindigenous nation-state such as Guatemala or Greenland, the successful application of decolonization
principles to indigenous nations within the U.S. could allow the extension of such applications to
indigenous peoples in other parts of the planet.

17
I.H.S. Affirmative

Consistent US support for indigenous accommodation resolves international secessionist
conflicts
Gottlieb, Council on Foreign Relations, 1993
(Giddon, Nation against state: a new approach to ethnic conflicts and the decline of
sovereignty, p. 86-7
The United States is in need of a principled policy for addressing the conflicts that involve claims for
self-determination and for secession. The traditional Wilsonian commitment to self-determination offers an
uncertain guide at best. The idealistic and moralistic strain in American opinion cannot be neglected with
impunity. A failure to rescue victims of the Bosnian war from genocide, from the horrors of concentration
camps, for mass rapes, which the American people can see nightly on their television screens, could have a
profound unsettling effect on public opinion. American intervention in areas such as the Gulf in which vital
American interests are directly at stake could be jeopardized by popular disenchantment with a government
willing to shed blood for oil, but not for people. The United States can help bring about inevitable
changes in the international order by considering solution to ethnic strife that do not necessarily
require formal territorial changes. Such a policy can identify the United States as an ally of nations
striving for self-determination without pitting this country against states determined to defend their
territorial integrity. The adoption of a states-plus-nations policy would keep Washington on high moral
ground. The Yugoslavian wars have demonstrated that ethnic cleansing is not a policy that the United States
can countenance. The Security Council has formally condemned that strategy. What the Irish program, the
Cyprus problem, the Kurdish question, and the killings in the Caucasus have in common is the need
for an approach breaking new ground and for wider conceptual horizons. They call for the conscious
enlargement of the international system and for the inclusion of a system of nations.

18
I.H.S. Affirmative

A global model of accommodation prevents conflicts while preserving minority rights
Roy, 01
(Audrey, B.A., Cornell University, in the Department of Indigenous Self-determination Programs, Sovereignty and Decolonization: Realizing
Indigenous Self-Determination at the United Nations and in Canada, 2001, http://www.tamilnation.org/selfdetermination/98roy.pdf, accessed 73-09)EM
To highlight the complexity of this problem, lets look at how the claim of indigenous peoples to the right of
self-determination fairs under the definitions offered thus far. For Hurst Hannum, self-determination is
merely a tool through which decolonization of geographically distinct territories can occur. External
self-determination means decolonization via the salt-water thesis and necessitates statehood; internal
self-determination means freedom from foreign influence, most notably after decolonization has been
achieved. Indigenous peoples, who do not live in dependant territories or colonies, are thus excluded from
self-determination. 24 Hannum also argues that the United Nations focus on independence has encouraged
state governments to equate all claims for self-determination with independence and secession. Making
this link in domestic negotiations may inhibit the resolution of claims that are not as wholly incompatible as they may first appear.25
Given this tendency, Hannum argues that as indigenous peoples argue for rights, they should use other, less emotionally volatile terms,
such as self-governance. True meaningful self- government or autonomy does not threaten the established
international law norms and meets most indigenous needs.Through a right to autonomy, indigenous
people s may be able to access some degree of internal self-determination, but Hannum does not question
the ultimate sovereignty of the state nor does he see any norm or right of self-determination that would
permit action infringing on the territorial integrity and sovereignty of the state. Indigenous peoples seeking
recognition of their right to self-determination fare better under Umozurikes vision of internal selfdetermination, but his particular use of terms like state, nations, and peoples muddles the application of this
limited right of self-determination, roughly paralleling what Neuberger calls small self-determination. Nations for Umozurike seem
to be states and externally dependant territories, states are non-dependant political units, and peoples are minorities within states.27 How
then do the rights of peoples and nations differ? Indigenous peoples would most likely be excluded from external self-determination and
could find themselves with only a minimum of internal self-determination depend ing on the definitions given to these terms. The highly
contested definition of self-determination, minorities, and peoples contributes to the confusion. The meanings attached to some terms,
however, pose a real problem for indigenous peoples, especially because the international community has not recognized the peoplehood
of what the UN refers to as indigenous populations. Gudmunder Alfredsson, a human rights scholar at the Raoul Wallenberg Institute
of Human Rights and Humanitarian Law, offers five possible meanings for self-determination: 28 1. the right of a people to determine its
international status, including the right to independence, sometimes referred to as external self-determination; 2. the right of a state
population to determine the form of government and to participate in government, sometimes extended to include democratization or
majority rule and sometimes called internal self-determination; 3. the right of a state to territorial integrity and non-violation of its
boundaries, and to govern its internal affairs without external interference; 4. the right of a minority within or even across state lines to
be free from non-discrimination, but possibly the right to cultural, educational, social and economic autonomy for the preservation of
group identities. land added to this list of special rights; and 5. the right of a state, especially claimed by the developing countries, to
cultural, social and economic development. The examples of what self-determination can mean and [has] been used to mean offered
by Alfredsson do not sufficiently address the reality of peoples and nations within states. Alfredsson appears to equate people with
external self-determination, state populations with internal self-determination, states with protection of territorial integrity, and
minority populations within oracross state lines with special rights. Notably, indigenous peoples are included as
minorities. As such, they may be able to access a degree of internal self-determination not external selfdetermination and are problematically and inaccurately grouped under minorities.29 The reasons Alfredsson
offers for this denial that are similar to those offered by the other scholars: the territorial integrity and
sovereignty of the states that run international forums and dictate their laws cannot be violated.

19
I.H.S. Affirmative

The Trust Doctrine establishes a model that protects minority rights without forced
assimilation or secessionism
Wood, assistant professor of law at the University of Oregon, 1995
(Mary Christina, Protecting the Attributes of Native Sovereignty: A New Trust Paradigm for Federal Actions
Affecting Tribal Lands and Resources, Utah Law Review 109. p. 131-2, EKC)
The competing assimilation paradigm which has dominated other chapters of Indian policy and law during significant periods of history,
n76 is suspect. Granted, some contend that the Allotment policy--perhaps the policy most destructive of Indian sovereignty n77 --was
prompted by genuine advocates of Indian interests who felt that converting Indian people to a Christian, agrarian, "civilized" way of life
and assimilating them into the great American melting pot was a virtuous endeavor and in the tribes' best interests. n78 There is no doubt
that assimilationist pressures persist today. However, assimilationist policies, even though historically promoted as
acts of federal benevolence toward the Indian people, were in all likelihood prompted at least in part by the
majority society's persistent and insatiable demand for land. Further, as a practical matter, the assimilationist
approach to the "best interests" question presumes only a transitory role for the trust doctrine, and for
tribes themselves. Theoretically, upon full assimilation the law ceases to differentiate between Indians
and the rest of majority society. As a fundamental matter, the trust doctrine cannot be invoked to
destroy the very entities to which the government holds a fiduciary duty--the tribes themselves.
Assimilationist goals--because they countenance destruction of the tribal entity--are conceptually inconsistent
with Indian trust analysis. In addition, defining the trust doctrine to embrace tribal separatism and
sovereignty is critical to preserving freedom of choice for native people. As recognized citizens of the
United States, Indian people have the option of assimilation at hand. For those who choose assimilation,
civil rights statutes and constitutional guarantees offer protection of their interests as individuals and
as racial minorities. But for those who seek to maintain a tribal way of life, the range of laws securing
individual liberties is inadequate. Tribal interests find unique expression in notions of sovereign trusteeship
and in treaty promises. Reducing the trust doctrine to standards which promote assimilationist tendencies
over separatism effectively deprives native people of the freedom to choose their own lifestyles within
the larger society.
Finally, self-determination conflicts go nuclear

Shehadi, Research Associate International Institute for Strategic Studies, 1993
(Kamal, Ethnic Self Determination and the Break-up of States, p. 81-82)
This paper has argued that self-determination conflicts have direct adverse consequences on international
security. As they begin to tear nuclear states apart, the likelihood of nuclear weapons falling into the
hands of individuals or groups willing to use them, or trading them to others, will reach frightening levels.
This likelihood increases if a conflict over self-determination escalates into a war between two nuclear
states. The Russian Federation and Ukraine may fight over Crimea and the Donbass area; and India and
Pakistan may fight over Kashmir. Ethnic conflicts may also spread both within a state from one state to the
next. This can happen in countries where more that one ethnic self-determination conflict is brewing: Russia,
India, and Ethiopia, for example. The conflict may also spread by contagion from one country to another if
the state is weak politically and militarily and cannot contain that conflict in its doorstep. Lastly, there is a
real danger that regional conflicts will erupt over national minorities and borders. Self-determination
conflicts also have indirect consequences on International security.

20
I.H.S. Affirmative

Plan: The United States Federal Government will reauthorize the Indian Health Care
Improvement Act of 1976 and provide an increase in discretionary funding for the federal
Indian Health Service, including funds for culturally-specific health care programs and
Indian Health Service affiliated services provided through both on and off-reservation
health service programs for American Indians and Alaskan Natives.

21
I.H.S. Affirmative

Contention 4: Solvency
Reauthorizing the Indian Health Care Improvement Act massively improves Native health
care and enhances self-determination
Barry et. al., Chairwoman of the U.S. Commission of Human Rights, 2004
Among the pending changes identified thus far, the reauthorization of the Indian Health Care
Improvement Act appears to hold the most promise for improving the lives of Native Americans. The
proposal for reauthorization of IHCIA is a tribally prepared, far-reaching proposal for addressing
every aspect of providing medical care to Native Americans. Tribal leaders initiated the proposed
legislation; the final version is the product of years of consultation between tribal leaders and federal
government representatives. Anticipating the expiration of IHCIA, IHS organized regional consultation
meetings with tribal leaders in 1998 to solicit input on changes to the Act. Based on the outcome of the
regional consultation meetings, the tribes formed a National Steering Committee (NSC) of tribal leaders to
draft a comprehensive proposal that would address a range of health care concerns using the reauthorization
of IHCIA. The NSC specifically sought to make IHCIA more responsive to current real-world needs, to
increase opportunities for attracting more revenue into the health system, and to facilitate greater
exercise of self-determination in health care program decision-making and regulations. There is no
single change in the reauthorization of IHCIA that will close the health status gap for Native Americans.
Instead, the House and Senate bills, as proposed, attempt to address many of the contributing problems
by including provisions aimed at increasing access to appropriate health facilities, increasing access to
and enrollment in health insurance programs, increasing federal funding, improving the quality of
care, decreasing poverty, and increasing the level of educational attainment for Native Americans.
Federal action through the I.H.S. is the best actor they are best at delivering service,
infrastructure development, and working with Indian nations
System, September. Page 52 & 53. MAG)
Despite a lack of resources that limits both quantity and quality of IHS-provided health care, there are
advantages to a federally operated system. First, the direct delivery system does bring services to
remote Indian reservations where market conditions would otherwise prevent the delivery of health
services. The frequent closure of rural hospitals and a decreasing number of providers who leave rural
areas to join managed care organizations elsewhere are among the factors that make it more difficult
for rural residents to access health services. Furthermore, many small tribes lack the resources and
expertise to provide or manage care on their own; IHS direct service brings health care facilities and
services to often remote reservations. In short, IHS brings both resources and expertise. The ability of the
federal government to provide federal benefits (of greater value than the tribes can afford to pay) and
therefore recruit more and better qualified individuals is one reason some tribes choose not to enter
into self-governance, or compacting, agreements to operate their own health programs. In addition, as
long as the government is providing care there is less fear that all funding will be withdrawn. As the
tribes take over, some fear that the federal government will use that as motivation to back out of its
obligation to pay.44 Second, while disparities still exist, the health status of Native Americans has
improved. Several sources familiar with Native American health care issues agree that IHS has done a
remarkably good job considering formidable obstacles and limited funding. Since 1973, mortality rates
have declined for the following: tuberculosis (82 percent); maternal deaths (78 percent); infant deaths (66
percent); accidents (57 percent); injury and poisoning (53 percent); and pneumonia and influenza (50
percent).47

22
I.H.S. Affirmative

Reauthorizing the Indian Health Care Improvement Act would substantial improve
reservation health care
Tom Rodgers President of Carlyle Consulting, Blackfoot tribal member, 2008
Native American Poverty, A Challenge Too Often Ignored
http://www.spotlightonpoverty.org/ExclusiveCommentary.aspx?id=0fe5c04e-fdbf-4718-980c-0373ba823da7
In addition to their symbolic exclusion from the table, America's indigenous populations have struggled for
recognition. Most of the world's nations have been reluctant to take positive steps to support the rights of
indigenous peoples. The United Nations Permanent Forum on Indigenous Peoples set a goal early this
century for adoption of the Declaration on the Rights of Indigenous Peoples. In 2007, 143 countries finally
adopted the declaration. The United States the wealthiest country in the world was not one of them.
Expanding formal rights is important, but we also need better federal performance on these issues. The
Government Accountability Office (GAO) has leveled a number of criticisms at the agencies responsible for
federal Native American policy, including "long-standing financial and programmatic deficiencies" in the
Interior Department's American Indian programs. A 2006 GAO report also found that the Office of the
Special Trustee for American Indians has failed to implement several key initiatives specified by the
American Indian Trust Fund Management Reform Act of 1994, including establishing an actual timetable for
completing its mission. The government should also take more aggressive action on providing essential
services and the necessary tools for effective self-governance to Native American communities.
Congress has failed to reauthorize the Indian Health Care Improvement Act since 1992. Initially passed
in 1976, the Indian Health Care Improvement Act was designed to bring the waning health of Native
American communities up to the standard enjoyed by all Americans. Unfortunately, current inaction on this
issue constitutes a grave travesty. Health systems in many Native American communities are in serious
need of updating and improvement. Reauthorizing this legislation will improve disease screening in
Native American communities, encourage health enrollment in existing federal programs, provide
better investment in Native American health professionals, and ensure funding in order to modernize
facilities in Native American communities.
Funding for culturally-specific dramatically improves health care services

System September. Pages 5-6. MAG)
Finally, in Chapter 6, this report makes recommendations for improving the delivery and quality of Native
American health services. Several of the recommendations are rooted in increased funding, but this is not to
exclude or underemphasize the value of significant reforms that can be implemented without sharp increases
in IHS funding. Several recommendations focus on using existing resources wisely and adopting innovative
approaches to disease prevention and detection. An example of change requiring little or no increase in
funding is a re-examination of how IHS teaches the value of preventive medicine and early detection.
These concepts are uncommon in Native American communities. After careful examination, Dr. Linda
Burhansstipanov, a member of the Western Cherokee Nation in Tahlequah, Oklahoma, concluded that for
Native American adults prevention and detection is a low priority. Native Americans who are raised on
reservations, or those with very traditional beliefs, value prevention and detection more when framed
in the context of family and bringing in a healthy next generation.12 A woman will understand, for
example, the value of an annual mammogram if she is told that early detection will allow her to survive to
teach her grandchildren the stories of her people.13 This same woman may not see the value of breast
cancer screening if only told that it makes good medical sense. Likewise, teaching health care providers to
be culturally aware and to demonstrate cultural sensitivity during the examination and treatment of
Native American patients will increase the numbers taking advantage of available detection and
intervention procedures.

23
I.H.S. Affirmative

The plan provides capital to facilitate tribal autonomy and decision-making power of
health care resources
American Indian Law Review, Volume 21)
The Indian Self-Determination and Education Assistance Act of 1975, buttressed by subsequent amendments,
provided a mechanism for transferring programs traditionally administered by the BIA and the IHS to tribal
governments. Tribes have become increasingly interested and involved in assuming control over health
care programs, but generally lack sufficient capital (human and physical, as well as financial) to
effectively and efficiently assume full responsibility for the provision of care. Neutral with respect to selfdetermination and self-governance, the IHS provides services through tribes as well as directly through
IHS facilities and personnel and through contracts with other non-IHS providers.
I.H.S. funds balances a smooth transition of health care decisions to the tribal-level while
protecting Indian interests at the federal level
URBAN INDIAN HEALTH CARE CRISIS, NYU Law Review, Vol. 18, p. 150-1)
According to the IHS Office of Tribal Self-Governance (OTSG), Self-Governance is fundamentally
designed to provide Tribal governments with more control and decision-making authority over the
Federal financial resources provided for the benefit of Indian people. This system is explicitly predicated
on the provision of federal financial resources. OTSG asserts that when administration and management
authority is in tribal hands, federal funds will be more efficiently employed. While the rhetoric sounds
appealing, the reality remains that tribes attempting self-governance and self-determination are
hamstrung by statutory limitations and the unremitting inadequacy of financial resources. In 1998,
94% of tribal leaders and health system directors reported plans to enter into self-determination or selfgovernance agreements with the IHS.168 For the transition to work, increased federal funding was critical. It
must be understood that tribal self-governance in the provision of health care does nothing, in and of
itself, to increase and enhance the very limited pool of health care resources. Whats more, tribal
provision of health care may also result in increased costs of production as tribes compete within and
among themselves for these limited resources.
Medicaid inclusion wont fill in only the I.H.S. solves and prevents Congressional
backsliding
Katz, JD, MPH, George Washington University, 2004
(Ruth J. Addressing the Health Care Needs of American Indians and Alaska Natives, American Journal of Public
Health January; 94 (1): 1314)
Strategies that have improved access to health care for other underserved populations need to be identified
and studied. Medicaid is one possible mechanism for reaching low-income American Indians/Alaska Natives,
but the community itself will have to decide whether to pursue this approach. Relying on a stateadministered, means-tested entitlement program, as well as on appropriations, may provide greater financial
stability. On the other hand, Medicaid itself is under stress, and such a shift could inadvertently weaken
the federal governments obligation, contained in treaties and case law, to provide health care to
American Indians/Alaska Natives. Other options to explore might include conducting an assessment of
how the IHS deploys its limited resources or proposing federal legislation, accompanied by adequate
appropriations, to redefine the scope of IHS services or expand eligibility criteria.

24
I.H.S. Affirmative

There is not risk of paternalism - IHCIA prevents federal domination of health services and
privileges input from Indian communities
While the federal policy of blatant termination was abandoned in the late 1950s, comprehensive reform
legislation affecting major service programs was not developed until the 1970s.93 Two major pieces of
legislation enacted in the 1970s - the Indian Self-Determination and Education Assistance Act of 1975 and
the IHCIA of 1976 - dramatically influenced Indian health care. Recognizing that federal domination of
Indian service programs had hindered rather than assisted the progress of Indian people, the Indian SelfDetermination and Education Assistance Act provided a mechanism for the transfer of programs traditionally
administered by the IHS to tribal governments and authorized technical assistance to tribes to enhance their
ability to administer such programs. The IHCIA encouraged participation of Indians in planning and
managing health services and authorized grants for recruitment of Indian health professionals,
scholarships, and continuing education allowances.

25
I.H.S. Affirmative
Inherency Reauthorizing the IHCIA

The vote concerning the reauthorization of the Indian Health Care Improvement Act
continues to be stalled, although most Native Americans are in full support of it.
Moore, Council Representative Rosebud Sioux Tribe, 2008
(Robert, Indian Country Today, United for better healthcare,10-31-08, http://www.indiancountrytoday.com/opinion/letters/33599464.html,
6-29-09, ESM)
Indian country always has been, and always will be, united in working to ensure Native Americans are provided the
health care services they were promised by the U.S. government.
Recently, an inaccurate analysis appeared in Indian Country Today on the stalled vote in the U.S. House of
Representatives on the reauthorization of the Indian Health Care Improvement Act. I can personally attest that
the National Congress of American Indians, along with the IHCIA National Steering Committee, the National
Indian Health Board, the National Council of Urban Indian Health and tribal leaders from across Indian
country have all made, for the last several years, getting this legislation passed their number one priority.
Their united effort has been unprecedented. Now, more than ever before, this is a time for us to come together.
Tribal leaders look to our national organizations to lead the way and be our Washington, D.C., staff and our voice on
Capitol Hill and we will confidently continue to do so. As a councilman of the Rosebud Sioux Tribe, I have
witnessed over and over the health disparities Native people face on a daily basis. Unlike the ICT analysis, I can
tell the real story of the united fight for reauthorization of the IHCIA. That ongoing struggle began decades ago
to end the crisis of Native people whose lives have been cut short, or have experienced unnecessary pain and
suffering, due to the subpar health care Native people face. They are the real stories and they deserve the real
analysis. Take Marrles Moore, an 86-year-old elder of the Rosebud Sioux Tribe, as an example. Marrles, who is
also my father, fell in his home, sustaining extensive trauma to the head. He suffered in an IHS emergency room
waiting area for two hours, bleeding from the head, before being seen by a physician. Through reauthorization of the
IHCIA, my father could have been living in an assisted living facility or had in-home care, and the fall could have
been treated immediately or possibly even prevented. It would also have provided a fully staffed and modern
medical facility where he could have been adequately treated upon arrival. These types of stories are the reason
Indian country has been united in its efforts. Its time to stop playing politics with peoples lives. Native people are
dying. Along with our congressional representatives, the Senate Committee on Indian Affairs, the House
Resources Committee, the House Native American Caucus, and their hard-working staff, we must stay united
and get this bill passed. I can assure you that tribal leaders and the national Native organizations will continue to
put Indian people first. That is a promise.

26
I.H.S. Affirmative
Inherency Reauthorizing the IHCIA

The Indian Health Care Improvement Act continues to be denied reauthorization and
funding.
Reynolds, staff writer Indian Country Today, 2008
(Jerry, Indian Country Today, Health Care Reauthorization Act Fails, 10-3-08,
http://www.indiancountrytoday.com/home/content/30274779.html, 6-28-09, ESM)
Lead organizations and lobbyists have admitted the defeat of efforts to reauthorize the Indian Health
Care Improvement Act. Declaring efforts to enact the bill shut down in Congress, the National Indian
Health Board stated on its Web site Sept. 29 that it will continue to pursue strategies for enacting the
reauthorization bill during what little remains of the current 110th Congress. But already by the evening of Sept.
26, a longtime lobbyist on Indian health issues, speaking on condition of anonymity when anything could still happen, said
key congressional committee staff had put its chances of passing at slim to none. By then, as recounted by NIHB, attempts to
attach the bill (H.R. 1328 in the House of Representatives) to a continuing resolution on the budget i.e., a measure to fund
the federal government until Congress can pass a national budget had faltered. The bills chances didnt improve over the
weekend of Sept. 27 28. In the process of trying to move smaller parts of a larger bill that has faltered
through the legislative system separately, the bills advocates tried to strip out Title II of the larger bill
the section providing enhanced Native access to Medicare, Medicaid and the State Childrens Health
Insurance Program as a stand-alone bill. Kind of like taking apart an automobile, as Blackfeet lobbyist
Tom Rodgers of Carlyle Consulting described it. But when that process gets started, he said, its not long before
the separate parts add up to less than the sum of the whole. Unfortunately, NIHB summarized on its Web site
(www.nihb.org), House [l]eadership was not able to fund the first five years of the bill in an amount of $53
million. That was for the proposed stand-alone bill comprised of Title II. Though the Congressional Budget
Office had estimated the original reauthorization bill to cost $129 million over 10 years, funding had
become a problem for the bill as Congress arranged the well-known $700 billion bailout bill for the
financial credit system, along with at least $1 billion in tax giveaways and a $25 billion loan package for
Detroit automakers. On Sept. 24, as conditions in credit access built toward the $700 billion crisis, Rep. Tom
Cole, R-Okla., enrolled Chickasaw, urged passage of H.R. 1328. Budgetary pressures in 2009 could work against
even modest new expenditures, he warned. But House leadership had decided not to offer the bill for a vote in
the first instance because of the abortion issue. An amendment forbidding the use of federal funds to pay for
abortions under the reauthorization had been added to the Senate version of the bill by Sen. David Vitter, R-La.
House Republicans, despite what NIHB calls Indian countrys consistent position that abortion is inappropriate
to an Indian health bill and already restricted under current law on federal funding, now wanted to attach the
Vitter amendment to the House version. In addition, NIHB relates, the National Right to Life Committee
threatened to score votes on the bill as pro- or anti-abortion if the amendment were not permitted. Because the
committee would score a vote on the amendment in any case, the political calculus boiled down to this for House
leadership: to bring the bill forward would be to register a vote on abortion little more than a month before every
member of the House faced the voters on Nov. 4. Lawmakers are generally allergic to making choices so close
to an election, Rodgers explained. The abortion amendment dominated and clouded the whole debate, he
added. He cited another reason for the bills setback. Indian country needs to have more allies on the [House]
Energy and Commerce Committee. It is basically an urban committee which does not reflect historical ties
to Indian country. Indian country, especially health care advocates and professionals, must work to address
the problem substantively and procedurally as Nov. 4 approaches, he said. Thats what elections are for. ... You
do that by embracing your friends and punishing your enemies, and that can only be done by hard work. Other
principal committees of jurisdiction on the bill House Natural Resources under Rep. Nick Rahall, D-W.Va.;
Senate Indian Affairs under Sen. Byron Dorgan, D-N.D.; and Senate Finance under Sen. Max Baucus, D-Mont.
performed exceptionally well on the bills behalf, Rodgers said. As the 110th Congress approached recess, the
failure of the Indian Health Care Improvement Act reauthorization left an angry mood among its
advocates. Theyre bitter, very bitter, said Gregory Smith, of Smith and Brown-Yazzie LLP in Washington,
D.C. The National Congress of American Indians had made the bill its top legislative priority. NIHB, the
National Council of Urban Indian Health, the National Steering Committee on Reauthorization of the Indian
Health Care Improvement Act, the California Rural Indian Health Board, a host of other organizations and tribes,
tribal leaders and individual Native people, lawmakers and legislative staff and lobbyists by the score have
poured their efforts into refining the bill and passing it, many of them for years running. Theyll try again next
year, Rodgers said, with new strategies for the new political landscape of the next Congress.

27
I.H.S. Affirmative
Inherency Lack of Funding

Natives are dependent on programs like Medicaid, but corruption and lack of funding
ensures that they remain one of the poorest groups in America, despite treaty obligations
Marquez 2001
(Carol A. Associate program director/collaborating investigator in the Department of Nursing, University of
Minnesota who has worked with indigenous peoples for 20 years, The Challenges of Medicaid Managed Care for
Native Americans, Wikazo Sa Review, 16.1:151-159. EKC)
Until 1996, families and children who received cash assistance under Aid to Families with Dependent Children (AFDC) program were
automatically entitled to Medicaid coverage (Schneider and Martinez, 1997). The report further states that Native Americans who are
eligible for health care coverage through the Indian Health Service (IHS) may be entitled to Medicaid coverage if they meet the state
categorical and financial eligibility requirements. In a recent fact sheet, the Kaiser Family Foundation (2000) notes that Medicaid
and other public programs are the primary source of health insurance coverage for 25% of American
Indians and Alaska Natives (AI/AN) in contrast to 9% white or Anglo-Americans. Schneider and Martinez
(1997) discuss the significant roles Medicaid plays in health care delivery to American Indians and Alaska Natives, including insurance
coverage, revenue source to providers of care, and purchaser of managed care products, to name only a few. Given the significant role of
Medicaid in health care delivery to American Indians and Alaska Natives, policy changes in the past few years have had a significant
impact on access for both tribal and urban Indians. This essay reviews the managed or restricted reimbursement of health care services to
Medicaid-eligible beneficiaries in Indian country. Managed health care is the managing of fiscal resources to ensure cost-effective health
care service delivery. Groups of health care providers who participate in managed care systems all too often find that managed care
programs compensate profit-minded managers who restrict access by patients to health care services.
Thus, the process of implementing managed care while maintaining adequate health care services may
fall foul of treaty obligations to American Indian tribes to provide health care services to American
Indians and Alaska Natives (Rolin 1998). This contradiction continues even in light of U.S. Surgeon
General Satchers statement that AI/AN health status ranks among the poorest of all groups in the nation
(Satcher 2000). Further erosion of the current level of funding for health care services does not allow
the Indian Health Service (IHS) to meet its goal of increasing the health status of AI/AN people to a
level comparable with that of the general population. This goal is not only a major justification for the
existence of IHS, but is also a goal of the Healthy People 2010 Initiative. This paper examines key challenges
facing the Indian Health Service, tribes, and urban Indian communities as services are provided with
diminished resources in a managed care environment. The American Indian and Alaska Native tribes, unlike
any other ethnic minority in the United States, possess a unique relationship with the federal government.
(Kunitz 1999). The Indian Health Care Improvement Act is under reauthorization; the amendments
include funding of tribal and urban Indian health programs to maintain and improve the health of the
Indians consonant with and required by the federal governments historical and unique legal
relationship, as reflected in the Constitution, treaties, federal statutes and the course of dealings between
Indian tribes and the United States resulting in government to government and trust responsibility and
obligations to the American Indian people. This relationship underscores the need for and importance of
health care delivery to the more than five hundred tribes and estimated 1.4 million American Indians residing
in the United States. In his 1999 congressional testimony on American Indian/Alaska Native unmet health
needs, Rolin (1999) restates Senator Inouyes 1993 statement that American Indians purchased the first
prepaid health care plan when treaties were exchanged for millions of acres of land. Kunitz expanded on
this point by his mention of the historical conflict between the federal role of trustee for American Indian
rights and resources and pressures from non-Indian constituents, especially those in the western states that
coveted access and ownership to these lands (Kunitz 1999). Additionally, the Snyder Act of November 2,
1921 (25 U.S.C., 13) gave the government authority to provide health care services to American Indians. The
Snyder Acts broad scope of authority has been the foundation of the Indian Health Care Improvement Act
and its subsequent reauthorization, currently P.L. 102-573. The act authorizes appropriations for the
provision of health care services to tribes as well as to Indians residing in urban areas. Unfortunately,
legislative protections of the trust responsibility and treaty obligations have not yet yielded equivalent
health services for all American Indian and Alaska Native people (Satcher 2000). Due to the level of poverty
across Indian country, many American Indians are eligible for Medicaid reimbursement of health care services (Rosenbaum and Zuvakas
1996). However, because of federal and state changes that have attempted to limit Medicaid expenses over the past decade, Medicaid
beneficiaries have been enrolled in managed care plans that control access to provider sites as well as the level of reimbursement for
services (Kauffman et al. 1997). Rolin (1998) noted the disparity in cost per IHS beneficiary in contrast to that of the typical Medicaid
beneficiary; $1,403 for an IHS beneficiary versus $3,369 for each Medicaid user was reported per year 19931997. Rolin also
highlighted the difficulty of decreasing disparities in health status of racial and ethnic populations because the IHS has fallen far
behind other agencies in the Department of Health and Human Services in funding level increases in
recent years (Rolin 1999).

*** Inherency***
28
I.H.S. Affirmative

29
I.H.S. Affirmative

Tribal health care is funding well below the national average More Federal IHS funds are
necessary to improve Native American health care access
Lillie-Blanton, DrPH, Henry J. Kaiser Family Foundation and Roubideaux, MD, MPH,
Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, 2005
(Marsha & Yvette, Understanding and Addressing the Health Care Needs of American Indians and Alaska
Natives,American Journal of Public Health http://www.pubmedcentral.nih.gov/ articlerender.fcgi?artid=1449250)
In the 2000 US Census, 4.1 million people (about 1.5% of the US population) identified themselves as AIAN,
solely or in combination with 1 or more other racial/ethnic groups.1 When mortality rates are used as the
indicator of health outcomes, American Indians and Alaska Natives face a disadvantage, relative to
Whites, at each stage of the life span, with persistent disparities in infant mortality, life expectancy, and
mortality from a variety of conditions including chronic diseases.2 There is also sufficient evidence of
disparities in health care financing, access to care, and quality of care to conclude that American
Indians and Alaska Natives are disadvantaged in the health care system. The federal government has a
unique relationship with American Indians and Alaska Natives that is defined by the US Constitution,
treaties, Supreme Court cases, and legislation.5 In exchange for tribal lands, the US government agreed to
provide health care to members of federally recognized tribes. The Indian Health Service (IHS), an
agency of the US Department of Health and Human Services, has fulfilled that responsibility since 1955. The
AIAN health system has evolved greatly since then and now consists of IHS hospitals and health centers
managed by the federal government, tribally managed services, and urban Indian health programs. While IHS
is the hub of the AIAN health system, AIAN people also qualify for private and other public sources of health
financing and services. In fact, about half (49%) of American Indian and Alaska Natives younger than 65
years have job-based or private coverage.6 An estimated 17% of the AIAN population has coverage through
Medicaid or other public programs. Medicaid is playing an increasing role in financing AIAN care and as a
revenue source for IHS providers.7 However, large disparities exist in the funding and availability of
health services for AIAN people relative to other Americans. In fiscal year 2003, IHS had an operating
budget of $2.9 billion to provide or pay for care for a service population of approximately 1.5 million of
the 4.1 million people who identify themselves as AIAN. This amounts to $1914 per patient per year,8
which was less than the nation spent per capita in 2002 on public sector health care financing programs
serving the nonelderly population ($3545) (unpublished data from the Kaiser Family Foundation analysis of
the 2002 Medical Expenditure Panel Survey, available from the authors). According to one study that used
the Federal Employees Health Benefits Plan (FEHP) as the primary benchmark, an additional $1.8 billion
would be needed to provide active IHS users with services at the same level as those provided in a
mainstream health plan such as the FEHP.9

30
I.H.S. Affirmative

Lack of funding and poor interaction with Natives ensures failure of the Indian Health
Service in the status quo
Marquez 2001
(Carol, Associate program director/collaborating investigator in the Department of Nursing, University of Minnesota
who has worked with indigenous peoples for 20 years, The Challenges of Medicaid Managed Care for Native
Americans, Wikazo Sa Review, 16.1:151-159. EKC)
Diminishing state Medicaid reimbursement levels resulted in service reduction through contract and
compact tribal health programs (ibid.). Recently, these clinics have adopted stricter service eligibility
requirements, which further limit services to members of their service populations.
U R B A N I N D I A N H E A LT H C A R E S E RV I C E S
Prior to the passage of P.L. 93-437, little if any Indian Health Service funding was available for health care services to urban American Indians (Kauffman,
Johnson, and Jacobs 1997). The relocation policy of the Bureau of Indian Affairs in the late 1950s through the early 1960s resulted in a mass exodus from tribal lands to
major cities. The relocation program was geared toward training programs for young Indians; however, it resulted in isolating Indians from their families, tribes, and
homeland while assimilating these youth to American values and ways. The other significant event that led to the development of urban Indian populations was the end
of World War II. The return of WWII veterans and especially a significant number of young Indian veterans to urban locations tended to ensure that these young Indian
veterans settled in urban locations. Today there are 41 urban Indian health programs (I/T/U) located in 34 sites across the country. These programs provide primary and
preventive health care services with few resources. Urban programs estimate that less than 25% of their service needs are met with IHS appropriations (Waukazoo
2000).
MANAGED CARE ENVIRONMENT
Tribal and urban programs continue to face challenges to their health care delivery systemthat of the ever changing managed care environment (Fleury 2000).
Fleury noted that neither
the Indian Health Service, tribally operated clinics, nor urban Indian health
programs had populations well suited to participate in the typical managed care organization (MCO).
Factors such as geographic isolation, population mobility, case mix, and maintenance of continuous
Medicaid eligibility previously identified in Roundtable Reports (Rosenbaum 1996) are key factors that
contribute to the unsuitability of enrolling Native American Medicaid beneficiaries in MCOs. Both Fleury
and Clain characterized these factors as barriers to the feasibility of Medicaid managed care models succeeding in Indian Medicaid reimbursement for services to AI/AN
states
expectations of managed care organizations are based on the medical model. In contrast, I/T/U
organizations provide more preventive types of services for response to the needs of their clients (Waukazoo
Medicaid beneficiaries. I/T/U providers struggle to seek reimbursement of services to Medicaid beneficiaries (Clain 2000; Fleury 2000). In general,
2000). Despite the challenges, I/T/U organizations continue to seek Medicaid reimbursement because it supplements IHS funding of health care services to AI/AN
patients. Further limitations placed by local MCOs on assignment of Medicaid beneficiaries to I/T/U organizations create additional hardships for these clinics.
urban Indian health clinics were seeing increasing numbers of

uninsured American Indian patients not eligible for Medicaid coverage. However, urban Indian health programs are
Waukazoo (2000) and Bushyhead (2000) noted that
required to serve these patients. In order to address this issue, the Minneapolis clinic has challenged Hennepin County to reimburse the Indian Health Board (IHB) for
estimated lost Medicaid reimbursements over a seven-year period due to reassignment of Indian Medicaid beneficiaries to other primary providers (gatekeepers) under
the Hennepin County Managed Care Plan. When some former IHB patients sought care at IHB, the center was unable to seek reimbursement because it was not their
designated provider. IHB could not be reimbursed for its services unless the patient requested a change of primary care site (Bushyhead 2000). This situation resulted
from the establishment of Hennepin County as one of the counties involved in a statewide demonstration project to control and reduce the cost of Medicaid expense for
eligible beneficiaries in Minnesota. This demonstration was approved by the Health Care Financing Administration under an 1115 waiver that not only restricted
freedom of choice of provider by Medicaid beneficiaries but implemented other changes aimed at modeling managed care plans for Medicaid patients (Marquez
1996). This IHS action resulted in a loss of income for the Indian Health Board because it was not reimbursed for services provided to these patients. Furthermore, the
IHB was not assigned many of its former patients eligible as Medicaid beneficiaries under the Hennepin County plan. This is only one example of a situation common
This situation remains a critical issue across the country as is noted in the points
made by Michael Mahsetky, IHS Chief of Legislation (2000).
Recent health indicators reported by the Indian Health Service reveal premature death rates and
tuberculosis rates higher than those of the general population (Kunitz 2000). Rolin, of the National
Indian Health Board, reported substantial unmet health needs in IHS 1998 testimony before the Senates
Indian Affairs Committee (1998). The current trends in state-run Medicaid managed care plans present
a dismal future for any significant decreases in the health disparities between American Indians,
Alaska Natives, and the general population.
to many urban Indian health clinics.

31
I.H.S. Affirmative

Indian Health care underfunding
Marquez 2001
(Carol, Associate program director/collaborating investigator in the Department of Nursing, University of Minnesota
who has worked with indigenous peoples for 20 years, The Challenges of Medicaid Managed Care for Native
Americans, Wikazo Sa Review, 16.1:151-159. EKC)
An area not often considered in the AI/AN health care delivery system arena is that of patient satisfaction. Dixon et al. (1997) discuss the Indian patients conflicts in
Conflicts existed not only for providers

but also for I/T/U patients as rural and urban patients made provider changes. Most patients felt comfortable and
attitudes and satisfaction with services in a study of provider choices made by patients in selected sites.
pleased with the Indian clinics in contrast to their assigned managed care providers in urban areas. One interviewee in the Minneapolis area noted that she would
return to the urban clinic after her baby was born because of comfort level, familiarity with providers, and a friendlier atmosphere. Another Minneapolis patient, a
grandmother responsible for the care of her five grandchildren, viewed managed care as an evil form of health care. She had lived in California for a number of years
and received health care services from a managed care organization. Her experience under a managed care system convinced her to seek out an urban Indian program
for her health care (ibid.). Tribal health care clinic participants in the study argued that the
federal government had an obligation to

provide health care services regardless of the patients ability to pay (P.L. 102-573). This basic concept of federal obligation
was widespread among most of the clinics. Additionally, it was felt that the implementation of managed care brought increasing problems, negatively affecting the clinic
and its ability to provide adequate services. The San Francisco Bay areas Urban Indian Health Board director, Martin Waukazoo, shared his perceptions of the impact of
managed care on the program. He said within
the past five years, the Native American Health Center has faced its
most stringent challenge: operating in a continually shifting health care environment, operating on the
margin, and drawing upon diminishing resources for increasing costly care to growing numbers of
uninsured or underinsured low-income residents in our community (Waukazoo 2000).
There is chronic under-funding of current Native health care provisions.

Senator Cantwell, Wisconsin Democrat on Senate Indian Affairs, 2008
(Maria, States News Service, Summery of the Hearing on the Indian Health Care Improvement Act, Febuary 26,
2008, no p. CME)
Cantwell co-sponsored two amendments that were included in the final version of the bill. The first
amendment adds an official resolution of apology for the federal government' long history of ill-conceived
policies regarding Indian Tribes. Currently, Washington state tribes are in desperate need of additional
health care facilities and health care staff. Cantwell's second amendment aims to correct the facilities
construction funding structure that currently uses outdated criteria for allocating federal dollars to
health facilities. With passage of the reauthorization bill, Cantwell will now turn her attention to the [there
is] chronic under-funding of the Indian Health Care Improvement Act. It is estimated that its
programs are funded at only 40 percent of need, leaving Northwest Tribes with annual resources that
fall far short of service demand.
Native Americans in the status quo lack necessary healthcare funding.

Bresko, Department of Public Administration and Political Science, 2008
(Peter, Indian Country Today, Obama for Indian healthcare,9-19-08, http://www.indiancountrytoday.com/opinion/letters/28654134.html, 628-09, ESM)
You probably would not be surprised to learn that Haitis life expectancy rate is the lowest in the Western
Hemisphere. But you might be and should be shocked to find out that the populations with the second
and third lowest rates are located right here in the United States, the richest country on the planet. They are
the Pine Ridge and Rosebud Indian reservations in South Dakota. The health issues facing American
Indians in the United States make them the most at-risk minority in the country, and yet the IHS
receives only 55 percent of the funds that it needs. The IHS only has roughly 15,000 employees and 31
hospitals, and barely 200 dentists, to serve the 1.9 million American Indians within its jurisdiction (there
are 3.2 million American Indians in all). The Bush administration has been pushing to eliminate urban
Indian health centers altogether, which would leave Native people who do not reside on a reservation
without access to the health care they are entitled to. The Indian Health Care Improvement Act, currently
pending in Congress, would increase funding in the IHS by $1 billion per year through 2017, which it
desperately needs if the United States is to honor the treaties that require it to provide health services
to 1.9 million Natives. Its co-sponsor is Sen. Barack Obama. It is not clear whether increasing funding for
the IHS alone would be a sufficient response to the health problems in the Native community, nor is it clear
how best to address these health issues without impeding on the sovereignty of the reservations. But
Obamas demonstrated recognition of the problems and commitment to addressing them make his election
critical for American Indian health.

32
I.H.S. Affirmative

Despite moderate improvements the Indian health care systems is collapsing
Lillie-Blanton, DrPH, Henry J. Kaiser Family Foundation and Roubideaux, MD, MPH,
Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, 2005
(Marsha & Yvette, Understanding and Addressing the Health Care Needs of American Indians and Alaska
Natives,American Journal of Public Health http://www.pubmedcentral.nih.gov/ articlerender.fcgi?artid=1449250)
The articles on AIAN health issues in this months Journal advance our understanding of the problems, the
progress, and the challenges in addressing AIAN health care issues. The authors cover a wide spectrum of
issues, including oral health, mental health, visual health, infectious diseases, risk factors for chronic
diseases, and systems of financing AIAN health services. Several of the studies highlight the health care
challenges faced by the Indian health system. Denny and coauthors10 confirm other studies that reveal a
higher prevalence of risk factors for chronic diseases in AIAN elders, including obesity, physical
inactivity, and smoking. Nez Henderson and coauthors11 also highlight, in the case of cigarette smoking,
how these risk factors for chronic disease vary by region, often resulting in a need to tailor intervention
efforts to the local tribe or culture. Puukka et al.12 demonstrate how using more advanced and appropriate
statistical methods reveals that the burden of cancer is actually greater than previously documented in
American Indians and Alaska Natives. Despite advances and improvements in health care for American
Indians and Alaska Natives, some conditions, such as tuberculosis, continue to be a significant health
challenge for this population, as shown by E. Schneider.13 Mansberger and coauthors14 illustrate how
research can help identify the causes of visual impairment in American Indians and Alaska Natives, which
may lead to better diagnosis and treatment in the future. All of these studies help highlight persistent and
growing disparities in risk factors and health conditions that will continue to challenge the already
underfunded Indian health system.
American Indians are excluded from health policy debates and receive inadequate funding
Ruth J. Katz, JD, MPH, George Washington University, 2004
Addressing the Health Care Needs of American Indians and Alaska Natives, American Journal of Public Health
January; 94(1): 1314
Although the public health community is generally aware that American Indians and Alaska Natives
have a higher burden of illness, injury, and premature mortality than non-Hispanic Whites,1 the health
care needs of this population are often excluded from policy discussions. This exclusion reflects, at least
in part, an absence of data, a misperception that the Indian Health Service (IHS) is an adequate source
of care for most American Indians/Alaska Natives, and a failure to recognize pervasive disparities. In
this issue of the Journal, Zuckerman and colleagues plant the seeds of a long overdue national dialogue on
the health care challenges facing American Indians/Alaska Natives. Zuckerman et al. demonstrate that
American Indians/Alaska Natives are more likely than non-Hispanic Whites to be uninsured and that
troubling gaps exist in access to health care and rates of service utilization, particularly for low-income
American Indians/Alaska Natives.2 Almost half (48%) of low-income American Indians/Alaska Natives
are uninsured. Given that more than half (55%) of American Indians/Alaska Natives have incomes below
200% of the federal poverty level ($28 256 for a family of 3 in 2001), compared with 25% of Whites, the
impact on the community is widespread. Included among the uninsured are American Indians/Alaska Natives
who report receiving health care from the IHS. Slightly fewer than half of low-income American
Indians/Alaska Natives with no other form of insurance have access to the IHS, making it important to
understand the role and limitations of the IHS. On the basis of treaties and federal statutes, the US
government has a trust responsibility to provide health care to members of federally recognized tribes,
a responsibility filled since 1955 by the IHS. In fiscal year 2003, the IHS received $2.5 billion in federal
appropriations for its services. According to the IHS Federal Disparity Index, an additional $1.8 billion
would be needed to provide active IHS users with services at the same level as services provided by the
Federal Employees Heath Benefits program.

33
I.H.S. Affirmative

Native Americans have the worst healthcare and receive the least funding, both historically
and today.
Melmer, Indian Country Today writer ,2004
(David, Indian Country Today, More bad news about health care funding,9-10-04, http://www.indiancountrytoday.com/archive/28210949.html,
6-28-09, ESM)
A Bush administration official told tribal leaders here that they need not look for any additional
funding for health care in the future. Instead Michael OGrady, assistant secretary of the Health and
Human Services Department said the tribes should look for ways to do more with less. Tribal health
officials and elected leaders have fought for better health care funding for generations and under the Bush
administration they continue to talk about the same issue, lack of funds that they have discussed for many
years. Health program officials have become creative to provide health care in the face of inadequate
budgets. The word from the Health and Human Services Department is less than encouraging. Tribal
officials gathered for a Montana-Wyoming Tribal Leaders Conference were told not to expect any
increased funding in the near future. O'Grady did not shy away from the fact that IHS is currently under
funded and that future funding may not improve the situation. O'Grady said cooperation between the tribal
health programs and the IHS could work to prevent long-term health problems that would benefit both the
people and the budget. In the Rocky Mountain Region and the Great Plains, closure of IHS clinics or
changes that eliminate emergency care or in-patient services have plagued the regions for many years.
Complaints about referrals to other health facilities or specialists requiring the threat of loss of limb or
life have been at the center of criticism against the IHS system. Many families have trouble establishing
any type of credit because they have been billed by non-IHS facilities for treatment when the IHS should
have paid the bill. It all comes down to lack of funds, and O'Grady put the blame squarely on Congress for not fully
funding the IHS. Sen. Tom Daschle, D-S.D. drew exception to O'Grady's comment. Daschle said the assistant secretary's comments
were an example of "political doublespeak." Daschle said that congressional Democrats repeatedly proposed full funding clinical care in
the IHS budget, but the Bush administration blocked the funding. "Now in an election year, they are trying to shift the
blame," Daschle said. "It is a national disgrace that the federal government spends twice as much per
person on health care for federal prisoners as it spends for Native Americans." Per capita expenditure
for American Indian health is $1,900. For federal prisoners it is $3,800 and for the general population,
$5,600 is spent annually on health care. Daschle also said that instead of bemoaning the injustice both parties should work
together to adequately fund the IHS and honor the federal government's treaty and trust obligations to tribes. O'Grady suggested that
more use of Medicare and Medicaid would relieve the financial pressure on IHS budgets and that preventive medicine will reduce the
cost of emergency room expenditures. He said the recent changes in Medicare that cover 75 percent of prescription drug costs would
help. Screening for heart disease and diabetes will also help to reduce long-term care expenses, he said . Tribes have to deal with
many areas of health care; addictions to drugs and alcohol, fetal alcohol syndrome and effect, kidney
dialysis, cancer, diabetes and a growing problem with heart disease. With an estimated $2.5 billion
shortfall each year it creates health care problems that become long term and more costly in the future,
tribal leaders argued. Tribal officials asserted that a larger long-term commitment by the federal
government is necessary and that commitment is a trust responsibility obligated by treaty and the
constitution. Some tribes are taking a progressive approach to the situation by contracting with the federal government to manage
their own health care programs. Under a 238 contract the tribes receive funding directly from the federal government and manage it
according to the tribe's needs. Yet the funds are still inadequate and most tribes do not have the resources to pay the bills, tribal leaders
said. Tribes and tribal health programs do not have the ability to bill third-party payers, such as
Medicare and Medicaid or insurance companies. If they could adequately bill third parties the money
would then go to the tribes. Daschle also complained that the Bush administration and the Republican
Congress failed to approve the Indian Health Care Improvement Act, the act that authorizes funding
for the IHS. The previous act approved in 1992, expired three years ago. Congress has had to pass appropriations on a
yearly basis since the act expired. The new version, written by tribal leaders, would help the reservations recruit health care professionals
and establish preventive health care programs that would go a long way to solve issues of alcoholism and diabetes, tribal leaders said.
The act would put the tribes in charge of decision making for their own health care. But funding is still the problem. Sen. Daschle
proposed a substantial increase in that funding that would be appropriate for adequate health care. While the battle over the budget
continues, patients are not receiving proper medical care. The tribes can apply for grant money to help fill the gap, but tribal leaders said
that only takes care of short-term needs and does not fulfill the long-term need. O'Grady did admit the federal government needed to
find better long-term funding for programs that have a demonstrated success rate. He also said that federal health officials need to open
the lines of communication with Indian country to create a coordinated effort that will make health care more efficient.

34
I.H.S. Affirmative

Native American health facilities leave often their patients undertreated or untreated,
sometimes even turning them away.
Humphrey 08 (Kay, Indian Country Today, Healthcare horrors reveal need for change, 9-10-08,
http://www.indiancountrytoday.com/archive/28187369.html, 6-28-09, ESM)
Patients and their relatives who have suffered through Indian Health Service treatment rose and told their
stories one by one to Cheyenne River Sioux tribal officials in a series of hearings to document the failures of a
crumbling health care system. They told of a system that has threatened and cost the lives of tribal members
and left others desperately trying to safeguard their health and going in debt to private clinics to survive.
More than 80 tribal members gathered to give taped testimony about the state of medical care on the northern South Dakota reservation.
Cheyenne River Sioux Health Committee Chairman Harold Frazier and Tribal Attorney Rebecca Kidder sat and listened March 12 as tribal
member after tribal member tell of failures in critical situations at the Eagle Butte IHS Hospital where time
might have made the difference. Tribal members detailed misdiagnosis, misconduct, failures by physicians to
examine charts, the dispensing of medications deadly to those suffering from particular health conditions,
pharmacy personnel dispensing the wrong prescriptions to tribal members and tribal members being given
bags of Motrin and Robitussin to pacify them as a substitute for treatment. Some said they were given the
over-the-counter medicines even if they did not need them. Others complained of physicians refusing to see
them when immediate care was needed in life-threatening circumstances. Some said tribal members sat waiting for hours before
anyone would respond. Often the response was to simply send them home . In some cases, just a few hours later they would have
to return for emergency care. Frazier said the hearings were to provide testimony for the U.S. Senate Indian Affairs Committee to
assist the tribe in obtaining the necessary funding for a new facility, provide more staff for the facility and allow families to tell
their stories to determine if their cases should be further examined by malpractice attorneys. While the tribal Health Committee has
been looking at health care for the past year, it was not until the death of a widely respected tribal elder that it
came to the forefront of issues facing Cheyenne River Sioux officials. Leonard Moses Fiddler, 66, of Green Grass, S.D. died on New
Year;s Eve in the midst of confusion while an ambulance service was ordered not to take him to the hospital. Although an Emergency Medical
Technician pronounced him dead at his house, the time and cause of his death has still not been officially determined. (See related story on this
page) According to written reports by a deputy county coroner and a responding tribal police officer, the doctor on
call, who is no longer at the facility, told the ambulance drivers to take him back to his residence or dump him
in a ditch. Tribal members have demanded investigations of the incident from Sen. Tim Johnson, D-S.D., the IHS Aberdeen Area office and
IHS director Michael Trujillo, M.D. According to Tribal Chairman Gregg Bourland and Health Committee Chairman Frazier, they have received
no response. "I have been on the committee for a year and half. There have been a lot of horror stories. Enough is enough. It is time to
stand up as a tribe and our rights for what is owed to us," said Frazier. Tribal Attorney Rebecca Kidder told
tribal members their testimony was important because most of the nation's congressmen are unaware of life on
the reservations. "They are living in the big city have no idea what we live with every day," she said. "This tribe is trying very hard to get a
new facility. Not only a new facility, but to staff it with the doctors." Congress has only funded 40 percent of the need based
on 1996 figures, she said. Meanwhile, she told tribal members not to fear retaliation from hospital officials despite apparent threats some
tribal members have received that if they testified at the hearings they would be denied medical care. "They have no legal right to deny you
health care. If they do, you need to call us immediately," Kidder said. Another tribal member told of a woman suffering from a brain tumor who
was denied contract care due to a lack of funds. "The IHS hospital said, 'We're sorry Nina, we don't have the funds. Come back next fall, and
maybe we will have the money,'" she said. "Looks like they are just letting all the elderly go." Lois Spotted Bear, a retired nurse who returned to
the reservation to be near her relatives, said many tribal members receive poor medical care because they do not know what questions to ask.
Spotted Bear had a heart attack in 1999. Although her emergency care at the hospital met with her approval, the follow-up care she received in the
clinic fell short. "Everything was done because I knew what to ask and what medications to take. When I got back to clinic there was a big mixup," she said. Spotted Bear said she saw nearly a dozen doctors, never seeing the same one twice and her medications were changed, causing her
to become dehydrated. Her husband Danny suffers from diabetic neuropathy, a condition that affects the nervous system. "He's in pain, but they
don't have any sympathy," she said. "The ambulance workers don't want to transport him anymore. The doctors hired here are temporary. You are
forever telling them the same story. They never look at the chart." Tribal members gave numerous accounts of people who
came to the emergency room with appendicitis only to be sent home until their families made return visits to
IHS. Many were not taken into emergency surgery until the appendix ruptured. Patients said they have been turned away for
care because a doctor employed at the facility says he has an allergy to latex gloves. Betty Come Crow, who worked at
the hospital for many years, said, "They come and all they give them is pain killers," she said. Come Crow said her son is suffering from
leukemia. "IHS wouldn't write a statement. He is suppose to be getting medication, but he can't afford it because his wife divorced him and he
isn't on her insurance anymore," she said. "You are practically dead before they admit you." Germaine Means, 69, wondered how
non-medical personnel could control the decision on who would receive a referral. Those reviewing who should be referred for further treatment,
she said, are picked by non-medical staffers. "This is where it gets frustrating. Who allows for non-professional people making these
determinations when our doctors refer us? A lot of our lives are at stake here," she said. "How can I diagnose this is life or death? What is the
criteria for priority or should there even be such a measure? One person's needs can't outweigh another person's needs." Simple lab services
which help in diagnostic work and patient treatment are contracted requiring patients to wait for days for the results. "We used to have lab
services," said Raylene M. Lebeau. The contracting of the services delayed treatment, LeBeau said. "They told me 95 percent of IHS
budget goes for staff salaries. Somewhere we are getting the short end of the stick.

35
I.H.S. Affirmative

I.H.S. is severely underfunded
Giago, Grand Forks Herald Columnist, 2009
(Tim, will health reform bypass Indians? Grand Forks Herald, June 28, 2009, no p. CME)
Health care in America is a failing proposition. An estimated 47 million Americans do not have health insurance. And yet Health
and Human Services Secretary Kathleen Sebelius calls the health care of American Indians historic
failure. What about health care in the rest of America? The efforts to introduce universal health care
can be traced to the days of Woodrow Wilson and more recently to the political fiasco during the Bill Clinton
administration in 1993 and 1994. The most powerful opposition to universal health care can be found in the medical profession and the
insurance companies. They present a formidable lobby on Capitol Hill. Those Americans opposed to it compare it to
Canadas or Britains health care systems, which they say are nothing but socialized medicine. The
Indian Health Care system has also been labeled as socialized medicine, and the fact that Sebelius
would label it as a failure does not place much faith in an even larger universal health care system. It
just seems that every time the federal government takes total control over anything, failure is almost
assured. Watch out, General Motors. Key Senate committees will begin writing legislation this month. President Barack Obama
expects to have a bill on his desk by the end of the year, and he is confident that universal health care will become the law of the land. If
this legislation passes, how will it impact the Indian Health Service? If all Americans are provided health insurance, will that include
Indians? How will it affect the Indian hospitals in urban areas and out on the Indian reservations? President Obama has called for an
increase in funds for Indian health care of 13 percent in Fiscal Year 2010. This would bring the largest funding increase in 20 years to the
Indian Health Service. Will the introduction of universal health care change any of this? There is not an Indian alive today
who has not witnessed the many shortcomings of the Indian Health Service , but as the head of the Indian Health
Service, Dr. Yvette Roubideaux, has said, most of the failures were because of an extreme shortage of funds. An article in Time
magazine asks some important questions. Will there be a big, new government system? How can a nation already deeply in debt afford
health care reform, too? Can we really cover everyone? And if so, what will be covered? How will we bring down the costs? With a
deficit nearing $1 trillion, this last question is very relevant. I believe Sebelius and Roubideaux are stepping into a situation that, for the
first time in the history of the Indian Health Service, will be dramatically swayed by what is happening on the national scene. Fighting
for funding every year for the Indian Health Service was a given. It was an ongoing battle that never changed, and the IHS was often the
loser. But with universal health coverage looming on the horizon, the funds now available will become even more stretched because the
federal government will be looking for ways and means to cover health care for everyone, not just the Indians. Some experts predict the
cost of universal health care will be somewhere around $1.5 trillion. Drastic budget cuts in other areas will have to occur to free up more
money to cover the costs. As I asked earlier, how will that affect the Indian Health Service? This brings us full circle to the
old saying, If you think the government can solve all of our problems, ask an Indian.
Indian Health Service facilities suck in the squo: they're underfunded and can't deal with
chronic illnesses
Roubideaux, MD, MPH, professor of Public Health at the University of Arizona, 2002
(Yvette, Perspectives on American Indian Health, American Journal of Public Health. 92.9: 1401-1403, EKC)
I HAVE EXPERIENCED THE health challenges faced by American Indians and Alaska Natives from a
number of perspectives over time. As an American Indian child, I received health care in an Indian Health
Service (IHS) facility, and I was aware at an early age that the burden of health problems was significant.
Every visit to the clinic meant a 4-hour wait in a crowded waiting room. I heard the complaints of
relatives about the poor care they received, and there was always a sense that better care was available in
the non-Indian health clinics nearby. I also noticed that I had never seen an American Indian or Alaska
Native (AI/AN) doctor in the clinic. Perhaps if there were more AI/AN doctors, I thought, health care
would be more culturally appropriate and of higher quality. From my perspective years later, as an
American Indian physician working in the IHS, I noted that the problems and challenges in Indian health
care were still there, and now I was the doctor people waited 4 hours to see. The burden of chronic diseases
was so significant that I was often surprised to see a patient without diabetes. The epidemic of diabetes in
Indian communities, especially in the Southwest, has become so great that in some AI/AN communities,
40% to 50% of adults have diabetes.1,2 Cardiovascular disease, once thought to occur less commonly in
the AI/AN population than in the US general population, is now the leading cause of death for all American
Indians and Alaska Natives.3 The growth in the prevalence of chronic diseases in this population is a
crisis for the IHS, which was originally designed as a hospital based, acute care system and is currently
severely underfunded.

36
I.H.S. Affirmative

The Federal government funding to Indian Health Services falls short, only representing 50
percent of need.
Berry, Indian Country Today correspondent, 09
(Carol, Indian Country Today, Native health needs and federal apathy are told at an HIS conference, 6/24/09,
DENVER IHS funding shortfalls and health care cutbacks are identified every year, but nothing is
done about it, according to one tribal leader who said We want better health care for our people and we
want to be heard.The words were those of Theresa Two Bulls, president of the Oglala Sioux Tribe, Pine
Ridge, S.D., but the underlying sentiment seemed to be universal among tribal representatives who attended a
two-day summit with federal officials April 15 and 16.The Health and Human Services tribal consultation
included representation from Native nations in Colorado, Utah, Wyoming, South Dakota, Montana and North
Dakota and from HHS and IHS regional and national offices.Although the current IHS budget of $3.58
billion represents a seven percent increase over 2008, it still represents only about 50 percent of need,
according to tribal participants.
Tribal representatives underscored their concerns with first-hand experiences: The Northern Arapaho man
who recalled that a few counties over they had better treatment (for West Nile virus) They give us peanuts
and expect us to accept it, said Two Bulls, who urged tribes to speak with a unified voice. Every time a
crisis happens on the national level its the Indian programs that get cut first.The Obama administration has
promised change, so Im holding that in my heart and my mind for my Lakota people.for their horses than
for the Indians. Or the woman whose cancer-stricken mother would not take medical marijuana prescribed
for her out of fear she would be evicted from federal housing. There was the sign reported at the OB-GYN
sign-in at an IHS facility, You will not be seen unless you are in labor. The stark reality was recounted of
dealing with a reservations youth suicides, occurring at an alarming rate.The IHS budget would be double
its present $3.5 billion-plus if it were fully funded, said Dr. Donald Warne, executive director of the
Aberdeen Area Tribal Chairmans Health Board. The additional $3 billion represents less than 1
percent of the $700 billion HHS budget and would solve a lot of health needs if it were made
available.Creating an assistant secretary of Indian health position with policy directing authority and
awarding block grants directly to tribes would be positive measures, he said.Doni L. Wilder, of the Rosebud
Sioux Tribe, who was named acting deputy director of IHS in February, said the budget includes $7.5 million
for domestic violence prevention after a study of the problem by Amnesty International.Under the American
Recovery and Reinvestment Act, $1.3 million each is allocated for two Indian health centers: The Bristol Bay
Area Health Corporation in Dillingham, Alaska and the Native American Community Health Center,
Phoenix, Ariz., according to conference material.Other funding areas include $500 million for construction,
operation and improvement of health facilities; $5.3 million for urban health clinics and tribal entities; and
$153 million to benefit changes in Medicaid and the Childrens Health Improvement Program.The
presidents IHS fiscal year 2010 budget of more than $4 billion builds on resources provided in the
American Recovery and Reinvestment Act. Anslem Roanhorse Jr., executive director of the Navajo
Nation health division, cited grim but familiar reservation statistics on the Navajos West Virginia-size
tribal lands: A diabetes death rate three times the national average; alcohol-related deaths at eight
times and homicides more than two times the national rates; and 46 percent of residents with one sign
or another of obesity. Among other needs, tribal leaders stressed reauthorization of the Indian Health
Care Improvement Act, which has been awaiting congressional action for a decade, and the fulfillment
of federal treaty and trust responsibilities. Marjorie Bear Dont Walk, Salish/Chippewa, director of the
Indian Health Board, in Billings, Mont., pointed out that although nearly 70 percent of Native people live offreservation, only about one percent of the IHS budget is designated for urban programs.

37
I.H.S. Affirmative

The Federal Governments lack of funding for health care prevents Natives from receiving
proper attention
Melmer, Indian Country Today Writer, 03
(David, Indian Country Today, American Indian Health Care Involves States, 12/5/03,
It;s not all bad. Indian health care infuses $170 million into the state economy with an estimated total
economic impact of $512 million. Those figures are estimated and not based on actual data provided through
scientific means.
Although those figures may indicate that health care is properly funded, there are many cases where people
are not receiving proper health care because of limited funds. Contract health care for American
Indians is care provided off the reservation in hospitals for approved conditions including surgery and
life-threatening illnesses that cannot be handled by IHS facilities. Much if that care can be denied for
payment based on the availability of funds in a discretionary fund established by Congress. This leaves
the patient responsible for payment, which in many cases is not possible because of lack of employment
or limited employment.
Hospitals such as Rapid City Regional have to write off much of the debt. David Goehring, vice
president of finance for RCRH said that facility has had to write off $1.5 and 2 million per year from
non-collectible debt on American Indian health care. "A lot of Native Americans off the reservation go
to the ER thinking IHS will pay the bill," said Mike LaPointe, R-Mission, and member of the Rosebud
Sioux Tribe.There are other programs provided through the state that many American Indians can apply for
that would take care of at least a portion of their medical payments, including Medicaid."During routine
visits, discharge planners work with patients to look at what the patient is eligible for. This has improved over
the years," said Vern Donnell, service unit director for the Pine Ridge IHS Hospital.Some patients take
applications home and never return the paperwork that would make them eligible for other financial
programs.Underfunding also creates a larger pool of people that are placed on credit risk status that
makes them ineligible for borrowing for home mortgages and other products. This creates another
economic negative for the state.But what can the state do to help increase health care and economic
stability? "It all goes back to economics. We don't see enough federal funds for health care," Donnell said.
Dale Young, deputy service unit director for Rosebud said that IHS tries to bring in a larger number of
specialty care physicians to the IHS facilities and to do so contract health funds are used.What IHS
facilitators in South Dakota try, they said, is to be creative with what funds they have. The Rapid City
Regional facility sees about 10 new American Indian patients a day and has at any time up to 60 in-patients,
said Kathy Ducheneaux, patient's rights advocate at RCRH, and member of the Cheyenne River Sioux
Tribe.There is an IHS facility, Sioux San in Rapid City, but services are limited there. Patients are referred
from Sioux San to RCRH and Medicare and Medicaid patients usually go directly to RCRH, Ducheneaux
said.RCRH has five reservations within its area and Ducheneaux said that contact must be made with the
person's reservation within 72 hours after coming to the emergency room and sometimes it's difficult when
the person lives on one reservation and is enrolled on another.The bottom line is that quality of health care
is linked to funding and the federal government has fallen behind in that category, state legislators and
IHS officials agreed."This is never going to stop unless congress funds IHS like they said," said J.E.
"Jim" Putnam, R-Wagner, on the Yankton Reservation.

38
I.H.S. Affirmative

American Indians are finding death more economically beneficial than paying for health
care, resulting in shorter life expectancy
Briggs, Indian County Today Columnist, 08
(Kara, Indian Country Today, 8/29/08, Briggs: New track for Indian health care
Northwest tribal health advocates say the rising cost of fuel is exacerbating budget shortfalls at tribal
and IHS clinics, and it is increasing the suffering of Indian people who need health care. Andy Joseph
Jr., the vice chairman for both the Portland Area Indian Health Board and an elected member of the
Colville Confederated Tribes business council, believes the time for talk is over.;'We're not just maintaining
status quo,'' Joseph said. ''We're losing ground. We're losing our elders.''At a July meeting of the tribal
delegates to the health board, Joseph was thinking. He was thinking about a Native cancer patient whose
family had to choose between paying their bills and buying gas to drive her more than 100 miles each way
for cancer treatments.The patient died because the family couldn't afford the gas.Joseph was thinking about
this while Doni Wilder, the Portland Area director of the IHS, was giving her report to the delegates.Fresh
from a stint as the acting assistant director of the IHS, Wilder, who is Rosebud, was showing slides about the
state of federally-funded care for Northwest Indian communities and relating anecdotes from her adventure
in headquarters.Her communication didn't relate to Joseph's growing sense of frustration and grief, or that of
others in the room.''The time for talk is over,'' he said, ''I am thinking of declaring a state of emergency in the
Indian Health Service because of fuel prices. They're not only affecting us, they're killing our people.''Wilder
who was still at the microphone, said ''I don't know who you call to declare a state of emergency?''She
mused, ''Do you call the county or the state or FEMA?''But Joseph was ignoring her. He knew that most of
the health board delegates were elected leaders in their nations, who could take a declaration back to their
councils for enactment.''I move,'' he said, ''that a state of emergency be declared because of all the deaths.''A
second came from somewhere in the audience. The vote when called was unanimous. A few delegates made
supporting comments, and then the meeting moved on as if nothing had happened.Three weeks went by.I
wondered, if a declaration of a state of emergency goes unheard, does that mean it didn't count?I called
Joseph at his office in Nespelem, Wash., the capital of the Colville Confederated Tribes.He hadn't heard
anything more about the declaration either. But he hopes that it can in time help to change the direction of
federal policy, or at least kick start federal inaction. The magnitude of the problem is most clear on
reservations, where some tribes say the expense of death benefits is rising faster than the budget for
health care.''People are not living longer than they were in the recent past,'' Joseph said. ''Go back 10
years ago, we were given reports where we were starting to live longer lives.''But Joseph, 48, said
people are dying, including many his age and younger.The role of a state of emergency is clear in cases
of a natural disaster.
According to the Web site of the U.S. Federal Emergency Management Agency, states of emergency are declared for the purpose of
alleviating hardship and suffering, providing appropriate emergency measures, or for the purpose of identifying, mobilizing and
providing necessary equipment and resources.But can states of emergency be effective when declared by tribal leaders for social issues?
Joseph believes that they can be effective in focusing attention.The Colville Confederated Tribes had success with a different grim
declaration two years ago, Joseph said. It was declared after a series of suicides occurred on the reservation in Central Washington state.
''It had to do a lot with we're only funded in our mental health department at one-third of our need for the size of our tribe,'' he said.That
declaration also might have gone unheard, if not for a statement Joseph made during a U.S. Department of Health and Human Services
budget hearing.Joseph, who I've seen wear his buckskin regalia to meetings where all the other tribal leaders wore business suits, has a
way of cutting to the quick of issues.After that speech, dollars were found to increase mental health services on the Colville reservation.
Not enough dollars, but some. Joseph credits these increased services with halting the suicides.The dollars in that case came from the
DHHS, not the IHS. He thinks that the answer to the current problems could include resources from various federal agencies. These
resources could, for one example, help rural Native nations to buy hybrid vehicles to transport patients long distances to medical
care.Such declarations from tribal leaders need to be carefully considered by all, even when the status quo suggests that nothing is going
to change.Joseph doesn't blame the IHS employees for the state of Indian health, but he said they can play an increased role in
documenting the effect of funding gaps.He is asking them to document the shortfalls not only on budget sheets but in reports. In these
reports, he said, he'd like them to write how many children went untreated, how many elders died and how many treatments were
delayed because there wasn't enough money in the budget.''I'm getting tired of no action from the people who are
supposed to save my peoples' lives,'' Joseph said. ''I swore an oath to be responsible for all my people
and to uphold the constitution of the United States. They are obligated to look after our health needs. I
think every employee from Indian Health Service needs to know that.''

39
I.H.S. Affirmative

Native Americans suffer some of the worst health problems, and lack the federal funding
for basic health care.
New York Times, 2008
(New York Times Vetoing Historys Responsibility.1-28-08, http://www.nytimes.com/2008/01/28/opinion/28mon3.html?
_r=1&scp=1&sq=vetoing%20history's%20responsibility&st=cse, accessed 6-29-09, ESM)
President Bushs threat to veto a bill intended to improve health care for the nations American Indians is
both cruel and grossly unfair. Five years ago, the United States Commission on Civil Rights examined the
governments centuries-old treaty obligations for the welfare of Native Americans and found
Washington spending 50 percent less per capita on their health care than is devoted to felons in prison
and the poor on Medicaid. Additional commentary, background information and other items by Times
editorial writers. A bipartisan bill to begin repairing this shameful situation is now on the Senate floor. It
takes aim at such long neglected needs as the plight of urban Indians, who account for two-thirds of the
nations 4.1 million tribal population. Most of the American Indians and Alaska natives living in cities
are either ineligible for, or unable to reach, the limited help of the Indian Health Services reservationbased programs. During the Bush years the White House has sought to eliminate not bolster the
severely underfinanced Urban Indian Health Program. Studies have established that Native Americans
suffer worse than average rates of depression, diabetes and cardiovascular disease. The Senate bill would
improve treatment for these problems, as well as address alcohol and substance abuse, and suicide among
Indian youth. It would expand scholarship help so more American Indians could pursue careers in health
care. The administration insists it wants to improve health care for Native Americans. But it objects to
the most basic parts of the Senate measure, including its provisions for better urban health programs
and its proposal to provide better access to Medicaid and Medicare. Officials also reject the bills
proposal to build new clinics because it would require the government to pay construction workers
prevailing local wages and benefits. The nation has clear legal and moral obligations to protect the
welfare of Native Americans. Congress must rebuff President Bushs veto threat and vote overwhelmingly
to strengthen and reauthorize the Indian Health Care Improvement Act.
Despite federal responsibility to provide American Indians with health care, they receive
the least funding of any group.
Indian Report, 2004
(Indian Report, The Indian Report, An Inequity that Must End, Winter 2004, http://proquest.umi.com/pqdweb?
index=8&did=652770611&SrchMode=1&sid=2&Fmt=3&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1246256184&clientId=
10553, 6-29-09, ESM)
How would you like to receive treatment only if you were in danger of losing life or limb, with preventive
care out of the question? Due to grossly insufficient provision of funds from Congress, health care
services are -- by default -- rationed in Indian Country. This inadequate funding is complicated by
increased pharmacy costs, lack of access to specialists, and a growing native population. Although
Indian health care is a federal responsibility, denial of care continues despite treaty obligations and
severe need. Advocates are challenging the status quo. Few in the U. S. are completely satisfied with their private health insurance
and care, let alone Medicare, veterans benefits, or Medicaid. Still, most people would be astonished to learn how generous their benefits
are compared to those administered by the Indian Health Service (IHS). The expenditure per Medicare enrollee is
around $6,000; each veteran receives around $5,200 and each federal worker receives approximately
$3,800 through the Federal Employees Health Benefits program. In contrast, roughly $1,900 is spent
per Native American eligible for IHS services. Our government spends twice as much on health care
for federal prisoners as for Native Americans. The poorest and, in many ways, least healthy members
of our society must make do with the fewest resources. On parts of the Navajo reservation, some people
receive less than $800 per capita. Take Action Now: The amount budgeted for Indian Health Services for
Fiscal Year 2004 edged up only a fraction despite well-documented shortfalls in care, mandatory cost
increases for salaries, and high inflation in medical costs. Urge your representative to support significant funding
increases to meet health needs of indigenous people and to support immediate reauthorization of the Indian Health Care Improvement
Act (S 556, HR 2440) to update, refocus, and expand programs for Indian health. FCNL also supports the Healthcare Equality and
Accountability Act (S 1833, HR 3459) advanced to improve the health status of minority groups and to provide culturally and
linguistically appropriate care.

40
I.H.S. Affirmative

The federal government continues to make budget cuts to Native American healthcare
programs, leaving the growing number of urban Native Americans with no options.
Smith, Navajo Times writer, 2006
(Noel Lyn, Navajo Times, Flagstaff clinic vital to off-rez Natives, 3-30-06, http://proquest.umi.com/pqdweb?
index=0&did=1052761841&SrchMode=1&sid=5&Fmt=3&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1246257165&clientId
=10553, 6-29-06, ESM)
FLAGSTAFF - Behind the front desk in the lavender colored lobby of the Native Americans for Community
Action Family Health Center sit the medical charts of 6,000 patients. The waiting room has pamphlets about
health care and disease prevention. Near a TV there are videotapes about diabetes, including one entitled
"Rez-Robics for Couch Potato Skins." Beyond the entry area are four examination rooms where nearly 5,000
Native Americans who reside in Flagstaff and surrounding off-reservation communities are seen for
medical treatment each year. This clinic is one of 34 urban Indian health centers in the nation that face
closure if Congress approves President Bush's proposal to eliminate $33 million in funding for the
program. Bush says the money should be redirected to reservation health programs. The clinic staff is
composed of two medical doctors, two medical assistants, two registered nurses, a nurse practitioner, a
diabetes educator, and six office support staff. They provide services arranging from family medicine, illness
care, immunizations, health promotion and disease prevention, family wellness advocacy, prenatal care,
family planning, and diabetes nutrition services. Carol Barth, a registered nurse at the Flagstaff clinic,
describes it as having a "family practice" atmosphere. The Flagstaff clinic sees up to 60 patients a day,
many of whom could not get back to the reservation for health care, she said. Approximately 97.5
percent of the patients are Navajo, 1.5 percent are Hopi, and the remainder are from other tribes including
Apache, Hualapai, Supai, Paiute, Cherokee and Sioux, according to statistics for the period October 2004 to
September 2005. The clinic also served 1,423 non-Indian patients during that time. "I think it is absurd...I
think it is cruel to do and it breaks treaties as far as I'm concerned," Barth said about plans to close the
urban clinics. "I don't care if people live on the reservation or off, they're entitled to health care." Helping
diabetics In addition to treating illness and providing preventive care, the Flagstaff NACA clinic houses a
diabetes office, which is managed by Teresa Eichinger. During "Diabetes Days," the clinic offers diabetic
patients check-ups and mental health screenings, and a visit with the nutritionist or the diabetic coordinator.
The diabetes program is not targeted by the proposed cuts, but where it would be located remains uncertain if
the clinic closes. There is no pharmacy in the clinic, but some medications are dispensed at discounted prices
to Native American patients through an agreement with the Indian Health Service. Barth explained that a 10day course of antibiotics might cost a patient $7 at the clinic, compared with $25 or more if he or she bought
the same medicine elsewhere. Uninsured patients also are accepted for treatment, paying a maximum of $20
to see a doctor and the minimum cost for medication. If a patient has no money, the center uses some of its
funds to cover the cost of the visit. No one is turned away because he or she cannot pay for services, Barth
said. Modern and traditional Like most urban Indian health centers, the Flagstaff clinic offers both modern
and traditional methods of therapy. Five counseling services are available and all incorporate some aspect of
traditional practices within the treatment. Those traditional healing opportunities are not available at other
local health care centers, said Crystal Pohl, director of planning and development for the NACA clinic.
"Those centers are not cultural attuned, I think that is a real important thing for patients," she said. In urban
Indian health centers, those who know about traditional healing are able to help patients with either modern
medicine or traditional healing, Pohl said. "I always thought that what the government did to indigenous
people, that health care was one of the things that we're always going to be provided," said Gabriel Yaiva,
who visited the Flagstaff clinic recently with a sore throat. "I guess it is still being provided but at a minimal
level ..." One-percent saving The NACA Family Health Center contracts with IHS under the authority
of Title V of the 1976 Indian Health Care Improvement Act. The proposed $33 million cut represents a
little over one percent of the total IHS budget, said Dana Russell, NACA chief executive officer. Not
only would closing the clinics save little or no money, it runs counter to the growing number of urban
Indians, Russell said.

41
I.H.S. Affirmative

Native American healthcare programs continue to lack funds and the federal government
refuses to fulfill its obligation.
Melmer, Indian Country Today writer, 2005
(David, Indian Country Today, Healthcare is all about the funding, 11-16-05, http://proquest.umi.com/pqdweb?
=10553, 6-9-09, ESM)
RAPID CITY, S.D. -- While some health care organizations presented information on research, data
collection and surveys at the recent Aberdeen Area Tribal Chairman's Health Board annual meeting,
tribal and IHS officials focused on money -- or the lack thereof. Budgets for IHS facilities in the
Aberdeen Area and elsewhere in the country have been flatlined for the past decade, putting the
funding at about 40 percent of the actual need, IHS officials said. The Aberdeen Area covers North
Dakota, South Dakota, Nebraska and Iowa. No one denied the disparities in Indian country health care.
More money is spent per capita on federal prisoners than on American Indians, which is a treaty
obligation of the U.S. government. Funding is under $2,000 per American Indian, while federal prisoners
receive just under $3,000. The national average is more than $5,000 per person. "That's why Indians want to
go to prison," one tribal person joked. The underfunding of American Indian health care is nothing new,
yet the service is critical. Attempts to increase funding are ongoing, with congressional hearings and by
individual tribal representatives working one-on-one with congressional leaders. The solution remains: lobby
Congress for more funding, said John Blackhawk, chairman of the Winnebago Tribe of Nebraska and
president of the AATCHB. The method of lobbying may change, with the collection of more data and
statistics. The bottom line is that some people do not even try to access health care because funds for it have
run out and the red tape involved with the collection of fees intimidates many tribal members in need of
health care. Now, veterans on reservations are being told to access medical needs at veterans facilities, which
would require a lengthy drive from most of the reservations. Funding is so critical that tribal members who
need services such as hip or knee replacement surgery may have to wait until the next budget cycle. Priority
payments go to heart patients. Contract Health Service, part of the IHS, distributes funding to the
service units for medical needs. If the CHS referral committee denies payment for services, the patient
is held responsible for the bill, Jesse Taken Alive, Standing Rock Sioux Tribe council representative, said. Health officials said
it is best if the patient seeks pre-approval for any procedure to determine if it is covered. "We need to hold the government to the treaty
obligations," said Carole Anne Heart, executive director of the AATCHB. "We need to think of strategies to tell people our health is not
taken care of, that people are dying because we don't have any money." Heart said people have to resort to using the ambulance as a
substitute for a doctor's appointment. The tribes in the Aberdeen Area have direct-service health care; they do not contract, as do many
tribes. The large land-based treaty tribes that constitute the Aberdeen Area assert that the federal
government needs to fulfill its fiduciary and treaty obligations. The now-completed 2006 budget
consultation process includes a majority of policy benefits recommended by tribal officials. More than 300
comments were incorporated, the most of any final budget document, Gena Tyner-Dawson, senior adviser for
tribal affairs in the Office of Intergovernmental Affairs, said. But with the comments in place, there still is no
guarantee of increased funding. In the shadow of underfunding, additional frustrations may be headed
Indian country's way. Congress is in the process of working on a deficit reduction policy in which
Medicaid is on the hit list for funding cuts. If that is the case, Indian country -- already on the bottom
rung of the funding ladder for health care -- will be hit very hard. Eric Broderick, DDS, senior adviser
for tribal health policy in the Office of Intergovernmental Affairs, said the reduction in Medicaid funding is
a valid concern and any cuts will affect states and tribes. Medicaid funding is pass-through from the state
to the tribes. With the poverty rate on the reservations very high, Medicaid becomes an important
source of funding for childrens' and elders' health care needs. Data collected by the IHS and tribes form a
foundation with which to approach Congress. The tribal leaders were told frequently that Congress wants the
data; if that is the case, the goal is to get congressional leaders to take a hard look at it. Jon Perez, director of
the Division of Behavioral Health, said funding is all about politics. Funding for Veterans Administration medical
health care facilities, with half the patients, is four times greater than that for IHS, he said. "We are now getting the data that will go to
Congress," he said. "Information is power and data is a weapon. You can't go hat in hand and expect anything. "If you can count coup,
you can count services." Data reduces people to numbers, Roger Trudell, chairman of the Santee Sioux Tribe of Nebraska, said: "People
are not data -- we deal with real people. "Where is the money to help people? There is money to collect data." One frequent and longtime
complaint from the tribal leaders is that the budget for direct health care has to compete with administrative and other expenses. In the
Aberdeen Area, the chief executive officers of three service units were relocated. Other people transferred in to cover those positions and
others moved around -- a series of expensive maneuvers. To cover the expenditure, IHS estimates the cost and submits the request to the
Department of Health and Human Services. Most of the cost does not come out of the IHS budget, officials said.

42
I.H.S. Affirmative

American Indians lack healthcare despite US obligation
Jalonick , Associated Press reporter for North Dakota, 09
(Mary, Atlanta News, Promises, Promises: Indian health cares victims, 6-15,
http://www.ajc.com/services/content/health/stories/2009/06/15/forgotten_Indian_victims.html, accessed: 6-29-09,
KEH)
On some reservations, the oft-quoted refrain is, dont get sick after June, when the federal dollars run out.
Its a sick joke, and a sad one because it is sometimes true. Officials say they have about half of what they
need to operate, and patients know they must be dying or about to lose a limb to get serious care.
Wealthier tribes can supplement the federal health service budget with their own dollars. But poorer tribes,
often those on the most remote reservations, far away from city hospitals, are stuck with grossly
substandard care. The agency itself describes a rationed health care system.
The sad fact is an old fact. The U.S. has an obligation, based on a 1787 agreement between tribes and the
government, to provide American Indians with free health care on reservations. But that promise has
not been kept. About one-third more is spent per capita on health care for felons in federal prison, according
to 2005 data from the health service. In Washington, a few lawmakers have tried to bring attention to the
broken system as Congress attempts to improve health care for millions of other Americans. But tightening
budgets and the relatively small size of the American Indian population have worked against them.
It is heartbreaking to imagine that our leaders in Washington do not care, so I must believe that they do not
know, Joe Garcia, president of the National Congress of American Indians, said in his annual state of Indian
nations address in February. When it comes to health and disease in Indian country, the statistics are
staggering. American Indians have an infant death rate that is 40 percent higher than the rate for
whites. They are twice as likely to die from diabetes, 60 percent more likely to have a stroke, 30 percent
more likely to have high blood pressure and 20 percent more likely to have heart disease.
American Indian health clinics are often ill-equipped to deal with such high rates of disease, and poor clinics
do not have enough money to focus on preventive care. American Indian programs are not a priority for
Congress, which provided the agency with $3.6 billion this budget year. Officials at the Indian Health Service
say they cant legally comment on specific cases such as TaShons. But they say they are doing the best they
can with the money they have about 54 cents on the dollar they need. One of the main problems is that
many clinics must buy health care from larger medical facilities outside the health service because
they are not equipped to handle more serious medical conditions. The money that Congress provides for
those contract health care services are rarely sufficient, forcing many clinics to make life or limb decisions
that leave lower-priority patients out in the cold.
American Indian healthcare funding is substandard

Bowman, FierceHealthcare, 09
(Dan, FierceHealthcare News, American Indians receiving substandard healthcare, 6-15,
http://www.fiercehealthcare.com/story/american-indians-receiving-substandard-healthcare/2009-06-15 , accessed:
6-29-09, KEH)
In a sad, but all too true case of healthcare negligence in the United States, the Associated Press reports that
the Indian Health Service System's level of care for it's 2 million patients in 35 states is "grossly
substandard" a good portion of the time. Among other reportable statistics, death rates for American
Indian infants were found to be 40 percent higher than their white counterparts.
Many qualified American Indians don't apply for services such as Medicare and Medicaid because they don't
have access to the sign-up process, says the Associated Press. A lack of federal dollars also is a big reason
for the poor health statistics of American Indians; Congress approved a budget of $3.6 billion for the
Indian Health Service System for this year, not nearly enough to attract top-tier doctors, or purchase
top-of-the-line equipment.
Heck, even inmates in federal prison have it better when it comes to healthcare: 2005 data points out that
one-third more is spent, per capita, on the healthcare of felons in federal prison than on healthcare for
reservations. While Sen. Byron Dorgan (D-ND) has attempted to bring this issue to light, he has not had any
luck getting any legislation passed. Furthermore, a problem of political "clout" exists: Ron His Horse is
Thunder, chairman of the Standing Rock tribe, pointed out to the Associated Press that his tribe is "not one
congruent voting bloc in any one state or area."

43
I.H.S. Affirmative

IHC is underfunded, greatly decreasing life expectancy- only plan solves
Modern Healthcare, 09
(Lexis Nexis, Leaders say status quo for CDC despite pandemic announcement, 6-15,
http://www.lexisnexis.com/us/lnacademic/search/homesubmitForm.do, accessed: 9-30-09, KEH)
The Senate Indian Affairs Committee hosted a hearing to learn about suggestions for improving the nation's
American Indian healthcare system. According to Sen. Jon Tester (D-Mont.), who opened the hearing,
estimates show that the Indian Health Service, an HHS agency, is funded at about 52% of need. ``We
must do something to address the appalling health statistics among Native Americans,'' Tester said. He added
that American Indian women in Montana have a median life expectancy of 64 years compared with the
average of 81 years for the general population. Type 2 diabetes, infant mortality and suicide rates are
also higher in the American Indian population as compared with the general population, Tester said.
IHS is a big recipient of both federal stimulus money and a proposed budget boost (June 1, p. 6). The purpose
of the hearing was to inform committee members before they draft a ``concept paper'' that they will send to
tribes for review and reaction, said Barry Piatt, spokesman for the committee. Piatt said that the committee
could introduce a new Indian Healthcare Improvement Act next month. Last year, the Senate passed the act,
but the House did not approve the bill. Paul Carlton, a physician and retired lieutenant general in the U.S.
Air Force, testified before the committee about strategies used in Iraq that could be applied to the Indian
Health Service to improve services, such as using mobile surgical vans.
Funding is inadequate: the Indian Health Service currently sorts about 60% of what is needed
and is subject to change because it is part of discretionary spending.
Fottler et Al., Professor and Executive Director of Health Administration Programs at The
University of Central Florida, 2003
(Myron D., Can Community Health Center Funding Enhance Health Services for Native American Tribes and
Organizations? JournalofHealthCareforthePoorandUnderserved,15,September23rd,Page196,MAG)
Congressional Funding of IHS: Federal funding for Native American health care is not based on
entitlement appropriations, as Medicare and Medicaid are, but instead on discretionary funding from
the budget of the DHHS. Consequently, the IHS budget is subject to strong political influences; the IHS
budget suffers from chronically inadequate adjustments to keep up with inflation. The transfer of the
responsibility for Native American health care from the Department of the Interiors Bureau of Indian Affairs
to the IHS in 1954 was not so much to improve Native American health care as to initiate the dismantling of
specific federal support of Native American health care. Overall, Congress funds Native American health
care at the average rate of 60% of needs. This 60% of needs funding translates into a per capita level of
$1,776 for IHS enrollees compared with a per capita level of $5,490 for Medicare enrollees. Figure 3
shows a comparison of IHS per capita funding with other health care plans. Indian Health Service funding
has increased 95% from 1990 to 1999. However, in constant 1998 dollars, the increase has only been 26%.
Figure 4 shows the trend of the IHS budget for the fiscal years 19901999. Because the IHS service area
population increased 25.2% for the period 19902000, real per capita expenditures were flat over the 10-year
period.

44
I.H.S. Affirmative
AT: Medicaid Solves

Medicaid spending is being cut short causing a reduction in available services to Native
Americans
Marquez, a Co-investigator on the Wellness Circles Project at the Center for American
Indian Research and Education, 2001
(Carol A., The Challenges of Medicaid Managed Care for Native Americans, p.151-154 , KS)
However, because of federal and state changes that have attempted to limit Medicaid expenses over the
past decade, Medicaid beneficiaries have been enrolled in managed care plans that control access to
provider sites as well as the level of reimbursement for services (Kauffman et al. 1997). Rolin (1998)
noted the disparity in cost per IHS beneficiary in contrast to that of the typical Medicaid beneficiary;
$1,403 for an IHS beneficiary versus $3,369 for each Medicaid user was reported per year 19931997.
Rolin also highlighted the difficulty of decreasing disparities in health status of racial and ethnic populations
because the IHS has fallen far behind other agencies in the Department of Health and Human Services in
funding level increases in recent years (Rolin 1999). Since 1967, the IHS has taken steps to increase tribal
involvement in the administration of health care programs to the present level of contracts and federal
compacts (Kauffman, Johnson, and Jacobs 1997). Tribal self-governance is an IHS policy that allows for
tribal control of Indian health care facilities. Developed after years of tribal requests for participation in
the planning and implementation of health care services, tribal self-governance has seen much success
in areas of Alaska, where local control with full participation by consumers helped to build a strong
system of managed care (Dixon et al. 1997). In other states, however, diminishing state Medicaid
reimbursement levels resulted in service reduction through contract and compact tribal health programs
(ibid.). Recently, these clinics have adopted stricter service eligibility requirements, which further limits
services to members of their service populations. Prior to the passage of P.L. 93-437, little if any Indian
Health Service funding was available for health care services to urban American Indians (Kauffman,
Johnson, and Jacobs 1997). The relocation policy of the Bureau of Indian Affairs in the late 1950s through
the early 1960s resulted in a mass exodus from tribal lands to major cities. The relocation program was
geared toward training programs for young Indians; however, it resulted in isolating Indians from their
families, tribes, and homeland while assimilating these youth to American values and ways. The other
significant event that led to the development of urban Indian populations was the end of World War II. The
return of WWII veterans and especially a significant number of young Indian veterans to urban locations
tended to ensure that these young Indian veterans settled in urban locations. Today there are 41 urban
Indian health programs (I/T/U) located in 34 sites across the country. These programs provide primary
and preventive health care services with few resources. Urban programs estimate that less than 25% of
their service needs are met with IHS appropriations (Waukazoo 2000).

45
I.H.S. Affirmative
AT: Medicaid Solves

Because many Native Americans live in more isolated areas, help from Medicaid is needed
greatly, but hard to access
Marquez, a Co-investigator on the Wellness Circles Project at the Center for American
Indian Research and Education, 2001
(Carol A., The Challenges of Medicaid Managed Care for Native Americans, p.154-156 , KS)
Tribal and urban programs continue to face challenges to their healthcare delivery systemthat of the
ever changing managed care environment (Fleury 2000). Fleury noted that neither the Indian Health
Service, tribally operated clinics, nor urban Indian health programs had populations well suited to
participate in the typical managed care organization (MCO). Factors such as geographic isolation,
population mobility, case mix, and maintenance of continuous Medicaid eligibility previously identified in
Roundtable Reports (Rosenbaum 1996) are key factors that contribute to the unsuitability of enrolling
Native American Medicaid beneficiaries in MCOs. Both Fleury and Clain characterized these factors as
barriers to the feasibility of Medicaid managed care models succeeding in Indian Medicaid reimbursement
for services to AI/AN Medicaid beneficiaries. I/T/U providers struggle to seek reimbursement of services to
Medicaid beneficiaries (Clain 2000; Fleury 2000). In general, states expectations of managed care
organizations are based on the medical model. In contrast, I/T/U organizations provide more preventive types
of services for response to the needs of their clients (Waukazoo 2000). Despite the challenges, I/T/U
organizations continue to seek Medicaid reimbursement because it supplements IHS funding of health
care services to American Indian/AN patients. Further limitations placed by local MCOs on assignment of
Medicaid beneficiaries to I/T/U organizations create additional hardships for these clinics. Waukazoo (2000)
and Bushyhead (2000) noted that urban Indian health clinics were seeing increasing numbers of
uninsured American Indian patients not eligible for Medicaid coverage. However, urban Indian health
programs are required to serve these patients. In order to address this issue, the Minneapolis clinic has
challenged Hennepin County to reimburse the Indian Health Board (IHB) for estimated lost Medicaid
reimbursements over a seven-year period due to reassignment of Indian Medicaid beneficiaries to other
primary providers (gatekeepers) under the Hennepin County Managed Care Plan. When some former IHB
patients sought care at IHB, the center was unable to seek reimbursement because it was not their designated
provider. IHB could not be reimbursed for its services unless the patient requested a change of primary care
site (Bushyhead 2000). This situation resulted from the establishment of Hennepin County as one of the
counties involved in a statewide demonstration project to control and reduce the cost of Medicaid expense for
eligible beneficiaries in Minnesota. This demonstration was approved by the Health Care Financing
Administration under an 1115 waiver that not only restricted freedom of choice of provider by Medicaid
beneficiaries but implemented other changes aimed at modeling managed care plans for Medicaid patients
(Marquez 1996). This IHS action resulted in a loss of income for the Indian Health Board because it was not
reimbursed for services provided to these patients. Furthermore, the IHB was not assigned many of its former
patients eligible as Medicaid beneficiaries under the Hennepin County plan. This is only one example of a
situation common to many urban Indian health clinics. This situation remains a critical issue across the
country as is noted in the points made by Michael Mahsetky, IHS Chief of Legislation (2000). Recent health
indicators reported by the Indian Health Service reveal premature death rates and tuberculosis rates
higher than those of the general population (Kunitz 2000). Rolin, of the National Indian Health Board,
reported substantial unmet health needs in IHS 1998 testimony before the Senates Indian Affairs
Committee (1998). The current trends in state-run Medicaid managed care plans present a dismal
future for any significant decreases in the health disparities between American Indians, Alaska Natives,
and the general population. An area not often considered in the AI/AN health care delivery system arena is
that of patient satisfaction. Dixon et al. (1997) discuss the Indian patients conflicts in attitudes and
satisfaction with services in a study of provider choices made by patients in selected sites.

46
I.H.S. Affirmative
Inherency Health Care Costs

Health care is too expensive for Native Americans
Ho, Reporter at Hearst Seattle Media, 09
(Vanessa, seattlepi.com, Native American death rates soar as most people are living longer, 3-12,
http://www.seattlepi.com/local/403196_tribes12.html, accessed: 6-29-09 , KEH)
On the Okanogan plains in northeast Washington, the Colville tribes recently buried a man who died after
facing a bleak decision: spend his money on trips into town for dialysis, or buy food for his family.
It was a variant of a fate that has doomed many people on the stark, remote reservation, causing the timberdependent tribes to increasingly spend their money on burials. "It's a choice between feeding your family and
living," said Andy Joseph Jr., a Colville Confederated Tribes council member. "Our people can't afford to pay
for their funeral services." From isolated reservations across the state to urban pockets around Seattle, Native
Americans are dying at higher rates than a decade ago, at a time when people in Washington are living
longer, healthier lives. A recent state Department of Health most report showed that the march against
cancer, heart disease and infant mortality has largely bypassed Native Americans. In 2006, the latest
year studied, Native American men were dying at the highest rate of all people, with little change since
the early '90s. Their life expectancy was 71, the lowest age of all men, and six years lower than that of
white men. The news was just as grim for Native American women. Their death rate had surged by 20
percent in a 15-year period, while the overall death rate had decreased by 17 percent.
But the starkest health disparity was among babies. Native American babies were dying at a rate 44
percent higher than a decade ago, while the overall rate of infant deaths had declined.
"People are suffering," said Marsha Crane, health director of the Shoalwater Bay Tribe in Western
Washington. "It's, 'Here's the bad news, here's your diagnosis. But here's the worse news: We can't afford
to pay for your drugs, or your surgery.' That's happening every day with tribes across the country."
The trends are a reversal of the progress made in the past century, when the Indian Health Service, a federal
agency, made great strides in sanitation, disease control and vaccinations. Deaths nationwide largely fell from
the 1950s to the '80s.
"It's astounding what the agency did, in terms of life expectancy," said Joe Finkbonner, executive director of
the three-state Northwest Portland Area Indian Health Board. "But what I'm starting to see, in some of the
data, is that that progress has either stagnated or is starting to reverse itself."
Health experts say the downward drift, which reflects national trends, stems from entrenched health
disparities exacerbated by years of inadequate funding.
Treaty obligations and acts of Congress require the United States to provide health care for Native
Americans, but experts say funding chronically falls short of medical inflation.

47
I.H.S. Affirmative
Inherency Lack of Coverage

American Indians suffer from severe coverage gaps
Giago, Grand Forks Herald Columnist, 2009
(Tim, Will health reform bypass Indians? Grand Forks Herald, June 28, 2009, no p. CME)
Key senate committees will begin writing legislation this month. President Barack Obama expects to have
a bill on his desk by the end of the year, and he is confident that universal health care will become the law
of the land. If this legislation passes, how will it impact the indian health service? If all americans are
provided health insurance, will that include indians? How will it affect the indian hospitals in urban
areas and out on the indian reservations?
President obama has called for an increase in funds for indian health care of 13 percent in fiscal year 2010.
This would bring the largest funding increase in 20 years to the indian health service. Will the introduction of
universal health care change any of this? There is not an indian alive today who has not witnessed the
many shortcomings of the indian health service, but as the head of the indian health service, dr. Yvette
roubideaux, has said, most of the failures were because of an extreme shortage of funds. An article in time
magazine asks some important questions. Will there be a big, new government system? How can a nation
already deeply in debt afford health care reform, too? Can we really cover everyone? And if so, what will
be covered? How will we bring down the costs? With a deficit nearing $1 trillion, this last question is very
relevant. I believe sebelius and roubideaux are stepping into a situation that, for the first time in the history
of the indian health service, will be dramatically swayed by what is happening on the national scene.
Fighting for funding every year for the indian health service was a given. It was an ongoing battle that
never changed, and the ihs was often the loser. But with universal health coverage looming on the
horizon, the funds now available will become even more stretched because the federal government will be
looking for ways and means to cover health care for everyone, not just the indians. Some experts predict the
cost of universal health care will be somewhere around $1.5 trillion. Drastic budget cuts in other areas will
have to occur to free up more money to cover the costs. As i asked earlier, how will that affect the indian
health service?
Health Care for Natives has been plagued with alarmingly severe inadequacies; the need
for action could not be clearer
Representative Young, Arkansas Republican, 2009
(Don, States News Service, BIPARTISAN LEGISLATION TO IMPROVE ACCESS TO HEALTHCARE FOR
NATIVE AMERICAN COMMUNITIES, June 5, 2009, no p. CME)
"The unmet health needs of American Indians and Alaskan Natives are alarmingly severe and grow
worse everyday we fail to act on this important issue," said Pallone, Chairman of the House Energy and
Commerce Subcommittee on Health. "Native Americans have difficulty accessing the simplest of services,
such as primary medical care and dental services, due to lengthy wait times, distant locations and
transportation challenges. For far too long there has been a growing divide between the healthcare
services afforded Native American communities. This legislation is long overdue and is needed to improve access to
quality healthcare for American Indians and correct the inequities these communities experience."
"I have pushed for reauthorization of the Indian Health Care Improvement Act for the last five Congresses,
and I will not stop that push until all of those living in Indian Country have access to quality and modernized
care," Rahall said. "As Chairman of the House Committee on Natural Resources, I am prepared to hold a
hearing on this critical and needed legislation in the near-term, so that we may see through, once and for all,
the reauthorization of the basic health services provided under the Act."
"For far too long, access to health care for Native Americans has been grossly inadequate ," Kildee said.
"The disparity between the health status of Native Americans and the rest of the American population
continues to get worse over time, and the need for action could not be clearer. This critical legislation will make
great strides to help end this inequality and improve health care for our Native American population."

48
I.H.S. Affirmative

American Indians have problems with the affordability, availability, accessibility, and
acceptability of their healthcare.
U.S. Commission on Civil rights, 2004.
(U.S. Commission on Civil Rights, commission of the U.S. federal government charged with the responsibility for investigating, reporting on,
and making recommendations concerning, civil rights issues that face the nation, NATIVE AMERICAN HEALTH CARE DISPARITIES
BRIEFING, Tribal-Federal government relationship, February 2004, p. 5, ESM)
Access to health care is determined by four major factors of health care coverage: affordability, availability,
accessibility, and acceptability.107 Affordability is the ability to purchase insurance or care.108 Availability of
care is determined by availability of staff and facilities and measured by the ratio of providers to population.109
Accessibility is indicated by the eligibility for and/or entitlement to receive care, and by the ease of service access
and utilization.110 Acceptability is determined by whether the service provided and received is perceived to be
acceptable to the health care recipients.111 These four factors are of major concern for Native Americans. To a
limited degree, IHS services have made health care affordable for eligible Native Americans. A later section of this
summary will examine funding issues and the degree to which federal funding makes adequate health care
affordable. Additionally, IHS initiatives and a greater number of tribes getting involved in the management and
operation of health care services are making IHS services more culturally acceptable k or Native Americans. These
and other issues associated with quality and acceptability of care will also be discussed later. The remaining factors,
availability and accessibility of health care, are influenced by IHS organization and its service delivery system. How
IHS services are structured and provided significantly influence the degree to which Native Americans have access
to health care. Each will be discussed below. Unfortunately, for the more than 538,000 Native Americans living
on reservations or other trust lands where the climate is inhospitable, the roads are often impassable,112 and
where transportation is scarce, health care facilities are far from accessible. Anslem Roanhorse, director of the
Division of Health for the Navajo Nation, stated that on the Navajo reservation 78 percent of the public roads
are unpaved and 60 percent of the homes lack telephone service.113 Even worse, for those who can get to the
facilities, the equipment, medicine, and services are often not available for their needed treatment. Traveling
to more distant facilities or delaying treatment are the only options. For example, in Eagle Butte, South Dakota, the
Cheyenne River Sioux tribe does not have an obstetrics unit in its hospital and is worried that the new proposed
hospital will not have one. .Obstetrics services for the tribe.s approximately 210 births a year are contracted out, .and
last year there were five births in the ambulance on the way to Pierre,. 90 miles away..114 For the Kalispel tribe in
Usk, Washington, the problem extends beyond specialty services. The tribe has no on-site primary care
facility, so tribal members must travel 75 miles to receive care at the Wellpinit Service Unit IHS clinic or use an
IHS contract facility, if available.115 Geographical access problems are not limited to remote, rural facilities.
For the 25,000 urban Indians living in Denver, Colorado, the closest IHS hospitals are in Albuquerque, New
Mexico (450 miles away) and Rapid City, South Dakota (400 miles away).116 Beyond location and inadequate
transportation, understanding the availability and accessibility factors requires an understanding of how the
eligibility requirements, and structure and operation of IHS influence access. After discussing eligibility
requirements, this section will explore the three delivery mechanisms for health services (IHS direct delivery,
tribally operated facilities, and urban Indian health facilities), including their respective advantages and
disadvantages.

49
I.H.S. Affirmative

Less access to health care results in American Indians only seeking treatment in emergency
situations, which is more expensive and less practical.
Of the four major factors affecting access to health care, affordability is often considered the most
formidable. Because the government has a trust responsibility to provide health care to Native
Americans, the adequacy of federal funding becomes one measure of affordability, one measure of
access to health care. Federal funding will be addressed in a later section of this summary. This section will
address the individual Native Americans contribution to funding health care as represented by enrollment in
health insurance programs. Because Native American enrollment figures for job-based insurance and public
insurance programs fall well below those for white Americans, the barriers to health insurance are the focal
point for this discussion. Data from the Kaiser Commission on Medicaid and the Uninsured indicate that 43
percent of Native Americans have access to employer-sponsored health insurance, compared with 72
percent of white Americans.209 This low figure may be partly attributed to high unemployment among
Native Americans, 7.6 percent as opposed to 3.0 percent for white Americans,210 and to the fact that many
jobs available to Native Americans do not offer health insurance.211 In addition to those with job-based
insurance, 27 percent rely on public health insurance, such as Medicaid, Medicare, the State Childrens
Health Insurance Program (SCHIP), and the Veterans Administration services.212 This leaves the remainder,
nearly one-quarter of the Native American population, with no insurance at all.213 For those
individuals, IHS is the only obligated provider. If IHS is unable to provide services, the uninsured
Native American must seek charity, or more frequently, go without health care until the situation
requires emergency attention. Of those who are uninsured some percentage are eligible for coverage but
are not enrolled because they either lack access or they choose not to enroll. Many choose not to enroll
based on the belief that the federal government is required to provide health care, without regulation or
limitation, as a result of treaties and obligations created in court decisions and legislation.214 The barriers
to insurance that Native Americans face are numerous and substantial. They can be explained using
three overlapping categories: social and cultural factors that limit enrollment, procedural factors that
discourage enrollment, and factors that limit the collection of third-party funds to which Native
American patients and/or IHS are entitled. The specific factors within each category are discussed in
sequence below.

50
I.H.S. Affirmative

American Indians must go through a long process in order to receive healthcare, and even
then they are frequently turned away.
Through its Contract Health Services (CHS) program, IHS purchases primary and specialty health care
services for eligible Native Americans when services are not available through IHS direct or tribal
services.193 For FY 2004, $493 million has been requested for CHS, amounting to 25 percent of funds
allocated for clinical services.194 To receive contract health services, in addition to meeting IHS
eligibility requirements, Native Americans must live within designated contract health service delivery
areas.195 Because of severe funding restrictions, IHS limits contract health care to those services determined
to have medical priority.196 According to Ed Fox, executive director of the Northwest Area Indian Health
Board, these priorities are established locally and vary depending on the level of funding and the relative
nature of the need.197 In FY 2001, IHS deferred payment authorization for 111,620 recommended cases
and denied care for 22,030 cases,198 a 75 percent increase in denials from 1998.199 The denial rate has
reached the point that the existence of a loss of life or limb rule is commonly recognized.200 Mr. Fox
observed that by August, with several weeks remaining in the fiscal year, most facilities either defer or deny
gallbladder surgeries and eyeglass prescriptions, as well as other services of equivalent urgency.201 As an
illustration, IHS officials identified one facility where only 14 of 45 cases needing referral for necessary
services were even forwarded for CHS review.202 Even fewer of those reviewed actually received
contracted care.203 As a further impediment to accessing quality health care, IHS requires that other
non- IHS sources be exhausted for payment before contract services are sought.204 In other words, the
patient still receives a referral, but instead of IHS paying the bill, the referral lists the alternate health
care provider as the payer, subject to any applicable restrictions. If the alternate provider requires any
deductible or co-payment IHS may pay it, if funding is available.205 As discussed earlier, Contract Health
Services programs require that patients live in certain contract health service delivery areas identified
for their respective tribes. Accessibility to IHS contract health care services is effectively ended when
individuals move from their home reservations to urban or rural locations, which are often outside
contract health service delivery areas.206 Consequently, IHS-funded services are generally not
accessible to the estimated 61 percent of Native Americans who live off reservations in urban areas. The
exceptions are the estimated 150,000 with limited access to the 34 Urban Indian Health Programs. As
explained earlier, not all IHS and tribal hospitals provide a full range of specialty services such as
cardiology, ophthalmology, and orthopedics. For these services, patients must use the Contract Health
Services program, subject to the severe budgetary constraints discussed above. Contract services are usually
restricted because most of CHS funding is consumed by emergency care.207 Those awaiting more routine
care experience lengthy delays and unnecessary complications.208 Accordingly, while contract services
provide health care otherwise unavailable through IHS direct or tribal providers, due to restricted funding,
limited services, and lengthy delays in receiving services, Native Americans do not have full access to health
care through the Contract Health Services program.

51
I.H.S. Affirmative

Tribes receive the lowest social services of any group availing Natives as second-class
citizens
The truth is that health care is merely one example of the way we consistently deprive Native American
communities of the services they desperately need. A 2003 study by the U.S. Commission on Civil Rights
found that, per capita, Native Americans receive disproportionately lower funding than the general
population for federally administered services and programs. This means that for every essential
service our government agrees to provide for its citizens including basic law enforcement, education,
and infrastructure Native Americans get less than any other segment of society. The time for action is
long past due. Native Americans were the very last to be granted the right to vote, and were therefore
too long treated as second-class citizens. Now there are those who seek to treat Native American
governments as second-class sovereigns. They seek to accomplish this by not availing them of the same
tools for self-reliance and recognition afforded to state and local governments. The issue of poverty is
an integral first step. Poverty is both the cause and the consequence of all the ills visited upon Native
Americans. Failure to address poverty causes deprivation and hardship in these communities today,
and robs the next generation of any opportunity to succeed and thrive tomorrow. The invisibility,
silence, and neglect must end. As President-elect Barack Obama ascends to the White House, now is the
significant moment to address the many problems Native Americans endure, including systemic
poverty. Barack Obamas election symbolizes Americas progress in healing the racial wounds that scar our
history. A new commitment to Native Americans will continue that process. His pledge to reduce poverty in
America should extend to the Native American communities that feel poverty most acutely, and that have
been relegated to the shadows of our society for far too long. Advocates, legislators and the new president
must put Native Americans on the national agenda. Including Native Americans in our vision of a better
America is an indispensable part of the "change we need."

52
I.H.S. Affirmative
Inherency Coverage Denial

Natives without documentation are being unfairly turned away from healthcare
Burke, Associated Press Writer, 07
(Garance, The Associated Press, Some health clinics deny care to urban Indians, 3/21/07,
http://www.usatoday.com/news/health/2007-03-08-1071298246_x.htm, Accessed 6/28/09. CAF
- After tribal elder Vera Quiroga was turned away from the very clinic she helped found, she had little choice
but to drive to a far-off reservation for her dental work. The reason, she said, is that the BIA doesn;t
recognize her as a Yaqui, even though her children and grandchildren have tribal documentation. ''They said
if you don't have federal paperwork, you can't get service anymore,'' said Quiroga, 82. While federal law
requires taxpayer-funded tribal clinics to serve all patients of Indian ancestry, some have recently stopped
admitting those who can't document their federal tribal status, patients and clinic officials told The Associated
Press. Federal officials deny that qualified patients are being turned away and say they're doing all they can to
ensure a health program for urban Indians isn't shut down entirely. The IHS oversees 33 clinics nationwide that
provide free or discounted medical services to city-dwelling Indians. But Martin Young, chairman of the board of
the Santa Barbara clinic where Quiroga was turned away, said it received a letter last fall from the BIA
instructing it to stop offering free health services to patients from unrecognized tribes or who don't have a
bureau identification card. It has since turned away about 200 patients, including Janet Darlene Garcia, 50, a member of
the Coastal Band of the Chumash Nation, which does not have federal status. She relied on the clinic for her diabetes counseling sessions. An IHS
spokesman said the letter explained who was eligible for care, but denied that the agency instructed Santa Barbara to withhold services. However,
clinic managers in Tucson, Ariz.; Wichita, Kan.; and Boston reported getting similar directives. ''IHS is suddenly saying that you can't serve this
Indian even though he looks Indian, and his family says he's Indian and has all of this history of being Indian, but he doesn't have this piece of
paper,'' said Susette Schwartz, director of the Hunter Health Clinic in Wichita. ''We need some consistency.'' Under the Indian Health Care
Improvement Act of 1976, Congress funds health care programs for members of tribes recognized by states or the federal government, as well as
their descendants. Many states recognize tribes the federal government does not. In California, the right to government-supported medical care is
extended a step further, to those whose ancestors lived here in 1852 and are ''regarded as an Indian by the community.'' Phyllis Wolfe, who
oversees urban Indian programs at the U.S. Department of Health and Human Services, said clinics that are granted federal dollars must follow
federal guidelines. Wolfe could not explain why the clinics would have changed their policies. ''I don't believe they would do that, but I can't say
that that's not been done,'' she said. Sen. Byron Dorgan, D-N.D., chairman of the Senate Committee on Indian Affairs, said tribal members who
lack federal documentation should still be treated at urban clinics. The committee held a hearing March 8 on amending the IHCIA, and Dorgan
said afterward the law doesn't need to be changed to ensure care for patients like Garcia and Quiroga. ''We shouldn't be having people
turned away from these health clinics because they don't have a piece of paper,'' said Dorgan, who also has
heard reports of patients being denied care because they lacked proper paperwork.
Coverage denials are rampant

Further, due to restricted funding, those patients awaiting more routine care experience lengthy delays
and unnecessary complications. For example, Cherokee Nation states that a child experiencing recurring
ear infections would not be referred to an ear, nose, and throat specialist for treatment until the child shows
signs of hearing loss. Dr. Craig Vanderwagen, acting chief medical officer for IHS, acknowledged how
rationing health care is not the optimal method of treating patients: We dont feel good about the
number of patients who need care who are rejected because their problem is not life-threatening. . . .
Its rationing. We hold them off until theyre sick enough to meet our criteria. Thats not a good way to
practice medicine. Its not the way providers like to practice. And if I were an Indian tribal leader,
Id be frustrated. In summary, the rationing of health care leads to the denial or delay of treatment, and
compels patients to accept cheaper and less effective treatment interventions or to go without care.
While there is insufficient data to assess the actual impact of rationing services on mortality and morbidity
rates, denying or delaying treatment as a result of rationing inevitably worsens the overall health status
of Native Americans. Although Contract Health Services programs provide health care otherwise
unavailable through IHS direct or tribal providers, the limited services and rationing of care erect an
insurmountable barrier, ensuring Native Americans will not have full access to adequate health care.

53
I.H.S. Affirmative
Inherency Lack of Services

American Indians are receiving inadequate health services as a consequence to the
governments lack of funding to health care
Pallone , member of the Native American Caucus of the U.S. House of Representatives, 03
(Frank, Indian Country Today, Rep. Pallone: Inadequate Health Care Service equals Inadequate Services, 1/15/03,
An old health care funding concept has recently been converted to a mathematical equation. It is: ihc$=ihcs.
Simply explained: inadequate health care funding provided by the federal government equals
inadequate health care services to American Indian peoples. Since the beginning of the contractual
relationship between tribal governments and the U.S. government, the federal funding system has
consistently provided inadequate health care funding, failing to fulfill this aspect of the agreement. The
contract called for Indian peoples to relinquish vast amounts of their prime homelands and natural
resources, in exchange for, among other things, on-going federal heath care. The land transfers
occurred. Adequate funding for Indian health care did not. The provision of health services to members of federally
recognized tribal governments grew out of the unique government-to-government relationship between the federal government and tribal
governments. This long-standing relationship is affirmed in the U.S. Constitution, as well as various treaties, court decisions, federal
statutes, Executive Branch policies and tribal government law. These legal strings verify that tribal governments retain their inherent
powers as nations, self-governing authority and the ability to enter into legally binding agreements with the federal government.The
health-care system that serves Indian peoples is known as the Indian Health Service (IHS). Currently, the IHS meets approximately 40
percent of the health care needs of Indian peoples, due to a shameful lack of federal funding.The current IHS budget is $2.9 billion. For
the IHS to meet the health care needs of the vast majority of the under-served within its service population, funding would have to be
increased six fold. The National Indian Health Board estimates that $18 billion is needed to have the health care system run effectively
and efficiently. However, Indian peoples and the IHS would settle for yearly incremental increases, starting this fiscal year with a $5
billion dollar budget.Without moving forward with accelerated funding increases for the IHS, well-
documented problems will continue and undoubtedly be joined with additional problems for this
health-care system and the federal government. For example, as a result of the inadequate health-care
capabilities of the IHS, the federal government has paid more than $24 million in malpractice settlements and
judgments in the past 48 months alone. Some lawsuits brought by Indian patients or their families have been
dismissed by federal judges on technicalities or other legal justifications. Makeshift operating and recovery
rooms equipped with minimal, unqualified staff are becoming more commonplace in federally
sponsored Indian hospitals and health clinics. These doctors and support staff often have poor
professional track records, and when coupled with inadequate medical equipment and supplies, the
result is an environment that cannot insure the well being of Indian patients. There is no doubt why
some federal judges have referred to the IHS services as substandard.The health care provided by the IHS
is often considered less comprehensive than what privately insured Americans receive. At times,
patients in the IHS system have to do without some essential medical procedures and exams, such as
mammograms or gall bladder surgery. On average, Americans receive $3,800 each in health care per
year. The IHS is able to provide approximately $1,300 per Indian person.Nevertheless, if similar healthcare services were mandated for non-Indian people of this country, there would be major outcry and
resistance from, among others, lawmakers, medical professionals, health insurance agents and patients. If
such health-care mistreatment would not be tolerated in the general population, why are such services
deemed acceptable for Indian peoples? Given such facts, if the Congress and the president do not provide
the on-going health-care funding necessary to run the IHS system appropriately, the health-care
problems for Indian patients will worsen. When this happens, the federal government will continue to
mismanage crucial funding through the back end of the accountability system via malpractice lawsuits and
settlements.The federal government has a legal and moral responsibility to provide adequate health-care
funding for the IHS. For too long, businessmen and nearly every state have become very wealthy reaping the
benefits of the historically flawed relinquishment of Indian land. The least that the President and the new
Congress can do beginning in January is to fulfill both obligations by ensuring that adequate health-care
funding exists for American Indian peoples.

54
I.H.S. Affirmative

Native Americans receive drastically less healthcare than the general US population and
Federal prisoners, which has led to the minority having the highest rates of diabetes, heart
disease, SIDS, and tuberculosis
Dashle, senior senator from South Dakota, 03
(Tom, Indian Country Today, Sen. Dashle: The time has come to improve health care in Indian Country, 8/24/03,
Through treaties and Federal statute, the federal government has promised to provide health care to
American Indians and Alaskan Natives. Sadly, our federal government has not even come close to
honoring that commitment. While the Indian Health Service is the only source of health care for many
Indians and is required to provide it, funding has never been adequate. Despite this treaty obligation
and evidence showing a major health care crisis in Indian country, Republicans in Congress continue
to vote against even the most basic increase in funding for Indian health care.The meager funding for
Indian health care is all the more shocking when compared to other groups for which the federal
government has direct responsibility for health care. A Civil Rights Commission report investigating
health care funding for Native Americans found that our government spends about $5,000 per capita
each year for health care for the general U.S. population and $3,803 for federal prisoners. Shockingly,
the federal government spends only $1,914 per capita for Indian health care, roughly half of what we
spend for federal prisoners. The results of this neglect are apparent in countless communities in South
Dakota and across the country. The July U.S. Commission on Civil Rights report documented shocking
health care disparities between Indians and other Americans. Native Americans have a lower life
expectancy than other Americans and a disproportionate number of serious medical problems. Indians
have the highest rates of diabetes in the country, the highest rates of heart disease, the highest rates of
sudden infant death syndrome and the highest rates of tuberculosis. Additionally, Native Americans
are often denied care most of us take for granted, and in many cases would consider essential. They are
often required to endure long waits before seeing a doctor and may be unable to obtain a referral to see
a specialist. Sometimes lack of funds means care is postponed until Indians are literally at risk of losing
their lives or their limbs. Other times, they receive no care at all. The end result is a population that
lives sicker and dies younger than other Americans.The case for immediate action could not be more
compelling. Native Americans have the greatest need, the greatest number of extraordinarily difficult health
problems, yet they have one-half the resources we commit to federal prisoners.Sadly, Republicans in
Congress and the Bush administration have chosen to turn a blind eye to the health care needs of Native
Americans. When Republicans had the chance to approve an amendment I offered to provide an additional
$2.9 billion to the Indian Health Service, the measure was defeated on a party-line vote. Months later,
Republicans again rejected a second amendment that would have provided a modest $292 million increase in
funding for the IHS - an amendment they earlier had claimed to support. Native Americans are facing a
literal "life or limb" test before they can access health care today. The problem is real. The solution is
simple. We must start giving the Indian Health Service the funds it needs to provide Native Americans
the health benefits they were promised.This fight will not be easily won, but I am committed to improving
health care in Indian country. The United States has promised to provide health care for Native Americans,
and I will continue to work as hard as I can to make good on that promise.
Native Americans face major health problems and the current health care structure is
inadequate
Alaska Natives continue to experience significant disparities in health status compared with the US
general population and now are facing the new challenges of rising rates of chronic diseases. The
Indian health system continues to try to meet the federal trust responsibility to provide health care for
American Indians and Alaska Natives despite significant shortfalls in funding, resources, and staff.
New approaches to these Indian health challenges, including a greater focus on public health, communitybased interventions, and tribal management of health programs, provide hope that the health of Indian
communities will improve in the near future. (Am J Public Health. 2002;92:14011403)

55
I.H.S. Affirmative

American Indians receive less and lower quality health care than the rest of Americans,
resulting in higher morality rates.
Phillips, Science Spectrum Magazine Writer, 06
Bruce, Science Spectrum Magazine, Minority Health Care---Separate and Unequal, 11/1/06,
http://www.sciencespectrumonline.com/artman/publish/article_196.shtml, Accessed 6/28/09, CAF)
Racial and ethnic disparities in U.S. health care are well documented. One of the most thoughtful and
thorough examinations of health care disparities was chaired by Louis W. Sullivan, M.D., a former secretary
of the U.S. Department of Health and Human Services. The Sullivan Commission concluded, in a report
published in 2004, that the primary cause of the poor health care for minorities resulted from unequal
representation of these minorities in the health care professions: The lack of minority health
professionals is compounding the nations persistent racial and ethnic health disparities. From cancer,
heart disease, and HIV/AIDS to diabetes and mental health, African Americans, Hispanic Americans,
and American Indians tend to receive less and lower quality care than whites, resulting in higher
mortality rates. While African Americans, Hispanics, and Native Americans make up more than 25 percent
of the U.S. population, they account for only nine percent of nurses, six percent of physicians, and five
percent of dentists, according to the Sullivan Commission report. Increasing the number of ethnic health care
providers, however, will not in itself solve this complex, multifaceted problem. So what will? Science
Spectrum recently interviewed several experts to discover why minorities continue to suffer from disparities
in health care and, most importantly, to learn what can be done about it. Self-inflicted Wounds Many of the
diseases that disproportionately harm minorities, such as diabetes and heart attacks, are made much
worse by cultural habits and traditions. Obesity is an example. A National Health and Nutrition
Examination Survey, published recently in the Journal of the American Medical Association found that
nearly 40 percent of all non-Hispanic Black youth surveyed were obese. Not fat, not chubby---obese.
Obesity is the direct result of diets high in excess fat, carbohydrates, and salt. Lack of regular exercise is also
cited as a contributing factor. Obesity, like health care itself, seems to be a class issue. Education, culture, and
income appear to be the culprits. Wealthier Americans of all races tend to be healthier, more weight
conscious, and insistent on better health care. And they get it. Thomas A. LaVeist, Ph.D., is director of the
Johns Hopkins University Center for Health Disparities Solutions. He is the author of Minority Populations
and Health: An Introduction to Health Disparities in the United States, published by Jossey-Bass. He says,
The evidence is overwhelming that health care disparities do exist, explaining that there are health care
disparities across race and social status. ... There are disparities in access, utilization, and quality of care
received.Determinants for these disparities involve a complex web of genetics, individual behavior, and
socio-environmental factors. These disparities determine how long we live and how healthy our life is, Dr.
LaVeist emphasizes, offering a number of statistics to buttress his argument: Whites live an average of 5--7
years longer than Blacks. African Americans are more likely than whites to be victims of homicide and
HIV/AIDS. Infant mortality is double for Blacks. Its been that way since statistics have been kept, he
says.While the social environment is partly to blame for health disparities, economic policy is also a factor.
Noting that health insurance is still largely employer based, not government based, and that Blacks suffer
disproportionately from unemployment, Dr. LaVeist believes that serious changes to the health care delivery
system itself are in order. He says, Forty-six million Americans have no coverage, and there is a great
difference between quality and scope of health coverage for those who have it. Every other western society
has a government-sponsored health care program, which provides exactly the same health care coverage to
every citizen, he emphasizes.He isnt convinced that simply increasing the number of minority health care
providers will solve the problem. There is no evidence to suggest that increasing minority health care
providers will increase the quality of care. However---and this is true for all ethnic groups---patients report
more satisfaction when they are of the same culture as the provider. No Easy SolutionsThere are no easy
solutions, says Dr. LaVeist. The most promising solution is to focus on evidence-based quality
improvements, where they standardize care as much as possible.He is not impressed by racial medicine
theories, whereby drugs are targeted for people according to their race. I am not convinced that there are
genetic differences that substantially affect medicine, he says, continuing, Race has complicated and
compromised science. Race has the ability to make logical people not think logically. ... Minor genetic
differences cannot begin to explain the disparities we see in health care, even if minor genetic differences do
exist.I think the solution to health disparities is to fix issues logically. Get politics and political correctness
out of it, he tells us.Garth N. Graham, M.D., M.P.H., deputy assistant secretary for Minority Health, Office

56
I.H.S. Affirmative

Phillips, Science Spectrum Magazine Writer, 06 (Continued)
of Minority Health, Department of Health and Human Services, agrees that diabetes, heart disease, and
obesity all disproportionately impact minority communities. Infant mortality death rate is an indicator of
the health of a population, Dr. Graham says, pointing out that the African-American death rate for infants is
twice as high as that of white infants. Its even worse for Native Americans, where the infant mortality
rate tops that of whites by a full 48 percent. He is most troubled by the high rate of HIV/AIDS among
minorities and says, Blacks have 38 percent of all AIDS-related deaths in the U.S., despite the fact that they
are only 12 percent of the total population. ... In 2004, the rate of AIDS for Black women was 23 times
higher than for white women, and 8 times higher for Black men than white men.Dr. Graham advocates a
number of steps to improve health care for minorities. For one thing, it would help to have more diversity in
the health care work force, because patients and providers with the same background work well together.
Whats more, in his view, cultural competency does impact quality of care. This includes behavior as simple
as respecting the values and customs of patients, as well as language proficiency to make it possible for
provider and patient to communicate freely. To achieve parity, he says, it is important to provide the same
standards of care for the same symptoms, regardless of race or class.If increasing the size of the minority
work force is important, how can this be achieved? Dr. Graham says his office is working with minority
colleges and universities---including the HBCUs---as well as majority institutions to encourage students to
get into the health field, but acknowledges that We need to double our efforts and reach out to people. ...
Minorities bring cultural sensitivity. We need health care professionals to be representative of our
communities.\He emphasizes the importance of creating public-private partnerships to reduce disparities.
Everybody needs to be aware of this problem, he says. Its not just a racial or ethnic problem. It affects
everyone. We need everybody involved, not just the public sector. Invisible People. Polly Olsen sees
minority health care problems firsthand. As director of the University of Washingtons Native American
Center of Excellence, she works to improve the lives of Native Americans. A member of the Yakima tribe, she
grew up on Washingtons Yakima reservation and attended public schools before earning a college degree in cultural anthropology.The
role of centers of excellence, like the one Olsen oversees, is to encourage, recruit, and retain Native American students to be health care
professionals and return to the tribal community.She told Science Spectrum that the health care disparity among American Indians is
very real. Native medical problems are similar to those in other minority populations, Olsen points out, citing obesity-related illnesses
such as diabetes, arthritis, cardiovascular disease, cancer, and others. She says that Native Americans tend to be left out of
national studies and research, which further alienates this community from the larger health care
community. There are a number of reasons for this, it turns out. For one thing, many Indians are unwilling to participate because
they dont want to be guinea pigs. They distrust the American research system in part because they doubt that the benefits will ever get
back to them. Furthermore, the Native American population is small and, consequently, difficult for health care researchers to access.
This issue of being invisible is especially true for urban Indians, she believes, because they blend into the dominant culture and are not
easily identified as ethnics. Lack of adequate health care funding is another problem for Native Americans.
According to Olsen, the Indian Health Service (IHS) has the lowest payout per patient of any federal
health program. The IHS receives approximately $1,000 per patient for a year of health care, she says,
while veterans receive about $5,000. Prisons get more per patient than the Indian Health Service, she
says.

57
I.H.S. Affirmative
Inherency Lack of Services (Urban)

Native Americans living in urban areas receive even less care and health coverage than those on
reservations.
Pagano, Ojibwe News writer, 2006
(Jean, Ojibwe News, Native Urban Healthcare Crisis: New Study Highlights Disparities, 9-1-06,http://proquest.umi.com/pqdweb?
=10553, 6-29-09, ESM)
Using census data from 1900 through 2000, a new study examines health care disparities between Native
Americans who move from the reservation to urban centers. This study, conducted by a group of health care
professionals, identifies what happens when Native people move away from the reservation and need to find health
care in urban areas. This study is available in the August edition of the American Journal of Public Health
(www.ajph.com). The demographics of the study are not surprising. Native Americans were twice as likely to be
poor, unemployed, and have no college degree. Similarly, the same percentages applied to mothers who received
no prenatal care or received it late, mothers who drank alcohol, mortality related to sudden infant death syndrome,
chronic alcoholism, and liver disease. In 1970, 38% of Native Americans lived in urban environments. By 2000,
this number had grown to 61%. The great migration from the reservation to the city was precipitated by the
federal policies that drove Natives away from the reservation and to the opportunities that existed in cities for
education, employment, and housing. While the benefits of access to education, housing, and jobs may be
greater than on the reservation, the move from reservation to urban living also had one big setback: the loss
of access to healthcare. Native healthcare is provided by the Indian Health Service (IHS), an entity within the
Department of Health and Human Services. To compensate for the movement of Natives to the city, IHS has
contracted with 34 urban health organizations to provide health care in urban centers that have previously been
identified as relocation areas for Native Americans. The study found that in some regions of the country, Native
Americans are misclassified in vital statistics records and that these errors consistently account for under
representation in infant mortality rates, injuries, cancer, and overall mortality rates. In some cases, miscoding
may be as high as 47% when Natives die in urban environments. The study found it difficult to evaluate data
concerning the Urban Native American. The 34 urban health units have "minimal" technical infrastructures
and demographic data is not shared among the different urban health units. Due to the dearth of information from
the urban health centers, the study used information about Natives living in urban areas to approximate the data of
those Natives served by these centers. States served by urban health units are New Mexico, California, Montana,
Illinois, Texas, Colorado, Michigan, Arizona, Wisconsin, Massachusetts, Nebraska, Minnesota, New York, South
Dakota, Oregon, Nevada, Utah, Washington, and Kansas. In the 2000 census, 4.1 million people claimed Native
heritage (either mixed race or solely Native), and 2.5 million claimed solely Native heritage. 1.5 million Natives live
in urban settings and 34% of urban Natives live in areas served by urban health units. Nearly 25% of Natives living
in urban health unit areas were listed as having a disability. The percentages of children born with low birth
weights to Native mothers in urban areas were about 25% lower than the general population in the same areas. The
number of premature children born to Native mothers was higher in these same areas than in the rest of the urban
population. Native mothers in urban areas and nationwide who received no health care or late prenatal care
were twice as numerous as other population groups. The rates for maternal smoking and/or maternal
drinking for Native mothers in urban areas was approximately three times higher than in the general
population. 70% of Native infant mortality was found in unmarried mothers whereas the general population was
around 65%. Between 1995 and 2000, infant mortality rates were higher among Native women than in the general
population. Over time, the infant mortality rates in the general population declined but a similar reduction was not
observed for urban Native women. In the same time period, Sudden Infant Death Syndrome (SIDS) in children born
to urban Native women was the highest cause of infant mortality, almost twice as prevalent in this group as in the
general population. Over time, the SIDS numbers diminished in the general populations, but not among Natives. In
the time period from 1990 through 1999, roughly 20% of all Native deaths occurred in areas serviced by the
urban health centers. The leading cause of death a family of three, $15,577; for a family of two, $12,755; and for
unrelated individuals, $9,973. The report, "Income, Poverty, and Health Insurance Coverage in the United States:
2005," also contained figures on health insurance coverage. The Census said the number of people with and
without insurance rose from 2004 to 2005. Nearly 30 percent of American Indians and Alaska Natives, or
about 661,000 people, were uninsured, according to the data. This was statistically unchanged from figures
released last year. Only Hispanics had a higher uninsured rate of 32.7 percent, again the same as the year prior.

58
I.H.S. Affirmative
Inherency Lack of Services (Elderly)

Native elders in poverty need better healthcare
Moscovice and Wakefield, PhD, Director University of Minnesota Rural Health Research
Center School of Public Health and Deputy Director University of North Dakota Center
for Rural Health , 07
(Ira and Mary, Health Insurance Coverage and Access to Health Care for American Indian and Alaska Native Elders,
Upper Midwest Rural Health Center, Page 1-2, KEH)
There is a 20-fold difference in the uninsured rate between Native elders 65 years of age and older and
the U.S. general population of the same age group (15% versus 0.7%). Native elders who live on a
reservation, trust land, or in an Indian community are more likely to report they had no health insurance
than those who reside elsewhere. Transportation is an especially challenging barrier to overcome for rural
Native elders because even if they have health insurance, transportation costs are often not covered by health
insurance, and reliable, affordable transportation may not be available. Access to medical care is
problematic for those who are uninsured. Uninsured Native elders are two times more likely to have no
regular personal doctor or health provider than those who are insured, and access in rural areas is
especially difficult. In general, the uninsured are three to four times more likely to report problems
getting needed medical care, are less likely to get preventive health screenings and regular care for
chronic health conditions, and are more likely to be hospitalized for avoidable health problems (Kaiser
Commission on Medicaid and the Uninsured, 2004; Institute of Medicine, 2002). Minorities
Elders rely on IHS funding

School of Public Health and Deputy Director University of North Dakota Center for Rural
Health , 07
Upper Midwest Rural Health Center, Page 3-4 , KEH)
and over due to the eligibility for Medicare coverage at age 65. However, not all Americans are eligible
for Medicare because of the requirement for 40 quarters of Social Security-covered employment. This
eligibility requirement may be more problematic for Native elders than other elders due to high
unemployment rates on reservations. Alternatively, some Native elders under 65 years of age may be
eligible for Medicare if they are disabled or have End State Renal Disease (CMS, 2007). For both age groups,
the most frequently reported health insurance coverage is Medicare (Figure 1). The 55 to 64 years of age
group relies more on private and tribal insurance (19% and 10.4%, respectively) than do elders 65 years
and over. Page 2 UMRHRC POLICY BRIEF OCTOBER 2007 HEALTH INSURANCE COVERAGE AND
ACCESS TO HEALTH CARE FOR AMERICAN INDIAN AND ALASKA NATIVE ELDERS What are the
Characteristics of the Uninsured Native Elders? Age is the greatest predictor of health insurance status
among Native elders. Young Native elders, 55 to 64 years of age, are most likely to be uninsured with
one-third reporting having no insurance while 13 percent of adults 55 to 64 years of age in the U.S.
general population report they are uninsured (Kaiser, 2004). Older Native elders, 65 years and older,
are also less likely to be insured; Page 3 UMRHRC POLICY BRIEF OCTOBER 2007 HEALTH
INSURANCE COVERAGE AND ACCESS TO HEALTH CARE FOR AMERICAN INDIAN AND
ALASKA NATIVE ELDERS there is a 20-fold difference in the uninsured rate between Native elders 65
years of age and older and the U.S. general population (15% versus 0.7%). Overall, the percent of
uninsured Native elders residing in rural areas is higher than those in urban areas (Table 1). In addition,
Native elders who live on a reservation, trust land, or in an Indian community are more likely to report they
had no health insurance than those who reside elsewhere. Income also infl uences health insurance status
among Native elders. About onefourth of Native elders with annual incomes less than $25,000 report
they are uninsured, while 15 percent of Native elders with incomes of $25,000 or more per year, report
not having health insurance.

59
I.H.S. Affirmative
Inherency Lack of Services (Elderly)

Native elders without insurance forgo care
Center School of Public Health and Deputy Director University of North Dakota Center
for Rural Health , 07
Upper Midwest Rural Health Center, Page 1-2, KEH)
Uninsured Native elders are more than twice as likely to indicate they have no regular personal doctor
or health provider as insured Native elders (43% versus 20.4%). Access to a regular source of care is also
more problematic for rural Native elders than for urban Native elders (27% versus 19%). Uninsured
Native elders report seeking health care at an IHS/tribal or community health center more frequently than
insured elders (80% versus 63%) and less than two percent of all Native elders identify a hospital emergency
room as their source of health care. Native elders who lack any coverage are the most likely to report going
without needed health care in the prior year as compared to Native elders with coverage (17% versus 12%).
Native elders in the lowest income category with annual incomes less than $10,000 were six times more
likely to report going without care than Native elders with incomes $25,000 and over. Additionally, Native
elders identify long waiting times, transportation, and cost as reasons for not getting health care when it was
needed.These results indicate that Native elders face low levels of adequate insurance coverage and, as a
consequence, less access to needed health care. Relative to the levels of coverage and access for the general
population, these results suggest dramatic disparities. Clearly, the lack of health insurance serves as a
barrier to accessing health care services but it is not the only barrier. In addition to cost, other reasons cited
for not getting health care when it was needed included long waiting times and transportation problems.
Transportation is an especially challenging barrier to overcome for rural Native elders because even if they
have health insurance, transportation costs are often not covered by health insurance, and reliable, affordable
transportation may not be available. Policies are needed that address the financial, geographical, and cultural
aspects that negatively impact access to culturally appropriate care. A multi-faceted policy strategy to
increase health care access is required if meaningful progress is to be made in eliminating the health
disparities experienced by Native elders and the AI/AN population.

***Health Advantage***
60
I.H.S. Affirmative

61
I.H.S. Affirmative
Health Impacts Disease/Death

American Indians are several times more likely to die of curable diseases because they lack
proper healthcare.
Senator Cantwell, Wisconsin Democrat on Senate Indian Affairs, 2008
(Maria, States News Service, Summery of the Hearing on the Indian Health Care Improvement Act, Febuary 26,
2008, no p. CME)
Improving the delivery of health care services for American Indians is long overdue , said Cantwell.
Overall trends in the health of this population are simply unacceptable. American Indians and Alaskan
Natives across the country are 400 percent more likely to die from tuberculosis, 291 percent more
likely to die from diabetes complications, and 67 percent more likely to die from influenza and
pneumonia than other groups. Passage of this bill in the Senate is a critical first step to strengthening health
care services for American Indians, and living up to our long-standing trust responsibility to provide
for their well-being.
American Indians are 517% more likely to die from alcoholism than the average American;
have the poorest health status compared to any other group in the U.S.
Allen, Tribe Chairmen of the SKlallam Tribe of Washington, 2009
(Ron, Committee Report, HOUSE ENERGY AND COMMERCE SUBCOMMITTEE ON HEALTH ON
COMPREHENSIVE HEALTH REFORM DISCUSSION DRAFT, DAY 2, PART 2 CME)
Here are some of the challenges that tribal leaders face every day. Many American Indian and Alaska
Natives live in the poorest and most remote communities in the Unites States. Indian people have
among the highest rates of disease and poorest health status of any other group in the United States.
Over the past 50 years, the Native population diseases have transitioned, along with the U.S. general
population, from infectious diseases pandemics to those of aging and lifestyle disease, such as diabetes
and cardiovascular disease, cancer, and alcohol and drug abuse. Data for the Indian people is often
incomplete. However, some of the comparisons with the non-Native population are quite disturbing: We die
at higher rates than other Americans from: alcoholism (517%), tuberculosis (533%), motor vehicle
crashes (203%), diabetes (210%), unintentional injuries (150%), homicide (87%) and suicide (60%); ?
Our people have a life expectancy that is almost 4 years less than the U.S. all races population (72.9 years to
76.5 years, respectively; 1996-98 rates), and our infants die at a rate of 8.8 per every 1,000 live births, as
compared to 6.9 per 1,000 for the U.S. all races population (1999-2001 rates).
Native Americans have significantly higher mortality rates and health problems than any
other ethnic group.
U.S. Commission on Civil rights,2004.
Despite the funds appropriated by Congress to deliver health care services for Native Americans, a
wide range of public health status indicators demonstrate that Native Americans continue to suffer
disproportionately from a variety of illnesses and diseases.18 Dr. Jon Perez, director of behavioral
health for IHS, described these health disparities as .real and highly visible . to Native Americans.19 He
explained that while the incidence and prevalence of many infectious diseases have been dramatically reduced through increased clinical
care and public health efforts such as vaccination for infectious diseases and the construction of sanitation facilities, Native
Americans continue to experience health disparities and higher death rates than the rest of the U.S.
population.20 IHS has been given primary responsibility for eliminating this disproportionate health status and has been largely
successful in reducing mortality rates, while making significant improvements in other areas.21 Today, Native Americans
continue to experience significant rates of diabetes, mental health disorders, cardiovascular disease,
pneumonia, influenza, and injuries. Native Americans are 770 percent more likely to die from
alcoholism, 650 percent more likely to die from tuberculosis, 420 percent more likely to die from
diabetes, 280 percent more likely to die from accidents, and 52 percent more likely to die from
pneumonia or influenza than other Americans, including white and minority populations.22 As a result
of these increased mortality rates, the life expectancy for Native Americans is 71 years of age, nearly five
years less than the rest of the U.S. population.23 Dr. Perez pointed out some of these health disparities as
well as some of the mortality rates during the briefing.

62
I.H.S. Affirmative

American Indians are now being plagued with deaths caused by preventable diseases
Cantrell, Master of Science in Social Work Center for Indian Research and Education,
2001
(Betty Geishirt, Access and Barriers to Food Items and Food Preparation among Plains Indians, P. 65-66, KS)
Chronic diseases such as diabetes, heart disease, and hypertension have reached epidemic proportions
among American Indians in North America. In 19911993, the age-adjusted type II diabetes mellitus
mortality rate for American Indians and Alaska Natives was 31.7 per 100,000. If the three Indian Health
Service (IHS) areas with problems in the underreporting of Indian race on death certificates are
excluded, the type II diabetes mellitus mortality rate rises to 41.4 per 100,000. This is 248% higher than
the U.S. all races rate of 11.9 (USDA Health and Human Services 1996), that is, almost two and a half
times higher! The radical changes in the diet and lifestyle of American Indians over the past few decades
have moved cardiovascular disease from an uncommon cause of death among American Indians to the
leading cause of death (Alpert et al. 1991). High cholesterol levels, hypertension, and cigarette smoking
are now major problems in American Indian populations. Hypertension is often inadequately detected
and treated in Indians. Obesity accompanies high cholesterol levels. Constant cigarette smoking has now
replaced occasional ceremonial use of tobacco. All these factors have led to the great increase in the
incidence of cardiovascular disease. The Strong Heart Study is a long-term study of cardiovascular disease
among American Indians to determine cardiovascular disease rates and the prevalence of risk factors among
members of tribal groups in South Dakota, North Dakota, Oklahoma, and Arizona (Welty et al.1995; Lee et
al. 1990). While the severity of risk factors varied across the tribal groups, all tribal groups need to address
obesity, especially as it relates to cardiovascular disease and diabetes. Extremely high smoking and
cholesterol rates were also of concern. Exercise needs to be emphasized to reduce risk factors associated with
cardiovascular disease, diabetes, and obesity. Heavy alcohol consumption was also seen as a risk factor. The
severity of these risk factors and their impact is especially extreme within the Sioux tribe, in which the risk of
developing heart disease is twice that of other tribal groups.
Due to inadequate funding for healthcare, many Native Americans are being forced to live
in pain
Guedel, Lawyer and editor of Foster Peppers Legal blog, 2009
(Greg, Foster Peppers Legal Blog, Health Care Reforms Desperately Needed for Native Americans, 3-12-09,
http://www.nativelegalupdate.com/2009/03/articles/health-care-reform-desperately-needed-for-native-americans/, 630-09, KS)
Health care reform is touted as a top priority by the Obama administration, and one need only look to
Tribal reservations to see the urgency. Treaty obligations and acts of Congress require the United
States to provide health care for Native Americans, but in 2004 a Civil Rights Commission report found
the government spent more per capita on health care for federal prisoners than for Native Americans.
In addition to the lack of direct funding, Tribal members suffer from a lack of access to rural doctors and
clinics. As reported by The Seattle Times, two years ago Michael Buckingham of the Makah Tribe lost two
fingers in a fishing accident in the waters off his reservation, in the isolated coastal town of Neah Bay,
Washington. Buckingham needed physical therapy for a third finger that was severely injured, but couldn't
afford the gas to make 70-mile trips to the closest therapy clinic in Port Angeles. "If I can't get it fixed, I'm
just ready to have it cut off, because it's too painful," Buckingham said. The lack of federal funding for
health care has resulted in many Native Americans being forced to live with chronic pain, forgo
prenatal care, and suffer from untreated depression. The Indian Health Service presently operates only
31 hospitals nationwide, less than one per state. President Obama has proposed a $4 billion budget for
the IHS, a $700 million increase. Yet with federal spending at an all time high and Congress focused on
the countrys financial condition, it is uncertain how quickly new funds to improve Native health care
will emerge.

63
I.H.S. Affirmative

Numerous Native Americans die and are harmed because their health system lacks enough
money to provide service to all but those on the brink of death.
Baucus, Senator, 2007
( Max, Capital Hill Hearing Testimony, Health Care and Child Welfare Services for Native Americans, 3-22-07,
Lexis-Nexis, MEL)
But for the last 13 years, Native Americans have been waiting for Congress to fulfill those promises. For the
last 13 years, we have seen Congress fail to reauthorize the law. As a result, the current funding level for
the Indian Health Service system is only 52 to 60 percent of the need. That means that in any given year,
by the month of June, the only patients who can receive treatment in Indian Health Service hospitals are
those with conditions that "threaten life or limb." Listen to the story of one 25-year-old Native
American, a veteran of the Gulf War. He was diagnosed with a problem that required removal of his gall
bladder. Now, gall bladder removal has become a pretty routine operation. But this young man could not
be referred for surgery in an Indian Health Service hospital. His condition did not "threaten life or
limb."So he had to wait. So his gall bladder became inflamed. His kidneys and other organs shut down.
Because of this needless delay, he will be on dialysis for the rest of his life. And we can trace that result
back to a lack of adequate funding for his care. Listen to some other results of inadequate health care
funding in Indian country: Native Americans younger than 25 years of age die at a rate three times that
nationwide. Native Americans are three times more likely to die in accidents. Native Americans are
four times more likely to die from diabetes. And Native Americans are seven and a half times more
likely to die from tuberculosis.

64
I.H.S. Affirmative
Health Impacts - Diabetes

American Indians also suffer from some of the worst rates of diabetes in the world.
Diabetes Diabetes is one of the most serious health challenges facing Native Americans, resulting in significant
morbidity and mortality rates.27 In fact, Native Americans have the highest prevalence of Type 2 diabetes in
the world, and rates are increasing at .almost epidemic proportions..28 The National Institute of Diabetes &
Digestive & Kidney Diseases (NIDDK) defines diabetes mellitus as a group of diseases characterized by high blood
levels of glucose stemming from defective insulin secretion and/or action.29 Most Native Americans with diabetes
have Type 2 diabetes, also known as adult onset diabetes, which is caused by the body.s resistance to the action of
insulin and impaired insulin secretion. Type 2 diabetes can be managed with healthy eating, physical activity, oral
medication, and/or injected insulin.30 In fact, Dr. Jon Perez stated that one of the most distressing aspects of Type 2
diabetes is that with lifestyle changes it is largely preventable.31 Despite the fact that the rates of diabetes in the
Indian community are .staggering,. the rates do not paint a true picture of how devastating the disease can
really be, according to Dr. Dee Ann DeRoin, board member of the Association of American Indian Affairs.32 This is
because the leading cause of mortality in the Indian community is heart disease, and hidden in that statistic is
the fact that the largest percentage of deaths from heart disease are caused by diabetes. Thus, diabetes is both
devastating the community in terms of quality of life and .maiming and killing. Native Americans.33 Another
startling fact regarding the prevalence of Type 2 diabetes is that it has recently become a significant threat to
Native American children.34 Its incidence is rising faster among Native American children and young adults
than any other ethnic population.35 IHS has documented a 54 percent increase in the prevalence of diagnosed
diabetes among Native American youth 15 to 19 years of age since 1996.36 Historically, Type 2 diabetes has
been restricted to adults, at least partially as a result of declining insulin sensitivity with age.37 Its presence among
children foreshadows the early arrival of more serious complications.38 Another national health care authority
expressed concern about the challenges that diabetes presents for Native Americans of all ages. In 2000, Dr. David
Satcher, the Surgeon General of the United States, testified that .the diabetes rate for American Indians and
Alaska Natives is more than twice that for whites. The Pima [American Indians] of Arizona have one of the
highest rates of diabetes in the world..39 Furthermore, NIDDK estimates that approximately 15 percent of Native
Americans who receive health care from IHS have diabetes.40 Native Americans are 2.6 times more likely to be
diagnosed with diabetes than non-Hispanic whites of a similar age.41 As troubling as these numbers are, they may
understate the number of Native Americans with diabetes. In a screening study conducted in three geographic areas,
NIDDK found that 40 to 70 percent of Native American adults between the ages 45 and 74 have diabetes, many
previously undiagnosed. Data from the Navajo Health and Nutrition Survey showed that 22.9 percent of Navajo
adults 20 and older had diabetes. At least 14 percent had a history of diabetes, but another 7 percent were found to
have undiagnosed diabetes during the survey.42 Although measures can be taken to reduce the likelihood of
disability and death from diabetes, the disease is still associated with serious health complications and premature
death.43 From 1994 through 1996, the IHS age-adjusted death rates for diabetes mellitus were 350 percent greater
than the rates for the rest of the American population.44 Dr. Perez emphasized the prevention of diabetes as a way of
eliminating costly treatment options, in addition to reducing the disease burden from the suffering population.

65
I.H.S. Affirmative
Health Impacts - Diabetes

Diabetes devastates American Indian communities- has reached epidemic levels
Native American Diabetes Resources, No Date
(Native American Diabetes Resources, no date, Native Americans and Diabetes-The Facts
http://vltakaliseji.tripod.com/Vtlakaliseji/id2.html, accessed 7-7-09, AN)
This information on Native Americans and Diabetes is taken from the American Diabetes Association.
Diabetes is a disease that affects the body's ability to produce or respond to insulin, a hormone that allows blood glucose (blood sugar) to
enter the cells of the body and be used for energy. Diabetes falls into two main categories: type 1, which usually occurs during childhood
or adolescence, and type 2, the most common form of the disease, usually occurring after age 45. Diabetes is a chronic
disease that has no cure. Prevalence of type 2 diabetes among Native Americans in the
United States is 12.2% for those over 19 years of age. One tribe in Arizona has the highest rate of
diabetes in the world. About 50% of the tribe between the ages of 30 and 64 have diabetes. Today,
diabetes has reached epidemic proportions among Native Americans. Complications
from diabetes are major causes of death and health problems in most Native American
populations. Of equal concern is the fact that type 2, or adult-onset diabetes, is increasingly being
discovered in Native American youth. Diabetes Rapidly Increasing Among Native Americans, Alaskans
Reported in the December, 2000 issue of Diabetes Care: Diabetes has been growing in prevalence among
Native Americans and Alaskan Natives, according to a recent study by the federal Centers for Disease
Control and Prevention. The study found a nearly 30 percent increase in diabetes diagnoses
among these populations between 1990 and 1997. During this time period prevalence among women was
higher than among men, but the rate of increase was higher among men than women (37 percent v. 25 percent). The
increase in prevalence was highest in Alaska, where it rose 76 percent during the 1990s, and lowest in the Northern Plains region of the
United States, where it rose by 16 percent during this time period. According to the National Institute for Diabetes and Digestive and
Kidney Diseases, the "thrifty gene" theory proposes that African-Americans, Hispanic-Americans, Asian Americans and Native
Americans inherited a gene from their ancestors which enabled them to use food more efficiently during "feast and famine" cycles.
Today there are fewer such cycles; this causes certain populations to be more susceptible to obesity and to developing type 2 diabetes.
The serious complications of diabetes are increasing in frequency among Native Americans. Of major concern are increasing rates of
kidney failure, amputations and blindness. Ten to twenty-one percent of all people with diabetes develop kidney disease. In 1995,
27,900 people initiated treatment for end stage renal disease (kidney failure) because of diabetes. Among
people with diabetes, the rate of diabetic end stage renal disease is six times higher among Native
Americans. Diabetes is the most frequent cause of non-traumatic lower limb amputations. The risk of a
leg amputation is 15 to 40 times greater for a person with diabetes. Each year 54,000 people lose their foot or
leg to diabetes. Amputation rates among Native Americans are 3-4 times higher than the general
population. Diabetic retinopathy is a term used for all abnormalities of the small blood vessels of the retina caused by diabetes,
such as weakening of blood vessel walls or leakage from blood vessels. Diabetic retinopathy occurs in 18% of Pima Indians and 24.4%
of Oklahoma Indians.

66
I.H.S. Affirmative
Health Impacts - Tuberculosis

Tuberculosis is also more prevalent in American Indian communities.
45 Tuberculosis Although the tuberculosis rate among Native Americans is declining, it continues to
disproportionately affect this population in the number of cases and severity of disease.46 The
American Lung Association reported that in 1998, the incidence rate of tuberculosis among Native
Americans was 12.6 cases per 100,000 persons, which is more than five times the rate for non-Hispanic
whites (2.3).47 Similarly, in 2001, it was reported that the annual incidence of tuberculosis for Native
Americans was twice that of the overall U.S. population; mortality rates were six times higher.

67
I.H.S. Affirmative
Health Impacts Heart Disease

American Indians have also experienced an increase in heart disease
Major Cardiovascular Diseases In the past, heart disease and strokes were rare among Native
Americans, but recently heart disease has become the number one cause of death; stroke is now the fifth
leading cause of death.75 This dramatic increase appears as the general population has experienced a 50
percent decrease in heart disease; thus, Native Americans now have cardiovascular disease rates twice
that of the general population.76 These soaring rates can be traced to the high rates of diabetes, high blood
pressure, and the presence of other risk factors, including poor eating habits and sedentary lifestyles.77 The
Centers for Disease Control and Prevention conducted a national telephone survey to determine the
extent that risk factors for heart disease and stroke (i.e., high blood pressure, current cigarette smoking,
high cholesterol, obesity, and diabetes) were present in this population. According to the survey, 63.7
percent of Native American men and 61.4 percent of Native American women reported having one or
more of these risk factors. The following specific risk factors were reported in significantly high
percentages: 21 percent of men and 23 percent of women said they had been told by a health professional
that they had high blood pressure. 32.8 percent of men and 28.8 percent of women reported that they were
current smokers. Almost 16 percent of respondents had been told by a health care professional that they
had high cholesterol and more than 7 percent were told that they had diabetes. Almost a fourth of the
male respondents (23.6 percent) and nearly one-fifth of the females (19.1 percent) were obese (21.5 percent
of all Native Americans).78 The CDC also observed that having more than one risk factor for heart
disease and stroke was more common among older Native American men and women, the unemployed,
those with less education, and those reporting their health status as fair or poor.79 69

68
I.H.S. Affirmative
Health Impacts - Cancer

American Indians have higher cancer mortality rates than the rest of the U.S. population.
Cancer among Native Americans is a growing concern.82 While some statistics indicate lower cancer
mortality rates for Native Americans in some regions of the United States than for whites, African
Americans, Asians, and other races, it has become the leading cause of death for Alaska Native women
and is the second leading cause of death among Native American women.83 Among health care
professionals there is concern that lower mortality rates obscure important regional and cancer-specific
differences in mortality, knowledge of which could assist local cancer prevention and treatment strategies.84
Specifically, higher rates of cancer mortality appeared in Alaska and the Northern Plains region of the
United States, with 217.9 deaths (per 100,000 population) and 238.6, respectively, from 1994 through
1998.85 The overall cancer mortality rate for the rest of the United States for this period was 164.2
deaths per 100,000.86 These Native American cancer mortality rates in Alaska and the Northern Plains
region are attributed to colorectal, gallbladder, kidney, liver, lung, and stomach cancers.87 Similarly,
cervical cancer mortality rates were higher among Native Americans than among all racial and ethnic
populations (3.7 versus 2.6, respectively), especially in the East and Northern Plains regions of the United
States.88 A startling fact about cancer in Indian Country is that Native Americans have the lowest cancer
survival rates among any racial group in the United States.89 Though some data are available, there is
insufficient research on cancer among Native Americans.90 Nevertheless, experts have suggested that
Native American cancer patients experience the disease differently from non-Native populations.91
Reasons for the difference include genetic risk factors, late detection of cancer, poor compliance with
recommended treatment, presence of concomitant disease, and lack of timely access to diagnostic or
treatment methods.92 Lyle Jack, a representative of the Lakota Sioux, testified that misdiagnosis and
late diagnosis were especially prevalent on his reservation.93 Accordingly, additional research must be
conducted to more fully explore the magnitude and causes of cancer disparities among Native Americans.
American Indians are more at risk to death from cancer, in part because of lack of
research.
Cancer among Native Americans is a growing concern.81 While statistics indicate lower cancer incidence and mortality rates for Native
Americans than for whites, African Americans, Asians, and other races, it has become the leading cause of death for Alaska Native
women and is the second leading cause of death among Native American women.82 An additional concern is the relative comparison of
incidence and mortality rates. Although cancer incidence rates are significantly lower for Native Americans
(incidence rates for Native Americans are half the rates for whites and less than all other races), cancer
death rates are considerably closer (death rates for Native Americans are 70 percent of the rates for
whites and greater than the rates for Hispanics/Latinos and Asian/Pacific Islanders). Therefore, the
ratio of cancer deaths to new cancer cases is higher for Native Americans than the ratios for all other
races.83 The startling conclusion is that Native Americans have the poorest cancer survival rates among any racial group in the United
States. Furthermore, among health care professionals there is concern that lower mortality rates obscure
important regional and cancer-specific differences in mortality, knowledge of which could assist local
cancer prevention and treatment strategies. 85 Specifically, higher rates of cancer mortality appeared in Alaska and the
Northern Plains region of the United States from 1994 through 1998, with 217.9 and 238.6 deaths per 100,000, respectively.86 The
overall cancer mortality rate for the rest of the United States for this period was 164.2 deaths per 100,000.87 These Native American
cancer mortality rates in Alaska and the Northern Plains region are attributed to colorectal, gallbladder, kidney, liver, lung, and stomach
cancers.88 Similarly, cervical cancer mortality rates were higher among Native Americans than among all racial and ethnic populations
(3.7 and 2.6, respectively), especially in the East and Northern Plains regions of the United States.89 Though limited data are
available, there is insufficient research on cancer among Native Americans.90 Even with limited data,
experts have suggested that Native American cancer patients experience the disease differently from
other non-Native populations.91 Some of the factors contributing to this include genetic risk factors; late detection of cancer;
poor compliance with recommended treatment; presence of concomitant disease; and lack of timely access to diagnostic and/or
treatment methods.92 Accordingly, additional research must be conducted to more fully explore cancer
disparities among Native Americans.

69
I.H.S. Affirmative
Health Impacts Infant Mortality

Infant mortality rates among American Indians are higher than the general population,
and American Indian women also receive less prenatal care.
Infant mortality and maternal health rates are also considered to be indicators of health status for a
particular community.94 Historically, Native Americans have suffered inordinately high infant
mortality rates.95 Despite recent improvement, disparity persists. Native American infants continue to
die at a rate two to three times higher than the rate for white infants.96 Moreover, Georgetown
University.s Center for Child and Human Development, National Center for Cultural Competence,
reported that for Native Americans, the incidence of sudden infant death syndrome (SIDS) is more
than three to four times the rate for white infants.97 Not surprisingly, maternal health factors also indicate
lower health status. Pregnant Native American women consistently hold the lowest percentage of women
receiving early prenatal care when compared with women of other races and ethnicities. For example,
the percentage of Native American women receiving early prenatal care was 66.7 percent in 1995, compared
with 83.6 percent of white non-Hispanic women.98 In sum, the health indicators discussed above
document the reality that Native Americans have significantly higher mortality rates and markedly
lower health status than the general population. To understand why these health disparities persist, despite
the federal government.s promise to provide quality health care, we examine the health care programs,
services, and facilities available to Native Americans.

70
I.H.S. Affirmative
Health Impacts Pandemics

American Indians are more likely to be affected by influenza pandemics, but have less access to
the medicines necessary for treating it.
Pepus, doctor for the research firm of Influenza Informatics, 2005
(Dr. Martin, Native American Times, Native American perspective on new influenza threat,10-28-05, http://proquest.umi.com/pqdweb?
=10553, 6-29-09, ESM)
BOZEMAN MT -- The lore of the Hupa people of Northern California tells of an ominous cloud containing sickness and disease so the
Kixunai (spirits) directed a special dance to be held to ward off disease and disaster. Thus evolved among these Native American people
the traditional ceremonial Jump Dance in accordance with Kixunai instructions. Once again an ominous cloud of disease
called the H5N1 avian flu virus lurks ahead. It has been brought to Asia and certain parts of Russia by migratory
waterfowl with successive transmission to domestic poultry, swine, and other animals and to man as well. As of 10-10-05
Romania is another country reporting infected ducks. Many Asian countries especially in the Southeast regions have
suffered the effects of this virus with about 115 documented human cases and 60 deaths--usually occurring among people exposed to
infected poultry. While as of this date human to human transmission has not been documented such an occurrence could foretell the
beginning of a massive worldwide epidemic (called a pandemic). Experts feel that such an event is inevitable but cannot predict specific
timing. Although recently detailed information about a potential pandemic has been given wide exposure in newspapers, popular
magazines, radio and TV as well as the World Wide Web here is a brief review of important background information and insights which
should be of obvious importance to Native Americans and their First Nation brethren in Canada. An influenza Pandemic
occurred in 1918-19 during the closing phases of World War I and 50 million or more people died as a
result of this infection--exceeding the number killed in that war. There were about 675,000 influenza
deaths in the U.S. and according to historian, Alfred Crosby "American Indians suffered hideously in the
pandemic. According to the statistics of the Office of Indian Affairs 24% of reservation Indians caught
flu from October 1, 1918 to March 31, 1919 and the case mortality rate was 9%, about four times as
high as that in the nation's big cities". A later investigation in the far regions of Alaska disclosed the eerie finding of entire
silent villages of Inuit people--all eradicated by the pandemic virus . Although Native Americans and First Nation
people hold great and beautiful birds in the highest esteem -- their feathers adorning sacred dress and
symbols- it has been documented that various waterfowl birds now carry this flu virus, subtype H5N1.
While it seems good news that no infected migratory waterfowl have thus far been identified in North America the population of the
entire Western Hemisphere and all of rest of the globe cannot rest comfortably while the H5N1 virus exists elsewhere. In this day and
age of rapid transit of people and objects a dangerous virus as this one can spread worldwide with extreme rapidity causing sickness and
death of millions of people. And this includes persons of all socioeconomic classes, colors and diversity--overwhelming all medical
facilities and destabilizing social, commercial, military and civil institutions. The World Health Organization (WHO),
National Institute of Allergy and Infectious Disease, the National Communicable Disease Center
("CDC"), private and commercial medical and scientific research organizations are involved in
pandemic preparedness and response programs. Presently, the strategy put forth by the WHO is surveillance,
containment of breakouts in domestic poultry by destruction, stockpiling antiviral drugs, particularly one called Tamiflu and supporting
the development of specific vaccines which can protect populations against H5N1 flu virus. But for various reasons manufacturing
capability is severely limited. Moreover the specific influenza subtype causing a pandemic could conceivably be different than H5N1. In
any case the time interval from subtype identification to vaccine distribution would take 6 months using the traditional viral egg growth
medium. Numerous countries have either stockpiled Tamiflu for part of their populations or are standing
in line with their orders from the single manufacturer, Roche Labs (Switzerland). There are only a handful of vaccine
manufacturers in the world and many countries have already placed their orders. The bottom line is that there is likely to be severe
worldwide shortages of drugs and vaccines. As of this writing the US government has a Tamiflu stockpile of 2.3 million doses. Its aim is
to bring that figure up to 20 million doses and a $4 Billion appropriation-mostly to be used for that purpose has been approved by the
Senate and is being discussed by the lower house. Experts estimate that approximately 25% of the U.S. population would be infected in
the event of this type of pandemic. Initial death rate figures were estimated at between 89,000 and 207,000-probably-representing
computer modeling low-end numbers. However high-end figures of potential U.S. are as high as 1.9 million. With regard to the
prioritized list of who will be eligible to receive Tamiflu either as first line treatment-which must occur in the first 48 hrs of symptoms in
order to be effective-or for prevention the general rule appears to be first health care workers and other pandemic workers, government
officials, police and fireman. The preparedness and response plan does mention consideration of ethnic groups, however, definitive
hardfast rules of prioritization for distribution of drugs and vaccines have yet to be stated--either by Federal or State governments.
Regrettably the U.S. government preparedness plan has remained in the "draft" stage since August 2004 and as recently as 8 October
2005 announcements have been made indicating that the final version (which would include prioritization planning) is about to be
released. With respect to Native Americans and other ethnic minorities governing authorities seem to clearly acknowledge responsibility
for the well being of this segment of society. However, shortages of drugs and vaccines are imminent and
minority ethnic groups do have reasonable and justifiable cause for concern in light of sad historic
facts. The rational basis of such concern is reflected in at least three areas which affect Native
Americans: a) failure of Federal government to be a "faithful trustee" and to commit to equitable
resolution involving billions of dollars owed for various property rights, b) The National HealthCare
Disparities Report documenting inequalities in health care delivery based on race, ethnicity and

71
I.H.S. Affirmative
Health Impacts Pandemics

Pepus, doctor for the research firm of Influenza Informatics, 2005 (Continued)
socioeconomic status and c) A recent report of the (Federal) Government Accountability Office
declaring that many government-funded Indian Health Service facilities are failing to provide
adequate healthcare for a variety of health conditions. Other reasons for faltering confidence in Federal disaster
assistance include shortcomings of the Federal Emergency Management Agency [FEMA] in the case of hurricane Katrina and recent
"poor behavior" of CDC reflected in accusations of "hoarding" influenza data -- that is not making it generally available to scientists
working in the field. On the other hand fairness and credit is due to the Federal Government, its grant programs and Indian Health
Service in particular for diligent work and commitment in the many health areas of importance to Native Americans. This includes a
wide spectrum of preventive and treatment programs. Nevertheless the issue of influenza pandemic planning and
responsiveness as it specifically affects Native Americans remains a reasonable concern to such persons. While here we
have presented an educational overview about the "ominous cloud of disease" manifested by the influenza virus let us not forget the
entreaties in the California Hupa Tribal Jumping Dance ceremony. Though the dancers are adorned by a certain decorative head-dress
which to some extent cover the eyes and occlude vision we can be assured their hearts, souls and "mind's eye facing earth and sky
clearly understand the everlasting traditional requirements of spiritual recognition and the necessity for faithful defense against disease
and disaster.
American Indians are more severely affected by the influenza virus.

From 1994 through 1996, the Indian Health Service estimated that the age-adjusted death rate from
pneumonia and influenza for Native Americans was 71 percent greater than the rate for the entire U.S.
population.80 In 1998, Native American patients hospitalized for pneumonia accounted for the greatest
number of hospital discharges for elderly Medicare beneficiaries (49.3 per 1,000 discharges) in the entire
U.S. population.81

72
I.H.S. Affirmative
Health Impacts Alcoholism

A. Lack of coverage causes alcoholism
Burke, Associated Press writer, 08
(Garance, Indian Country Today, New report details health challenges facing American Indians, 3/19/08,
Rich or poor, American Indians in cities across the country are facing startling health challenges unlike
those of any other urban population, according to a new study of federal data.Even as urban American
Indians move up the income ladder, researchers found rates of binge drinking and tobacco use in the
community are staying the same - or sometimes even increasing - in cities from New York to Helena, Mont
'When Indian folks drink, it appears to have nothing to do with how much money they have, and that's
not true for any other racial group,'' said Maile Taualii, scientific director at the Seattle-based Urban
Indian Health Institute, which announced the findings March 5. ''There seems to be a sense of
hopelessness, a sense that diabetes, alcoholism and other health problems are inevitable in the
community.''More than half of all American Indians and Alaska Natives in the United States live in
cities.And for years - decades in some places - Native people have been receiving health care at
government-funded tribal clinics in or near the urban areas where they live. Yet rarely have medical
studies focused on the population's health as compared to other city dwellers, or to illness rates among Indian
people living on tribal lands.The nonprofit institute - which gets federal money to track disease trends
among Native people - analyzed five years of data from a random digit dial telephone survey
conducted by the Centers for Disease Control and Prevention in 34 cities.Analysts were alarmed by
what they found: Among Indian respondents who reported drinking, rates of binge drinking
sometimes grew higher as respondents' income increased, instead of declining as with all other races,
Taualii said.Researchers also concluded that rates of diabetes, obesity and smoking remained about the same
among low-income and wealthy urban Indians. That's not the case in the general population, where people
with lower incomes tend to experience higher rates of those health problems, Taualii said.Those results - and
data showing that Native people in some cities reported having more difficulty getting health care than
urbanites of other backgrounds - show special attention must be paid to the health disparities for urban
Indians, Taualii said.For the third year in a row, President Bush's 2009 budget proposal calls for the Urban
Indian Health Programs' funding to be cut. Newman Washington, who runs drug and alcohol programs at
a government-funded Indian clinic in Wichita, Kan., said tight finances already make it difficult to
meet the needs of patients from the Kickapoo, Potawatomi and other nearby tribes. Clients trying to
detox from alcohol often have to wait two months to be admitted to a hospital bed, or travel 75 miles to
Ponca City, Okla., to be seen in an inpatient facility, Washington said.
B. The impact is cultural destruction

Yellow Horse Brave Heart, PhD, Associate Professor University of Denver, 1998
(Maria, The American Indian Holocaust: Healing Historical Unresolved Grief, The Journal of American Indian
and Alaska Native Mental Health Research, volume: 8, p. 60, KS)
The effects of alcohol have been devastating for American Indian people (Shkilnyk, 1985). National
Indian Health Service (IHS) statistics reveal that the age-adjusted alcoholism death rate is 5.5 times the
national average (MS, 1995). Relatively little known prior to European contact, alcohol was used as a bargaining tool on the
American frontier, with inferior quality alcohol given to tribes prior to treaty negotiations (DeRosier, 1970) or fur
trading (MacAndrew & Edgerton, 1969). Role models for drinking behavior were usually pathological and associated with
violence, not a necessary correlation among societies (Levinson, 1989): Drunken comportment became a learned behavior for American
Indians (MacAndrew & Edgerton, 1969). Tolerance levels for alcohol consumption were low for American Indians, as most Natives had
limited prior experience with alcohol or mind-altering substances. 'The occurrence of fetal alcohol syndrome(FAS) varies among tribes _
but occurs on average once in 633 live births and can run as high as one in every 100 births (May & Hymbaugh, 1983). By comparison,
Niccols (1994) cites research showing FAS affects one to three infants per 1000 live births in the general population. FAS results in high
rates of mental retardation, physical deformity, and attention deficit and hyperactivity disorder among Indian children. Young's (1988 )
research shows that 75 percent of all Native American deaths can be traced to alcohol in some form.
Research reports show that five of ten leading causes of death among Indian individuals in the IHS
service areas result from alcohol-related accidents, cirrhosis of the liver, alcohol dependency, suicide and
homicide (Young, 1988; IHS Regional Report, 1994).

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I.H.S. Affirmative
Health Impacts Mental Health

Alarming number of American Indian Adolescents suffer from a menagerie of mental
illnesses that define their health status.
Barney, assistant professor at the University of Oklahoma School of Social Work, 2001
(David, Risk and Protective Factors for Depression and Health Outcomes in American Indian and Alaska Native
Adolescents, Wicazo Sa Review, Volume 16: Number 1, Spring 2001, pp. 135-150, CME)
The number of American Indian and Alaska Native adolescents reporting depression and emotional
disturbance is cause for concern. Rates of depression vary for different tribal groups (Office of Technology
Assessment 1990). Among American Indian and Alaska Native adolescents in grades 7 to 12, 20%
reported being depressed in the last month, and 34% reported feeling sad, discouraged, and hopeless.
High risk behaviors, such as delinquency and violence, often constitute expressions of depression
(Johnson 1994). In another study of ninth grade Eskimo students, 49% of the student population were
emotionally disturbed, which included serious depression at a rate of 25% (Kleinfeld and Bloom 1977).
American Indian and Alaska Native adolescents live under a great deal of stress as evidenced by their
strikingly high mental health problems when compared to the general population (Office of Technology
Assessment 1990). Stress is known to lead to and link up with depression, alcoholism, and suicide in
American Indian and Alaska Native adolescents (Dinges and Duong-Tran 1993). A substantial amount
of stress has been found to be associated with cultural concerns, including both deculturation and
acculturation (Mail 1989). Generally, depression, stress, and self-perception of overall well being are
major themes in how adolescents dene their health status (Blum 1987).
Protective factors such as psychological assistance may assist native adolescents in suicide
prevention, positive alcohol and drug decisions and coping with sexual abuse
Barney, assistant professor at the University of Oklahoma School of Social Work, 2001
(David, Risk and Protective Factors for Depression and Health Outcomes in American Indian and Alaska Native
Adolescents, Wicazo Sa Review, Volume 16: Number 1, Spring 2001, pp. 135-150, CME)
Numerous other studies of adolescents have shown that protective factors may reduce suicide, reduce
symptomatology in the adolescent with alcoholic parents, positively inuence alcohol and drug use help
in coping with sexual abuse, and, in general, protect against a constellation of problems related to
inner-city life (Rubenstein et al. 1998; Roosa et al. 1990; Chandy, Blum, and Resnick 1996; Safyer 1994;
Hawkins, Catalano, and Miller 1992).
There is severe lack of mental health services

Simmons, Indian Country Today Writer, 05
(Jeramiah, Indian Country Today, Simmons: A looming mental health crisis in Indian Country, 6/9/05,
However, there is now a movement to shift away from conventional counseling and move in the direction of
culturally sensitive mental health approaches that integrate American Indian cultural values into treatment to
better interface with the Indian patient population. IHS mental health clinics are geographically isolated and
pose complicated utilization barriers such as unconscious physician bias and prejudice. Also, the sociodemographic and cultural differences between American Indian communities create challenges to the
development of comprehensive, coordinated and sustained quality services specific to individual tribes.
More than half of all American Indians live in urban areas and receive little or no support from the
IHS. The remaining half live on reservations or rural non-reservation areas and receive support
through IHS facilities. Unfortunately, funding is not divided proportionally between these service
areas.A majority of the IHS budget is directed towards serving American Indians on reservations or
rural areas near reservations. The IHS operates on a $2.4 billion budget with $370 million directed at
IHS facilities. Under the fiscal year 2004 budget, only 2 percent of that budget is directed for the Urban
Indian Health Programs, which has been the norm since 1979. Only a fraction of this 2 percent will be
allocated to serve more than 50 percent of the Indian population;s mental health needs in urban areas.
As a result, a lack of professional specialty services and fewer comprehensive helper networks
contribute to the mental health crisis for urban Indians.

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I.H.S. Affirmative

American Indians also lack sufficient mental health care, some of these problems were
created by the poverty they were originally forced into by the federal government.
48 Mental Health Native Americans are at a higher risk for mental health disorders than other racial
and ethnic groups in the United States,49 and are consistently overrepresented among high-need
populations for mental health services.50 The Surgeon General reported that this overrepresentation
might be attributed to the high rates of homelessness, incarceration, alcohol and drug abuse, and stress
and trauma in Native American populations.51 The Surgeon Generals report further indicated that the
U.S. mental health system is not well equipped to meet these needs; specifically that IHS, due to both
budget constraints and personnel problems, is mostly limited to basic psychiatric emergency care.52
According to Dr. Perez, IHS does not provide quality, ongoing psychiatric care.53 Instead, IHS. approach
is one of responding to immediate mental health crises and stabilizing patients until their next episodes.54
The most significant mental health concerns today are substance abuse, depression, anxiety, violence,
and suicide.55 Of these, substance abuse, notably alcoholism, has been the most visible health disorder
crisis,56 while depression is emerging as a dominant concern.57 These two illnesses are often a
consequence of isolation on distant reservations, pervasive poverty, hopelessness, and intergenerational
trauma, including the historic attempts by the federal government to forcibly assimilate tribes.58
Alcohol abuse is widespread in Native American communities. Native Americans use and abuse alcohol
and other drugs at younger ages, and at higher rates, than all other ethnic groups.59 Consequently,
their age-adjusted alcohol-related mortality rate is 5.3 times greater than that of the general
population.60 The Department of Health and Human Services, Substance Abuse and Mental Health Services
Administration.s National Household Survey on Drug Abuse reported the following for 1997: (1) 19.8
percent of Native Americans ages 12 and older reported using illegal drugs that year, compared with
11.9 percent for the total U.S. population; and (2) Native Americans had the highest prevalence rates of
marijuana and cocaine use, in addition to the need for drug abuse treatment.61 One of the more troubling
indicators of the toll depression takes on Native Americans is reflected in the suicide rates. The suicide
rate for Native Americans continues to escalate and is 190 percent of the rate of the general population.
In fact, suicide is the second leading cause of death for Native Americans 15 to 24 years old and the third
leading cause of death for Native American children 5 to 14 years old.62 Recent data from the American
Academy of Pediatrics indicate that in 2002 the youth suicide rate for Native Americans was twice as great
among 14- to 24-year-olds, and three times as great among 5- to 10-year-olds, as it was in the general
population.63 Despite a significant demand for mental health services, there are approximately 101
mental health professionals available per 100,000 Native Americans, compared with 173 mental health
personnel per 100,000 whites.64 With a greater need for mental health specialists, but fewer available
for treatment, Native Americans frequently do not receive the necessary care for substance abuse,
depression, anxiety, suicide ideations, and other mental health conditions.

75
I.H.S. Affirmative

Native American veterans do not get care due to un-culturally sensitive options
Badkhen, Globe Correspondent,07
(Anna, The Boston Globe, Lexis Nexis, Native American veterans seen at risk - Region lags in efforts to help stressafflicted, http://www.lexisnexis.com/us/lnacademic/results/docview/docview.do?
docLinkInd=true&risb=21_T6873455738&format=GNBFI&sort=RELEVANCE&startDocNo=1&resultsUrlKey=2
9_T6873455747&cisb=22_T6873455746&treeMax=true&treeWidth=0&csi=8110&docNo=1, accessed: 6-30-09,
KEH)
But in New England, the effort to reach out to Native American veterans is lagging, mental health
specialists and some Native Americans say. At risk, they say, are thousands of Native American veterans,
who historically are more susceptible to combat trauma than other troops, but who also are less likely
to seek, and receive, mental health help from government-operated agencies as their non-Indian
comrades.
Studies of Native American veterans who fought in Vietnam showed that they were twice as likely to suffer
from post-traumatic stress disorder as other veterans. Although no one has studied the prevalence of
trauma among Native American veterans of the wars in Iraq and Afghanistan, mental health workers
anticipate that those troops may suffer from similarly high levels of trauma.
At least 18,000 of the 22,000 Native Americans currently in uniform had been deployed at least once to Iraq
or Afghanistan as of July, according to the US Department of Defense. Recent Army studies have found that
up to 30 percent of soldiers coming home from Iraq suffer from depression, anxiety, or post-traumatic
stress disorder. The studies did not include other branches of the military.
New England centers operated by the federal Department for Veterans Affairs, which is responsible for
providing mental healthcare to veterans, employ coordinators, usually members of a minority group, who
attend some tribal powwows and invite the region's approximately 10,000 Native American veterans to take
advantage of the agency's programs. The VA hospital in Bedford holds an annual powwow on the hospital
grounds, to which the veterans are invited.
"We work with the North American Indian Center," another federally funded organization serving more than
5,000 Native Americans in Greater Boston, "to learn all of the [tribal] events that are being planned, and then
we try to make it to these events," said Shirley Jackson, a minority coordinator for the Boston VA. Jackson
said she sometimes refers Native American veterans to the center.
But the efforts fall short of reaching most Native American veterans because many of them do not trust
the federal government and the services it offers, say some Indian veterans and mental health workers who
work for the VA.
"The [Indian] community's past dealings with federal agencies as a whole, some of these experiences may
not have been very positive," said Jay Shore, a Denver psychologist who works with Indian veterans.
"Historically... the Indian vets may have good reason not to feel very comfortable in the system."
Native American veterans are four times less likely to receive healthcare than other veterans,
according to the congressional testimony in 2004 of Gordon Mansfield, a deputy secretary for veterans'
affairs.

76
I.H.S. Affirmative

Due to lack of funding, the IHS cannot help many Native Americans with mental health
problems
Empsall, Bachelors Degree from Dartmouth in Government and Native American Studies,
2008
(Nathan, The Episcopal Public Policy Network, On the Issue: American Indian Healthcare, August 2008,
http://www.cuac.org/3654_101099_ENG_HTM.htm, 7-1-09, KS)
Despite some gains in recent years, American Indian health levels lag well behind the national average.
While the national life expectancy is 76.9 years, Indian life expectancy is at most 74.5 years, and perhaps as
low as 71. The National Center for Health Statistics reports that while 12% of the total national population is
limited in their usual activities due to one or more chronic health conditions, that number is 21.8% among
Indians. According to the Kaiser Family Foundation, 17.2% of Indians rate their health as fair or poor,
compared to 14.6% of African-Americans, 12.9% of Latinos, 7.9% of Anglo-Americans, and 7.4% of AsianAmericans. Many fatal diseases are found at higher rates in Indian communities than in the nation at large.
IHS reports that mortality rates for diabetes, tuberculosis, cervical cancer, pneumonia, influenza, SIDS,
alcoholism, homicide, and unintentional injuries are all disproportionately higher among Indians than the
general population. Heart disease and stroke mortality rates remain constant for now, but are on the rise in
Indian country despite a decline in the general population. Indian womens health lags behind the national
average. Not only does cervical cancer occur among Indians at a higher rate than any other race, but prenatal
care occurs at a lower rate than any other ethnicity. Only 69% of pregnant Indian women get prenatal care, as
compared to 85% of Anglo women. Perhaps as a result, the infant mortality rate is 150% greater than among
white infants, and sudden infant death syndrome (SIDS) occurs three to four times more often. Indian
diabetes rates are among the highest in the world. 15% of IHS patients have officially been diagnosed as
diabetic, and the National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) estimates that as
many as 70% of Indians between the ages of 45 and 74 may have diabetes. The age-adjusted death toll from
diabetes is an astonishing 350 times that of the greater population. Sadly, these numbers are increasing rather
than decreasing, and the rate of Type 2 diabetes among Indian children is climbing faster than that of any
other child population. Alcoholism affects Indian Country at a rate three times the national average, with a
mortality rate mortality rate 550% higher, according to IHS. Alcohol was introduced to Indian communities
with the arrival of European fur-trappers, and the combination of a possible genetic disposition for
alcoholism, the fur-trappers poor examples, a lack of experience with alcohol, and a federal ban on selling
alcohol to Indians led to the current health crisis. Poor mental health is another cause of high dependency
and suicide rates. In 2004, the U.S. Commission on Civil Rights reported that, IHS is mostly limited to
basic psychiatric emergency care, due to budget constraints and personnel problems IHS does not
provide ongoing, quality psychiatric care. Instead, the approach adopted by IHS is one of responding
to immediate mental health crises and stabilizing patients until their next episode. And while there are
173 mental health professionals for every 100,000 whites, the rate is only 101 per 100,000 for Indians.

77
I.H.S. Affirmative

Untreated mental illnesses lead to major problems in society such as alcoholism
Davis, Congresswoman with a degree in sociology and a masters degree in social work,
2007
(Susan, The House of Representatives, Veterans Health Care for Body and Mind, 3-11-07,
http://www.house.gov/susandavis/press/ed031107ptsd.shtml, 7-6-09, KS)
It is easy to see what combat can do to the body. The damage is often visible for anyone to see - a scar or a
lost limb. It is not always easy to see what combat does to the mind. But wars impact on the mind can be
just as devastating. Post-traumatic Stress Disorder or PTSD has become an all too familiar term in the past
few years. Also familiar are the inadequacies of the federal governments response to treating PTSD. When
it comes to the mental health care, the federal government needs to step up and address the need for
comprehensive reform of the management and treatment of veterans. There is reason to be deeply concerned
about the mental health of our service members returning from combat. As many as 25 percent of those
returning from Iraq are suffering from PTSD or another form of anxiety, according to a study by the New
England Journal of Medicine. Army studies have shown up to 30 percent of troops deployed to Iraq suffer
from depression, anxiety or PTSD and some experts predict that the number eventually requiring mental
health treatment could exceed 170,000. Specifically, the war in Iraq is putting a tremendous amount of strain
on the mental health of our service members due to extended and multiple deployments. Studies have
indicated that protracted warfare in Iraq with its intense urban street fighting, civilian combatants and
terrorism could drive PTSD rates even higher. As a former social worker, I pay close attention to this
issue. Serving on the House Armed Services Committee and as a former member of the Veterans Affairs
Committee, I hear first hand the problems and potential solutions to take care of our brave service members.
Unfortunately, the Department of Veterans Affairs (VA) and the Department of Defense (DOD) do not appear
ready to treat those who need mental health care. The VA, for example, does not track the total number of
veterans it treats for mental disorders each year. Without this information, it is impossible to know whether
we are providing adequate resources to the large number of veterans who will be in need of help.
Additionally, PTSD and depression can take years to fully develop, so additional service members will
require treatment years from now. Untreated mental health problems lead to alcoholism, drug abuse,
homelessness, chronic unemployment, suicide and other problems. That is not only bad news for the
service member but also for their families. The families of service members can often bear the brunt of
PTSD. We saw this after the war in Vietnam and we need to act now to avoid losing another generation of
service members to PTSD. My dedication to this issue has led me to take direct action to ensure our service
members receive the treatment they need and deserve. I have been a strong supporter of efforts in Congress
to bring vast improvements to the mental health treatment we give to both service members and veterans.
There are many challenges in dealing with the problem of PTSD from detection to treatment. So we dont
have any time to lose. Veterans only have two years of eligibility to enroll in the VA health care system. With
the possibility of PTSD manifesting itself beyond that, it is obvious that the enrollment period needs to be
extended. We must have a seamless transition and clear lines of authority for moving active duty service
members to veterans services. It is difficult for our soldiers, sailors, airman, and marines are often
compromised in their ability to determine whether or not to stay in the service or enter the VA system.
Imagine having to make this decision with the manifestation of symptoms from PTSD. One challenge is
treating veterans who do not live in urban areas. Veterans in urban areas with larger veterans populations,
such as the veterans in my district in San Diego, have better access to medical treatment and mental health
care than those in smaller towns or rural areas. With 23 percent of the nations veterans living in rural areas,
this is a real concern. A 2004 survey found that veterans living in rural areas are in poorer health than their
urban counterparts because of distance and other difficulties associated with obtaining care. We also face
limited resources in meeting these challenges, but we owe it to those who gave so much for us. We must not
let these men and women slip through the bureaucratic cracks. We need to act swiftly to find the resources
and methods to provide proper care. If we can provide proper treatment and intervene early, we could spare
our combat veterans from some of the difficulties associated with mental disorders.

78
I.H.S. Affirmative

Current system is inadequate: Doing nothing to help American Indians with mental health
issues.
Native Americans are at a higher risk for mental health disorders than other racial and ethnic groups
in the United States, and are consistently overrepresented among high-need populations for mental health
services.41 The Surgeon General reported that this overrepresentation might be attributed to the high
rates of homelessness, incarceration, alcohol and drug abuse, and stress and trauma in Native
American populations. The Surgeon Generals report further indicated that the U.S. mental health
system is not well equipped to meet these needs; more specifically, IHS is mostly limited to basic
psychiatric emergency care, due to budget constraints and personnel problems. According to Dr. Jon
Perez, IHS does not provide ongoing, quality psychiatric care. Instead, the approach adopted by IHS is
one of responding to immediate mental health crises and stabilizing patients until their next episode.45
The most significant mental health concerns today are the high prevalence of substance abuse, depression,
anxiety, violence, and suicide.46 Substance abuse, most notably alcoholism, has been the most visible
health disorder crisis. Depression is also emerging as a dominant concern. These two illnesses are
commonly attributed to isolation on distant reservations, pervasive poverty, hopelessness, and
intergenerational trauma, including the historic attempts by the federal government to forcibly
assimilate tribes. Alcohol abuse is widespread in Native American communities. Native Americans use and
abuse alcohol and other drugs at younger ages, and at higher rates, than all other ethnic groups.50
Consequently, their age-adjusted alcohol-related mortality rate is 5.3 times greater than that of the general
population.5 The Department of Health and Human Services, Substance Abuse and Mental Health Services
Administrations National Household Survey on Drug Abuse reported the following for 1997: 19.8 percent of
Native Americans ages 12 and older reported using illegal drugs that year, compared with 11.9 percent for the
total U.S. population. Native Americans had the highest prevalence rates of marijuana and cocaine use, in
addition to the need for drug abuse treatment.52 As identified earlier, depression is the most serious
emerging mental health disorder in the Native American population. One of the more troubling
indicators of the toll it takes on Native Americans is reflected in suicide rates. From 1985 to 1996,
Native American children committed suicide at two and one-half times the rate of white children.
During this period, 449 Native American children committed suicide.53 The suicide rate for Native
Americans continues to escalate and is 190 percent of the rate of the general population. According to
the IHS FY 2005 Budget Justification, the highest suicide rate for the general population is found among
individuals 74 and older. Among Native Americans, the highest suicide rate is found in the 15-year-old to 34year-old age range.54 In fact, suicide is the second leading cause of death for Native Americans 15 to 24
years old and the third leading cause of death for Native American children 5 to 14 years old.55 Recent
data from the American Academy of Pediatrics indicate that in 2002 the youth suicide rate for Native
Americans was twice as great among 14- to 24-year-olds, a10-year-olds, as it was in the general
population.56 Despite significant demand for mental health services, there are approximately 101
mental health professionals available per 100,000 Native Americans, compared with 173 mental health
personnel per 100,000 whites. With a greater need for mental health specialists, but fewer available for
treatment, Native Americans frequently go without the necessary care for substance abuse, depression,
anxiety, suicide ideations, and other mental health conditions.

79
I.H.S. Affirmative
Health Impacts Mental Health (Suicide)

Native Americans deal with a number of problems such as suicide
Nelson, Professor at the University of Illinois Chicago, 2002
(Judith C., Families in Society, The Journal of Contemporary Human Services, 1-1-02, KS)
Knowing that particular mental disorders are more common in persons of one gender or culture can help the
social worker be more alert to the presence of symptoms in certain clients. Thus, it is helpful to know that
women in the United States, more often than men, suffer from depression and most anxiety disorders,
whereas men more commonly suffer from substance abuse problems that are thought to sometimes mask
these troubling emotional states-(Padgett, 1997). The difference in rates of depression between men and
women is greatest for the less severe symptoms (Hurst & Genest, 1995). Men are more likely to commit
suicide (Fawcett, Clark, & Busch, 1993). Interestingly, higher rates of depression among women do not hold
for African Americans, nor for most Asian American groups, until they become-acculturated (Okazaki, 2000).
The higher rates do hold for Latinas (Romero, 2000). Perhaps because the stress associated with lower
socioeconomic status is a risk factor for mental disorders in general (NIMH, 1999), a higher proportion of
Native Americans than others suffer from depression. However, only elderly African Americans and Hispanic
Americans have been found to report more depressive symptoms than non-Hispanic Whites (Black, 2000).
Suicide rates are higher among non-Hispanic Whites than among persons of color, with the exception of
Native Americans (Fawcett et al., 1993; NIMH, 1999). Many persons of Japanese origin consider suicide an
honorable death, but this belief is not reflected in a higher incidence of suicide (Fujii, Fukushima, &
Yamamoto, 1997). Although the rates of anxiety disorders in general are not greater in persons of color than
in Whites, African Americans show a higher incidence of phobias even when socio-demographic factors are
controlled (Guarnaccia, 1997). Some members of immigrant populations can be at significant risk for
posttraumatic stress disorder due to experiences of violence or terror in their home countries (APA, 2000).
Native Americans have a suicide rate 50% higher than other groups
CNN.com, 2001
(CNN, Report: Minorities lack proper mental health care, 8-27-01,
http://www.cnn.com/2001/HEALTH/08/26/mental.healthi?related D. C., 7-6-09, KS)
American Indians and indigenous Alaskans living in isolated, rural communities have "severely" limited
mental health treatment options, the report said. The report noted these groups have a suicide rate 50
percent higher than that of the general U.S. population. But a lack of research into mental health issues
surrounding Native Americans makes it difficult to design and evaluate appropriate mental health care, the
study said.
Several Mental Health Factors cause high suicide rates among Natives
- 1996
Blount, Doctoral Student at the School of Social Work at Florida State University,
(Mary, Cultural Diversity and Social Work and Practice, p.281, KS)
Developmental psychologists working with the THS have speculated on suicide causality in light of
Erickson's model which focuses on the adolescent tasks of identity versus identity diffusion. For example,
Neligh (1990) suggests that the lack of viable adult identities for Indian adolescents from tribes
experiencing extreme cultural stress may well be a factor contributing to unusually high-risk
behaviors during this developed mental phase. Bachman (1992) speculates that negative self-images
are due to school racism, abuse and neglect at home, or other environmental factors that increase the
frequency of depression and other symptoms of mental health problems that contribute to suicide.
Suicide research has identified several mental health factors that help identify youth at highest risk for
self-destruction. Some of these factors are: psychiatric disorders, affective disorders such as bipolar
disorder or major depression, personality disorders, and a family history of psychiat ric disorder
(Hollinger et al., 1994). IHS mental health professionals cite major depression, bipolar disorder, and
schizophrenia as significant mental health problems among American Indian youth, and these factors
are commonly documented in the majority of Indian suicides and homicides (Neligh, 1990).

80
I.H.S. Affirmative
Health Impacts Sexual Abuse/Reproductive Rights

Sexually abused Native American women do not have sufficient care due to lack of funding
Asetoyer, Executive Director of the Native American Women's Health Education Resource
Center in Lake Andes, 07
(Charon, The center For American Progress, The Failing State of Native American Womens Health, 5-16,
http://www.americanprogress.org/issues/2007/05/charon_asetoyer.html, accessed: 6-29-09, KEH)
Silence is a dangerous thing to fall victim to. Women living on American Indian reservations know this. To this day, the stories of Native
American women often remain untold. Geographic isolation and racial segregation have created a world of silence
around the problems these women face.

Limited access to health care is one of the most daunting of these problems, according to Charon Asetoyer,
Founder and Executive Director of the Native American Womens Health Education Resource Center. The Center is a grassroots
womens health institute on the Yankton Nakota Indian Reservation in South Dakota. Asetoyer spoke with the Center for American
Progress this week about the failures of our federal government to keep women on reservations safe and healthy.
The Indian Health Service, the federal agency responsible for providing health care on all reservations, is
failing Native American women on many fronts, says Asetoyer. Native American women do not have
access to reproductive health services such as abortion, emergency contraception, and sometimes even condoms. The gravity
of this situation is magnified by the high number of rapes and sexual assaults that occur on reservations. One in three Native
American women will be sexually assaulted or raped in her lifetimea rate 3.5 times higher than all
other racial groups. Yet victims of sexual violence often do not receive the treatment and care they need
from IHS hospitals. Victims sometimes have to travel hundreds of miles just to receive a rape kit and
screening for sexually transmitted infections.

81
I.H.S. Affirmative
Health Impacts Sexual Abuse/Reproductive Rights

American Indian women lack reproductive care
Anderson and Check, Human Rights Attorney, 07
(Katrina, RH [reproductive health] Reality Check, Health Care System is Failing Women of Color, 3-1,
http://www.alternet.org/reproductivejustice/79211/?page=entire, accessed: 6-29-09, KEH)
The Committee's conclusions were issued at the close of a two-week session in Geneva, Switzerland, during which it reviewed the U.S.'s
compliance with the International Convention on the Elimination of All Forms of Racial Discrimination (ICERD), a human rights treaty
which requires that countries take pro-active measures to address racial inequalities. It was no surprise that during the session the U.S.
was grilled about the persistence of racial segregation in public schools, the dismantling of affirmative action, and racial
discrimination in the criminal justice system. But the session also provided a unique opportunity to focus on the less publicized but
equally pervasive issue of racial discrimination in reproductive health care. Not surprisingly, the U.S. initially refused
to even acknowledge the stark differences in access to quality care between white women and women of color -- despite indicators like
shockingly high numbers of women of color dying during childbirth and record numbers being infected
with HIV/AIDS. Instead, it was U.S. activists who shed light on the overwhelming evidence of systematic racial discrimination in
the U.S. in reproductive health care.
Nancy Northup, the president of the Center for Reproductive Rights, testified before the Committee on February 18 and addressed how
women of color have significantly poorer sexual and reproductive health than the majority white population. While that's not a newsflash
to many of us, the data can be alarming:
African-American women are nearly four times more likely to die in childbirth than white women, 23 times more likely to be
infected with HIV/AIDS and 14 times more likely to die from the disease.
American-Indian/Alaskan Native women are over 5 times more likely than white women to have
chlamydia and over 7 times more likely to contract syphilis.
The unplanned pregnancy rate among Latinas is twice the national average; and Latinas are much more likely to contract human
papillomavirus, the infection that leads to cervical cancer.
These disparities speak to the significant barriers women of color face in obtaining reproductive health services. Across the board, racial
and ethnic minority women are less likely than white women to have adequate prenatal care, a full range
of contraceptive choices, or a timely and affordable abortion. Even more disheartening -- U.S. policies
have not only failed to narrow the disparities, but have exacerbated them.
More young African-American females and Latinas than white women are given abstinence-only instruction in school, instead of
comprehensive sex education. This means they aren't taught about contraceptive use to prevent pregnancy or protect against HIV and
other sexually transmitted infections (STIs). Abstinence-only programs have proven ineffective, and in some cases counter-productive,
but every year the government has increased their funding dramatically, now totaling $176 million annually.
Although the U.S. has the resources to reduce maternal deaths and has acknowledged the importance of prenatal care to prevent
them, it has adopted policies which force women to delay pregnancy-related care or forego it altogether. Unreasonable requirements for
Medicaid like the 5-year bar on benefits for legal residents prevent many immigrant women from receiving even basic services. Not only
did the Committee recognize the need for the U.S. to take action to address racial disparities, it rejected the government's argument that
the poor health outcomes arose from behavioral choices rather than government policy choices that fail to address American citizens'
human right to adequate reproductive health care. In order to address these needs, the Committee recommended that the U.S.: (1)
improve access to pre- and post-natal care, including by eliminating eligibility barriers to Medicaid, (2) facilitate access to
contraceptive and family planning methods, (3) provide adequate sexual education aimed at the prevention of unintended pregnancies
and STIs. It's fitting that these recommendations came on the eve of International Women's Day, the nearly century-old commemoration
of the worldwide battle to ensure equal rights for women on issues like work, voting and abortion. The Committee's comments are a
victory for reproductive health advocates and women of color. Now it's time for the U.S. to stop making excuses and to
adopt health care policies to ensure that the basic rights of women of color to reproductive health care.

82
I.H.S. Affirmative
Health Impacts - Genocide

Denial of Indian health care is a part of an ongoing legacy of genocide and institutional
racism against American Indians
Belcourt-Dittloff and Stewart, Professors of Psychology, University of Montana, 2000
(Annjeanette & J. Historical Racism: Implications for Native Americans, American Psychologist, 55, 1166-1167)
After reading this article, we were struck by the similarities that exist between this cultural group and Native
Americans. Native Americans have historically been and currently are highly affected by intergroup racism,
racism being the existence of beliefs, attitudes, institutional arrangements, and acts that tend to denigrate
individuals or groups because of phenotypic characteristics or ethnic group affiliation (Clark et al., 1999, p.
805). One long-standing example of intergroup racism that continues to have pervasive effects is historical
racism. It is our belief that historical racism has had and continues to have a profound impact on Native
Americans. We outline below some possible ways in which historical racism constitutes a stressor with
biopsychosocial implications for American Indians. The concept of historical racism is an outgrowth of the
fact that American Indian people have long been known to experience racism and oppression as a result
of colonization and its accompanying genocidal practices (Brave Heart & DeBruyn, 1998). It is estimated
that the population of Native American peoples was decreased to only 10% of its original number by the end
of the 18th century (Sue & Sue, 1990). The massive loss of lives, land, and culture is believed to have
resulted in a long legacy of chronic trauma and unresolved grief for Native Americans (Brave Heart &
DeBruyn, 1998). Similar to the lasting effects of slavery on African Americans, the historical legacy of
trauma and unresolved grief experienced by Native American peoples because of historical racist acts has
become an unfortunate foundation of the American Indian experience. Also similar to the experiences of
African Americans, this foundation has had tragic ramifications on the well-being of Native American
peoples. As stated elsewhere, the trauma and intergenerational grief and despair associated with these
experiences is still readily evidenced in most tribal cultures and is still taking a toll in many tragic ways
(Sommers-Flannagan & Sommers-Flannagan, 1999, p. 376). In addition to the overt racism and
discrimination experienced by Native Americans, many American Indians continue to encounter more
subversive racial discrimination. Examples of institutionalized discriminatory practices abound. One
illustration of this practice exists in the area of health care for American Indian peoples. Despite the
fact that Native Americans are plagued by disproportionately high rates of suicide, homicide, accidental
deaths, domestic violence, child abuse, alcoholism, and mental health problems (Brave Heart & DeBruyn,
1998; Indian Health Service, 1995), Native Americans are both an underserved and underrepresented
health care population.

83
I.H.S. Affirmative
Health Impacts - Racism

Racial discrimination plays a big part in the healthcare disparities among American
Indians.
The causes of the disparities in the health status of Native Americans are many and varied. Among the
causes identified by the director of IHS is racial discrimination.99 Analyzing the effects of that
discrimination proves difficult as the unique racial or ethnic status and political history of Native Americans
introduce unique emotional variables. According to Michael Bird, .when you dispossess people of their
land or labor, their culture, their language, their tradition, and their religion you set into force
powerful forces that impact in a very negative and adverse way..100 These comments on
discrimination echoed the findings of the Commissions 1999 report on health care disparities,101 as
well as those of several other government agencies. The National Institutes of Health recognized that
racial bias contributed significantly to differences in health care among people of color in its Strategic
Plan for Health Disparities Research,102 while the Institute of Medicine established that .whites are more
likely to receive more, and more thorough, diagnostic work and better treatment and care than people
of color, even when controlling for income, education, and insurance..103 Few studies, however, have
addressed how racial bias systematically affects the health of Native Americans. Though the categorization of
discrimination in general terms is possible, the nature of that discrimination has changed to become
subtle and more difficult to address.104 Consequently, identifying all areas in which racial bias and
discrimination influence or contribute to existing health disparities proves difficult. Current research
indicates that there are five primary contributors to disparities in health status and outcomes for Native
Americans. It must be observed that these factors are not beyond the influence of racial bias and
discrimination, either systemic or individual. The five factors include: Limited access to appropriate
health facilities. Poor access to health insurance, including Medicaid, Medicare, and private insurance.
Insufficient federal funding. Quality of care issues. Disproportionate poverty and poor education.105
These five factors are not mutually exclusive; in fact, there is substantial overlap. As heard throughout
the briefing, this is particularly true when funding considerations are implicated. For example, a person may
arrive at a health facility only to find that lack of funding has prevented the facility from providing the
necessary services or that there is an extended waiting period before services will be available. Lyle
Jack, councilman of the Oglala Sioux, stated that although his tribe has what is considered to be one of the
best rehabilitation centers, it does not have sufficient funding to staff the facility properly.106 Regardless of
the reason, health care access remains limited. Thus, we turn to a discussion of the five factors that sustain
the disparities in health status.

84
I.H.S. Affirmative
Health Impacts Moral Obligation

The USFG has a moral obligation to provide Native Americans with the necessary
healthcare.
TRIBAL-FEDERAL GOVERNMENT RELATIONSHIP Native Americans are dying of diabetes,

alcoholism, tuberculosis, suicide, unintentional injuries, and other health conditions at shocking rates.
Beyond the mortality rates, Native Americans also suffer significantly lower health status and
disproportionate rates of diseases compared with all other Americans. During the briefing, Michael
Bird, executive director of the National Native American AIDS Prevention Center, made evident how
long these devastating realities have afflicted the Native American peoples as he quoted from an address
to Congress by President Nixon in 1970: The First Americans.the Indians.are the most deprived and most
isolated minority group in our nation. On virtually every scale of measurement: employment, income,
education, and health, the condition of the Indian people ranks at the bottom. This condition is the
heritage of centuries of injustice. From the time of their first contact with European settlers, the American
Indians have been oppressed and brutalized, deprived of their ancestral lands, and denied the opportunity to
control their own destiny.4 The conditions described by President Nixon, which still exist today, are the
result of the federal government.s failure to respect promises made to Native Americans over the past
300 years in exchange for 400 million acres of tribal land and the unfulfilled .trust. relationship that
requires the government to protect tribal lands, assets, resources, treaty rights, and health care, among
other obligations. The legal source of this trust obligation, however, is imprecise as the boundaries and
duties of the trust relationship have evolved over the past two centuries. Pursuant to the power .[t]o regulate
Commerce . . . with the Indian tribes.5 a series of treaties, judicial decisions, and statutes has shaped federal
trust responsibility. Accordingly, the federal government has accepted many obligations, including education,
construction, law enforcement, and medical services. This health care obligation requires the government
to provide medical treatment to all Native Americans living in the United States.
Health Care is a human right

National Health Care for the Homeless Council, date unknown
(NHCHC, Human Rights, Homelessness and Health Care, date unknown, http://www.nhchc.org/humanright.html,
6-28-09, MEL)
The Universal Declaration of Human Rights, adopted by the United Nations in 1948, proclaimed that
everyone has the right to a standard of living adequate for the health and well-being of oneself and
ones family, including food, clothing, housing, and medical care.
Although this statement of high principle was adopted at the urging of the United States, and although it
reflects the truths of our nations founding documents, our government has achieved neither formal
recognition nor practical realization of these rights. Mass homelessness and the escalating health care
crisis in the US are compelling evidence of our disregard for human rights. Sadly, our country is but
one of many nations where grave offenses against the dignity of human beings are commonplace, and
global enforcement of human rights remains a distant goal. In the US, however, the twin advantages of
democratic institutions and great wealth provide the opportunity for our nation to implement the principles
human rights. Implementation of human rights principles will lead inexorably to the elimination of mass
homelessness.

85
I.H.S. Affirmative
Health Solvency Reauthorization

Reauthorizing the IHCIA improves tribal health care
Marquez 2001
In order to compete with larger managed care systems for Medicaid dollars, the I/T/U systems must
transition from a system of rationed care under a defined budget, to a system of managed care under
prepaid capitated payments (Kaufman, Johnson, and Jacobs 1997).
A point stressed by several sources is that IHS has always been a rationed health care delivery system.
Congressional testimony submitted by Buford Rolin, National Indian Health Board chair, addressing unmet
health needs, indicated that tribal projections estimated close to 50% of health needs went unmet, and this
was separate from budgetary considerations for facilities, which would require billions of dollars to
bring them up to present health care facility standards (Rolin 1998). Rolins estimates do not even begin
to include the needs of urban Indian patients who have unmet health needs estimated at close to 75% of
current funding levels. Nor do his estimates fully reflect the needs of urban communities with sizable
Indian populations that have no urban Indian health programs. Indian health care providers have
explored some of the options (Bushyhead 2000).
Presently, proposed legislative action is evident in the more than 50 versions of the Indian Health Care
Improvement Act. The reauthorization of this act is currently before Congress with particular emphasis
placed on Title IV, Medicaid Demonstration; the revision includes the addition of a new demonstration
site that could directly bill Medicare and Medicaid and bypass the state. Perhaps Michael Mahsetky,
assistant to the director of IHS, advanced the crux of the issue with respect to managed care. When recently
queried about the current issues facing I/T/Us, he offered the following:
Exempt American Indians and Alaska Natives from mandatory enrollment in Medicaid managed
care plans
Eliminate auto-assignments of IHS beneficiaries to managed care organizations
Authorize Medicaid payments to IHS/tribal/urban providers even when the American Indian/Alaska
Native is enrolled in a managed care organization
Exempt payment of premiums and cost sharing by American Indians and Alaska Natives under the
state managed care plans and Childrens Health Insurance Plan (CHIP) (Mahsetky 2000)
Fleury underscored the rationale for exempting I/T/Us from managed care plans: managed health care is
not a compatible system of care for Indian people. IHS/tribal/urban health clinics serve low-income
populations (Fleury 2000). Review of cost and service risk in relation to a typical managed care population is
not available to each tribal program (Clain 2000). However, other primary health care providers to lowincome populations recognize the need to document the level of acute and chronic illness in their patient
populations. Clain (2000) noted that it might be difficult for the I/T/U provider to document the cost of
services provided per encounter because of internal systems built upon established rates set per encounter
versus rates set on the actual cost of services provided. A long-standing recommendation has been an
examination of risk-adjusted rates for services to Medicaid beneficiaries (ibid.). Even with extension of the
federally qualified health center legislation, tribes will not be able to forecast their costs based on need, let
alone on their wishes.

86
I.H.S. Affirmative

Reauthorized of the Indian Health Care Improvement Act is crucial to removing American
Indians from the bottom of every health care indicator in the US.
Stockes, Indian Country Today Writer, 01
(Brian, Indian Country Today, 2/28/01, Healthcare gets new scrutiny
http://www.indiancountrytoday.com/archive/28194149.html , Accessed 6/28/09, CAF)
Late last year, the law which authorizes federal health care for all Indians expired. Since then,
Congress, the administration and the tribes have worked to redraft and update new legislation. The
result of that work was introduced as a bill, along with other Indian health care initiatives, by Sen. Ben
Nighthorse Campbell, R-Colo., chairman of the Senate Committee on Indian Affairs. The Indian
Health Care Improvement Act was initially authorized by Congress in 1976 and enables the Indian
Health Service (IHS), to provide a variety of health care services to Indian people."American Indians
rank at or near the bottom of every health care indicator in the United States today," Campbell said.
"Infant mortality, diabetes, substance abuse and cancer rates plague Native people at rates much
higher than any racial or ethnic group in the nation. I am hoping that by incorporating the lessons we
have learned over the past 30 years we can help turn this situation around." In 1999, the administration,
through the IHS, sponsored a number of regional meetings between tribal health care providers, both on
reservation and in urban areas, to discuss various health care concerns and to gather recommendations on the
reauthorization of the Indian Health Care Improvement Act. Following initial meetings, tribes, tribal
organizations, and urban Indian organizations formed a National Steering Committee.
The Indian improvement act needs to be reauthorized now to prevent the loss of more lives
Briggs, Indian Country Today correspondent, 07
(Kara, Indian Country Today, Healthwise., 3/22/07,
In the Indian Affairs Committee hearing on March 8, Richard Brannan, chairman of the Northern Arapaho
Tribe, talked about Dylan Whiteplume, an Arapaho 5-year-old who died from cancer because the Wind
River Service Unit lacked the money to pay for his chemotherapy. By the time charities raised the
money, the child was in the late stages of the disease. ''He entered a children's cancer treatment facility
where one of his friends was a little girl that was diagnosed with the same disease at the same time as
Dylan,'' Brannan told the committee. ''She was able to access treatment earlier than Dylan and was
healthy at the time of our reporting.''It's not that the reauthorization would guarantee the survival of
every child cancer patient, but this political game being played by the Bush administration and
Republican leaders is costing lives in real time, and has the potential to cost even more. A cadre of career
staffers in key federal agencies is willing to sacrifice lives as a test scenario for terminating all federal trust
responsibility, said Eric Eberhard, partner in Dorsey and Whitney law firm and a former staffer to Sen. John
McCain. These staffers, most particularly in the departments of Justice and Interior, Eberhard said, have
consistently, over many administrations, espoused the end of federal trust responsibility as the objective for
U.S. Indian policy. These are the people who have been whispering in Congress members' ears for the decade
in which the reauthorization has been kicked around.Now more than ever, Native voices need to be
louder.Among the strongest Native voices in this fight has been Rachel Joseph, former chairman of the Lone
Pine Paiute-Shoshone and co-chairman of the National Steering Committee for the Reauthorization of the
Indian Health Care Improvement Act. At the March 8 Senate hearing, Joseph pointed the thinking back to 30
years ago when the Nixon and Ford administrations moved the Indian Health Care Improvement Act into
law. Then the intention was to bring health care standards for American Indians up to those of other
Americans.In the words of President Gerald Ford from 1976: ''This bill is not without faults, but after
personal review I have decided that the well-documented needs for improvement in Indian health
manpower, services and facilities outweigh the defects in the bill. While spending for the Indian Health
Service has grown from $128 million in FY 1970 to $425 million in FY 1977, Indian people still lag
behind the American people as a whole in achieving and maintaining good health. I am signing this bill
because of my own conviction that our first Americans should not be last in opportunity.''

87
I.H.S. Affirmative

The Indian Health Care Improvement Act includes a laundry list of new measures to
increase quality of American Indian healthcare.
Title II: Health Services. The changes in Title II, in broad terms, aim to improve the quality of health
service programs providing care to Native Americans. Improvement will be accomplished by:
institutionalizing the national diabetes program that is currently funded by special appropriations;
decentralizing control of the Catastrophic Health Emergency Fund to the area level; expanding
preventive services to cover all cancers, instead of limiting coverage to mammography screening for breast
cancer; establishing epidemiology centers in all 12 areas; requiring staff in tribally operated facilities to
meet the same licensing requirements as IHS facilities; strengthening the prohibition against contract
health service providers holding individual patients responsible for payment for contract health
services obligations; establishing a program to monitor nuclear and environmental health hazards; and
designating the entire state of Arizona as a Contract Health Service Delivery Area. Title III: Health Facilities.
As a starting point, Title III will institutionalize tribal consultation for facilities expenditures. This
change will ensure that facilities decisions accurately reflect the needs and priorities of the affected
populations. In addition, the consultation will result in a priority system that encompasses all facilities, not
just a top 10. This change ensures that a true and complete spectrum of unmet need in Indian
Country is presented. Concerning accreditation, Title III will authorize accreditation under any
nationally recognized accrediting authority. Doing so will expand the ability of smaller facilities to meet
eligibility requirements for public insurance programs, increasing the funding available to purchase
additional health care for Native Americans. Several of the other changes involve the creation of more
flexible funding options. These include the creation of IHS-tribal joint ventures; allowing for innovative
financing by tribes, coupled with an IHS commitment to equipment and staffing; the creation of a Health
Care Facilities Loan Fund; and express permission to use any other source of funds for tribal services to
provide health care. A provision is included to ensure that the use of other sources by tribes will not
jeopardize their positions on the priority list for future construction projects. These flexible funding options
have the potential to significantly increase the operating funds available to tribally operated facilities
and will serve as a multiplier for federal funding.

88
I.H.S. Affirmative
Health Solvency I.H.S. Funding

Health care specifically targeted at Native Americans is uniquely key to their cultural
integrity and self determination, and represents a fundamental shift away from
assimilation strategies
Ignance, President of the National Council of Urban Indian Health (NCUIH) and member
of the Menominee Tribe, 2006
(Plea For Urban Indian Health. Native American Law Digest May 2006. Accessed 30 Jun 2009. EKC)
3 "The American Indian has demonstrated all too clearly, despite his recent movement to urban centers,
that he is not content to be absorbed in the mainstream of society and become another urban poverty
statistic. He has demonstrated the strength and fiber of strong cultural and social ties by maintaining
an Indian identity in many of the Nation's largest metropolitan centers. Yet. at the same time, he
aspires to the same goal of all citizens--a life of decency and self-sufficiency. The Committee believes that
the Congress has an opportunity and a responsibility to assist him in achieving this goal. It is, in part,
because of the failure of former Federal Indian policies and programs on the reservations that thousands
of Indians have sought a better way of life in the cities. His difficulty in attaining a sound physical and
mental health in the urban environment is a grim reminder of this failure."
"The Committee is committed to rectifying these errors in Federal policy relating to health care
through the provisions of title V of H.R. 2525. Building on the experience of previous Congressionallyapproved urban Indian health prospects and the new provisions of title V, urban Indians should be able to
begin exercising maximum self-determination and local control in establishing their own health
programs."
Increasing funding to Indian health services solves

Rather than the President's proposal, NCUIH urges this Committee to support a $12 million increase for
Urban Indian programs in the FY 2007 budget. Even as the percentage of Indians living in urban areas
has climbed, the percentage of IHS funding to urban Indian health programs has declined from 1.48% in 1979
to 1.06% in 2005. With its current funding level of approximately $31 million, the urban Indian health programs, amazingly, are able to serve 150,000 urban Indians.
However, additional funding is needed as there are more than one million urban Indians.
there is a need to enhance existing programs, expand the urban Indian health program
epidemiology center in Seattle, Washington, conduct a planning study on the 18 new urban Indian
health programs and establish an automated mutually compatible information system to capture
health status and patient care data for urban Indian health programs. This increase will elevate the
Urban Indian Health Program funding from $31,816,000 to $44,016,000 and represents a great step
towards addressing the funding gap for urban programs. While this cannot address the total need, it will
make a huge difference in access to and quality of care for American Indians/Alaska Natives living in
urban areas.
Moreover,
The Indian Health Service needs 50% more funding to function properly and modernize its
services
COCHRAN, Bilings Gazette News Journalist, 2009
(Diane, Tribes keep eye on health care reform, Missoulian, June 29, 2009, CME)
We don't know what health care reform is going to look like, so it's hard to position ourselves, said
Pete Conway, a director for the Indian Health Service in Billings. Whatever Congress decides to do about
health care, tribes want to gain ground, not lose it. And that means achieving at least two goals keeping their status as sovereign nations and improving the Indian Health Service system. The most
important thing that needs to happen for American Indians and Alaska Natives is for our (health) system to be
protected and, at the same time, improved, said Jennifer Cooper, legislative director for the National Indian
Health Board in Washington, D.C. Some 1.9 million American Indians get medical care through IHS, an
often-criticized health care delivery system that historically has been funded at about 50 percent of
need. Tribal advocates have been lobbying Congress for 10 years to renew the Indian Health Care
Improvement Act, legislation that would increase IHS funding and modernize its services.

89
I.H.S. Affirmative

Increasing funding for the Indian Health Service to $18 billion solves
The federal government has a trust responsibility to provide health care for American Indians and
Alaska Natives, based on multiple treaties, court decisions, and legislative acts. However, the IHS is
critically underfunded. Although its budget for fiscal year 2002 is $2.8 billion, tribal leadership has
estimated that a needs-based budget for Indian health care should be closer to $18 billion. Per capita
expenditures for Indian health care were approximately one third as much as expenditures for
individuals in the US general population in 2001.4 Lack of adequate funding and services is a constant
stress on the Indian health system and plays a significant role in the continuing health disparities in Indian
communities.
All I.H.S. problems can be solved by more federal funding.

Kauahquo, Native American Times writer, 2005
(Michelle, Native American Times, Fixing Indian health servicessome suggestions, 3-16-05, http://proquest.umi.com/pqdweb?
index=0&did=836919181&SrchMode=2&sid=1&Fmt=3&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1246255456&clientId=
10553, 6-29-09, ESM)
Free Health Care for all Native Americans! The Federal Government allocated funds specifically for the
Indian Health Service (IHS) in 1921, in order to provide Natives with Health Care. The notion of "free"
paired with healthcare sounds very appealing. I am a Native American and am entitled to this free healthcare,
however I have not utilized this system since I was a young child. Why, you ask, would I pay for something
that I can get for free? I have grown up going to a private physician rather than going to the "Indian clinic."
From family members that use and work for IHS, I have always had this preconceived idea that IHS
provides less than average healthcare. Is the care provided through the IHS necessarily insufficient or is
this just a reputation that I have assumed? Seeing that IHS is the only form of "national" healthcare available
in the United States, it is actually run pretty well; although there are many improvements that could be made
through our efforts, as the Natives that utilize this service. According to the IHS mission statement, their
purpose is to uphold the Federal Government's obligation to promote healthy American Indian and Alaska
Native people and also to achieve this at the highest level. However, looking at the IHS, it is apparent that the
highest level is not being achieved across the board, with some service units receiving better care than
others. Also, the care being provided at a majority of the clinics is not even close to the highest quality
level of care. Almost two-thirds of the care needed for American Indians and Alaska Natives is not
available through Indian Health Service (IHS) or Tribal programs. The Pawnee Benefit Package(PBP) is a
program that has been established by IHS and being run by the Pawnee Nation that has been an attempt at
solving this remaining two-thirds problem. The PBP works as a sort of insurance plan for the community
served by the Pawnee Area Hospital. Each member receives a PBP card that is accepted by predetermined
private doctors so that they may receive care, which is not provided by HIS. The PBP is a fairly new
program, which works at solving this problem. It is an excellent start that can be tweaked to provide
maximum care. IHS funding is actually 40% less than the average that it costs for mainstream health
insurance plans.3 This 40% deficit accounts for the racial disparities in health among Native Americans.
The IHS does provide the baseline money needed to fund programs such as Diabetes Awareness and
AIDS Prevention. However, this money does not take into account the ancillary costs of these
programs. The Director of Facilities for IHS-Lawton, Frank Kauahquo, suggests that the money and
initiative is there for the new programs but there just isn't enough space in which to host these programs.
Space, being one of these ancillary costs, can also be attributed to the problem of waiting time at certain
"Indian clinics," such as the Lawton Area Hospital. At this hospital, in particular, there is one exam room per
doctor. This lack of space slows down the whole outpatient process. Even though the space isn't there, the
doctors are available. The IHS Scholarship program has been established to attract undergraduate,
graduate, and medical students to the Medical Field, and more particularly, to work for the IHS. The
scholarship is meant to attract Native Americans to give them the means to get a professional degree to
enable them to come back and work for their people. However, the number of Native Americans applying
has been declining. All the above statements describe problems within IHS that can be solved. They all
can be solved with extra funding. The Federal Government supplies us with funding for our "Free"
basic health care needs; it is our job, as Native people, to take the initiative to help pay for the extra costs.
With our increase in funding from gaming endeavors, we have the resources to do so.

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I.H.S. Affirmative

IHS facilities are inadequate due to lack of funding which in turn limits the services they
can provide
Office of the General Counsel U.S. Commission on Civil Rights, 2004
(Native American Health Care Disparities Briefing Executive Summary, p.20, KS)
In general, IHS direct services are limited in scope compared with services in non-IHS facilities. IHS
hospitals are smaller and have fewer beds than other U.S. community hospitals. In addition, IHS hospitals
provide limited inpatient services and fewer high-technology services. Aside from the three large IHS
hospitals (the Alaska Native Medical Center in Anchorage, Alaska; the Gallup Indian Medical Center in
Gallup, New Mexico; and the Phoenix Indian Medical Center in Phoenix, Arizona), IHS hospitals have
fewer than 50 beds and most are without surgical or obstetrics services. Following the national trend,
IHS services are shifting from inpatient care to an emphasis on ambulatory care services. Despite IHS
efforts to provide for the health care needs of Native Americans, limited funding has led to the
rationing of services. Rationing of health services limits patients access to only medically necessary
services. Medically necessary services are defined by an attending physician who determines the health
care treatment that is necessary to preserve life, limb, and sensory organs or to prevent clear
deterioration of health status. Limited funding also forces IHS officials to restrict patient access to
specialty care services.
The IHS needs much more funding from the government in order to reach more American
Indians and without this funding, success rates could be reversed
Empsall, Bachelors Degree from Dartmouth in Government and Native American Studies,
2008
(Nathan, The Episcopal Public Policy Network, On the Issue: American Indian Healthcare, August 2008,
http://www.cuac.org/3654_101099_ENG_HTM.htm, 7-1-09, KS)
Since its creation in 1954, the Indian Health Service (IHS) has attempted to respond to these needs
through a broad range of services. Because of the federal governments official trust relationship with
Indian tribes, members of the 562 federally recognized tribes are entitled to free health care. IHS
serves approximately 1.9 million (out of 3 million) American Indians and Alaskan Natives on or near
reservations in 35 states. Congress appropriated $3.2 billion for IHS in 2008, which was supplemented
by an additional $628 million in third party collections (Centers for Medicare and Medicaid Services,
private insurance companies, etc). Approximately half this budget authority and a majority of health
services are administered by tribes rather than the IHS itself. IHS services include inpatient, ambulatory,
emergency, dental, and preventative care. Specific focuses include general clinic services, maternal and child health, diabetes, hepatitis
B, alcoholism, and mental health. IHS provides for medical facilities, including the construction, equipping, and maintenance of
hospitals, health centers, clinics, and sanitation facilities. Despite the remaining health disparities that persist in Indian Country, IHS has
achieved significant results. Since 1974, life expectancy has risen from 63.5 years to 71, and mortality rates for pneumonia, alcoholism,
chronic liver disease, tuberculosis, gastrointestinal disease, injuries, and poisoning have significantly decreased. The U.S.
Commission on Civil Rights credits these successes to improved access to quality health care and
increased public efforts to control infectious diseases, but cautions that the rate of improvement has
diminished in recent years, and without more IHS funding, could be reversed.
The Indian Health Care Improvement Act would directly increase funding
System, September. Pages 129 & 130, MAG)
As mentioned above, the proposed reauthorization of IHCIA recognizes that many, and in some areas most, tribes have assumed
responsibility for administering their own health programs under contracts and compacts. While tribes rely on government funding, the
reliance is to varying degrees. Many tribes have found it necessary to access tribal money, charitable grants, and other funding sources.
The new bill will allow for additional and more flexible funding options, as explained above. In addition
to these options, the reauthorization will produce gains in direct funding for health care. Specifically,
the improvements identified above would generate at least an additional $6.9 billion for direct
spending on Native American health care over the next 10 years.

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I.H.S. Affirmative

The IHS is ineffective now- any improvements will likely be reversed. We have a moral
imperative to improve the system.
Most of these improvements may be attributed to increasing access to health care and public health efforts to
reduce the effects of infectious diseases. In recent years, the rate of improvement has diminished
considerably as disease patterns have changed.98 Consequently, Native Americans health status is
improving little, both relative to other racial/ethnic groups and in real terms. Given this plateau, there
is concern that the lower frequency at which Native Americans access care will erode the previous
health status improvements. The National Healthcare Disparities Report revealed that Native
Americans have worse access to routine health careas measured by outpatient visits per population,
percentage of persons with a dental visit, and percentage of persons with prescription medicationsthan the
general population.99 Another trend that may further erode progress is found in data from IHS: per capita
expenditures for Native Americans accessing IHS services is lower than the national average, and IHS
users are served by only half the number of nurses and physicians compared with the national
average.100 Given that the stated goal of the Indian Health Service is to raise the health status of
Native Americans, and that goal has, at best, met with limited success, accountability becomes a
significant concern. The starting point for any discussion of accountability for Native American health
care is defining the source and the scope of the federal governments responsibility to Native
Americans.
Funding would solve the current discrepancy in funding for the Indian Health Service and
fulfill the federal governments trust obligations.
System September. Pages 87. MAG)
The need for additional funding is particularly well supported by advocates for Native American
health care, who have developed a variety of measurements to verify the inadequacy of present funding
levels. Over the years, they have made the following arguments to the President and Congress when
requesting additional funding, which are discussed later in this chapter: Annual per capita health
expenditures for Native Americans are only 60 percent of the amount spent on other Americans under
mainstream health plans. Annual per capita expenditures fall below the level for every other federal
medical program and standard. Annual increases in IHS funding have failed to account for medical
inflation rates and increases in population. Annual increases in IHS funding are less than those for
other HHS components. Annual increases have effectively been reduced to reflect increased collection
efforts despite express congressional intent that appropriations not be reduced. Examined individually, these
measurements express in clear terms that funding levels are inadequate. When examined together, the
conclusion is unmistakable that current funding levels are far below that necessary to maintain basic
health services and that the federal government has failed to satisfy its explicit trust obligation. The
first section of this chapter addresses affordability as measured by government spending, including a detailed
examination of several methods for measuring the adequacy of funding levels. This discussion will be
followed by an analysis of specific identifiable funding needs for contract health services, contract support
costs, and the Urban Indian Health Program, as well as an evaluation of certain administrative issues
surrounding the financing of Native American health care. These administrative issues include the frequently
misunderstood term entitlement, rules for the distribution of funds among tribes and regions, and rules for
the administration of designated appropriations. The second section of this chapter isolates the insurance
component of health care financing. Specifically, it examines the various barriers that produce startling
numbers of uninsured Native Americans and how those barriers have a detrimental influence on the
affordability of and the access to health care. The chapter closes with the identification of findings and
specific recommendations to address them. Funding background is provided before the examination of
financial barriers to place the discussion in context.

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I.H.S. Affirmative

Funding needed- The Indian Health Service needs major funding to maintain current levels
of care, and will need a substantial amount more than that to increase any services.
The preceding section made clear that funding levels are inadequate by the governments own standards.
This government failure is compounded by the failure of annual increases to even keep pace with
inflation and population growth. Current estimates place the growth rate of the IHS user population at 1.8
percent per year. Furthermore, the fastest growing segments of the population are the very young and the
elderly, both of which carry the highest burden of disease. The overall IHS budget has grown at a rate
slightly below the rate of inflation over the past several years. The $2.97 billion budgeted for FY 2005
appropriations represents an increase of 1.6 percent from FY 2004.40 This follows an increase of only 2.6
percent in FY 2004, an amount far below that needed to maintain the current level of services. As recently as
FY 2000, annual appropriations included a line item to compensate for inflation. Though less than the
calculated inflation rate, Congress at least attempted to maintain constant spending levels. Since FY 2000,
not one dollar has been allocated specifically to address the rising cost of health care for Native
Americans. In FY 2005 alone, this shortfall will amount to more than $50 million. With only limited
increases proposed, actual spending power will continue to decline due to the high medical inflation
rate, the moderate health services and facilities inflation rates, and the significant population growth
identified above. The Northwest Portland Area Indian Health Board estimated that $360 million, a full 12.4
percent increase, would have been needed in FY 2004 simply to cover current services and mandatory costs.
Those figures, when updated, will certainly be larger for FY 2005 as the gap continues to widen. As an
additional measure of the effectiveness of the growing budget, the HHS budget justification breaks down
the allocation of individual increases, including an analysis of the services those increases provid

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I.H.S. Affirmative
Health Solvency I.H.S. Empirically Solves

IHS solves- since theyve been put in charge of American Indian health, mortality rates
have dropped.
Consequently, not only is reduced health status a burden to Native Americans, but a cumulative drain
on the entire Native American existence. Poor health inhibits the economic, educational, and social
development of Native Americans and establishes an inescapable cycle of disparity. Nevertheless, not all
news regarding health status is bad news. The IHS, which has been given primary responsibility for
eliminating this disproportionate health status, has been largely successful in reducing mortality rates,
while making significant improvements in other areas.5 Dr. Perez explained that the incidence and
prevalence of many infectious diseases have been dramatically reduced through increased clinical care and
public health efforts such as vaccination for infectious diseases and the construction of sanitation facilities.
Today, Native Americans continue to experience significant rates of diabetes, mental health disorders,
cardiovascular disease, pneumonia, influenza, and injuries. Specifically, Native Americans are 770
percent more likely to die from alcoholism, 650 percent more likely to die from tuberculosis, 420
percent more likely to die from diabetes, 280 percent more likely to die from accidents, and 52 percent
more likely to die from pneumonia or influenza than the rest of the United States, including white and
minority populations.7 As a result of these increased mortality rates, the life expectancy for Native
Americans is 71 years of age, nearly five years less than the rest of the U.S. population.8 A comparison of
earlier life expectancy data illustrates one of the problems facing IHS in eliminating disparities. In 1976, the
life expectancy for Native Americans was 65.1 years, compared with 70.8 years for other Americans.9
Consequently, while life expectancy for Native Americans has improved by six years, the difference in
life expectancy relative to other Americans has changed very little. Another problem facing health care
providers is the increasing importance of the behavioral component of health status. During the October
briefing, Dr. Perez explained that fully seven of the top 10 causes of high morbidity and mortality rates are
directly related to, or significantly affected by individual behavior and lifestyle choices.

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I.H.S. Affirmative
Health Solvency Cultural Programs

Cultural sensitivity increases solvency by strengthening the level of care for American
Indian patients.
System September. Pages 5-6. MAG)
Finally, in Chapter 6, this report makes recommendations for improving the delivery and quality of Native
American health services. Several of the recommendations are rooted in increased funding, but this is
not to exclude or underemphasize the value of significant reforms that can be implemented without
sharp increases in IHS funding. Several recommendations focus on using existing resources wisely and
adopting innovative approaches to disease prevention and detection. An example of change requiring little
or no increase in funding is a re-examination of how IHS teaches the value of preventive medicine and
early detection. These concepts are uncommon in Native American communities. After careful
examination, Dr. Linda Burhansstipanov, a member of the Western Cherokee Nation in Tahlequah,
Oklahoma, concluded that for Native American adults prevention and detection is a low priority. Native
Americans who are raised on reservations, or those with very traditional beliefs, value prevention and
detection more when framed in the context of family and bringing in a healthy next generation.12 A
woman will understand, for example, the value of an annual mammogram if she
is told that early detection will allow her to survive to teach her grandchildren the stories of her
people.13 This same woman may not see the value of breast cancer screening if only told that it makes
good medical sense. Likewise, teaching health care providers to be culturally aware and to
demonstrate cultural sensitivity during the examination and treatment of Native American patients
will increase the numbers taking advantage of available detection and intervention procedures. These
changes, though not costly, would increase detection of many diseases that
The IHS has a commitment to respecting native cultures & healing practices
System, September. Page 34 MAG)
Generally, IHS recognizes the importance of culturally competent care. Dr. Charles W. Grim, director of
IHS, cited cultural and language barriers as factors that affect health disparities and access to health care. He
added that IHS is working to make its programs culturally relevant, and as a result, cultural
competence is losing significance as a factor for accessing IHS services. Dr. Richard Olson, acting
director of Office of Clinical and Preventive Services, also acknowledged that cultural competence is an
aspect of quality of care. IHS defines culturally competent care as a term implying that IHS
programs and staff should be aware, sensitive, and accommodating of a wide diversity of Native
languages, customs, beliefs, values, and traditions of healing and wellness. While IHS acknowledges
that culture and language can be barriers to care for over 560 federally recognized tribes, many with their
unique cultures and languages, IHS claims that, because it employs a high percentage of Native
American staff, cultural competency is not a major issue at IHS. According to IHS, it recognizes the
value of traditional beliefs, ceremonies, and practices in the maintenance of wellness and the healing of
the body, mind and spirit. Therefore, IHS encourages an atmosphere where traditional beliefs are
upheld and respected to ensure that they are a vital force within Indian communities and that those
traditional beliefs remain an integral component of the healing process. Furthermore, IHS makes
traditional medicine, as defined by tribal or village traditional culture, accessible in all its service
delivery locations. IHS is also designing and constructing its new clinics and hospitals to include space for
spiritual healing practices. In terms of whether IHS facilities are successfully delivering culturally competent
health services, a focus group of Native Americans in Albuquerque, New Mexico, revealed that
participants were generally satisfied with IHS providers awareness of the significance of Native
American culture. This finding tends to support Dr. Grims testimony that cultural and language
barriers have become less of an issue for IHS services

95
I.H.S. Affirmative
Health Solvency Cultural Programs

Funding is necessary for culturally-sensitive programs
Unfortunately, the dissatisfaction found by the focus group indicates that the cultural training IHS
provides may be insufficient for addressing cultural barriers for Native Americans. Despite the
recognized importance and need for cultural competency training, IHS does not have a specific budget
set aside for training its IHS direct or contract health service providers. The IHS reports that some
formal and informal training is conducted at the area or local level.76 However, IHS did not provide specific
information as to how managers have sought to incorporate culturally competent care into the delivery
of health services at IHS and non-IHS facilities. In addition, IHS did not provide the requested
information on the impact or outcome of its efforts to incorporate culturally competent care into the
delivery of care on the health status and outcomes for Native Americans. Overall, despite requests for
detailed and specific information on IHS training and policy implementation efforts to ensure culturally
competent care, IHS was unable to identify monitoring mechanisms, training initiatives, or targeted funding
indicative of the commitment needed to develop cultural competency in the delivery of health services at IHS
and non-IHS facilities.

96
I.H.S. Affirmative
Health Solvency I.H.S. Reforms

Simply reinstating the IHS isnt enough- reforms need to be made in order for it to work
efficiently and reduce racial discrimination
Racial bias and discrimination continue to play a role in medical and treatment decisions. As the main
health care provider and advocate for Native Americans, IHS has a duty to ensure that IHS and IHS
contract service providers deliver health services that are culturally sensitive and free from bias. To
ensure that Native Americans are provided this level of health care: IHS should create separate
complaint processing offices within each IHS facility to monitor, investigate, and resolve complaints alleging
bias and discrimination in either IHS facilities or contract health facilities. These offices should report
directly to senior management. IHS should establish formal review and appeals procedures at the area
office level and in headquarters to ensure timely resolution of all discrimination complaints and
prompt notification to complainants regarding the status of their complaints. IHS, upon creation of its
complaint processing offices, should require each office to produce periodic reports summarizing the number of complaints, the nature
of the complaints received, and any remedial action taken. Based on analysis of these reports, IHS should formulate appropriate training
programs aimed at eliminating bias and discrimination. IHS should implement formal cultural training programs
aimed at teaching providers to present culturally specific health information and provide culturally
appropriate services. IHS should implement cultural training programs for non-IHS providers at
contract health facilities. IHS should, in addition to providing cultural training, expand efforts to hire
more Native American providers who can better understand and communicate with Native American
patients. IHS and other federal agencies, working in partnership together, should create and
implement economic development strategies aimed at increasing tribal economic opportunities. These
strategies should be tailored to meet the needs of each individual tribe as identified through tribal consultations and sound research.
IHS should involve Native American communities in collecting and monitoring community health data by partnering Native American
communities and tribes with researchers, colleges, universities, and others with technical expertise in health research or Indian health
research, in particular. HHS should increase the availability of grants to Native American communities for conducting health research
and data collection. IHS should create and implement a formal policy to ensure that adequate professional language assistance is
available at all IHS and non-IHS contract facilities, such as the use of call centers where IHS can provide and direct telephone language
translation services. IHS should create and make available health information brochures in English and local native languages. These
brochures should be distributed through IHS service units.
Funding alone doesnt solve. Structural changes are needed within the Indian Health
Service.
Native Americans face barriers to gaining access to health care. As Chapter 2 explained, there are social
and cultural barriers such as discrimination, bias, and a lack of culturally competent care. In addition,
the system itself creates barriers. As this chapter has explored, structural barriers limit access to care.
Providing additional funding will certainly address some of the resource issues. However, structural
problems involving IHS management, operation, and administration of its health care system go
beyond funding appropriation and allocation. Operational decisions by IHS on where to place facilities
and what types of services to provide affect access. Lack of meaningful tribal participation and input on
operational decisions concerning the location of the facilities and the types of services to be provided
negatively affects Native American patients. Native Americans, limited by impassable road conditions
and lack of transportation, face real physical access barriers in reaching IHS facilities that are too far
away from their homes. Furthermore, the types of services they need are not always provided at the
IHS facility they use and, therefore, Native Americans are forced to seek contracted services or travel
long distances to access services. In addition, even when Native Americans are able to get to IHS
facilities, they face barriers caused by aging facilities and long wait times. On average, IHS facilities are
much older than non-IHS facilities and, often, these aging facilities are accompanied by haphazard or
insufficient use of space. Long wait times at IHS facilities make it even more difficult for patients to gain access to care. While
walk-in patients may crowd waiting rooms and cause delays for providers, IHS management and operation decisions must take into

97
I.H.S. Affirmative
consideration that, due to transportation issues, some Native Americans are forced to seek walk-in services and therefore, IHS must take
measures to address long wait times.

98
I.H.S. Affirmative
Health Solvency Exemptions/Subsidies

American Indian-Specific Provisions must be utilized for total solvency
LEGISLATION MUST CONTAIN INDIAN-SPECIFIC PROVISIONS The following Indian-specific
provisions need to be included to make sure the promise of health reform reaches American Indian and
Alaska Natives across the country:
1. Exempt American Indian and Alaska Natives from mandates and penalties. American Indian and
Alaska Natives have already paid for their health care coverage. Failure to acknowledge that Native people
are different from other groups needing health care coverage will result in either an abrogation of the federal
trust responsibility or denial of their right to fully participate in health reform. It is not appropriate to
subject American Indian and Alaska Natives to the individual mandate, especially the penalty for
failing to acquire or purchase health insurance. We recommend the House bill, like the Senate HELP
Committee draft, expressly exempt Indians from individual mandate penalties.
American Indians should be eligible for insurance subsidies

American Indians and Alaska Natives should be eligible for insurance subsidies. Permit American
Indian and Alaska Natives to participate in subsidized insurance and explicitly permit tribes to pay
premiums and cost sharing on their behalf. This concept is no different than how Medicare, Medicaid,
CHIP, state subsidized insurance plans or employer based insurance work right now.

99
I.H.S. Affirmative
Health Solvency Urban Indians

IHS Urban Indian health centers are important for Native Americans
In the strongest possible terms, NCUIH opposes the President's proposal to zero-out funding for the
Urban Indian Health Program.
If adopted, this proposal would lead to the complete collapse of many urban Indian health centers and
greatly limit the work of those that could survive such a cut. Contrary to the assertions made in the
President's FY 2007 Budget, Urban Indian health centers do not duplicate the functions of other
programs but rather serve a unique and non-duplicable purpose within the large urban Indian
community. The fact that there are other health services available in urban areas is already reflected in
how IHS funding is distributed, with urban Indian programs receiving only about 1% of the IHS
budget although according to the 2000 Census nearly 70% of Americans identifying themselves as of
American Indian or Alaska Native heritage live in urban areas.1 NCUIH urges the Committee to support
a $12 million increase, rather than a complete elimination of this vital program.
Urban Indians face unique health problems only the aff solves
Attached to this testimony are Impact Survey forms from programs funded by the IHS Urban Indian Health
Program. These forms layout with great specificity what would happen if this program was eliminated,
including bankruptcy, lease defaults, elimination of services to thousands of individuals who may not seek
care elsewhere, an increase in the health care disparity for American Indians and Alaska Natives and the near
annihilation of a body of medical and cultural knowledge addressing the unique cultural and medical needs
of the urban Indian population held almost exclusively by Urban Indian Health programs.
Disease knows no boundaries. As one Federal court has noted, the "patterns of cross or circular migration on
and off the reservations make it misleading to suggest that reservations and urban Indians are two welldefined groups." United States v. Raszkiewicz, 169 F.3d 459, 465 (7th Cir. 1999). With the 2000 census
showing that well over half of the Indian population now resides in urban areas, the health problems
associated strongly with the Indian population as a whole can only be successfully combated if there is
significant funding directed at the urban Indian population, as well as the reservation population.
For similar reasons, urban Indians suffer from the same severe health care problems common to reservation
Indians. Institute, urban Indians suffer higher mortality rates "due to accidents (38% higher than the
general population rate), chronic liver disease and cirrhosis (126% higher), and diabetes (54% higher).
Alcohol-related deaths in general were 178% higher than the rate for all races combined." The rate of
Sudden Infant Death Syndrome was 157% higher when compared to the rate for all children
combined. Nearly one in four Indians residing in areas served by Urban Indian Health Organizations
live in poverty and nearly half live below 200% of the Federal poverty level. These rates are substantially
higher than the rates for the general (all races combined) population (i.e., 14% below 100% FPL and 30%
below 200% FPL).2

100
I.H.S. Affirmative

Urban Indian health programs are key to solve they reduce costs, provide treatment
earlier, save more lives, and overcome cultural barriers
Urban Indian health programs provide unique and non-duplicable assistance to urban Indians who face
extraordinary barriers to accessing mainstream health care. What Urban Indian health programs offer cannot
be effectively replaced by the HRSA's Health Centers program which, even according the President's FY
2007 budget could only address the needs of an additional 25,000 Native Americans, at a loss of the nearly
150,000 Native Americans served by Urban Indian health programs.
* Urban Indian health programs overcome cultural barriers. Many Native Americans are reluctant to go
to health care providers who are unfamiliar with and insensitive to Native cultures. Some Indians may be
reluctant or unable to describe their health needs to strangers outside their own culture. Frequently,
mainstream providers misunderstand or misinterpret the reticence and stoicism of some Indians. Urban
Indian programs not only enjoy the confidence of their clients, but also play a vital role in educating other
health care providers in the community to the unique needs and cultural conditions of the urban Indian
population.
* Urban Indian health programs save costs and improve medical care by getting urban Indians to seek
medical attention earlier. Without Urban Indian programs, many urban Indians would not seek or otherwise
would dangerously delay seeking proper medical care. Such a delay in seeking treatment can easily result
in a disease or condition reaching an advanced stage where treatment is more costly and the
probability of survival or correction is lower. Urban Indian programs reduce the number of emergency
room visits and otherwise raise the standard of care for a marginal additional cost to the system.
* Urban Indian health programs are better positioned to identify health issues particular to the Native
community. Urban Indian programs are experienced in those health issues, whether physical or mental, that
are prominent in the Native community. They are able to diagnose more quickly and more accurately the
needs of the patient, as well as more readily point a patient to the appropriate medical resource to address
his or her condition.
* Urban Indian health programs are better able to address the fact that movement back and forth
from reservations has an impact on health care. Indian movement back and forth between the reservation
and the urban environment is common and can significantly affect the ability of health professionals to
provide prompt, quality follow-up care. Urban Indian programs understand this issue and account for it in
their work with patients.
* Urban Indian health programs are a key provider of care to the large population of uninsured urban
Indians who might not go elsewhere. Many Urban Indians, particularly those employed at or near
minimum wage, have no insurance coverage or have coverage through plans that do not cover
preventive or major medical care. For example, in Boston, 87% of the Boston Indian Center's clients have
no health insurance, and two out of every three urban Indians in Arizona are uninsured. Coming to an Urban
Indian health clinic provides an open door for urban Indians in this situation who otherwise would be very
reluctant and even afraid to seek care in a non-Indian health facility.
* Urban Indian health programs reduce costs to other parts of the Indian Health Service System by
reducing their patient load. Many urban Indians, if they cannot seek medical advice at an Urban Indian
health clinic, will return to their reservation to access far costlier services.

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I.H.S. Affirmative

Urban Indian health programs are part of the trust doctrine we have a moral obligation
to provide health care to Native Americans to make up for past wrongdoing
"The responsibility for the provision of health care, arising from treaties and laws that recognize this
responsibility as an exchange for the cession of millions of acres of Indian land does not end at the
borders of an Indian reservation. Rather, government relocation policies which designated certain urban areas as relocation centers for Indians,
have in many instances forced Indian people who did not [want] to leave their reservations to relocate in urban areas, and the responsibility for the provision of health
care services follows them there."
Congress has "a responsibility to

assist" urban Indians in achieving "a life of decency and self-sufficiency" and has acknowledged that
"[i]t is, in part, because of the failure of former Federal Indian policies and programs on the
reservations that thousands of Indians have sought a better way of life in the cities. Unfortunately, the
same policies and programs which failed to provide the Indian with an improved lifestyle on the
reservation have also failed to provide him with the vital skills necessary to succeed in the cities."
House Report No. 94-1026 on Pub. Law 94-437, p. 116 (April 9, 1976).
Congress enshrined its commitment to urban Indians in the Indian Health Care Improvement Act where it
provided: 4 "that it is the policy of this Nation, in fulfillment of its special responsibility and legal
obligation to the American Indian people, to meet the national goal of providing the highest possible
health status to Indians and urban Indians and to provide all resources necessary to effect that policy"
Senate Report 100-508. Indian Health Care Amendments of 1987, Sept. 14, 1988, p. 25 (emphasis added).3
IHCIA covers urban American Indians

The IHCIA of 1976 articulated the current mission of the IHS: to assure the highest possible health status for
Native Americans. Comprehensive in scope, the IHCIA provided a new framework for the provision of
health services to Native peoples by consolidating IHS programs, by authorizing funds to improve services
and to extend services to urban Indians, and by establishing education programs for health professionals to
work in Indian communities.45 The IHCIA and its 1992 amendments provided for a number of new
programs which serve as models for public health care and national health planning. The Act specified
the following objectives for the IHS: (1) to assure Indians access to high-quality comprehensive health
services in accordance with need; (2) to assist tribes in developing the capacity to staff and manage their own
health programs and to provide opportunities for tribes to assume operational authority for IHS programs in
their communities; and (3) to advocate for Indians with respect to health matters and to assist them in
accessing programs to which they are entitled.46
The plan covers urban American Indians

IHS programs for Indians who live in urban areas offer a range of ambulatory medical, dental, mental
health, social support, and referral services; IHS urban projects do not provide hospital care directly but
may refer Indians to an IHS hospital if one is located in the area. Urban Indian health projects, authorized
and funded under the IHCIA, operate separately from reservation-based IHS programs. Urban
projects may receive funding from non-IHS sources as well as from the IHS; they are likely to treat
non Indians as well as Indians; and they may request payment from both Indians and non-Indians based on
a sliding fee scale in accordance with income.48

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I.H.S. Affirmative

I.H.S. programs can effectively reach urban populations
In the absence of large-scale epidemiological studies of Indian health, indicators of access to care typically
rely on service availability and utilization data. Though there are IHS hospitals in Phoenix, Albuquerque,
and Anchorage, the IHS primarily serves Indians on or near reservations or in rural areas. This was
certainly appropriate when most Indians lived on or near reservations. Today, however, over half of the
American Indian population live in urban areas, less than a quarter live on reservations, and the
remainder live in rural areas (often defined as Indian Country, and containing generally eligible
Indians). At the same time, despite the movement to urban locations, the demand for care in local IHS and
tribal programs continues to increase. It is not uncommon for Indians living in urban areas to return to
their home areas to receive health care services at IHS facilities rather than receive care at non Indian
facilities.
Non-Indian service providers refer urban individuals to I.H.S. providers

1976 report to the American Indian Policy Review Commission, Task Force Eight, addressed the problems of
nonreservation Indians. Two decades later, limited progress has been made in solving problems, such as the
need for additional facilities, personnel, medicine, and information, associated with the delivery of health
care off reservations. The IHCIA recognized the health needs of urban American Natives by authorizing
funds for urban Indian health projects. Funding has resulted in the establishment of health clinics as
well as outreach and referral programs. Some of these health clinics that have developed close political
and financial relationships with municipal governments, are supported by diversified funding sources,
and have become comprehensive ambulatory health centers. Nonetheless, because Indian health care
facilities continue to be located primarily on reservations, Indians residing in cities or nonreservation areas
have limited access to care. Some Indians are hesitant to utilize non-Indian health facilities in their
communities; 126. Id. at 9. For sore throat with fever, 60.8% of IHS-users (defined as Indians living on or
near a reservation or in Alaska, and eligible for IHS supported services, who use IHS supported services) did
not receive care, as compared to 56.1% of the general U.S. population; for abdominal pain of two or more
days duration, 75.4% of IHS-users did not receive care, as compared to 73.2% of the general U.S. population;
for skin rash/infection, 51.0% of IHS-users did not receive care, as compared to 70.0% of the general U.S.
population; for ear infection among those under age 18, 29.5% of IHS-users did not receive care, as
compared to 32.0% of the general U.S. population; for diarrhea of at least two days duration among those
under age 18, 74.9% of IHS-users did not receive care, as compared to 84.1% of the general U.S. population
and non-Indian providers are often averse to treating Indians because of uncertainty about reimbursement or
provider reluctance (sometimes outright refusal) to assume responsibility for treatment even though they may
in fact be responsible for the provision of care. Non-Indian providers often refer Indians to Indian
facilities, usually at some distance; unfortunately, this means that Indians often do not receive care until
their health needs become critical.

103
I.H.S. Affirmative

Reservation proximity to urban areas means the aff increases access to urban and rural
populations
The longstanding doctrine of assigning highest priority to Indians living on or near reservations is based on
two major principles. First, with inadequate resources, it is generally accepted that highest consideration
should be given to those living in locations where there are simply no other health services, Indian or
non-Indian, available. A number of reservations remain in this situation. Although it is recognized that
proximity to other health services such as exist in urban locations does not ensure access, Indians
residing in urban areas theoretically have access to health care not generally available on most
reservations. This is the primary reason that the original intent of IHCIA was for outreach and referral
services to assist urban Indians in gaining access to health care.
Expanding urban I.H.S. programs solves the Indian health crisis in the city
As the number of urban American Indians continues to grow, the already devastating scarcity of resources
that plagues both urban and rural Indian health care will continue to leave urgent health care needs unmet.
Indeed, IHS itself reports that the funding level for urban Indian programs is estimated at 22% of the
projected need for primary care services.22 Although it is widely conceded that reservations in Indian
Country23 should receive the lions share24 of the HIS budget, the general scarcity of health care facilities
and hospitals in rural areas creates an unacceptable disparity in the allocation of resources between urban and
rural Indians. This disparity is even greater considering the increasing number of American Indians now
living in urban centers. Despite the common misconception that urban Indians are in better health than
their rural counterparts, recent data proves that urban Indian health problems are, unfortunately, just
as dire as for those living on reservations. When the urban Indian health care program was first authorized
in 1976, House Report 94-1026 recognized that [i]t is, in part, because of the failure of former [f]ederal
Indian policies . . . that thousands of Indians have sought a better way of life in the cities, and that the same
policies and programs that failed to provide Indians with an improved lifestyle on the reservations have also
failed to provide [them] with the vital skills necessary to succeed in the cities. The plight of urban Indians
has not improved since the expansion of the IHS program to urban Indians in 1976, and given the
increasing number of Indians residing in urban areas, the federal government must modify the IHS
program to render it more fully responsive to the health care needs of these American Indians. As
Congress recognized when it first authorized the urban Indian health programs, the federal governments
trust obligation to Native Americans does not end at the borders of the Indian reservations.

104
I.H.S. Affirmative

Reauthorizing the IHCIA provides comprehensive health coverage for urban Indians
The story of Indian health care has largely been a story of inadequate funding. Without more budgetary
appropriations, it will be difficult to achieve any positive change in Indian health care. Certain structural
changes, however, can and should be made to health care delivery to American Indians both on and off
reservation. The Reauthorization of the Indian Health Care Improvement Act (IHCIA) has been postponed or
stalled in Congress since 2000. After the Act was reintroduced in March of 2003, hearings for the Reauthorization
were held in July 2003 and, most recently, Secretary Tommy Thompson endorsed the Act in a hearing before the
Senate Committee on Indian Affairs in July 2004.222 Despite Thompsons expressed support for the
Reauthorization, there has been no further movement toward enactment as of mid-September. The current
Congressional session is scheduled to adjourn in early October 2004. In 1999, the IHS director convened a National
Steering Committee (NSC) to develop a report on IHCIA recommendations. The NSC is composed of one elected
tribal representative and one alternate from each of the twelve IHS Areas, a representative from the National Indian
Health Board, a representative from the National Council on Urban Indian Health, and the Tribal Self-Governance
Advisory Committee.223 Although the NSC heard from many tribal leaders who supported authorizing Indian
health care as an entitlement program, the Committee was unsure how to proceed with such a mighty undertaking.
As a compromise, the NSC included in Title VIII of the draft bill a provision that would create a
Tribal/Congressional Commission to evaluate entitlement issues and make recommendations to Congress.225 Now
that the Health Care Equality and Accountability Act has been introduced, it is unclear whether this Commission on
an Indian Entitlement will remain in the revised version of the bill. The proposed Reauthorization bill contains
several improvements for urban Indian health delivery. Title IV of IHCIA authorized urban health programs to
recover reasonable charges for services provided to individuals who have private or public medical insurance. The
urban Indian health organization is currently deemed an out-of-network provider for health insurance,
Managed Care organizations, Medicare and Medicaid, and a change in this status is key to reimbursement.
Section 509 authorizes grants which would allow urban projects to lease, purchase, renovate, construct, or expand
facilities to be used as satellite clinics.227 Section 516 authorizes the development and construction of two
residential treatment centers for urban Indian youth who suffer from mental health and substance abuse problems.
Like the two urban demonstration projects in Oklahoma, funding for all urban Indian clinics should be kept in a pool
separate from that open to Tribal self-governance and self-determination programs. Urban projects are currently
able to offer only a fraction of the services that Tribal and IHS programs can provide for free. Furthermore,
the two urban demonstration projects in Oklahoma have proved a tremendous success. Not only should their
protection be preserved in the Reauthorization of the IHCIA, but the time has come for more urban clinics to
receive the funding and legal status that these two demonstration projects currently enjoy. Lastly, if the
currently existing Urban Indian Health Programs are to survive the ongoing changes in states Medicaid programs,
they must at least receive 100% reimbursement rates, as do other IHS clinics, hospitals, and tribal programs. Urban
programs have the potential to expand state Medicaid funding, and their continued survival is needed to
ensure that the federal government does not fully abandon its obligation to provide Indian-specific health
care to individual Indians living off-reservation.

105
I.H.S. Affirmative
Health Solvency Mental Health

The Indian Health Care Improvement Act would expand services for mental health and
substance abuse patients.
System, September. Page 129, MAG)
Title VII: Behavioral Health Programs. Title VIIs primary focus is to establish a continuum of care. Specifically,
it establishes a seamless and comprehensive treatment model for behavioral health that is inclusive of
substance abuse and mental health disorders. Combining the various behavioral health issues in one system
will allow for more effective assessment and treatment in a holistic manner in one facility, limiting referral of
individual patients to several agencies or facilities to address unified conditions. In addition, this title provides for
the establishment of at least one in-patient mental health facility for each IHS area, a significant expansion of
current mental health treatment capacity.

106
I.H.S. Affirmative
A2: I.H.S. is Racist

The IHS isnt racist only private health care providers link
However, despite Dr. Grims statement that IHS provides training for non-IHS providers at contract
facilities,66 the findings from the Albuquerque focus group revealed Native American patients
dissatisfaction with biased behavior and cultural insensitivity toward the importance of traditional
medicine by health care providers from the private sector.6 7 Supporting the general findings of the
Albuquerque focus group, tribal representatives and leaders with whom the Commission spoke agreed that,
generally, cultural competency is not a major concern when accessing IHS direct services. The sense of
dissatisfaction with a lack of cultural sensitivity derives primarily from services provided to Native
Americans by contract health providers. When asked to provide specific information on the number
and the types of administrative and judicial complaints concerning the IHS direct, tribal, and contract
health services, IHS merely responded that the Contract Health Services program does not maintain
complaint-related data. Because of IHS failure to provide requested information on any complaints
concerning the quality of care provided at IHS direct, tribal, and contract health facilities, it is difficult
to assess the degree to which the lack of culturally competent care is affecting the quality of care Native
Americans receive.

107
I.H.S. Affirmative
A2: Transportation
The Indian Health Care Improvement Act solved transportation issues, but after it lapsed,
it has resurfaced.
System, September. Page 70 & 71 MAG)
For the more than 538,000 Native Americans living on reservations or other trust lands where the climate
is inhospitable, the roads are often impassable, and where transportation is scarce, health care facilities are
far from accessible. Anslem Roanhorse, director of the Division of Health for the Navajo Nation, testified
that on the Navajo reservation 78 percent of the public roads are unpaved and 60 percent of the homes lack
telephone service.216 Even worse, for those who can get to the facilities, the equipment, medicine, and
services are often not available for necessary treatment. Traveling to more distant facilities and
delaying treatment are the only options. For example, in Eagle Butte, South Dakota, the Cheyenne River
Sioux Tribe does not have an obstetrics unit in its hospital and is worried that the new proposed hospital will
not have one. Obstetrics services for the tribes approximately 210 births a year are contracted out, and last
year there were five births in the ambulance on the way to Pierre, 90 miles away, according to tribal
leaders. IHS has announced that the new facility will have an obstetrics unit, however, there is concern that
there will be insufficient funding to hire an obstetrician. For the Kalispel Tribe in Usk, Washington, the
problem extends beyond specialty services. They have no on-site primary care at this time; tribal
members must travel 75 miles to receive care at the Wellpinit Service Unit IHS clinic or use an IHS
contract facility, if available. Geographical access problems are not limited to remote, rural areas. For
the 25,000 urban Indians living in Denver, Colorado, the closest IHS hospitals are in Albuquerque,
New Mexico (450 miles away) and Rapid City, South Dakota (400 miles away). The geographical access
problem is not a new problem facing IHS. It has long been recognized that geographic location and the
resulting transportation problems hamper IHS efforts to provide health services. In 1976, by passing
the Indian Health Care Improvement Act to raise the health status of Native Americans, Congress
acknowledged the grave health disparities Native Americans were facing. Among other access problems,
Congress explained that many Native American patients were hitchhiking or relying on costly rides from neighbors to get to IHS
facilities.223 This situation, unfortunately, has not changed today. Many Native Americans continue to depend on others traveling to IHS
facilities. Because of unpredictable travel arrangements, they are unable to plan ahead and make appointments at the IHS facilities; thus,
many show up without appointments, leading to long wait times at the facilities. The problem is magnified as many facilities are unable
to accommodate walk-in patients and limit their services to appointment-only services.225
IHS solves: Telemedicine solves transportation issues, allows for better levels of care.
Where IHS locates its facilities ultimately affects how accessible its services are to Native Americans. As
stated, IHS is developing new criteria and guidelines to determine its plans for IHS facilities and soliciting
input to ensure that the placement of facilities and the types of services to be provided are determined based
on community needs. One notable step IHS has taken to address the geographical barrier between
remote communities and health care providers is telemedicine. IHS is applying technology to bring
primary care and specialty medicine to remote locations. Telemedicine refers to the use of electronic
communication and information technologies to provide or support a diverse group of health-related
activities that may include health professionals education, community health education, public health
research, and the administration of health services. There are about 40 telemedicine programs and
partnerships within IHS that are delivering care to smaller, more isolated communities. For example,
clinical engineers are equipping small remote villages in Alaska with telemedicine systems to transmit digital
images of patients eardrums, skin conditions, and even tonsils to distant health care providers. Through
telemedicine, small rural communities can communicate during emergencies with social workers via
video conferencing when transportation is difficult or impossible. Telemedicine allows pre- and postoperation services to be provided at the local facility and eliminates trips to regional medical centers. The
local on-site primary care provider can receive quick consults from regional medical centers, which results in
a faster treatment time. It also provides access to continuing medical and community education.
Telemedicine has the potential to eliminate some of the geographical access issues for Native Americans
in rural communities.

108
I.H.S. Affirmative
A2: Transportation
I.H.S. can overcome transportation and infrastructure problems
The breadth of IHS responsibility is justified by the size of the Indian population living in isolated
rural areas on or near reservations. These areas often lack the infrastructure of roads, utilities, and
public services that support service delivery to other (non-Indian) rural and urban populations. The
IHS facilities construction program provides hospitals, clinics, and living quarters for facility staff for
reservation-based IHS services.

109
I.H.S. Affirmative
A2: Structural/Distribution Barriers

Past I.H.S. failures are a result of insufficient resources not structural barriers
American Indian Law Review, Volume p. 238)
IHS success in the provision of a comprehensive range of services within a system that permits local and
regional involvement has depended to no small extent on the ability of the IHS to integrate services both
regionally and nationally. It would be a mistake to think that transferring responsibility for service
provision to tribes will leave IHS successes undisturbed - particularly when they depend on systemic
characteristics - while freeing up resources for attention to its failures. This is especially true to the
extent that IHS failures have been the result of insufficient resources rather than structural factors.
I.H.S. problems are a result of funding insufficiency not distribution structure

The IHS is frequently criticized, internally and externally, for its resource allocation methods and the
resulting distribution of health facilities, personnel, and services. To a large extent, these criticisms reflect
the inadequate levels of congressional appropriations for IHS services and facilities . It also reflects,
however, a belief among many that the IHS is not distributing resources equitably or cost-effectively.103 The
lack of consensus among critics as to what would constitute an equitable resource distribution attests to the
difficulty inherent in attempting to resolve issues of equity so as to satisfy the many varied and competing
interests.

110
I.H.S. Affirmative
A2: No Qualified Professionals

IHS solves: they have effective methods of recruitment and a substantial percentage of
their health care professionals are American Indian.
System, September. Page 79-80. MAG)
Improvements in recruiting, training, and compensation are necessary to reduce the shortage of health
professionals at IHS facilities. To reduce staff shortages, IHS has been implementing a system of special
pay, bonuses, and allowances. IHS also has scholarship and loan repayment programs. Both of these
programs provide benefits to health professionals in exchange for serving in IHS. Through IHS Indian
Health Professions programs, IHS has been recruiting and retaining Native American health
professionals. These recruitment and retention activities are essential to staffing and managing IHS
health care delivery system. Under the authorization of IHCIA, IHS administers the IHS Health Professions
Scholarship Program. This program includes Section 103 Health Professions Preparatory Scholarship
Programs for Indians, which authorizes two scholarship programs for Native American students in preprofessional education and pre-medicine or pre-dentistry education, and Section 104 Indian Health
Professions Scholarship, which authorizes scholarships to Native American students in health professional
schools. In addition, authorized by Section 108 of IHCIA and funded through appropriations, IHS offers loan
prepayment programs. Through scholarships and loan repayment programs, from 1981 to 2003, the
total number of IHS professional staff members grew 51 percent and the number of Native American
federally employed health professionals increased 230 percent. The proportion of the Native American
professional staff has increased 125 percent over the same period. In 1981, 84 percent of the IHS health
professional staff was non-Indian and by 2003, 64 percent of the staff was non-Indian and 36 percent Indian.
In addition, acknowledging that a monetary incentive is sometimes necessary to retain health professionals in
remote IHS facilities, HHS announced $1.7 million in new grants to tribal communities to assist in
recruitment and retention programs. The objective of these grants is to recruit, place, and retain health
professionals in areas with high vacancy and staff turnover rates.

111
I.H.S. Affirmative
A2: Bureaucrats
Physicians and Indian health professionals will decide coverage not bureaucrats or
government officials
Rationing affects, and is affected, by the services provided. Hence, decisions about what services will be
available go hand in hand with decisions about the distribution of those services. A relatively limited
package of benefits serves more individuals than do more comprehensive packages at comparable costs.
There are no universally accepted criteria for determining what constitutes a comprehensive package
of basic health services. After much debate, the IHS has adopted a concept of a benefits package defined
as those services which in the judgment of the attending physician are necessary to preserve life, limb,
and sensory organs or to prevent clear deterioration of health status. This has the advantage of leaving
the decision with the attending physician rather than with a lower level health professional, a clerk, or
a bureaucratic list or manual, and accords with the comprehensive thrust of the IHS.

112
I.H.S. Affirmative
A2: IHS doesnt use traditional medicine

I.H.S. provides both modern and traditional health care
Availability and usability of health care for Indians are influenced significantly by the organization of
the IHS and its service delivery system. Affordability of care within the IHS system has generally been
ensured for those services which are provided to eligible Indians. Acceptability of modern health care
has grown with the help of visionary Indian leaders and with the acknowledgement of Indian healing
methods as potentially complementary to modern medicine.

113
I.H.S. Affirmative
A2: IHS has arbitrary eligibility standards

The tribes not the IHS determine eligibility for services always deferring to tribal not federal standards for
eligibility
Most tribes have appeared reluctant to draw the inference that tribal membership is not the same as
eligibility for a limited number of services, arguing that tribal membership - not the IHS - should
determine eligibility for health services. The IHS would have no interest in eligibility criteria if there
were sufficient funds to meet the great demand for services. It has had a tradition of inclusion rather
than exclusion that has grown out of its emphasis on community care and a history in which the Indian
community was fairly well defined. The problem, of course, is that decisions regarding eligibility become
critical when limited resources have to be allocated across competing demands. The issue is complicated by
the lack of a common definition of membership across tribes. Unfortunately, any advantages associated with
relatively permissive eligibility requirements must be balanced against budget considerations, a continuing
dilemma that will only grow more acute.
The I.H.S. uses the least restrictive means to determine eligibility that favors broad
definitions of Indian
The Snyder Act, with its lack of specificity regarding legal rights and responsibilities, contains no express
language identifying beneficiaries other than "Indians throughout the United States." Courts have
ruled repeatedly that the Snyder Act is to be construed liberally in favor of Indians. Exactly what this
may mean with respect to eligibility requirements is unclear except that there appears to be
considerable latitude for agency discretion in determining who qualifies for services designed to benefit
Indians. While ruling against the BIA in its restriction of eligibility for services in the landmark case Morton
v. Ruiz, the U.S. Supreme Court did acknowledge the importance of agency decision making in allocating
limited funds.

114
I.H.S. Affirmative
A2: Blood Quantum

The I.H.S. does not apply a blood quantum to distribute services
American Indian Law Review, Volume 21, p. 250-1)
The current IHS eligibility criteria remain very loose, requiring only that a person be of Indian descent
and have close socioeconomic ties to the Indian community served by the local facilities and
program.134 In the mid-1980s, criteria were made more restrictive by ending the previous eligibility of non
Indian wives of Indians (non-Indian male spouses had long since been excluded). An exception was made in
the case of a non-Indian woman pregnant with an eligible Indian child in order to ensure care for that unborn
eligible Indian. The non-Indian mother remains eligible for care throughout the puerperium and therefore
care is afforded for six weeks after delivery. An obvious difficulty in interpreting eligibility rules is the vague
language "close socioeconomic ties," which has never been precisely defined. For most purposes, the IHS
regards individuals within the scope of its services if they are regarded as Indian by the community in
which they live, as indicated by factors such as tribal membership, enrollment, residence on taxexempt land, ownership of restricted property, or active participation in tribal affairs. These rules
apply to those eligible for medically-necessary direct care services. Because of the increased reliance on
high-cost contract care, additional criteria have been adopted for receipt of contract services. In addition to
meeting the criteria for direct care services, individuals must also reside within a specific contract health
service delivery area (CHSDA), generally comprised of counties on or near reservations. Indians who have
moved from a CHSDA do not qualify for contract care in the new locations and when these individuals return
to a CHSDA, it is necessary to reestablish residence and remain there for 180 days before again becoming
eligible for contract services.136

115
I.H.S. Affirmative
A2: Medicaid Solves

Medicaid and other programs dont solve- theres too much confusion about the
application process.
Many Native Americans are hindered by the confusing and difficult nature of the enrollment process.
Very few Native Americans understand the Medicaid and SCHIP eligibility requirements; in fact,
many IHS employees are equally confounded. At least one state, Oklahoma, has solved this problem by
placing state employees in Indian health facilities to facilitate Medicaid enrollment. In other states, IHS and
tribal officials encounter resistance working with county and state workers. One frequent
misunderstanding in the enrollment process involves Native Americans being asked for co-payments
for programs such as SCHIP, when they are specifically exempt from the co-payment requirement. Any
form of cost sharing acts as a barrier to enrollment in public programs, more so when the co-payment
is neither required nor necessary. In addition, at least four states (California, Oregon, Washington, and
Idaho) are debating co-payment and/or premium provisions to their state Medicaid programs. In a very
encouraging development, the state of Washington attempted to implement a special provision to allow a
waiver of co-payments for Native Americans. However, the Centers for Medicare & Medicaid Services
(CMS) recently notified Washington that doing so violated Title VI of the Civil Rights Act. Another historical
error has been the application of liens to enforce payment of medical bills. Many Native Americans in
northern Nevada, and elsewhere, refuse to apply for Medicaid for fear they will lose their property.
Compounding the overall lack of knowledge is inconsistent guidance provided by CMS. Because CMS
regulations are seen as unclear and incomplete with respect to Native American health caresince they are
not aligned with IHS regulations and policyCMS policy is frequently interpreted by telephone from CMS
headquarters. Therefore, the answer to a specific question, and consequently, policy at the local level, may
depend on which CMS official answers the telephone on that specific occasion.
The Indian Health Care Improvement Act solves Medicare issues- it waives fees for
American Indians
In addition to the system and facility requirements, individual eligibility requirements can also impose
barriers. In the context of Medicare, the requirement for 40 quarters of Social Securitycovered employment
excludes many elderly applicants who would otherwise qualify for Medicare. With high unemployment rates
on reservations and the disproportionately high number of persons failing to meet the 40-quarter requirement,
tribes have sought a Native American exemption. Such an exemption from the 40-quarter requirement would
markedly increase Medicare eligibility. Furthermore, confusion and insufficient information about the
availability of Medicaid to purchase Medicare Part B coverage have excluded an additional undefined
number of elderly Native Americans. In many of these cases, patients did not have access to Medicare
advisors or were not fully informed of this option and its benefits. Consequently, IHS has pursued
equitable relief in the form of special enrollment for potential Medicare beneficiaries in selected locations.
For those who have passed the age of enrollment, CMS applies a late fee. This prevents individuals from
waiting until they are ill with costly health conditions before they enroll. Title II, Section 419(b)(2), of the
Indian Health Care Improvement Act would waive the Medicare late enrollment penalty, as discussed
in more detail in the next chapter.

116
I.H.S. Affirmative
A2: Medicaid Solves

Natives are dependent on programs like Medicaid, but corruption and lack of funding
ensures that they remain one of the poorest groups in America, despite treaty obligations
Marquez, associate program director/collaborating investigator in the Department of
Nursing, University of Minnesota who has worked with indigenous peoples for 20 years,
2001
(Carol A., The Challenges of Medicaid Managed Care for Native Americans, Wikazo Sa Review, 16.1:151-159.
EKC)
Until 1996, families and children who received cash assistance under Aid to Families with Dependent Children (AFDC) program were
automatically entitled to Medicaid coverage (Schneider and Martinez, 1997). The report further states that Native Americans who are
eligible for health care coverage through the Indian Health Service (IHS) may be entitled to Medicaid coverage if they meet the state
categorical and financial eligibility requirements. In a recent fact sheet, the Kaiser Family Foundation (2000) notes that Medicaid
and other public programs are the primary source of health insurance coverage for 25% of American
Indians and Alaska Natives (AI/AN) in contrast to 9% white or Anglo-Americans. Schneider and Martinez
(1997) discuss the significant roles Medicaid plays in health care delivery to American Indians and Alaska Natives, including insurance
coverage, revenue source to providers of care, and purchaser of managed care products, to name only a few. Given the significant role of
Medicaid in health care delivery to American Indians and Alaska Natives, policy changes in the past few years have had a significant
impact on access for both tribal and urban Indians.
This essay reviews the managed or restricted reimbursement of health care services to Medicaid-eligible beneficiaries in Indian
country. Managed health care is the managing of fiscal resources to ensure cost-effective health care service delivery. Groups of health
care providers who participate in managed care systems all too often find that managed care programs compensate profit-
minded managers who restrict access by patients to health care services. Thus, the process of
implementing managed care while maintaining adequate health care services may fall foul of treaty
obligations to American Indian tribes to provide health care services to American Indians and Alaska
Natives (Rolin 1998). This contradiction continues even in light of U.S. Surgeon General Satchers statement
that AI/AN health status ranks among the poorest of all groups in the nation (Satcher 2000). Further
erosion of the current level of funding for health care services does not allow the Indian Health Service
(IHS) to meet its goal of increasing the health status of AI/AN people to a level comparable with that of
the general population. This goal is not only a major justification for the existence of IHS, but is also a goal of the Healthy
People 2010 Initiative. This paper examines key challenges facing the Indian Health Service, tribes, and urban Indian communities as
services are provided with diminished resources in a managed care environment.
The American Indian and Alaska Native tribes, unlike any other ethnic minority in the United States, possess a unique relationship
with the federal government. (Kunitz 1999). The Indian Health Care Improvement Act is under reauthorization;
the amendments include funding of tribal and urban Indian health programs to maintain and improve
the health of the Indians consonant with and required by the federal governments historical and
unique legal relationship, as reflected in the Constitution, treaties, federal statutes and the course of dealings between Indian
tribes and the United States resulting in government to government and trust responsibility and obligations to the American Indian
people. This relationship underscores the need for and importance of health care delivery to the more than five hundred tribes and
estimated 1.4 million American Indians residing in the United States.
In his 1999 congressional testimony on American Indian/Alaska Native unmet health needs, Rolin (1999) restates Senator
Inouyes 1993 statement that American Indians purchased the first prepaid health care plan when treaties
were exchanged for millions of acres of land. Kunitz expanded on this point by his mention of the historical conflict
between the federal role of trustee for American Indian rights and resources and pressures from non-Indian constituents, especially those
in the western states that coveted access and ownership to these lands (Kunitz 1999). Additionally, the Snyder Act of November 2, 1921
(25 U.S.C., 13) gave the government authority to provide health care services to American Indians . The Snyder Acts broad
scope of authority has been the foundation of the Indian Health Care Improvement Act and its subsequent
reauthorization, currently P.L. 102-573. The act authorizes appropriations for the provision of health care
services to tribes as well as to Indians residing in urban areas. Unfortunately, legislative protections of
the trust responsibility and treaty obligations have not yet yielded equivalent health services for all
American Indian and Alaska Native people (Satcher 2000).
Due to the level of poverty across Indian country, many American Indians are eligible for Medicaid reimbursement of health care
services (Rosenbaum and Zuvakas 1996). However, because of federal and state changes that have attempted to limit Medicaid expenses
over the past decade, Medicaid beneficiaries have been enrolled in managed care plans that control access to provider sites as well as the
level of reimbursement for services (Kauffman et al. 1997). Rolin (1998) noted the disparity in cost per IHS beneficiary in contrast to
that of the typical Medicaid beneficiary; $1,403 for an IHS beneficiary versus $3,369 for each Medicaid user was reported per year
19931997. Rolin also highlighted the difficulty of decreasing disparities in health status of racial and ethnic populations because the
IHS has fallen far behind other agencies in the Department of Health and Human Services in funding
level increases in recent years (Rolin 1999).

***Tribal Economies Advantage***
117
I.H.S. Affirmative

118
I.H.S. Affirmative
Tribal Economy Internals Poor Health

Poor health care undermines reservation economies
Belcourt-Dittloff and Stewart, Professors of Psychology, University of Montana, 2000
(Annjeanette & J. Historical Racism: Implications for Native Americans, American Psychologist, 55, 1166-1167)
Inadequate health care, along with the aforementioned high morbidity and mortality rates, is exacerbated and
perhaps precipitated by the high poverty and unemployment rates that exist for Native Americans. Perhaps
the best indicator of the current Native Americans health status is the fact that American Indians do not live
as long as other U.S. populations. Heart disease, liver disease (cirrhosis), diabetes mellitus, and accidents
constitute leading causes of death for this population (U. S. Congress, Office of Technology Assessment,
1990). The bleak current health status of Native Americans leads to the question What stressors are
contributing to the high rates of morbidity and mortality? Clark and his colleagues (1999) have outlined the
manner in which racism may constitute a stressor with negative biopsychosocial ramifications for African
Americans. Because of the inherent similarities between the experiences of racism of African Americans and
Native Americans, we believe that such a model helps explain why Native American health is marked by
high morbidity and mortality rates. By gaining a better understanding of the way in which racism as a
stressor can negatively affect the biopsychosocial functioning of Native Americans, clinicians may be able to
formulate more effective therapeutic and preventative tools.
Poverty is caused by lack of healthcare

Duffi, doctorate in cultural anthropology from Washington State University, 01
(Mary Kay, Project Muse, A Pilot Study to Assess the Health Needs and Statuses among a Segment of the Adult
American Indian Population of Los Angeles, 11-16, http://muse.jhu.edu/login?
uri=/journals/wicazo_sa_review/v016/16.1duffie.html, accessed: 6-29-09, KEH)
The 1952 Federal Relocation Program, sponsored by the Bureau of Indian Affairs, lured thousands of
Indians to Los Angeles and other metropolitan areas in the West. Government officials promised highpaying jobs, job-training programs, and housing assistance. The federal goal was assimilation. It is well
documented, however, that the program failed to assimilate American Indians and resulted in devastating
social consequences. After federal funding for the relocation programs dried up, for example, large Indian
ghettos formed, where unemployment and poverty created a socioeconomic pattern of abuse and despair.
Disconnected from cultural roots and illequipped for modern city life, many urban Indian families in the
1970s and 1980s broke under the stresses of urban existence. Today, urban Indian centers across Southern
California report high rates of poverty and alcoholism, low educational attainment, domestic abuse,
and support system deficits (particularly for elders and children). To validate these observations
scientifically, however, has proved a difficult task. To begin with, there is a paucity of statistically significant
data relevant to the health care statuses and needs of American Indians, even less pertaining to urban
Indians. Indeed, most of the available information comes from studies of rural and reservation-based Indians.
As a result, researchers and program planners tend to rely almost exclusively on data taken from a few
specific regions and tribes. The situation is made worse by the lack of adequate representation of the Indian
population in national surveys and databases. However, what data there are seem consistent with the
observations of the urban Indian Centers. Available data indicate that American Indians have a
disproportionate pattern of social problems, chronic illness, accident, homicide, suicide, and other
conditions, unparalleled among other racial and ethnic minorities in the United States. Because of
substantial limitations to medical care, we can surmise (but not fairly conclude) that these problems are
exacerbated in urban settings. Unlike their reservation-based counterparts, Los Angeless urban Indians do
not have appropriate access to an Indian Health Service facility. (Indian Health Service is the major federal
health care program for American Indians.) In many ways, urban Indians are the orphans of Indian
Health Service, left to depend on minimal and fragmented resources available from the state
government.

119
I.H.S. Affirmative
Tribal Economy Internals Poor Health

Health assistance promotes sustainable development/the economy on Native American
lands
White 07
(Bristol Bay Native Association, July, White Paper on the Native American Challenge Demonstration Project
Act, EKC)
Because Native economies are often plagued by the same challenges as the economies of the developing
world, Native economies are likely to benefit from the application of proven models employed in
international development efforts.
Of these, the Presidents Millennium Challenge Corporation is most appealing. Having undertaken a
comprehensive review and analysis of post-World War Two efforts by the U.S. And other developed nations
to invigorate the economies of the developing world, the Bush Administration took exception with the notion
that additional financial resources was all that was needed. Instead, the President sought to identify and
emphasize those traits found in successful economies and to encourage their use by other developing
countries.
Created pursuant to the Millennium Challenge Act of 2003, the Millennium Challenge Corporation aims to
create ongoing, bilateral relationships between the United States and eligible countries to pursue those
policies that are known to be effective and in the process reduce poverty and promote sustainable economic
growth in the host country. Typically, the activities that are funded by the Corporation are related to
agriculture, irrigation, and related land practices; physical infrastructure development to facilitate
marketing of goods and services; and a variety of health care programs. In addition, because the
Millennium Challenge Corporation model leaves the major decisionmaking in regard to economic
development objectives and the selection of specific projects to achieve those objectives up to the
countries seeking a development compact with the United States, we believe a domestic analog will
appeal to Native leaders and their citizenry.
Lack of health care lowers reservation standard of living

Lower income and educational levels are associated with poor overall health status and health outcomes. Due
in part to past and present discrimination in education and employment, Native Americans and other
people of color achieve lower levels of educational attainment and income. Native Americans, however,
have the highest poverty rate of any ethnic group. They have a poverty rate of 25.9 percent, while the
poverty rate is 22.1 percent for African Americans, 10.8 percent for Asian/Pacific Islanders, and 21.2 percent
for Hispanics. In comparison, while the national poverty rate is 11.3 percent, only 7.5 percent of whites
live below the poverty level. Native Americans remain at the bottom in almost every measurable
economic category and earn only about half of that earned by the average American. On Indian
reservations, poverty levels for Native Americans are significantly worse. Among the Navajo, for
example, over 50 percent live below the poverty level and almost 50 percent are unemployed. More than
50 percent of homes rely only on wood burning for heating, 32 percent lack adequate plumbing, and 60
percent lack telephone service.92 On the Pine Ridge Reservation in South Dakota, the unemployment
rate hovers around 80 percent and two out of three residents live below the poverty level.

120
I.H.S. Affirmative
Tribal Economy Internals Trust Doctrine

Tribal Sovereignty and self-determination are key to help development
Smith, Professor of Economics and Applied Indigenous Studies, 2000
(Dean Howard, Modern Tribal Development, p. 68, KS)
Tribal sovereignty and self-determination are the mainstays of current development plans. These goals
can only be truly realized if and when the population becomes self-supporting and the tribe overcomes
its dependency on the federal government. By developing a vigorous cycle of economic growth, the
tribe will be able to fulfill these goals.
Self-determination is key to economic self-sufficiency

Matheson, member of the Coeur d'Alene Indian Tribe and is a tribal chairman and lawyer,
09
(David, Self-determination, Arizona State Law Journal, no page listed, KS)
An economic means of attaining self-determination and self-sufficiency may be accomplished through
the operation of tribal businesses, which may be a tribe's only source of income apart from federal
subsidies. Tribes operate commercial enterprises to sustain their economies and thereby gain
independence from federal support. In that way, the businesses are an integral aspect of tribal sovereignty,
as they enable tribes to realize the goal of self-determination. A recent book chronicling the economic
"success stories" of four tribes explains this relationship between economic independence and sovereignty:
Without the means to establish economic sovereignty, most Native Americans remain America's
internal exiles, living within confines established by their conquerors hundreds of years ago. The
tragedy is that Indian destitution is entirely unnecessary. Many Native communities hold the raw
materials of true self-determination in their hands. . . . In the last two decades, several tribes have
recognized the extraordinary value of these assets, not only in terms of their material worth but in
terms of what they mean for the quality of Native life. After centuries of decline as the objects of
subjugation and neglect, these tribes have established and sustained profitable tribal economies -- internally
generated, not federally imposed -- as a strategy for addressing longstanding social problems and establishing
authentic independence. Employing every strategy from congressional lobbying to leveraged buy-outs, each
community, in its own way, has learned to play white society's games, but by different rules and according to
different scorecards. These communities are beginning to enter the mainstream economy so long denied them
to mount a quiet economic revolution, which has the potential for reestablishing a Native American
independence based on economic sovereignty or for global survival.
Native American sovereignty is key to tribal economies

Abdel-Monem, Research Specialist for the University of Nebraska, 2005
(Tarik, University of Nebraska, Economic Development and Native American Sovereignty, 3-31-05,
http://ppc.unl.edu/SorensenSeminar/EconomicDevelopmentandNativeAmericanSovereignty&year=2005, 6-28-09,
KS)
Although it is still true that some of the poorest communities in the US are tribal communities, in the
past several decades numerous American Indian tribes across the country have been developing
extremely successful commercial and entrepreneurial enterprises. This economic growth is related,
although by no means completely due, to changes in how sovereign nations are treated by the federal and
state governments. In a continually changing and complex legal environment, there is value in examining
and assessing the current state of Native-American commercial and economic activity, the varying degrees of
success, and its legal and social connections. This seminar focused on Native-American economic
development and sovereignty in Nebraska, as well as discussing the legal environment, perspectives, success
stories, and challenges to further tribal economic development in Nebraska.

121
I.H.S. Affirmative
Tribal Economy Internals Trust Doctrine

Economic sovereignty is necessary for any real Native American independence
Limas, Associate Professor of Law at the University of Tulsa College of Law and Codirector of the Native American Law Center, 1994
(Vicki, Arizona State Law Journal, no page number, Fall, KS)
An economic means of attaining self-determination and self-sufficiency may be accomplished through the
operation of tribal businesses, which may be a tribe's only source of income apart from federal subsidies. n61
Tribes operate commercial enterprises to sustain their economies and thereby gain independence from federal
support. In that way, the businesses are an integral aspect of tribal sovereignty, as they enable tribes to realize
the goal of self-determination. A recent book chronicling the economic "success stories" of four tribes explains this
relationship between economic independence and sovereignty: Without the means to establish economic
sovereignty, most Native Americans remain America's internal exiles, living within confines established by
their conquerors hundreds of years ago. The tragedy is that Indian destitution is entirely unnecessary. Many
Native communities hold the raw materials of true self-determination in their hands. . . . In the last two decades,
several tribes have recognized the extraordinary value of these assets, not only in terms of their material worth but in
terms of what they mean for the quality of Native life. After centuries of decline as the objects of subjugation and
neglect, these tribes have established and sustained profitable tribal economies -- internally generated, not
federally imposed -- as a strategy for addressing longstanding social problems and establishing authentic
independence. Employing every strategy from congressional lobbying to leveraged buy-outs, each community, in
its own way, has learned to play white society's games, but by different rules and according to different scorecards.
These communities are beginning to enter the mainstream economy so long denied them to mount a quiet
economic revolution, which has the potential for reestablishing a Native American independence based on
economic sovereignty or for global survival.

122
I.H.S. Affirmative
Tribal Economy Impacts - Gangs

A. Poverty, substance abuse, and few social resources lead to Native American gangs
Grant, National Native American Gang Specialist, 08
(Christopher M., NCSDDC.org, Gangs in Indian Country: An Overview of a Growing Problem 10-08,
http://www.ncsddc.org/upload/wysiwyg/2008%20presentations/Native%20American%20Gangs%20%20Christopher%20Grant.pdf, 7-5-09, WPW)
The contributing factors to gang behavior across Indian Country are myriad. Certainly the social issues
many tribal communities face continue to be a causative or contributing factor to some degree, in terms of
substance abuse, unemployment, poverty, high drop-out rates and the relative lack of social, cultural, and
recreational resources in many tribal communities. Although many of these same social issues are faced by
juveniles and young adults in other parts of the country, the lack of resources to deal with these problems
in Indian Country tends to exacerbate the situation and perpetuate destructive behavior such as gang
activity.
B. Gangs lead to the presence of the FBI

French, Professor of Social Studies at the West New Mexico University, 03
(Laurence A., Rowan and Littlefield, Native American Justice, 2003, http://books.google.com/books?id=_HVlLgBmRQC&dq=1990s+in+Indian+country.+Wounded+Knee&source=gbs_navlinks_s, 7-6-09, WPW)
And the effort to open communication and cooperation between tribal and state law enforcement
agencies has gotten attention far from Wisconsin. While some have raised questions about the potential
impact on tribal sovereignty, others point to the effectiveness of the new approach. By 2002, the Latin
Kings Milwaukee chapter had so infiltrated the Lac Courte Oreilles reservation the tribe declared a
state of emergency, turning to state and federal authorities to help control runaway cocaine trafficking
and violence. The resulting investigation landed 47 people in federal prison. That year another
investigation involving the state, sheriffs deputies, tribal police and the FBI resulted in six arrests in a
cocaine-marijuana ring on the Menominee reservation. Task forces are common in law enforcement; the FBI
has established more than a dozen to deal with reservation crime, but they typically operate with one or
two tribes at a time on a case-by-case basis. But Wisconsins version brought all eight tribal police agencies
to the table unheard of around the rest of the country.
C. FBI presence on Native American lands has led to military actions and hurts self
determination
Richmond, staff writer for the Associated Press, 09
(Todd, Native Times, Tribes, police band together to fight drugs, gangs, 6-5-09, http://nativetimes.com/index.php?
option=com_content&task=view&id=1894&Itemid=&Itemid=29, 7-6-09 WPW)
The Indian Reorganization Act of 1934 merely reinforced the concept of U.S.-type laws and law enforcement
in Indian country while the termination-relocation era of the early 1950s forced state laws and law
enforcement upon certain tribes. Often, this was a bad mix, since there appears to have been considerable
prejudice among those non-Indians who resided closest to Indian country. These prejudices have
extended to courts and law enforcement as well. Both the BIA and FBI resorted to military interventions from the 1970s through the 1990s in Indian country. Wounded Knee II and the Mohawk gambling
war quickly reminded tribal leaders that a strong sense of federal paternalism, especially when looking
at law enforcement, is still a presence during this current era of self-determination.

123
I.H.S. Affirmative
Tribal Economy Impacts Waste

Economic inequality makes Native American lands vulnerable targets for polluting
industries.
Brook, Cal Berkeley Sociology Professor, 98
(Dan, "The Environmental Genocide: Native Americans and Toxic Waste." American Journal of Economics and
Sociology, January 1998, http://findarticles.com/p/articles/mi_m0254/is_n1_v57/ai_20538772/pg_1?
tag=artBody;col1, 7/1/09, M.E)
One very significant toxic threat to Native Americans comes from governmental and commercial
hazardous waste sittings. Because of the severe poverty and extraordinary vulnerability of Native
American tribes, their lands have been targeted by the U.S. government and the large corporations as
permanent areas for much of the poisonous industrial by-products of the dominant society. "Hoping to
take advantage of the devastating chronic unemployment, pervasive poverty and sovereign status of
Indian Nations", according to Bradley Angel, writing for the international environmental organization
Greenpeace, "the waste disposal industry and the U.S. government have embarked on an all-out effort
to site incinerators, landfills, nuclear waste storage facilities and similar polluting industries on Tribal
land"
Poverty in Native American land leads to toxic waste dumping on reservations

Brook, American Journal of Economics and Sociology writer, 98
(Daniel, American Journal of Economics and Sociology, Environmental Genocide: Native Americans and Toxic
Waste, 1/98, http://findarticles.com/p/articles/mi_m0254/is_n1_v57/ai_20538772/, accessed 6/29/09, SP)
One very significant toxic threat to Native Americans comes from governmental and commercial
hazardous waste sitings. Because of the severe poverty and extraordinary vulnerability of Native
American tribes, their lands have been targeted by the U.S. government and the large corporations as
permanent areas for much of the poisonous industrial by-products of the dominant society. "Hoping to
take advantage of the devastating chronic unemployment, pervasive poverty and sovereign status of
Indian Nations", according to Bradley Angel, writing for the international environmental organization
Greenpeace, "the waste disposal industry and the U.S. government have embarked on an all-out effort
to site incinerators, landfills, nuclear waste storage facilities and similar polluting industries on Tribal
land" (Angel 1991, 1). In fact, so enthusiastic is the United States government to dump its most dangerous
waste from "the nation's 110 commercial nuclear power plants" (ibid., 16) on the nation's "565 federally
recognized tribes" (Aug 1993, 9) that it "has solicited every Indian Tribe, offering millions of dollars if the
tribe would host a nuclear waste facility" (Angel 1991, 15; emphasis added). Given the fact that Native
Americans tend to be so materially poor, the money offered by the government or the corporations for
this "toxic trade" is often more akin to bribery or blackmail than to payment for services rendered.(2)
In this way, the Mescalero Apache tribe in 1991, for example, became the first tribe (or state) to file an
application for a U.S. Energy Department grant "to study the feasibility of building a temporary [sic] storage
facility for 15,000 metric tons of highly radioactive spent fuel" (Akwesasne Notes 1992, 11). Other Indian
tribes, including the Sac, Fox, Yakima, Choctaw, Lower Brule Sioux, Eastern Shawnee, Ponca, Caddo, and
the Skull Valley Band of Goshute, have since applied for the $100,000 exploratory grants as well (Angel
1991, 16-17). Indeed, since so many reservations are without major sources of outside revenue, it is not
surprising that some tribes have considered proposals to host toxic waste repositories on their
reservations. Native Americans, like all other victimized ethnic groups, are not passive populations in
the face of destruction from imperialism and paternalism. Rather, they are active agents in the making of
their own history. Nearly a century and a half ago, the radical philosopher and political economist Karl Marx
realized that people "make their own history, but they do not make it just as they please; they do not make it
under circumstances chosen by themselves, but under circumstances directly found, given and transmitted
from the past" (Marx 1978, 595). Therefore, "[t]ribal governments considering or planning waste facilities",
asserts Margaret Crow of California Indian Legal Services, "do so for a number of reasons" (Crow 1994,
598). First, lacking exploitable subterranean natural resources, some tribal governments have sought to
employ the land itself as a resource in an attempt to fetch a financial return. Second, since many
reservations are rural and remote, other lucrative business opportunities are rarely, if ever, available to them.
Third, some reservations are sparsely populated and therefore have surplus land for business activities. And
fourth, by establishing waste facilities some tribes would be able to resolve their reservations' own waste
disposal problems while simultaneously raising much-needed revenue.

124
I.H.S. Affirmative
Waste Impacts Health

The toxins released from the waste dumping have a detrimental effect on the health of
those living in the reservations
As a result, "[a] small number of tribes across the country are actively pursuing commercial hazardous and
solid waste facilities"; however, "[t]he risk and benefit analysis performed by most tribes has led to
decisions not to engage in commercial waste management" (ibid.). Indeed, Crow reports that by "the end
of 1992, there were no commercial waste facilities operating on any Indian reservations" (ibid.), although the
example of the Campo Band of Mission Indians provides an interesting and illuminating exception to the
trend. The Campo Band undertook a "proactive approach to siting a commercial solid waste landfill and
recycling facility near San Diego, California. The Band informed and educated the native community,
developed an environmental regulatory infrastructure, solicited companies, required that the applicant
company pay for the Band's financial advisors, lawyers, and solid waste industry consultants, and ultimately
negotiated a favorable contract" (Haner 1994, 106). Even these extraordinary measures, however, are not
enough to protect the tribal land and indigenous people from toxic exposure. Unfortunately, it is a sad
but true fact that "virtually every landfill leaks, and every incinerator emits hundreds of toxic
chemicals into the air, land and water" (Angel 1991, 3). The U.S. Environmental Protection Agency
concedes that "[e]ven if the . . . protective systems work according to plan, the landfills will eventually
leak poisons into the environment" (ibid.). Therefore, even if these toxic waste sites are safe for the
present generation - a rather dubious proposition at best - they will pose an increasingly greater health
and safety risk for all future generations. Native people (and others) will eventually pay the costs of
these toxic pollutants with their lives, "costs to which [corporate] executives are conveniently immune"
(Parker 1983, 59). In this way, private corporations are able to externalize their costs onto the
commons, thereby subsidizing their earnings at the expense of health, safety, and the environment.
Toxic waste allows easy access for serous cancers and other dire medical conditions
First, toxic waste poses a severe health and safety risk. Some chemical agents cause leukemia and other
cancers; others may lead to organ ailments, asthma, and other dysfunctions; and yet others may lead
to birth defects such as anencephaly. Toxic waste accomplishes these tragic consequences through direct
exposure, through the contamination of the air, land, and water, and through the bioaccumulation of toxins in
both plants and animals. And because of what Ben Chavis in 1987 termed "environmental racism," people of
color (and poor people) are disproportionately affected by toxic waste. Native Americans are especially
hard hit because of their ethnicity, their class, and their unique political status in the United States.

125
I.H.S. Affirmative
Waste Impacts Health

Natives forced to accept Americas waste- destroyed reservations
Satchell, US News and World Reports, 1993
(Michael, US News and World Reports, 1-11-93,
http://www.nathannewman.org/EDIN/.race/.racefile/.jan-feb/.envi-race1/.nativeAm.html,
accessed 7-9-09, AN)
Some of the damage is self-imposed. Unlined garbage pits and midnight dumping have turned some
reservations into polluted eyesores. Poverty and unemployment have forced tribes to exploit their
natural resources beyond sustainability. Many overgraze their rangelands, overcut timber and overuse
pesticides. This last practice boosts crop yields but contaminates streams, kills fish and sickens wildlife. Says
Roderick Ariwite of the National Tribal Environmental Council, ''We've raped our homelands to
maintain our economies." Right for the tribes? Against this ruinous ecological backdrop, the issue of
waste disposal on the reservations is irradiated with controversy. ''Entrepreneurs pushing these poisonous
technologies are hoping to take advantage of the chronic unemployment, pervasive poverty and
sovereign status of Indian tribes," argues Bradley Angel of Greenpeace. But Mervyn Tano of the Council
of Energy Resource Tribes, an economic-development group, says Native Americans have a responsibility to
consider any legitimate means of providing jobs and economic security for themselves. ''Greenpeace and
other groups are trying to define what is right and wrong for the tribes," Tano says. 'Who are these people
telling Indians what to do?"

126
I.H.S. Affirmative
Waste Impacts Sovereignty/Culture

Toxic waste destroys tribal sovereignty
A second problem that Native Americans must confront when toxic waste is dumped on their lands is
the issue of tribal sovereignty, and more specifically the loss of this sovereignty. "Native American
governments retain all power not taken away by treaty, federal statute, or the courts. As an extension
of this principle, native governments retain authority over members unless divested by the federal
government" (Haner 1994, 109-110). Jennifer Haner, a New York attorney, asserts that illegal dumping
threatens tribal sovereignty because it creates the conditions that make federal government intervention on
the reservations more likely (ibid., 121). The federal government can use the issue of illegally dumped
toxic waste as a pretext to revert to past patterns of paternalism and control over Native American
affairs on the reservations; Native Americans are viewed as irresponsible, the U.S. government as their
savior.
Toxic waste has a catastrophic effect on both the health and the culture of Native
Americans
Native Americans have always altered their environment, as well as having it altered by others. The
environment, like culture, is inherently dynamic and dialectical. Native Americans "used song and ritual
speech to modify their world, while physically transforming that landscape with fire and water, brawn and
brain. They did not passively adapt, but responded in diverse ways to adjust environments to meet their
cultural as well as material desires" (Lewis 1994, 188). However, the introduction of toxic waste and other
environmental hazards, such as military-related degradation, have catastrophically affected the
present and future health and culture of Native Americans.
Native Americans do not want to allow toxic waste dumping on their land
Yet, Native Americans and other people of color, along with poor people, women, and environmentalists,
have been organizing against toxic waste and fighting back against the government and the corporations.
Indeed, "the intersection of race discrimination and exposure to toxic hazards", according to Andrew Szasz,
Professor of Sociology at the University of California, Santa Cruz, "is one of the core themes of the
[anti-]toxics movement" (Szasz 1994, 151).(4) In spite of the often desperate poverty of Indian tribes, "a
wave of resistance has erupted among Indian people in dozens of Indian Nations in response to the onslaught
of the waste industry" (Angel 1991, 5). Sporadic resistance has also developed into organized and sustained
opposition. Facing the threat of a toxic waste facility on their land in Dilkon, Arizona, in 1989, the Navajo
formed a group called Citizens Against Ruining our Environment, also known as CARE. CARE fought the
proposed siting by educating and organizing their community, and their success inspired other similarly
situated Native Americans. (CARE later merged with other Navajo groups fighting for the community and
the environment, to create a new organization, called Dine CARE). The following year, in June 1990, CARE
hosted a conference in Dilkon called "Protecting Mother Earth: The Toxic Threat to Indian Land", which
brought together "over 200 Indian delegates from 25 tribes throughout North America" (ibid.). The following
year's conference in South Dakota included "[o]ver 500 Indigenous delegates from 57 tribes" (ibid., 6). It was
at this second annual conference that the delegates created the Indigenous Environmental Network The IEN
states that it is "an alliance of grass roots peoples whose mission is to strengthen, maintain, protect and
respect the traditional teachings, lifestyles and spiritual interdependence to the sacredness of Mother Earth
and the natural laws" (Aug 1993, 7).

127
I.H.S. Affirmative
Waste Impacts Genocide

Toxic waste dumping is equivalent to genocide
This is wholly in concert with "the most enduring characteristic of American Indians throughout the history
of the continent: the ability to incorporate technological, natural, and social changes while maintaining
cultural continuity" (Crow 1994, 593). Therein lies the natural affinity between Indian opposition to toxic
waste and the broader environmental justice movement. "Environmental justice," according to the journal of
the Citizens' Clearinghouse for Hazardous Waste, Everyone's Backyard, "is a people-oriented way of
addressing 'environmentalism' that adds a vital social, economic and political element . . . When we fight for
environmental justice, we fight for our homes and families and struggle to end economic, social and political
domination by the strong and greedy" (Szasz 1994, 152-153). Fighting for environmental justice is a form
of self-defense for Native Americans. As the Report of Women of All Red Nations declared, "To
contaminate Indian water is an act of war more subtle than military aggression, yet no less deadly . . . Water
is life" (February 1980, in Collins Bay Action Group 1985, 4). Toxic pollution - coupled with the facts of
environmental racism, pervasive poverty, and the unique status of Native Americans in the United
States -"really is a matter of GENOCIDE The Indigenous people were colonized and forced onto
reservations . . . [Native Americans are] poisoned on the job. Or poisoned in the home . . . Or forced to
relocate so that the land rip-offs can proceed without hitch. Water is life but the corporations are
killing it. It's a genocide of all the environment and all species of creatures" (Bend 1985, 25; emphasis in
original). In effect, toxic pollution is a genocide through geocide, that is, a killing of the people through
a killing of the Earth.
Toxic waste is the modern form of genocide

Five hundred years after the commencement of colonialism and genocide, "the exploitation and assault
on Indigenous people and their land continues. Instead of conquistadors armed with weapons of
destruction and war, the new assault is disguised as 'economic development' promoted by
entrepreneurs pushing poisonous technologies. The modern-day invaders from the waste disposal
industry promise huge amounts of money, make vague promises about jobs, and make exaggerated
and often false claims about the alleged safety of their dangerous proposals" (Angel 1991, 1). Yet, also
500 years later, Native Americans are still resisting the onslaught and are still (re)creating themselves and
their cultures. And increasingly, Native Americans are better organized and more united than ever in their
struggle against environmental racism and for environmental justice.
Genocide against Native Americans is now working through modern techniques of business
Genocide against Native Americans continues in modern times with modern techniques. In the past,
buffalo were slaughtered or corn crops were burned, thereby threatening local native populations; now
the Earth itself is being strangled, thereby threatening all life. The government and large corporations
have created toxic, lethal threats to human health. Yet, because "Native Americans live at the lowest
socioeconomic level in the U.S." (Glass, n.d., 3), they are most at risk for toxic exposure. All poor people
and people of color are disadvantaged, although "[f]or Indians, these disadvantages are multiplied by
dependence on food supplies closely tied to the land and in which [toxic] materials . . . have been shown
to accumulate" (ibid.). This essay will discuss the genocide of Native Americans through environmental
spoliation and native resistance to it. Although this type of genocide is not (usually) the result of a systematic
plan with malicious intent to exterminate Native Americans, it is the consequence of activities that are
often carried out on and near the reservations with reckless disregard for the lives of Native
Americans.(1)

128
I.H.S. Affirmative

The nuclear industrys practices against American Indians is genocide.
Endres, Assistant Professor of Communication at the University of Utah, 2009
(Danielle, The Rhetoric of Nuclear Colonialism: Rhetorical Exclusion of American Indian Arguments in the Yucca
Mountain Nuclear Waste Siting Decision, Communication and Critical/Cultural Studies. March, Vol. 6, No. 1,
Pages 41 & 42, MAG.)
Before attending to the rhetorical nature of nuclear colonialism, it is important to emphasize the scope and
material effects of nuclear technologies on indigenous peoples and their lands. This is a history of
systematic exploitation and indigenous resistance, spanning from the 1940s to present. As the
Indigenous Environmental Network writes, the nuclear industry has waged an undeclared war against
our Indigenous peoples and Pacific Islanders that has poisoned our communities worldwide. For more
than 50 years, the legacy of the nuclear chain, from exploration to the dumping of radioactive waste
has been proven, through documentation, to be genocide and ethnocide and a deadly enemy of
Indigenous peoples United States federal law and nuclear policy has not protected Indigenous peoples,
and in fact has been created to allow the nuclear industry to continue operations at the expense of our
land, territory, health, and traditional way of life This disproportionate toxic burden-called
environmental racism- has culminated in the current attempts to dump much of the nations nuclear waste in
the homelands of the Indigenous peoples of the Great Basin region of the United States. From an
indigenous perspective, the material consequences of nuclear colonialism have affected the vitality of
indigenous peoples. This can be seen clearly in both uranium mining and nuclear testing. Uranium mining is
inextricably linked with indigenous peoples. According to LaDuke, some 70 percent of the worlds uranium
originates from Native Communities Within the US, approximately 66 percent of the known uranium
deposits are on reservation land, as much as 80 percent are on treaty-guaranteed land, and up to 90 percent
of uranium mining and milling occurs on or adjacent to American Indian land. To support the federal
governments desire for nuclear weapons and power production, the Bureau of Indians Affairs (BIA) has
worked in collusion with the Atomic Energy Commission and corporations such as Kerr-McGee and
United Nuclear to negotiate leases with Navajo, Lakota and other nations for uranium mining and milling on
their land between the 1950s to the present. BIA-negotiated leases are supported by the complex body of
Indian Law, which I will demonstrate enables federal intrusion into American Indian lands and governmental
affairs. These leases are heavily tilted in favor of the corporations so that American Indian nations
received only about 3.4 percent of the market value of the uranium and low paid jobs. Uranium mining
has also resulted in severe health and environmental legacies for affected American Indian people and
their lands. From uranium mining on Navajo land, there have been at least 450 reported cancer deaths
among Navajo mining employees. Even now, the legacy of the 1000 abandoned mines and uranium-tailing
piles is radioactive dust that continues to put people living near tailing piles at a high risk for lung cancer.
The history of exploitation and resistance continues with nuclear weapons production. As nuclear
engineer Arjun Makhijani argues, all too often such damage has been done to ethnic minorities or on
colonial lands or both. The main sites for testing nuclear weapons for every declared nuclear power are
on tribal or minority lands. From 1951 to 1992, over 900 nuclear weapons tests were conducted on the
Nevada Test Site (NTS)- land claimed by the Western Shoshone under the 1863 Treaty of Ruby valley. The
late Western Shoshone spiritual leader Corbin Harney proclaimed Western Shoshone to be the most nuclear
bombed nation in the world. According to Western Shoshone Virginia Sanchez, indigenous people may have
suffered more radiation exposure because of their land-linked lifestyle of picking berries, hunting, and
gathering our traditional foods, resulting in major doses of radiation. Yet, the federal government and
legal system have made only token gestures toward compensating victims of nuclear testing. The Radiation
Exposure Compensation Act (RECA) has strict qualification guidelines that have excluded many
downwinders from receiving compensation. In addition to the effects on human health from nuclear
testing, there is also an environmental toll through contaminated soil and water, which could harm
animal and plant life.

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I.H.S. Affirmative

Nuclear dumping is genocide
Thorpe, President, National Environmental Coalition for Native Americans, 1996
(Grace, Our Homes are not Dumps: Creating Nuclear-Free Zones, Natural Resource Journal, Volume 36, Number
4, p. 715)
The Great Spirit instructed us that, as Native people, we have a consecrated bond with our Mother Earth. We
have a sacred obligation to our fellow creatures that live upon it. For this reason it is both painful and
disturbing that the United States government and the nuclear power industry seem intent on forever ruining
some of the little land we have remaining. The nuclear waste is cause American Indians to make serious,
possibly even genocidal, decisions concerning the environment and the future of our peoples
Uranium mining brings about exploited communities, environmental degradation, and a

radioactive plague of cancers and disease.
Kuletz, award winning author of works dealing with technology and humanism, 2000
(Valerie, award winning author of works dealing with technology and humanism, "Tragedy at the Center of the
Universe" from "Learning to Glow." 2000, ed. John Bradley, pg. 145-147, 7/1/09, M.E)
Indian lands under uranium mining and milling development were, extensive, with the Navajo
Reservation, Laguna Pueblo, and Acoma Pueblo carrying some of the heaviest burden and consequently
suffering some of the most severe health repercussions. Though the uranium booms helped the destitute
Indian economy to some extent and for a brief time they also transformed these Indian lands (almost
overnight) from a pastoral to a mining-industrial economy, resulting in a mining-dependent population.
Indians did not get rich off the uranium development their lands because they lacked the capital and the
technical knowledge to develop them and, at least initially, they were kept ignorant of the value of their
land. Instead, development was contracted out to large energy companies. Because "national security" and
energy consumption needs (read "national competitiveness") were at stake, Indians were given the right to
stipulate conditions for development and reclamation for decades-and then the right was never sufficient.
Unchecked and unmonitored production was excused during World War II and the Cold War: on the grounds
of national security and, in the 1970s, on the basis of the energy crisis and the ongoing arms escalation that
mushroomed in the 1980s. Throughout the postwar period, American Indian populations were exploited as
a cheap source of labor. For example, Indian miners were paid at a rate two-thirds that of off-reservation
employees. In addition, Indians were not compensated adequately for the uranium taken from their lands. "As of 1984,
stateside Indians were receiving only an average of 3-4 percent of the market value of the uranium extracted from their
land." The median income reported in 1970 (at a boom time for uranium mining) at the Laguna Pueblo was only $2,661
per year-a little more than $220 a month, or $50 per week. And Indians paid a high price for the right to work the mines .
Uranium development's legacy has been one of a severely polluted environment, human and
nonhuman radiation contamination, cancers, birth defects, sickness, and death. Health risks associated
with uranium mining and milling have been identified and examined by different investigators, and reported in a variety
of sources including the Southwest Research and Information Center publications and the New England Journal of
Medicine as well as others. Since large amounts of water are used in the mining process and mountains of uranium
tailings are produced as a by-product, uranium pollution poisons the earth, air, and water. Radioactive particulates (dust
particles containing uranium-238, radium-226, and thorium-230) blow in the desert winds, and radioactive elements
travel in both surface and ground water. Radioactive materials from the mining of uranium produce radon and thoron
gases, which combine with the molecular structure of human cells and decay into radioactive polonium and thorium. The
dust irritates cells in the lining of the respiratory tract, causing cancer. Radioactive materials can also
damage sex cells, causing such birth defects as cleft palate and Down's syndrome." In seeking federal
assistance to study the effect of low-level radiation on the health of their children, Navajo health
officials called attention to at least two preliminary studies-one conducted by the March of Dimes
(principal investigator Dr. L. Shields) and the other by the Navajo Health Authority (principal investigator
Dr. D. Calloway). Calloway's study suggested that Navajo children may have a five times greater rate of bone
cancer and a fifteen times greater rate of ovarian and testicular cancer than the U.S. average." However,
despite these preliminary findings, no funding was granted for extended epidemiological studies of the
impact on Navajos living near uranium tailings and mines. IS Further extending the nuclear landscape and
causing harm to those who live there, millions of gallons of water in the Four Corners area were subjected to radiation
pollution by the extractive processes of uranium mining. Accidents, such as the Rio Puerco incident, cause serious water
pollution in an already water-scarce environment.

130
I.H.S. Affirmative

The issue of nuclear waste disposal is just one example of rhetorical exclusion that paints
American Indians as acting in a way that is not in the best interest of the whole country if
they dont allow their resources to be exploited.
Endres, Assistant Professor of Communication at the University of Utah, 2009
(Danielle, The Rhetoric of Nuclear Colonialism: Rhetorical Exclusion of American Indian Arguments in the Yucca
Mountain Nuclear Waste Siting Decision, Communication and Critical/Cultural Studies. March, Vol. 6, No. 1, Page
45-46, MAG.)
Resistance to nuclearism comes in many forms, one of which is the body of scholarship called nuclear
communication criticism. Within this corpus, Bryan Taylor and William Kinsella advocate the study of
nuclear legacies of the nuclear production process. The material legacies of the nuclear production process
include the deaths of Navajo uranium miners, the left-over uranium tailing on Navajo land, and Western
Shoshone downwinders. However, nuclear waste is in need of more examination; as Taylor writes, nuclear
waste represents of one of the most complex and highly charged controversies created by the postwar society.
Perhaps daunted by its technical, legal and political complexities, communication scholars have not widely
engaged this topic. One of the reasons that nuclear waste is such a complex controversy is its connection
with nuclear colonialism. Nuclear communication criticism has focused on examination of the
practices and processes of communication related to the nuclear production process and the legacies
of this process. At least two themes in nuclear discourse are relevant to nuclear colonialism: 1) invocation of
national interest; and 2) constraints to public debate. First, nuclear discourse is married to the professed
national interest, calling for the sacrifices among the communities affected by the legacies of the
nuclear production process. According to Kuletz, the American West has been constructed as a national
sacrifice zone because of its connection to the nuclear production process. Nuclearism is tautological in its
basic assumption that nuclear production serves the national interest and national security and its use
of national security and national interest to justify nuclearism. The federal government justifies
nuclear production, which disproportionately takes place on American Indian land, as serving the
national security. This justification works with the strategy of colonialism that defines the American
Indian people as part of the nation and not as separate, inherently sovereign entities whose national
interest may not include storing nuclear waste on their land. A second theme in nuclear discourse is its
ability to constrain public debate through invoking the national interest, defining opponents as
unpatriotic and employing discursive containment. For instance, discursive containment often operates
on the premise that public participation is a potential hazard to official interests and should be minimized and
controlled. The strategies of nuclear discourse that constrain public debate work in concert with
strategies of rhetorical colonialism that exclude and constrain the participation of American Indians in
decisions affecting their land and resources. Taken together, the intersection of the discourses of
colonialism and nuclearism create a powerful discourse aimed at perpetuating the nuclear production
process for the benefit of the colonizer at the expense of their colonial targets.

131
I.H.S. Affirmative
Waste Impacts Exterminating the Periphery

A. Nuclear dumping treats Native peoples as disposable justifying extermination of the
periphery
Reed, Professor of English and American Studies, Washington State University, 2009
(T. V., Toxic Colonialism, Environmental Justice, and Native Resistance in Silkos Almanac of the Dead, MELUS:
Multi-Ethnic Literature of the U.S., Volume 34, Number 2, Spring 2009
The founding document of the environmental justice movement, the manifesto that grew out of the First
National People of Color Environmental Leadership Summit in 1991, the same year in which Almanac of the
Dead was published, reads like a summary of the themes driving Silkos epic. Among the seventeen sections
of the manifesto, the following are particularly striking in their parallels to Almanacs positionings:
Environmental justice affirms the sacredness of Mother Earth, ecological unity and the interdependence of all
species, and the right to be free from ecological destruction . . . . Environmental justice calls for universal
protection from extraction, production and disposal of toxic/hazardous wastes and poisons that
threaten the fundamental right to clean air, land, water and food . . . . Environmental justice affirms the
fundamental right to political, economic, cultural and environmental self-determination to all peoples . . . .
Environmental justice affirms the need for an urban and rural ecology to clean up and rebuild our cities and
rural areas in balance with nature, honoring the cultural integrity of all our communities, and providing fair
access for all to the full range of resources . . . . Environmental justice opposes military occupations,
repression and exploitation of lands, peoples and cultures. Almanac ties all these threads together in a
critique of toxicity, militarism, and economic exploitation; like the manifesto, it calls for recognition of
species interdependence, cultural independence, and the self-determination of peoples modeled on
indigenous communities rooted in intimate relation with the land. As environmental justice critics have long
noted, Western capitalist discourse frequently has drawn a symbolic association between subaltern
peoples and waste, and declared the lands of subalterns to be wastelands. From the beginning of the
European colonial era to the present, dominant cultures have argued that the lands of indigenous peoples are
underdeveloped and empty (terra nullius) and that the people on them are less than human, less than
civilized. The wasting of peoples and lands has, as Silkos map puts it, gone on unabated but always
resisted, from the [End Page 29] expropriation of Native lands by guns and disease in the sixteenth century to
the toxic colonialism of the twenty-first century imposed on, for example, the Shoshone people, whose
resistance to the dumping of nuclear waste on their non-waste lands Valerie Kuletz brilliantly chronicled. The
euphemisms may change (national sacrifice zones of the recent past in the US are now being displaced by
national security rhetoric),5 but the waste- or wasted-lands seem inevitably to coincide with the
boundaries of Indian reservations (and the ghettos and barrios of others outside the sacred circle of
whiteness). What remains the same is who is making the sacrifice (or being sacrificed) and who is making
the decisions. As Native activist and former vice-presidential candidate Winona LaDuke trenchantly notes:
What happened when the best scientific minds and policy analysts in the world spent 20 years examining
every possible way to deal with problem of nuclear waste? They decided the solution was to ship the
radioactive stuff thousands of miles from all over the country and dump it on an Indian reservation.
(LaDuke is referring to Yucca Mountain, Nevada, a sacred site of the Shoshone people, chosen as the main
nuclear waste site of the military-industrial-scientific-governmental colonizers.).

132
I.H.S. Affirmative
Waste Impacts Exterminating the Periphery

B. Rendering Natives discardable populations results in systemic genocides necessitating
cycles of violence that culminate in extinction.
Santos, professor at the University of Coimbra, School of Economics, 2003
(Sousa, professor at the University of Coimbra, School of Economics, April 2003,
http://bad.eserver.org/issues/2003/63/santos.html, 7/1/09, M.E.)
According to Franz Hinkelammert, the West has repeatedly been under the illusion that it should try to
save humanity by destroying part of it. This is a salvific and sacrificial destruction, committed in the
name of the need to radically materialize all the possibilities opened up by a given social and political reality
over which it is supposed to have total power. This is how it was in colonialism, with the genocide of
indigenous peoples, and the African slaves. This is how it was in the period of imperialist struggles, which
caused millions of deaths in two world wars and many other colonial wars. This is how it was under
Stalinism, with the Gulag, and under Nazism, with the Holocaust. And now today, this is how it is in
neoliberalism, with the collective sacrifice of the periphery and even the semiperiphery of the world system.
With the war against Iraq, it is fitting to ask whether what is in progress is a new genocidal and sacrificial
illusion, and what its scope might be. It is above all appropriate to ask if the new illusion will not herald the
radicalization and the ultimate perversion of the Western illusion: destroying all of humanity in the illusion of
saving it. Sacrificial genocide arises from a totalitarian illusion manifested in the belief that there are no
alternatives to the present-day reality, and that the problems and difficulties confronting it arise from
failing to take its logic of development to ultimate consequences. If there is unemployment, hunger and death
in the Third World, this is not the result of market failures; instead, it is the outcome of market laws not
having been fully applied. If there is terrorism, this is not due to the violence of the conditions that generate
it; it is due, rather, to the fact that total violence has not been employed to physically eradicate all terrorists
and potential terrorists. This political logic is based on the supposition of total power and knowledge, and
on the radical rejection of alternatives; it is ultra-conservative in that it aims to reproduce infinitely the
status quo. Inherent to it is the notion of the end of history. During the last hundred years, the West has
experienced three versions of this logic, and, therefore, seen three versions of the end of history: Stalinism, with its logic
of insuperable efficiency of the plan; Nazism, with its logic of racial superiority; and neoliberalism, with its logic of
insuperable efficiency of the market. The first two periods involved the destruction of democracy. The last one trivializes
democracy, disarming it in the face of social actors sufficiently powerful to be able to privatize the state and international
institutions in their favor. I have described this situation as a combination of political democracy and social fascism. One
current manifestation of this combination resides in the fact that intensely strong public opinion, worldwide, against the
war is found to be incapable of halting the war machine set in motion by supposedly democratic rulers. At all these
moments, a death drive, a catastrophic heroism, predominates, the idea of a looming collective suicide, only preventable
by the massive destruction of the other. Paradoxically, the broader the definition of the other and the efficacy of its
destruction, the more likely collective suicide becomes. In its sacrificial genocide version, neoliberalism is a
mixture of market radicalization, neoconservatism and Christian fundamentalism. Its death drive takes a
number of forms, from the idea of "discardable populations", referring to citizens of the Third World not
capable of being exploited as workers and consumers, to the concept of "collateral damage", to refer to the
deaths, as a result of war, of thousands of innocent civilians. The last, catastrophic heroism, is quite clear on two
facts: according to reliable calculations by the Non-Governmental Organization MEDACT, in London, between 48 and
260 thousand civilians will die during the war and in the three months after (this is without there being civil war or a
nuclear attack); the war will cost 100 billion dollars, enough to pay the health costs of the world's poorest countries for
four years. Is it possible to fight this death drive? We must bear in mind that, historically, sacrificial destruction has
always been linked to the economic pillage of natural resources and the labor force, to the imperial design of radically
changing the terms of economic, social, political and cultural exchanges in the face of falling efficiency rates postulated
by the maximalist logic of the totalitarian illusion in operation. It is as though hegemonic powers, both when they
are on the rise and when they are in decline, repeatedly go through times of primitive accumulation ,
legitimizing the most shameful violence in the name of futures where, by definition, there is no room for
what must be destroyed. In today's version, the period of primitive accumulation consists of combining neoliberal economic
globalization with the globalization of war. The machine of democracy and liberty turns into a machine of horror and destruction

133
I.H.S. Affirmative
Waste Impacts - Colonialism

Waste dumping is radioactive colonialism
Bullard and Johnson, Director of the Environmental Justice Resource Center and Assistant
Professor of Sociology at Clark Atlanta University, 09
(Robert D. and Glenn S., Environmental Justice: Grassroots Activism and Its Impact on Public Policy Decision
Making, Environmental Sociology: from Analysis to Action, Second Edition, p.62-63, accessed 7-10-09, AJP)
There is a direct correlation between exploitation of land and exploitation of people. It should not be a
surprise to anyone to discover that Native Americans have to contend with some of the worst pollution in
the United States (Beasley, 1990b;Kay,1991;Taliman,1992;Tomsho,1990).Native American nations have
become prime targets for waste trading (Angel,1992;Geddicks,1993).More than three dozen Indian
reservations have been targeted for landfills, incinerators, and other waste facilities (Kay,1991).The vast
majority of these waste proposals have been defeated by grassroots groups on the reservations. However,
radioactive colonialism is alive and well (Churchill & LaDuke,1983). Radioactive colonialism operates
in energy production (mining of uranium) and disposal of wastes on Indian lands. The legacy of
institutional racism has left many sovereign Indian nations without an economic infrastructure to
address poverty, unemployment, inadequate education and health care, and a host of other social
problems. Some industry and governmental agencies have exploited the economic vulnerability of
Indian nations. For example, of the 21 applicants for the DOEs monitored retrievable storage (MRS)
grants,16 were Indian tribes (Taliman,1992a). The 16 tribes lined up for $100,000 grants from the DOE to
study the prospect of temporarily storing nuclear waste for a half century under its MRS program. It is the
Native American tribes sovereign right to bid for the MRS proposals and other industries. However, there
are clear ethical issues involved when the U.S. government contracts with Indian nations that lack the
infrastructure to handle dangerous wastes in a safe and environmentally sound manner. Delegates at the
Third Annual Indigenous Environmental Council Network Gathering (held in Cello Village, Oregon, on June
6,1992) adopted a resolution of No nuclear waste on Indian lands.

134
I.H.S. Affirmative
Waste Impacts - Capitalism

Waste dumping on reservations is a manifestation of capitalism
Consumption and production patterns, especially in nations with wasteful throw-away lifestyles like
the United States,and the interests of transnational corporations create and maintain unequal and unjust
waste burdens within and between affluent and poor communities, states, and regions of the world.
Shipping hazardous wastes from rich communities to poor communities is not a solution to the growing
global waste problem. Not only is it immoral, but it should be illegal. Moreover, making hazardous waste
transactions legal does not address the ethical issues imbedded in such transactions (Alston & Brown,1993).
Transboundary shipment of banned pesticides, hazardous wastes, toxic products, and export of risky
technologies from the United States, where regulations and laws are more stringent,to nations with weaker
infrastructure, regulations, nd laws smacks of a double standard (Bright,1990).The practice is a
manifestation of power arrangements and a larger stratification system in which some people and some
places are assigned greater value than others. In the real world, all people, communities, and nations are
not created equal. Some populations and interests are more equal than others. Unequal interests and power
arrangements have allowed poisons of the rich to be offered as short-term remedies for poverty of the
poor. This scenario plays out domestically (as in the United States, where low-income and people-of-color
communities are disproportionately affected by waste facilities and dirty industries) and internationally
(where hazardous wastes move from OECD states flow to non-OECD states).
Dumping on reservations is rooted in capitalism

The poisoning of African Americans in Louisianas Cancer Alley, Native Americans on
reservations,and Mexicans in the border towns all have their roots in the same economic system, a
system characterized by economic exploitation, racial oppression, and devaluation of human life and
the natural environment. Both race and class factors place low-income and people-of-color communities
at special risk. Although environmental and civil rights laws have been on the books for more than 3
decades, all communities have not received the same benefits from their application, implementation, and
enforcement. Unequal political power arrangements also have allowed poisons of the rich to be offered
as short-term economic remedies for poverty. There is little or no correlation between proximity of
industrial plants in communities of color and the employment opportunities of nearby residents. Having
industrial facilities in ones community does not automatically translate into jobs for nearby residents. Many
industrial plants are located at the fence line with the communities. Some are so close that local residents
could walk to work. More often than not communities of color are stuck with the pollution and poverty,
while other people commute in for the industrial jobs.

135
I.H.S. Affirmative
Waste Impacts Extinction

Nuclear genocide leads to extinction
Churchill, Associate Professor of Communications & Coordinator of American Indian
studies, 2002
[WARD, STRUGGLE FOR THE LAND: NATIVE AMERICAN RESISTANCE TO GENOCIDE, ECOCIDE,
ANDCOLONIZATION PAGES 278]
<Neither genocide nor ecocide can be "contained" when accomplished by nuclear means. The
radioactive colonization of Native North America therefore threatens not only Indians, but the survival
of the human species itself. The tools for fighting back against any threat begin, it is said, with a precise
understanding of the danger and, from there, the best means by which to counter it. In this instance, the
situation is simple enough: Like it or not, we are allIndian and non-Indian alikefinally in the same
boat. At last there is no more room for non-Indians to maneuver, to evade, to find more "significant" issues
with which to preoccupy themselves. Either the saving of indigenous lives becomes a matter of
preeminent concern, or no lives will be saved. Either Native North America will be liberated, or
liberation will be foreclosed for everyone, once and for all. The fight will either be waged on Indian
land, for Indian lives, or it will be lost before it really begins. We must take our stand together. And we
are all running out of time in which to finally come to grips with this fact for antinuclear activism is and has
always been in finding ways to sever nuclear weapons and reactors from their roots. This means, first and
foremost, that non-Indians cast off the blinders which have led them to the sort of narrow "not in my
back yard" sensibility voiced by Barry Commoner and his erstwhile vice presidential running mate,
LaDonna Harris (a Comanche and founding member of CERT).

136
I.H.S. Affirmative
A2: Hormesis/Radiation Good

Hormesis has been reviewed and debunked assumes their evidence
BOARD ON RADIATION EFFECTS RESEARCH, NATIONAL ACADEMY OF SCIENCES, 2006.
(HEALTH RISKS FROM EXPOSURE TO LOW LEVELS OF IONIZING RADIATION: BEIR VII PHASE 2. PG.
315. HTTP://BOOKS.NAP.EDU/OPENBOOK.PHP?ISBN=030909156X&PAGE=315) WBTA
The possibility that low doses of radiation may have beneficial effects (a phenomenon often referred to
as hormesis) has been the subject of considerable debate. Evidence for hormetic effects was
reviewed, with emphasis on material published since the 1990 BEIR V study on the health effects of
exposure to low levels of ionizing radiation. Although examples of apparent stimulatory or protective
effects can be found in cellular and animal biology, the preponderance of available experimental
information does not support the contention that low levels of ionizing radiation have a beneficial
effect. The mechanism of any such possible effect remains obscure. At this time, the assumption that any
stimulatory hormetic effects from low doses of ionizing radiation will have a significant health benefit
to humans that exceeds potential detrimental effects from radiation exposure at the same dose is
unwarranted.
Studies do not support the hormesis theory. Radiation damages the body and causes cancer.
NATIONAL ACADEMY OF SCIENCES, IN CONJUNCTION WITH THE NATIONAL
INSTITUTE OF MEDICINE, 2005
[LOW LEVELS OF IONIZING RADIATION MAY CAUSE HARM. A PRESS RELEASE FROM NAS.
HTTP://WWW8.NATIONALACADEMIES.ORG/ONPINEWS/NEWSITEM.ASPX?RECORDID=11340] WBTA
A preponderance of scientific evidence shows that even low doses of ionizing radiation, such as gamma
rays and X-rays, are likely to pose some risk of adverse health effects, says a new report from the
National Academies' National Research Council. The report's focus is low-dose, low-LET -- "linear energy
transfer" -- ionizing radiation that is energetic enough to break biomolecular bonds. In living organisms, such
radiation can cause DNA damage that eventually leads to cancers. However, more research is needed to
determine whether low doses of radiation may also cause other health problems, such as heart disease and
stroke, which are now seen with high doses of low-LET radiation. The study committee defined low doses as
those ranging from nearly zero to about 100 millisievert (mSv) -- units that measure radiation energy
deposited in living tissue. The radiation dose from a chest X-ray is about 0.1 mSv. In the United States,
people are exposed on average to about 3 mSv of natural "background" radiation annually. The committee's
report develops the most up-to-date and comprehensive risk estimates for cancer and other health
effects from exposure to low-level ionizing radiation. In general, the report supports previously
reported risk estimates for solid cancer and leukemia, but the availability of new and more extensive
data have strengthened confidence in these estimates. Specifically, the committee's thorough review of
available biological and biophysical data supports a "linear, nothreshold" (LNT) risk model, which
says that the smallest dose of low-level ionizing radiation has the potential to cause an increase in
health risks to humans. In the past, some researchers have argued that the LNT model exaggerates adverse
health effects, while others have said that it underestimates the harm. The preponderance of evidence
supports the LNT model, this new report says. "The scientific research base shows that there is no
threshold of exposure below which low levels of ionizing radiation can be demonstrated to be harmless
or beneficial," said committee chair Richard R. Monson, associate dean for professional education and
professor of epidemiology, Harvard School of Public Health, Boston. "The health risks particularly the
development of solid cancers in organs rise proportionally with exposure. At low doses of radiation, the
risk of inducing solid cancers is very small. As the overall lifetime exposure increases, so does the risk." The
report is the seventh in a series on the biological effects of ionizing radiation.

137
I.H.S. Affirmative
A2: Regulations Solve

State regulations fail
Similarly,tax breaks and corporate welfare programs have produced few new jobs by polluting
firms.However,state-sponsored pollution and lax enforcement have allowed many communities of color
and poor communities to become the dumping grounds.Louisiana is the poster child for corporate
welfare.The state is mired in both poverty and pollution.It is no wonder that Louisianas petrochemical
corridor,the 85-mile stretch along the Mississippi River from Baton Rouge to New Orleans dubbed Cancer
Alley,has become a hotbed for environmental justice activity.

138
I.H.S. Affirmative
A2: Casinos Solve Tribal Economies

Casinos have done next to nothing for the economies for tribes.
Because the Native American gaming industry has grown to encompass 220 tribes, 377 facilities, and
more than $16 billion per year in revenue, a perception exists that Indians have been given everything
they need and that federal handouts are no longer necessary. This perception is inaccurate on
several levels. First, it ignores the federal trust obligation discussed earlier in this report. Second, it
overstates the magnitude and impact of gaming profits. A report prepared for the American Indian
Program Council provides a clearer picture of the impact of casinos in Indian Country: Only half of all
tribes have casinos. Thirty-nine casinos produced the majority of casino-generated income. More
specifically, 39 percent of casinos accounted for 66 percent of revenue. Casinos in five states, with more
than half the total Native American population, accounted for less than 3 percent of all casino revenue.
Casinos in three states, with only 3 percent of the Native American population, accounted for more than 44
percent of all casino revenue. Dozens of casinos barely break even because of inadequate size or
location. The overall effect is that only a relatively small number of tribes have been very successful
successful enough to establish health care systems independent of federal aid. For most tribes, gaming
has brought increased administrative, legal, and lobbying expenses along with impressive gains for
non-Indian investors and state governments who have taken as much as 16 percent of revenue. After
other expenses are covered, some percentage of the successful tribes has appropriately applied some portion
of their increased revenue to health care. Nevertheless, the vast majority of tribes, and Native Americans,
must continue to rely on the inadequate funds appropriated to the IHS.

139
I.H.S. Affirmative
Waste Dumping - Solvency

Government enforcement of nondiscriminatory laws is key to alleviating poverty
The environmental justice movement has set out clear goals of eliminating unequal enforcement of
environmental, civil rights, and public health laws; differential exposure of some populations to harmful
chemicals, pesticides, and other toxins in the home, school, neighborhood, and workplace; faulty
assumptions in calculating, assessing, and managing risks; discriminatory zoning and land use practices;
and exclusionary policies and practices that limit some individuals and groups from participation in
decision making. Many of these problems could be eliminated if existing environmental, health, housing,
and civil rights laws were vigorously enforced in a nondiscriminatory way. The call for environmental
and economic justice does not stop at the U.S. borders but extends to communities and nations that are
threatened by the export of hazardous wastes, toxic products, and dirty industries. Much of the world
does not get to share in the benefits of the United States high standard of living. From energy consumption
to the production and export of tobacco, pesticides, and other chemicals, more and more of the worlds
peoples are sharing the health and environmental burden of Americas wasteful throwaway culture.
Hazardous wastes and dirty industries have followed the path of least resistance. Poor people and poor
nations are given a false choice of no jobs and no development versus risky, low-paying jobs and
pollution. Industries and governments (including the military) have often exploited the economic
vulnerability of poor communities, poor states, poor nations ,and poor regions for their unsound and
risky operations. Environmental Justice leaders are demanding that no community or nation, rich or
poor, urban or suburban, Black or White, be allowed to become a sacrifice zone or dumping grounds. They
are also pressing governments to live up to their mandate of protecting public health and the
environment.

***Trust Doctrine Advantage***
140
I.H.S. Affirmative

141
I.H.S. Affirmative
Trust Doctrine Internals Legal Obligation

Trust doctrine means we have an obligation to protect Native American health
This Federal government's responsibility to urban Indians is rooted in basic principles of Federal Indian law.
The United States has entered into hundreds of treaties with tribes from 1787 to 1871. In almost all of
these treaties, the Indians gave up land in exchange for promises. These promises included a guarantee
that the United States would create a permanent reservation for Indian tribes and would protect the
safety and well-being of tribal members. The Supreme Court has held that such promises created a
trust relationship between the United States and Indians resembling that of a ward to a guardian. See
Cherokee Nation v. Georgia, 30 U.S. 1 (1831). As a result, the Federal government owes a duty of loyalty
to Indians. In interpreting treaties and statutes, the U.S. Supreme Court has established "canons of
construction" that provide that: (1) ambiguities must be resolved in favor of the Indians; (2) Indian
treaties and statutes must be interpreted as the Indians would have understood them; and (3) Indian
treaties and statutes must be construed liberally in favor of the Indians. See Felix S. Cohen's Handbook
of Federal Indian Law, (1982 ed.) p. 221-225. Congress, in applying its plenary (full and complete) power
over Indian affairs, consistent with the trust responsibility and as interpreted pursuant to the canons of
construction, has enacted legislation addressing the needs of off-reservation Indians.
We have a legal and moral obligation to provide health care to Urban Indians
The Federal courts have also found that the United States can have an obligation to state-recognized
tribes under Federal law. See Joint Tribal Council of Passamaquoddy v. Morton, 528 F.2d 370 (1st Cir., 1975). Congress has provided, not only in the
IHCIA, but also in NAHASDA, that certain state-recognized tribes or tribal members are eligible for certain Federal programs. 25 U.S.C. Section 4103(12)(A).
The urban Indian is an Indian who has become physically separated from his or her traditional lands
and people, generally due to Federal policies. Some of these federal policies were designed to force
assimilation and to break-down tribal governments; others may have been intended, at some misguided
level, to benefit Indians, but failed miserably. The result of this "course of dealing," however, is the samea Federal obligation to urban Indians.5
The Federal Relocation of Indians. The BIA's Relocation program originated in the early 1950s as a response to adverse weather and economic conditions on the
Navajo reservation. A limited program was initiated to relieve the crisis by finding jobs for Navajos who wanted to work off the reservation as little or no job
opportunities existed on the reservation. Shortly afterward, the BIA converted its Navajo program into a full-fledged Bureau of Indian Affairs program applicable to
Solving reservation economic problems by relocating Indians off of their tribal lands is
roughly the equivalent of the Federal government, during the Depression, sending Americans
overseas to find work-something the Federal government would never have done. All told, between
1953-1961, over 160,000 Indians were relocated to cities, where they quickly joined the ranks of the urban
poor.6 Today, the children, grandchildren and great-grandchildren of the 160,000 Indians relocated by the
BIA are still in the cities.
many Indian tribes.
Its a federal obligation

Consultation is key to fulfilling the trust responsibility of the federal government to American Indian
and Alaska Native people. We would like to thank the Committee for recognizing this by ensuring that the
Health Choice Commissioner consults with tribes and tribal organizations. Children are sacred in Native
communities. We would like to thank the Committee for expressly including tribes as eligible recipients in
the home visitation program for families with young children. In light of American Indian and Alaska
Native maternal infant health disparities, it is essential that there be an adequate ``set aside`` for tribal
programs and that they are granted the flexibility to administer services in a culturally flexible
manner.

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I.H.S. Affirmative

We have a legal obligation to provide health care to Native Americans and Urban Indians
The Supreme Court and lower Federal courts have held that the Federal government's obligations to
Indians extends beyond reservation boundaries. "The overriding duty of our Federal Government to deal
fairly with Indians wherever located has been recognized by this Court on many occasions." Morton v. Ruiz,
415 U.S. 199, 94 S.Ct. 1055, 39 L.Ed.2d 270 (1974) (emphasis added), citing Seminole Nation v. United
States, 316 U.S. 286, 296 (1942); and Board of County Comm'rs v. Seber, 318 U.S. 705 (1943). In other
areas, such as housing, the Federal courts have found that the trust responsibility operates in urban
Indian programs. "Plaintiffs urge that the trust doctrine requires HUD to affirmatively encourage urban
Indian housing rather than dismantle it where it exists. The Court generally agrees." Little Earth of United
Tribes, Inc. v. U.S. Department of Justice, 675 F. Supp. 497, 535 (D. Minn., 1987).
The Federal courts have also stated that there is a trust responsibility for individual Indians, including
urban Indians. "The trust relationship extends not only to Indian tribes as governmental units, but to tribal
members living collectively or individually, on or off the reservation." Little Earth of United Tribes, Inc. v.
U.S. Department of Justice, 675 F. Supp. 497, 535 (D. Minn., 1987)(emphasis added). "In light of the broad
scope of the trust doctrine, it is not surprising that it can extend to Indians individually, as well as
collectively, and off the reservation, as well as on it." St. Paul Intertribal Housing Board v. Reynolds, 564 F.
Supp. 1408, 1413 (D. Minn., 1983) (emphasis added).
Indian Health Care is a federal responsibility

INDIAN HEALTH IS A FEDERAL RESPONSIBILITY Although the Federal government created the
Indian health system in use today, too often, Indian people and the Indian health system that serves
them are only an afterthought in legislation. While we have many mutual goals, the vehicle for
accomplishing them may need to be different in Indian Country. We must work together to be sure health
reform legislation builds on the current Indian Health system and then extends the promise of health
access to all Americans. Health reform must accomplish two equally important objectives. First, the Indian
health system must be protected from adverse consequences and fully supported as a critical
component of the federal responsibility to provide health care to American Indian and Alaska Natives.
Second, American Indian and Alaska Natives are also entitled to have the option to fully participate in health
reform initiatives, by using their insurance or other health care coverage at Indian programs and have the
Indian provider fully reimbursed for these services. We must be clear: specifically addressing the needs of
American Indians and Alaska Natives within health care reform legislation is not akin to providing
requirements for reducing health disparities or considering the needs of ethnically diverse populations. While
we may fall into those categories, the significant difference is that supplying health care to American
Indians and Alaska Natives is a federal obligation and being an Indian is a political status.

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I.H.S. Affirmative

The US Federal Government has the moral obligation to provide Native Americans with
healthcare, an obligation they have failed to fulfill
Schram, Metro Times Writer, 06
(Tom, Metro Times, Bad Medicine, 4/5/06, http://metrotimes.com/culture/story.asp?id=9067,
Accessed 6/30/09, CAF)
The statistics on the state of health care for American Indians are staggering.According to the 2004
U.S. Commission on Civil Rights report "Broken Promises," compared to the general population
Native Americans are more than seven times as likely to die from alcoholism, more than six times as
likely to die from tuberculosis, four times as likely to die from diabetes, nearly three times as likely to
die from accidents, and 52 percent more likely to die from pneumonia or influenza. They have the
poorest cancer survival rates of any racial group. The American Indian poverty rate is three times the
national average and their life expectancy is 71, nearly five years less than the rest of the U.S. population.As a result of federal
assimilation initiatives, nearly two-thirds of the 4.1 million Native Americans now live in urban areas. In metropolitan Detroit, there are
more than 38,000 Native Americans, as many as 27,000 without health insurance. Despite this, by far the largest proportion of the
budget of the federal Indian Health Services is spent on Indian reservations. These inequities exist in the face of the government's
promises to provide health care to all Native Americans. There is one federal government-funded health care clinic to care for the 38,000
Native Americans in southeast Michigan. It provides basic medical care and outpatient programs for such health issues as substance
abuse. But by the admission of its own director, it's not comprehensive. And it's not free. Patients pay according to a sliding scale based
on income."Really, nothing is free," says Lucy Harrison, Director of the American Indian Health and Family Services of Southeast
Michigan on Lawndale, near Michigan and Lonyo. "There is no longer a free clinic. The Indians who come here are the sickest and the
poorest in southeast Michigan. Those people who don't have a dime in their pocket, of course, we have to write that off." Those who
need more than basic services are referred to specialists where they often are faced with costs they have no way to meet."They're in a
boat with no oars absolutely," Harrison says. "You can make referrals all you want, but if there's no money that's what the problem
is. Yet the law said that we would provide health and education."American Indians are adamant that they do not want charity. They want
justice. Indians ceded or were forcibly removed from more than 400 million acres of their land. "This is our land; this is our
home," says Fay Givens, executive director of American Indian Services Inc., an Indian support group
based in Lincoln Park. "We gave up 95 percent of our land with guns at our heads. In return there were
very few things the government was obligated to do, most of which they have never done. They have
never honored their treaties. We do not feel that they want us to live."Harrison says that this concept is especially
relevant in the Detroit area."We were the first people in the nation here," she adds. "When Cadillac rowed that boat up, this was our
territory." There are also social and cultural barriers in place that contribute to health care disparities. Indians were actively at war with
the United States for most of the 19th century and efforts to wipe out Native Americans and their traditions, beliefs and culture were
very nearly successful. Is it really surprising that they remain wary of the government and its programs?In the late 1940s, the federal
government began what is called the Bureau of Indian Affairs Relocation Program, moving Indians off reservations and into urban
settings. In the early 1950s, Congress increased funding and enhanced the program. Participants received two years of benefits for either
on-the-job or vocational training. The program continued through the 1970s.While some argued that the program put Indians on the road
to independence, others argued that it forced Indians from their homes and did not improve their living conditions."They moved half the
Indian people in America into the cities," says Givens. "It was a social experiment to assimilate us and clearly it hasn't
worked."McGowan is Givens' sister. She serves as a staff anthropologist for the National Urban Indian Coalition. She represents
American Indians at the United Nations through the National Indian Youth Council and is a member of the National Indian Health Care
Advisory Board.She and Givens were born in Mississippi and are members of the Choctaw Mississippi Band. They grew up in Detroit.
McGowan says that Indians don't want to be assimilated."We don't want in," she says. "We don't want to adopt what the mainstream sees
as priorities. We have our own priorities our families, religion, generosity. We cling tenaciously to our own values. We are who we
are and we do not want to become part of the mainstream. It's insulting to us to become part of the melting pot."What Indians have
encountered is a continuing cycle of poverty and racism. According to the Commission on Civil Rights report:
"Persistent discrimination and neglect continue to deprive Native Americans of a health system
sufficient to provide health care equivalent to that provided to the vast majority of Americans. ...
Unfortunately, in this country, race matters when it comes to medical treatment. ... Studies show that
people of color are less likely to receive certain medical procedures. Much of the unfair treatment and
mistreatment stems from deeply rooted social inequities."Those inequities in southeast Michigan would be largely
addressed if the U-M Clinical Law Program lawsuit is successful. The suit would require the federal government to provide
comprehensive health care for Detroit-area Indians without cutting funds for reservation-based health clinics. A successful ruling could
no doubt set a precedent that would lead to increased funding for urban Indians across the United States.The U-M Clinical Law Program
is bringing the suit on behalf of the class and four named plaintiffs, three Native Americans and American Indian Services."The federal
government made promises and, as their very own document says, they broke those promises," Santacroce says. "The government made
a pact with these communities, in exchange for the surrender of their lands, to take care of them. And they are not doing it."The
Commission on Civil Rights, established by Congress in 1957, does, in fact say that. In "Broken Promises" the commission wrote: "

144
I.H.S. Affirmative

Schram, Metro Times Writer, 06 (Continued)
The federal government has a special relationship with Native Americans, commonly referred to as a
'trust' relationship, requiring the government to protect tribal lands, assets, resources, treaty rights,
and health care, among other obligations. ... This health care obligation requires the government to
provide medical treatment to all Native Americans living in the United States." Indian Health Services, the
federal agency under the Department of Health and Human Services that is charged with providing health care to American Indians,
would not disagree either. While the agency's Web site states that health care is not an entitlement, an IHS official says there is both a
moral and legal obligation to provide it."I think there's definitely a moral obligation," says Diane Dawson,
public affairs specialist at IHS in Washington. "I know what you're asking and certainly our answer is that there is a legal
obligation." Dawson says that the reason health care for American Indians is inadequate is simple: It is not well enough funded. "No, not
to meet the needs," she says. "I think it's pretty well understood that it's not, but we do the best we can with what we've got and we
appreciate everything we get. But a good effort is not good enough, Santacroce says."I don't doubt that any individuals within IHS and in
the government are doing their best to deliver medical services," he says. "The point is that their best is legally insufficient and that sits
at their doorstep. When the law requires the government to do something, they have to do something . 'We don't have the
money' is not a defense. It's as simple as that."
American Indians receive inferior healthcare, and the federal government must uphold its
obligation to provide the American Indians with the funds to improve it.
Garcia, President of the National Congress of American Indians, 2006
(Joe, The Native Voice, NCAI President Joe Garcia Delivers Fourth Annual State of Indian Nations Address 2-20-06,
http://proquest.umi.com/pqdweb?
=10553, 6-29-09, ESM)
Number Two: Healthcare Second of the Steps is healthcare: Because of inferior healthcare, the quality and
length of life for American Indians falls well below the rest of the US American Indians have a life
expectancy five years less than the rest of the country. A typical American Indian is 650 percent more
likely to die from tuberculosis, 420 percent more likely to die from diabetes, 280 percent more likely to
die in an accident, and 52 percent more likely to die from pneumonia or influenza than the rest of the
US population. Native American healthcare is often no more than emergency treatment, which means
that our people are getting care only when they can't wait anymore. There's little
preventive healthcare and little education for healthier living. Healthcare expenditures for Indian are
less than half what America spends for federal prisoners. Let me repeat that: Healthcare expenditures for
Indian are less than half what America spends for federal prisoners. And remember that there are real people
behind these numbers. The Ute Mountain Ute tribe in Towaoc, Colorado, recently lost three tribal elders in a
van accident because the only way these elders could get dialysis was to drive two-and-a-half hours each way
to the nearest hospital with the right equipment. What they needed wasn't close enough. Because of this, I
call upon Congress and the President to uphold their historic and contractual obligation by
reauthorizing the tribally proposed Indian Health Care Improvement Act during this session of
Congress. This legislation is no less than the framework for the Indian healthcare system. It will bring
our outdated and inadequate system into the 21st Century - addressing mental health, substance abuse
and youth suicide, and support for attracting and retaining qualified healthcare professionals. Basic
things such as in-home healthcare are becoming commonplace. But they are not yet a common part of the
system of Indian healthcare. They ought to be.

145
I.H.S. Affirmative

Te Federal Government has the obligation to provide American Indians with health care
grounded in numerous treaties
Dorgan, Chairman of the Senate Indian Affairs Committee, 07
(Byron, Indian Country Today, Dorgan: American Indian health care a national embarrassment, 12/23/07,
In August 2006, Ta'Shon suffered a collapsed lung. She ended up in Denver, where she was diagnosed with
an incurable form of cancer. She died on Sept. 1, 2006. Her grandmother believed that Ta'Shon's last two
years of life were spent in ''unmedicated pain'' and wondered whether an earlier diagnosis would have made
any difference.These stories are repeated every day on Indian reservations across the country. Health care
has become a hot issue. But as we work to improve the nation's health care system, we ignore the
health care crisis affecting American Indians, the First Americans.Why is Native health care not
simply an indistinguishable component of the overall health care system? Because our country has an
affirmative trust obligation toward American Indians. That obligation is grounded in numerous
treaties and, more generally, in the moral responsibility for the negative impact over generations of
changing federal policies.The great Chief Justice John Marshall, in the 1831 decision of Cherokee Nation v.
Georgia, recognized that the United States had a unique trustee relationship toward Indian tribes.Statistics
highlight the desperate condition of American Indian health care. Compared to the U.S. population as
a whole, Natives have a 600 percent higher incidence of tuberculosis, a 189 percent higher incidence of
diabetes and a 510 percent higher incidence of alcoholism. Suicides on reservations in the northern
Great Plains are 10 times higher than the national average.To improve the performance of the United
States as trustee for the health care of American Indians, more funding and continuous innovation are needed.
For 2005, the per capita federal health expenditure by the IHS was $2,130. By the way, that's about one-half
the per capita spending for federal prisoners' health care, and it was far below the estimated per capita
benchmarks of Medicare at $6,784 and the Veterans Administration at $4,653. It means we have full-scale
''health care rationing'' for American Indians, and it has to stop. We need to meet our obligations.The U.S.
Congress is now considering a reauthorization of the Indian Health Care Improvement Act. It has been eight
years since the Congress has taken action to improve Indian health care. This new legislation will make some
needed improvements such as developing a new type of convenient care clinic and authorizing a new effort
to combat the clusters of teen suicides on Indian reservations. But this is just a first step.Our nation has a
trust responsibility for the health of American Indians, and it's long past time we own up to that
responsibility.
The federal government has failed to uphold their obligations to American Indian health
care.
The Commission finds that IHS funding levels are inadequate by every applicable standard of
measurement and in every area of health service delivery within IHS. The lack of funding is, however,
particularly acute for contract health services and urban Indian programs. Federal policy, as expressed
in numerous documents and declarations over the past century, reflects congressional intent to maintain
credibility and to fully fund health care for Native Americans. Nevertheless, Myra Munson reminded us, the
ultimate policy document is always the budget document. Unfortunately, the budget has clearly failed to
reflect the stated policy objectives of providing adequate health care and erasing disparities. As a result,
the federal government has defaulted on its obligation and responsibility to Native Americans.
Considering the degree of inadequacy, the length of time over which it has been recognized, and the
obstinate refusal to take concrete action to remedy the situation, the only possible explanations are
either discrimination or gross neglect on the part of the federal government. The Commission has also
determined that the current regulatory framework needlessly restricts IHS officials from making minor
modifications to IHS facilities and structures, forcing inadequate facilities to remain in an unsatisfactory
condition while waiting for increased appropriations specifically designated for that facility. In
addition, current regulations requiring residence within defined Contract Health Service Delivery Areas
allow the denial of access to health care for many Native Americans living off-reservation for the
simple reason that they have exercised their right to live somewhere besides their home reservation.

146
I.H.S. Affirmative

Denial of American Indians to healthcare is a violation of the USFGs trust responsibility
and only one aspect of a long list of broken promises made by the government to Indians.
System, September. Page 141, MAG)
Based on the review and examination conducted by the Commission, the two most striking characteristics
of the Native American health care system created by the federal government are the use of limited and
incremental responses to the health care challenges faced by Native Americans, and the fact that the
health status of Native Americans continues to lag behind that of all other Americans. Native Americans
die at an earlier age than other ethnic groups and their quality of life is diminished as a result of the
prevalence of disease. Treaties and related court decisions form the foundation of the federal
governments undisputed responsibility to provide adequate health care to Native Americans. Congress
has formally acted upon that responsibility on more than one occasion, and virtually every political leader
addressing Native American health care has recognized this responsibility. This report evaluates the extent to
which rhetoric is matched by action specifically aimed at improving the delivery of health services and the
overall health status of Native Americans. Regrettably, the Commission concludes that our nations lengthy
history of discrimination against Native Americans, by way of unfulfilled promises, repeats itself as
evidenced by the failure of Congress to provide the resources necessary for the creation and
maintenance of an effective health system for Native Americans. The pattern of unfulfilled promises is
also evident in the existence of cultural, social, and structural barriers that continue to limit Native
American access to health care.
The federal government is failing its obligation to provide health care for Native Americans
McDonough, 09
(Cara, Finding Dulcinea, The Dark Side of Health Care on Native American Reservations, 6/16/09,
http://www.findingdulcinea.com/news/health/2009/june/The-Dark-Side-of-Health-Care-on-Native-AmericanReservations.html, accessed 6/29/09, SP)
Recent accounts suggest the federal health service for American Indians on reservations is in crisis. Will
President Obamas stimulus plan and health care reform plans help? A Broken Health Care System for
Native Americans On paper, the situation sounds good: Based on a 1787 agreement between tribes and the
United States government, the U.S. has an obligation to provide American Indians with free health
care on reservations. But thats not how it works, reports the Associated Press. Roughly one-third more is
spent per capita on health care for felons in federal prison, according to 2005 data referenced by the AP. The
systems ineffectiveness has yielded a common refrain on reservations of dont get sick after June,
because thats when federal funds run out. Some lawmakers have tried to bring attention to the serious
issue, but tightening budgets and the relatively small size of the American Indian population have
worked against them, reports the AP. Jefferson Keel, lieutenant governor of the Chickasaw Nation and first
vice president of the National Congress of American Indians, testified about the situation last week on
Capitol Hill. "Perhaps nowhere in this country is the debate on health care reform more important, or
will it have more of an impact, than in tribal communities," Keel said, according to Sioux Falls, S.D.
newspaper the Argus Leader. The story reports that tribal leaders have joined together to request several
changes to the system, including increasing Native American participation in government programs, such as
Medicaid; increasing long-term care options on reservations; and providing employee incentives to reduce
shortages in the Native American health system work force."It's clear the federal government isn't
fulfilling its trust responsibility to provide health care to Indian Country, Sen. Jon Tester, D-Mont.,
who chaired the hearing, said. The Argus Leader reports that government-sponsored health care is available
to some 1.9 million Native Americans living on or near reservations in 35 states, and that its been about ten
years since the Indian Health Care Improvement Act was updated.

147
I.H.S. Affirmative
Trust Doctrine Internals Poverty

Federal policies regarding Native Americans have locked nearly all of them into abject
poverty the federal government must make up for this with the plan
Ignance, President of the National Council of Urban Indian Health (NCUIH) and
member of the Menominee Tribe, 2006 (Plea For Urban Indian Health. Native American Law
Digest May 2006. Accessed 30 Jun 2009. EKC)
* Failure of Federal Efforts to Economically Develop the Reservations. The second major reason Indians
have moved to the city is the near total failure of Federal programs to promote economic development
on Indian lands, coupled with the ongoing success of the Federal efforts in the 1800's to undermine the
economic way of life of Indian peoples, locking nearly all Indians into hopeless poverty which still
plagues most reservations today. The long history of treaty-breaking by the Federal government is an
important part of this tale. As a result, out of desperation, a number of Indians have left their homelands to
go to the cities in search of work, even without the dubious benefit of the BIA's relocation program.
Generally, these Indians were no better equipped to handle life in the city than the BIA relocatees and
quickly joined the ranks of the urban poor. Congress has noted the correlation between the failure of
Federal economic policies and the swelling of the ranks of urban Indians: "It is, in part, because of the failure
of former Federal Indian policies and programs on the reservations that thousands of Indians have sought a
better way of life in the cities. His [urban Indians] difficulty in attaining a sound physical and mental health
in the urban environment is a grim reminder of this failure."7
* Termination of Tribes. In 1953, Congress adopted a policy of terminating the Federal relationship with
Indian tribes. Essentially, this was an abrogation of the Federal government's numerous commitments, in
treaties, laws, executive orders, and through the "course of dealing" with Tribes, to protect their interests.
Many tribes were coerced to accept termination in order to receive money from settlements for claims
against the United States for misappropriation of tribal land, water or mineral rights in violation of
treaties. The results of termination were devastating: having lost Federal support, and without tribal
sovereign authority over an established land basis, and with tribal members no longer eligible for
Federal programs and IHS services, the Tribes collapsed. Some members remained in the area of their old
reservations; many went to the cities, where they, too, joined the ranks of the urban poor.
Current federal policy that claims to help Natives is designed to undermine tribal
governments
Pinel, assistant professor of Conservation and Social Sciences at Idaho State University
07 (Sandra Lee, Culture and cash: how two New Mexico pueblos combined culture and development,
Alternatives: Global, Local, Political, January 1, Page 9, 32:1, EKC).
In the 1980s, federal programs expressed Reagan administration policies (1981-1988) to decentralize
governance and reduce local and Indian dependence on federal funds. The intent was for tribal
governments to become economically self-sufficient "by creating a more favorable environment for
the development of healthy reservation economies" by the private sector. (25) The 1984 Presidential
Commission on Reservation Economies recommended that tribal and federal governments remove
obstacles to private investment and entrepreneurship on Indian reservations--the biggest obstacles
being identified as antiquated tribal government structures. (26) Federal programs supported the
formation of community-development corporations (CDCs) and other strategies that would encourage and
reduce the risk for entrepreneurship and private investment by separating business management from
tribal-government politics. (27)

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I.H.S. Affirmative
Trust Doctrine Internals Poverty

Health care specifically targeted at Native Americans is uniquely key to their cultural
integrity and self determination, and represents a fundamental shift away from
assimilation strategies
3 "The American Indian has demonstrated all too clearly, despite his recent movement to urban centers,
that he is not content to be absorbed in the mainstream of society and become another urban poverty
statistic. He has demonstrated the strength and fiber of strong cultural and social ties by maintaining
an Indian identity in many of the Nation's largest metropolitan centers. Yet. at the same time, he
aspires to the same goal of all citizens--a life of decency and self-sufficiency. The Committee believes that
the Congress has an opportunity and a responsibility to assist him in achieving this goal. It is, in part,
because of the failure of former Federal Indian policies and programs on the reservations that thousands
of Indians have sought a better way of life in the cities. His difficulty in attaining a sound physical and
mental health in the urban environment is a grim reminder of this failure."
"The Committee is committed to rectifying these errors in Federal policy relating to health care
through the provisions of title V of H.R. 2525. Building on the experience of previous Congressionallyapproved urban Indian health prospects and the new provisions of title V, urban Indians should be able to
begin exercising maximum self-determination and local control in establishing their own health
programs."

149
I.H.S. Affirmative
Trust Doctrine Internals Congressional Backsliding

Failure to fund the I.H.S. undermines the federal trust doctrine
The United States government entered into hundreds of treaties with Native American tribes from 1787 to
1871. In almost all of these treaties, Native Americans gave up land in exchange for guarantees from the
federal government for, among other things, the creation of a permanent reservation for Indian tribes and
the protection of the safety and well-being of tribal members.8 The United States Supreme Court held
that these promises created a trust relationship between the federal government and Native Americans.9
In recognition of this trust relationship, Congress enacted wide-ranging pieces of legislation intended to
benefit Native Americans.10 The federal governments statutory and trust obligations towards Native
Americans notwithstanding, the inadequacy of federal funding for Indian programs is egregious. The
U.S. Commission on Civil Rights recently concluded that federal funding has been insufficient in
addressing urgent needs across the boardin health care, education, public safety, housing and rural
development.11 Furthermore, actions by the BIA ensure that Native Americans suffer not only from
inadequate federal funding, but that extant federal funding is not equally accessible to urban Indians,
despite the fact that they now make up more than 50% of the total American Indian population. For example,
the Snyder Act of 1921 provides authorization for federal appropriations to fund social services such as
general assistance, health care, child welfare, and employment assistance to a class of eligible beneficiaries
defined as Indians throughout the United States.12 However, the BIA has generally limited the Snyder
Acts class of beneficiaries to American Indians living on or near reservations, excluding urban Indians
from these assistance programs.13 Indian health care is one specific area where federal programs
designated for Indians do not serve urban Indians. American Indian health care is in a state of financial
crisis, with urban Indians receiving a disproportionately small share of federal health care funds.
Systemic lack of funding for the I.H.S. provides Congress with an excuse to entirely jettison
the trust doctrine
Inadequate funding has plagued federal programs for Indian health care since their inception in 1832.
Despite congressional recognition of the desperate state of federal Indian health care services, Congress
remains unwilling to allocate the funds necessary to meet the extraordinary demand for services.29 However,
beneath the persistent lack of financial resources is an emerging policy trend that threatens to
structurally undermineand perhaps ultimately eliminatethe federal governments obligation to
finance American Indian health care. This Note argues that the trend towards greater tribal selfgovernance and self-determination opens the door for the federal government to retreat from its
historical trust obligation to American Indians. Furthermore, as resource allocation is increasingly left to
the discretion of individual tribes, health care services for off-reservation urban American Indians may be
worse than they are under the current system. Tribes will be forced to make the ethically and politically
difficult choice between allocating funds for Indian Country or for offreservation tribal members.

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I.H.S. Affirmative

The trust doctrine allows Indian nations to hold the federal government accountable
The scope of the trust doctrine is difficult to define. As one scholar writes, [a]sserting the existence of the
trust relationship between Indian tribes and the federal government is far easier than defining its contours.
The ambiguity of the trust relationship has its roots in its original articulation by Chief Justice Marshall.
While in Cherokee Nation, Marshall analogized the relationship of the Indian tribes to the federal
government to that of ward to his guardian, one year later, in Worcester v. Georgia, Marshall analogized
that same relationship to one of feudatory and tributary states of Europe. The first characterization
connotes a state of subjugation while the second treats tribes as sovereign entities allying themselves to a
stronger power. This second formulation casts the relationship as one of government-to-government. To the
extent that the wardship analogy still persists, it has become rehabilitated as a trustee-beneficiary
relationship.49 While the government-to-government interpretation of the trust doctrine has become
predominant since the late twentieth century, the concept of a trustee-beneficiary manifests itself in
federal court rulings where tribes, as beneficiaries, are entitled to hold their federal trustee
accountable.
Underfunding Indian social services makes the trust doctrine a sham

In this way, the precise legal contours of the trust doctrine remain unchartered and its various
interpretations inconsistent with one another, despite the central role it plays in Indian law. Three
components define the trust relationship: land, self-governance, and social services. Thus, the concept
of trust has tremendous variation. For example, in Cobell, there are literal apportionments of land from which
individual American Indians are entitled to earn royalties.53 But with social services, there is nothing so
concrete upon which to rely, and thus the federal trust obligation is ill-defined with respect to specific rights
and responsibilities. In the social service context, the governments trust responsibility has been
construed as insufficient, in and of itself, to form the basis of a claim or to constitute a legal
entitlement.55 Although the federal trust obligation is often invoked in statements to and by Congress, the
empty promises that have resulted from budgetary restrictions suggest that the trust relationship is
nothing but a sham.

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I.H.S. Affirmative

Reauthorizing the IHCIA upholds the trust doctrine and prevents the federal government
from using devolution and self-governance to cut funding for the I.H.S.
Until and unless they are able to converge as a united political voice, urban American Indians must remain a
protected interest of the IHS. Congress must not allow the current funding designated for urban Indian
health projects to be commandeered by self-governing tribes. Tribal self-governance and selfdetermination are good programs that can potentially reach levels of success that the IHS has
historically struggled to reach. However, without adequate funding they will face the same roadblock
currently impeding the IHS. The federal governments trust obligation must also be observed with
vigilance. We have seen how tribes were shortchanged on indirect costs when attempting to run their
self-governed health programs. Structural changes in the IHS, as part of the Administrations One-HHS
initiative, can potentially result in continued downsizing of the IHS and less attention overall to the
needs of Indian health. On the other hand, if the Reauthorization of the IHCIA is finally approved, the
astonishing health disparity that afflicts American Indians may begin to improve gradually.
Without federal funding Congress will renege on the trust doctrine and dissolve the I.H.S.
The slow but steady movement towards the elimination of the IHScombined with congressional
failure to allocate more resources for either form of Indian health caresignals a retreat from the federal
trust obligation towards Indian health care. Dr. Rhoades and his co-authors surmise that some tribes fear
that self-determination and self-governance will lead to the dissolution of the IHS and, with it,
dissolution of federal responsibility for Indian health care.117 In the seven years since the publication of
Dr. Rhoades article, such dissolution is visible. Although compacts with local and tribal agencies can lead
to services greater and more efficient than the IHS delivery system, it is necessary to keep a watchful eye
on the backward creeping of the federal governments fulfillment of its trust obligation. Tribes have
not yet received the funding necessary to improveand oftentimes simply maintaintheir health care
systems, and congressional funding has even failed to keep up with the rate of inflation. The Bush
administration has already moved to collapse the IHS into the greater organizational structure of the HHS in
the One-department or One-HHS initiative, which will be explored more thoroughly in Part IV of this
Note. To the extent that the IHS is reduced and heath care is administered by tribes themselves, urban
Indian heath care will suffer a tremendous blow. The interests of urban Indians will necessarily be in
conflict with on reservation Indians with respect to the allocation of dangerously scarce resources.

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Trust Doctrine Impacts Modeling/Human Rights

Native American self determination is modeled globally
Vanderbilt Law School, Legal learning institution, 2008,
(Vanderbilt University, The Free Library, Indigenous Sovereignty: a reassement in light of the UN declaration on
the rights of Indigenous People, http://www.thefreelibrary.com/Indigenous+sovereignty:
+a+reassessment+in+light+of+the+UN+Declaration...-a0189159316, 6/29/09, WPW
Prior to the 1970s in the United States, and even today in Europe, indigenous peoples were not known to
textbooks in international law as actors of any significance in the field; if anything, they were viewed as
legal units of domestic law, as one arbitral tribunal characterized the Cayuga Nation in 1926. (69) Their
numbers had decreased: in the census of 1960, only 523,591 people in the United States identified
themselves as American Indian. (70) The conquerors' policies of assimilation and termination had had
significant effect. The 1960s and 1970s, however, were characterized by a revolutionary fervor that
fueled a remarkable resurgence of the First Nations that continues today. (71) The American Indian
Movement militantly protested the treatment of indigenous peoples in the United States. (72) In 1973,
they ended up in a memorable seventy-one-day standoff with federal authorities near Wounded Knee in
South Dakota, the site of the last major battle between white soldiers and Native Americans--as one view of
history would have it--or the site of a massacre of over three hundred Sioux men, women, and children--as
another opinion would hold. (73) The American Indian Movement's international offshoot, the
International Indian Treaty Council, (74) was founded in 1974, followed by the World Council of
Indigenous Peoples, (75) allowing leaders to unite indigenous pursuits in the Western Hemisphere from
Canada to Venezuela and beyond. The Fourth World had found its voice, (76) and it soon found entrance
into the institutions of the First World--in particular, the United Nations. Internationally united, the newly
founded organizations created media attention for the plight of their members and ultimately gained a seat at
the formal table of international decision making, the United Nations. Driven by Dr. Erica-Irene Daes, the
Chairperson of the UN Working Group on Indigenous Populations, established in 1982, they found a forum
in Geneva, where every indigenous group received five minutes, and not one second more, to bring its
complaints to the attention of the world. The Working Group fielded these claims and responded in 1993 with
a Draft Declaration on the Rights of Indigenous Peoples. (77)

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Trust Doctrine Impacts Modeling/Human Rights

The US must abide by international human rights standards it's key to US leadership and
influence
Aka, professor of Political Science at Chicago State University, 06
(Philip C., Analyzing U.S. Commitment to Socioeconomic Human Rights. Akron Law Review, 39: 417, EKC)
1. Benefits to the U.S. Government The U.S. needs to embrace international human rights standards
because human rights violations occur in the U.S., as in many other countries. "When a family is
homeless, when a school provides inadequate education, when people with disabilities are denied universal
access to buildings, when a woman is beaten or raped, or when a hate crime is committed, these are human
rights violations." n54 These are instances of human rights violations that took and still take place within the
United States. n55 Second, because it incorporates an appeal to rights based solely on a person's
humanity, n56 the human rights approach embedded in embracement of international standards is
superior. Although the U.S. Constitution and international human rights instruments share a similarity
embedded in the inalienability of rights the two sets of documents embody (the quality analysts (un)wittingly
celebrate when they talk about the U.S.'s distinctive rights culture), international human rights documents
assert the inalienability better than the U.S. Constitution. n57 The scope and meaning of inalienable
rights have come under attack during periods of internal and external threats in the U.S. n58
Such risk of derogation is absent with internationally-guaranteed human rights, given that phrasing one's
work in human rights terms "takes you back to the primacy of equality and dignity[,] no matter what the
circumstance." n59 And, third, the human rights approach affords a baseline for "independent review,"
now non-existent, "of the inadequacies of the U.S." constitutional and judicial order, n60 as Part V [*427]
elaborates. The Universal Declaration was designed "as a common standard of achievement" "all peoples and all nations" require to live
in dignity. n61 A feature critical to the nature of human rights is internationality and/or universality; human rights necessarily signify
international human rights. President Franklin D. Roosevelt's speech in 1941 elaborating "four freedoms" to be enjoyed "everywhere in
the world" at the end of World War II, n62 recognized these international standards to be applied to every nation without exception. So
too, arguably, did his address to Congress in January 1944, urging "a second Bill of Rights under which a new basis of security and
prosperity can be established for all - regardless of station, race, or creed," n63 but particularly so did his administration's initiatives
leading to the formation of the United Nations, which organization institutionalized these international standards. Roosevelt's own wife,
Eleanor, deservedly widely acclaimed as the "mother of the international human-rights movement," led those initiatives. n64 President
Roosevelt's commitment to a Second Bill of Rights of socioeconomic benefits is probably responsible for the fact that all U.S. States
today, excepting Iowa, accord some degree of constitutional recognition to access to quality education. n65 After
helping found the United Nations, the U.S. government, succumbing to pressure from southern states to
maintain racism and Jim Crow segregation, withdrew its support for international human rights
standards and abandoned the U.N. human rights treaty system. The occurrence severely impeded the
struggle for black equality, n66 hurt the [*428] struggle for socioeconomic human rights, n67 and had
a negative effect on the country's leadership of the international human rights movement. n68 The end
of the Cold War afforded the U.S. a fresh opportunity for (re)dedication to human rights. The U.S.
government under President William J. Clinton seized that opportunity during the 1990s by participating in
the humanitarian interventions in Bosnia, Kosovo, and East Timor, as well as in the U.N. human rights
tribunals in The Hague, Netherlands and Arusha, Tanzania. n69
Better treatment of one group spills over to others

In addition to the U.S. government, application of international human rights also immensely benefits the U.S. human rights community.
Little wonder that activists dealing with issues relating to immigrants, prisoners, the poor, and other minorities are now increasingly
using human rights as a tool of advocacy. n86 Commenting on the strategic utility of the human rights approach, one activist stated,
"You cannot reduce rights. You either have to hold the line or increase them." n87 The human rights approach affords social justice
activists a chance "to break out of the chokehold of domestic law," n88 as well as an indispensable "another place to go." n89 With more
and more poverty advocacy groups taking the position that "scarcity is not the issue - greed is," n90 a human rights approach
gets "people to think about economic inequality differently, in terms of rights." n91 It "acts as a
counter to society's unceasing attempt to make poor people think it's their fault that they can't make
it." n92 Placing economic and social needs like a living wage, decent shelter, adequate food, and lifesustaining health care "within an international human-rights framework would allow them to be
seen ... as falling squarely within the categories of rights." n93

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Trust Doctrine Impacts US Leadership

US endorsement of Human rights is key to soft power and hegemony
[*430] Human rights are a critical source of legitimacy and soft power (power not based on display of
sheer military strength). n81 Informed assessments affirm that "the only legitimate state in the modern
world is the liberal democratic state that" along with being "properly elected," also "protects a wide
range of internationally-recognized human rights." n82 In the aftermath of the terrorist attacks of 2001,
the U.S. needs the "moral authority" that comes with obedience to internationally-recognized human
rights to preserve its hegemony. n83 As Professor Henkin reminds us, international human rights laws and
institutions became necessary because national laws and institutions are never fully effective. n84 As he
explains, The purpose of international concern with human rights is to make national rights effective under
national laws and through national institutions. The purpose of international law relating to human rights and
of international human rights institutions is to make national human rights law and institutions effective
instruments for securing and ensuring human rights. In an ideal world - if national laws and institutions
were fully effective - there would be no need for international human rights laws and institutions. n85
Since we do not live in an ideal world where national laws and institutions are fully effective, the U.S.,
like any other country, must abide by international human rights standards.

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Trust Doctrine Impacts International Law

Current US treatment of Natives violates international law and exploits them
No human rights approach is complete if it does not integrate the rights of peoples, which is not a superfluous human
rights category. Instead, as the human rights scholar Seyom Brown explains, the criticalness of these rights is underscored
by the fact that "collective or peoples' rights frequently emerge out of situations in which individuals are denied their
basic rights, not simply as individuals, but because they belong to a group that the government or the dominant cultural
group [*457] wants to suppress or weaken." n219 An individual member of an aggrieved group may not feel personally
deprived of his or her individual rights, such as equal protection of the laws, freedom of expression and association, and
so forth, but may belong to a group whose minority status in a given society does not allow the group to exercise
sufficient weight in shaping the rules and policies of that society. n220 It is probably in cognizance of this reality that
both the ICCPR and the ICESR guarantee this right. Even before setting forth the rights of individuals,
Article 1 of both documents stipulates that "all peoples have the right of self-determination. By virtue of
that right, they freely determine their political status and freely pursue their economic, social, and
cultural development." n221 As previously indicated, women and children, along with persons with
disabilities, are entities upon whom international human rights instruments confer the rights of peoples. An
important first step in the U.S. commitment to protecting and promoting the rights of peoples would be for
the U.S. Senate to ratify without delay the Convention on the Rights of Children (CRC), and the Convention
on the Elimination of All Forms of Discrimination Against Women (CEDAW). This should not be too hard to
accomplish regarding a treaty like the CRC given that, as Professor Koh points out, the U.S. government
"actually complies in most respects" with the Convention. n222 Next, the United States should move to
apply international standards to its domestic policies relating to indigenous groups within the country.
Indigenous rights evolved within the international community as an outgrowth of the new world standards
that emerged after the Second World War in the wake of the dissolution of colonial empires. n223 Two
international instruments relating to the rights of indigenous peoples are Convention No. 169 Concerning
Indigenous and Tribal Peoples in Independent Countries, adopted by the International Labor Organization
(ILO), a specialized agency of the UN, in 1989; n224 and the Draft Declaration on the Rights of Indigenous
Peoples (DDRIP). n225 Convention No. 169 generally protects indigenous lands and sets out measures to
improve the health, education, and employment [*458] of indigenous peoples. The U.S. has not
ratified the Convention. The DDRIP guarantees the rights of indigenous peoples to determine for themselves in many issueareas, including culture and language, education, health, housing, employment, land and resources, environment and development,
intellectual and cultural property, and the capacity of indigenous peoples to conduct treaties and agreements with governments. n226
Going back in U.S. history, African Americans have viewed themselves as a distinct political (sub)culture. n227 Malcolm X conceived
and advocated the concept of a Black nation within the United States. n228 Before Malcolm X, in 1951, the Civil Rights Congress filed
a petition before the United Nations, significantly titled We Charge Genocide, accusing the United States government of genocide
because of its mistreatment of African Americans. n229 A most recent (re)formulation of this concept of black nationality is by the
political scientist Robert T. Stark who, in the context of a criticism of deracialization strategies, commented that, "black politics is a
group struggle for race-specific empowerment in order to exercise some degree of independence and self-determination. If campaign
behavior is a predictor of governance style and behavior, then deracialization is an anathema to the essence of black politics." n230 A
nationality group, even more so than African Americans, considered an indigenous population within the U.S. and the focus of the rest of
the analysis on this topic, are Native Americans. The most fundamental right Native Americans seek is the right to
[*459] remain indigenous, n231 specifically "rights to their culture, language and forms of worship[,]
and to maintain control over their territories and governance of their own affairs." n232 Yet, going
back to the very formation of this country, the U.S. government has impeded and continues to impede
through removal, killing, and or forced assimilation, the right of Native Americans to determine for
themselves. n233 Violations of Indian human rights in the U.S. include taking Indian lands by the federal government without due
process or compensation in an attempt to accelerate the assimilation of tribes through the elimination of their land base, federallyapproved destruction of Indian sacred sites critical to Indian cultural life, federally-approved destruction and contamination of natural
resources that Indians depend upon for food and water, continuing judicial attacks on the right of Indian governments to manage their
own territories and peoples, n234 and systematic erasure of Indian cultural identity. n235 A judicial decision laying the foundation for
contemporary violation of Indian human rights is Tee-Hit-Ton Indians v. the United States, n236 in which the Supreme Court ruled that
the U.S. government has the authority to seize Indian lands without compensation. It was this decision - and the failure to overturn it
during the ensuing decades - that led Native Americans to seek recourse in international human rights laws and mechanisms for
resolution of their land and natural resource claims against the U.S. government. n237 Analysts have described the
relationship between the U.S. government and Native Americans, embodied in U.S. law, as "an
involuntary permanent trusteeship with no accountability. The only other parallels are childhood or
mental incapacity. But the difference is that those relations end with age or compliance. Indians can't
end their relationship." n238

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Trust Doctrine Impacts Internal Self-determination

Internal recognition of indigenous rights leads to ethnic federalism
07 (Sandra Lee, Culture and cash: how two New Mexico pueblos combined culture and development,
Alternatives: Global, Local, Political, January 1, Page 9, 32:1, EKC).
Comprising approximately 4 percent of the world's population, indigenous peoples are not only ethnic
minorities and aboriginal descendents of the original inhabitants of a territory, they are self-defined groups
that want to maintain distinct political, economic, social, and legal systems--to maintain identities within the
nation-state while also claiming rights as citizens within those states. (4) The first United Nations Decade
of Indigenous Peoples (1995-2004) and the draft declaration of indigenous rights recognized that
indigenous peoples are determined to continue their existence as groups, transmit and continue their cultures
and political and legal institutions, and preserve their territory on which identity depends. (5) In making
international claims to sovereignty, indigenous people argue for collective rights and the possibility of
ethnic federalism that would relate indigenous forms of government to the state. (6) For some tribes and
indigenous communities, a primary goal of indigenous development is self-determination and autonomy
within the framework of a wider state. (7) This goal of maintaining difference runs up against the
state interest in uniformity and control of its subjects and its resources for the larger public good. (8)
Ethiopia proves
Muigwithania, Reporter, 09
(Muigwithania 2.0, Ethnic Federalism, 2-9-09, http://kikuyunationalism.wordpress.com/2009/02/09/ethnic-federalismkenya/, 6-28-09, KS)
Federalism which may be identified as territorial based or ethnic based has come to be seen as the best
alternative to promote the management of conflict prone multi-ethnic societies. Even those who extend
sharp criticisms against this form of government admit that federalism, when properly implemented,
has more often than not proved to offer tools for the better governess of supra-national institutions and
has facilitated effective decision making in complex systems and promoted democracy. In principle,
relating federalism to multi-ethnicity and evaluating its success as a balance between unity and diversity
involves a number of factors. In particular, how the boundaries of member states are drawn up and
how powers are distributed horizontally as well as vertically. Moreover, the institutional set up should be
examined if it represents a structure of diversity or at least minority accommodation providing institutional
and political power which democratically command loyalty to the common state. How far federalism, in
particular ethnic federalism practically solves problem of multi-ethnicity is yet to be seen. However, daring
decision has already been made in 1995 in Ethiopia adopting this approach as a solution to the longstanding
ethnic problems of the country. Albeit with difficulty, the choice was made, and ethnicity was favored as the
underling factor in the process of state formation. The new model of government ,nevertheless, appeared to
be peculiar from the outset not only because it follows an ethno-linguistic line for state formation but also in
a sense that it allows the right to self-determination including secession. The inclusion of particularly the
latter has made the Ethiopian model of federalism prone to critiques. The success of the Ethiopian
model of federalism in light of the inherent problems it poses along with some of the existing
opportunities.

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Internal self-determination is key to preserving American Indian culture and history.
Lawrence, 2004
(Bill, Publisher, Ojibwe News, Freedom of Information Award, The Ojibwe News, Not much new in Indian Healthcare Report, 9-3-04,
=10553&cfc=1, accessed 7-5-09)EM
The first human rights precept to be explored is the right of self-determination. This section focuses on
contemporary understandings of this precept and, in particular, its application to indigenous peoples. As
Professor James Anaya suggests, self-determination is a foundational principle of international law that
bears particularly upon the status and rights of . . . Native . . . people . . . in light of their history and
contemporary conditions.76 Numerous scholars have written on the origins and content of the right of selfdetermination.77 National courts and human rights bodies have similarly expressed their views on the
meaning and scope of this right.78 The term itself is often linked to Wilsonian ideals of democracy and
freedom, but its historical origins extend beyond Western political thought.79 Following World War II, selfdetermination of peoples became a part of international conventional law, most notably in the U.N.
Charter.80 In the 1960s, the right of self-determination served as a springboard for the process of
decolonization and became an integral part of the international human rights movement. Under the
International Covenant on Civil and Political Rights and the International Covenant on Economic, Social and
Cultural Rights all peoples have the right to self-determination, including the right to freely determine
their political status, to freely pursue their economic, social, and cultural development, and to freely
dispose of their natural wealth and resources.81 Today, self-determination is an accepted principle of
customary international law. 82 Current debates on the principle of self-determination often focus on two
questions: who are the peoples entitled to this legal right and how far does that right extend. These issues
have been explored in earlier works on indigenous self-determination.83 For purposes of this article, neither
issue need delay us for too long. First, domestic and international bodies have defined the term peoples to
include sub-national groups that are part of a larger territorial sovereign unit.84 When one considers the
common factors that make up these sub-national groups, which include common racial, ethnic, linguistic,
religious or cultural histories, some claim to territory or land, and a shared sense of political, economic,
social and cultural goals, one sees that indigenous groups of the Americas easily meet these criteria.85
Another major controversy concerns the meaning of self-determination itself. While some have sought to
equate this term with secession and independent statehood, 86 its meaning under contemporary international
law extends well beyond this statist framework. For instance, the two major human rights covenants link selfdetermination to notions of cultural survival, non-discrimination, economic development, political freedoms,
and other basic human rights.87 This suggests, as argued by Professor Anaya, that self-determination is not
separate from other human rights norms; rather [it] is a configurative principle or framework complemented
by the more specific human rights norms that in their totality enjoin the governing institutional order.88 In the
past several decades, indigenous peoples from around the world have garnered international support for their right to live and develop as
distinct communities.89 Their efforts have brought about significant changes in both conventional and customary international law. One
example is the Convention Concerning Indigenous and Tribal Peoples in Independent Countries, which recognizes the aspiration . . . of
[indigenous] peoples to exercise control over their own institutions, ways of life, and economic development and to maintain and
develop their identities, languages and religions within the framework of the States in which they live.90 Even more far-reaching in
terms of collective rights is the United Nations Declaration on the Rights of Indigenous Peoples, which was recently adopted by the
General Assembly.91 The Declaration specifies important freedoms, conditions, and rights necessary for
indigenous peoples to be fully in control of their own destinies. Two provisions directly address the right of
self-determination: Article 3 of the Declaration mirrors the language found in the two major human rights
covenants regarding the right of self-determination, and Article 4 states that [i]ndigenous peoples, in
exercising their right to self-determination, have the right to autonomy or self-government in matters relating
to their internal and local affairs. . . . However, equally important are the remaining parts of the Declaration,
which entail the constituent parts of indigenous self-determination. For instance, the Declaration affirms the
right to non-discrimination and full participation in the life of the State. Additionally, it addresses collective
rights to live as distinct peoples, including protection against genocide and ethnocide. It also protects the cultural,
spiritual, and linguistic identities of indigenous peoples. Finally, the Declaration seeks to improve socioeconomic conditions by, among
other things, recognizing the right of indigenous peoples to control their development, lands, and resources. In its fullest sense, the right
of self-determination embodies the right of indigenous peoples to live and

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develop as culturally distinct groups, in control of their own destinies, and under conditions of equality. A similar set
of core precepts can be found in a host of other U.N. and regional documents that, according to Professor Anaya,
are now widely accepted and, to that extent, . . . indicative of customary law.92 Many of these human rights
instruments address individual human rights. Yet it is the collective nature of indigenous rights that is crucial to
indigenous communities survival as peoples.93 As one U.N. working group observed, the harsh lessons of past
history showed that recognition of individual rights alone would not suffice to uphold and guarantee the continued
dignity and distinctiveness of indigenous societies and cultures.94 Admittedly, there has been some controversy
surrounding the final adoption of the Declaration on the Rights of Indigenous Peoples, particularly due to the use of
the word self-determination and its potential connection with the right to secede.95 While these and other related
objections are addressed in more detail elsewhere,96 most are based on a fundamental misunderstanding of what
indigenous self-determination embodies under current and emerging principles of international law.97 Existing and
emerging international norms on the rights of indigenous peoples set the foundation for political relationships that
strengthen (not tear apart) political alliances, but in a manner that does not engage the historical cycle of
conquest, oppression, and domination.98 In other words, indigenous groups are not looking to dismantle nationstates, but such groups do insist on the right to control their own lands, resources, and decision-making institutions,
and to maintain their own distinct cultures. From a reparations perspective, the right of indigenous selfdetermination has a dual function, which aligns with Professor Anayas approach to distinguishing between the
principles substantive elements and its remedial prescriptions. Substantive self-determination includes the right to
participate in the creation of or change in institutions of government as well as the right to make meaningful
choices in matters touching upon all spheres of life on a continuous basis.99 The substance of the norm, however, must be
distinguished from the remedial prescriptions that may follow from a violation of the norm, such as those developed to undo colonization.100
Thus, for instance, certain actions on the part of a State, such as the removal of indigenous children for purposes of eradicating a culture or
people, can constitute a violation of the substantive aspects of self-determination, including the right to live and develop as culturally distinct
groups. However, an appropriate remedy for this and other related human rights violations might also focus on maintaining or improving various
core aspects of self-determination, such as social welfare and development, cultural integrity, and self-government.101 Specific state policies
might include provisions similar to those found in the Indian Child Welfare Act, such as the right of indigenous nations to adjudicate or be
involved in future removal cases, as well as the right to seek funds for their own culturally relevant child welfare programs. Similarly,
rehabilitative steps may be necessary to undo the intergenerational cultural and psychological harms caused by the removal policy. The relevant
provisions of the ICWA that incorporate these international precepts of indigenous self-determination are explored in Part V of this article.
American Indians have a right to internal self-determination.

Roy, 01
(Audrey, B.A., Cornell University, in the Department of Indigenous Self-determination Programs, Sovereignty and Decolonization: Realizing
Indigenous Self-Determination
at the United Nations and in Canada, 2001, http://www.tamilnation.org/selfdetermination/98roy.pdf, accessed 7-3-09)EM
There is something deeply morally unsatisfactory in asserting that indigenous peoples do not have a right to
self-determination because of the power and strength of states. Certainly scholars cannot be faulted for
presenting the reality at the United Nations. Indeed, it is the biased reality of UN doctrine that creates this
moral twitch, a feeling of thats not right that is compounded by the UNs apparent lack of concern for the
historical side of the right to self-determination. Leaving state sovereignty and territorial integrity unquestioned,
in essence letting states have their way, may prove expedient but there can be no peace without justice and too
often expediency seems to leave the search for justice behind as a uncompleted project. In order to broaden
the reach of the subject of self-determination, and attempt to right the situation, an alternative to UN
endorsed limitations on the content of self-determination must be found. Practically, a more expansive vision of
self-determination and its application will exacerbate the problems of conflicting claims, especially for peoples
sharing a territory. Any broad formulation of self-determination must thus address how competing claims of
self-determination would be mediated and balanced.

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I.H.S. Affirmative
Trust Doctrine Impacts Waste

The federal trust doctrine is also vital to prevent waste disposal in Indian Country
Hansen, Professor of Anthropology, Arizona State University, 2001
(Randall, An Experiment in (Toxic) Indian Capitalism?: The Skull Valley Goshutes, New Capitalism, and Nuclear
Waste, PoLAR: Political and Legal Anthropology Review, Volume 24 Issue 2,
http://www3.interscience.wiley.com/journal/120706827/abstract, p. )
These toxic offers come at a time of crossroads for many Indian nations: on the one hand, tribes have
experienced an expansion of the political sovereignty over tribal lands in an era of self-determination (since
the early 1960s), yet on the other hand this political sovereignty has not meant economic viability. Indeed,
creating self-sustaining reservation economies remains a very difficult goal given the long history of
"underdevelopment" characteristic of Indian lands.15 Beginning with Reagan's election and continuing in
somewhat different forms subsequently, this difficult economic situation has grown worse for many
Indian nations. The Reagan Administration framed the Federal Trust Responsibility toward American
Indians as either a form of socialism or social welfare or both. In place of Federal obligations as spelled
out in treaties, Reagan, following the emergent neo-liberal economic logics that were gaining ascendancy
across the globe during this period (Overbeek 1993), posited the "market" as the conceptual framework
for the political and economic liberation of Indian nations. Applied to Indian Country, Reagan's "New
Federalism" thus translated into slashing Trust monies and increasingly forcing Indian nations to seek
marketization opportunities for their economic viability, such as leasing reservation lands to extractive
industries, forestry companies, and non-Indian ranchers and farmers. A few years after the implementation
of Reagan's Indian policy, "the amount of tribal lands used by Indians for agricultural purposes has actually
decreased, while non-Indian use of tribal lands has increased" (Morris 1988: 735). As I have explored
elsewhere in some detail, the initial marketing of nuclear waste to American Indians as a means of
economic development began to take concrete form in the latter 1980s with the creation of the U.S.
Department of Energy's quasi-independent "U.S. Office of the Nuclear Waste Negotiator" (Hanson 2001).
David Leroy, a professional "motivational" speaker and writer, and former Republican lieutenant governor
and attorney general of Idaho, was appointed by then-President Bush as the first U.S. Nuclear Waste
Negotiator. Leroy crafted a toxic multiculturalism in his three-phase marketing plan, tailoring his pitch with
references to American Indian figures and bits of oral traditions (ibid.), all in the service of reframing nuclear
waste as one more economic good rather than the supreme environmental "bad" as it has been historically
understood.

161
I.H.S. Affirmative
Trust Doctrine Impacts Water Rights

A. American Indian tribes depend on the trust doctrine to protect their water rights
from the states
Liu, Judicial Law Clerk, 95
(Sylvia F., U.S District Court, American Indian Reserved Water Rights: The Federal Obligations to Protect
Tribal Water Resources and Tribal Autonomy, Spring 1995,
http://www.lexisnexis.com/us/lnacademic/search/journalssubmitForm.do, Accessed 7/5/09, CAF)
In the arid American West, the control of scarce water resources has been a long-standing source of conflict
among water users. n1 While most private users appropriate water under state law, American Indian
tribes derive their water rights from federal laws. The rights are determined using the federal reserved
rights doctrine, which the Supreme Court first [*427] enunciated in the 1908 case of Winters v. United
States. n3 The incompatibility of these two legal systems has created enormous conflicts between tribal
water users and state law appropriators.
This paper discusses the development of the Winters doctrine and argues that when properly interpreted, this
doctrine directs the federal government to develop and protect American Indian water rights. Part II
sets forth the basic contours of the Winters right and some of the current debates between tribal users and
state law appropriators. Part III explores normative arguments that favor federal protection of Indian reserved
water rights. These arguments rely on concepts of historical redress, distributive equity, and the values of
maintaining community identity and tribal sovereignty. Part IV discusses the implications of these
arguments for the federal role in the protection of Indian water rights and for the current doctrine of Indian
reserved water rights. This part also describes the trust relationship between the federal government and the
Indian tribes and argues that the federal government has a duty to support a broad interpretation of
Indian reserved water rights. Once tribes receive their water rights, however, tribal sovereignty
requires that tribes retain full control over the subsequent uses of their water. Part V concludes that
proper recognition of American Indian water rights depends upon federal protection of these rights as
well as federal recognition of tribal sovereignty.
B. Insert Water Rights impacts

162
I.H.S. Affirmative
Trust Doctrine Impacts Assimilation Bad

Loss of trust status would crush tribal economies
Johansen, Professor of Native American Studies, University of Nebraska, 2000
(Bruce E., The New Terminators: A Guide to the Anti-Sovereignty Movement,
http://www.ratical.org/ratville/NewTerminators.html)
Loss of trust status would, according to the National Congress of American Indians, "eliminate tribal
authority regarding taxation and make the property subject to all applicable state and local sales
taxes." The bill proposed that trust status be restored if tax payments are made. According to NCAI, "Not
since the Allotment Era of 1877 to 1934 has Congress passed legislation designed to take tribal land out
of trust status. After stealing more than 90 million acres of tribal lands ... less than 8 percent [has] been
recovered." (Legislative Update) Reservation businesses face a stiff test on this issue from the National
Governors' Association, as well as from off-reservation business interests. Addressing hearings on the
proposal before the House Committee on Resources during October 1999, NGA executive director Ray
Scheppach asserted that "The failure of retail establishments on Indian trust lands to collect sales taxes
and excise taxes on tobacco and gasoline places merchants who comply with the law at unfair price
disadvantages. On products like gasoline and tobacco, the tax is a very large percentage of the cost of the
good." (Testimony). Michael Holahan, chief executive officer of the North American Truck Stop Network
and member of NATSO, a national association of truck-stop owners, told the same hearing that the problem
of tax-free sales on tribal lands is growing, threatening tax-collecting businesses and state governments
across the country. "Native American business owners who aren't collecting state taxes from non-tribal
members can gain a significant advantage selling two principal products -- fuel and cigarettes," he said.
(Holahan)

163
I.H.S. Affirmative
Trust Doctrine Impacts Assimilation Bad

Assimilate causes mass spiritual and cultural genocide
Davidson, American Indian, 2008
(T. GhostWolf, Nemasys, Spiritual and Cultural Genocide, 5-25-08,
http://www.nemasys.com/ghostwolf/Native/genocide.shtml, 6-28-09, MEL)
And; nothing has been done, nothing is being done... The languages, myths, art, spirituality, practices,
and beauty of the Native American culture is fading into history to be lost forever; to be mused over in
later years by the historically curious as a novelty... Spiritual and cultural genocide... as the Native
Americans are faced with either being totally assimilated by the Western Culture - or dying out on the
many reservations... kept there, out of the way and out of mind, by supposedly beneficent governments;
ignored and forgotten by the citizens of those nations... Spiritual and cultural genocide, as the elders and
parents helplessly watch their children leave to make a living in the "civilized" world, as those children and
young adults willfully turn their backs on their heritage, language, and culture and willfully accept the
stereotypical views of "civilization." Spiritual and cultural genocide, as the great civilized masses of North
America - and indeed the world - scurry pell-mell into the next century, focusing on technology and
consumer goods... as "save the whales" and "save the children" and "save the earth" become the battle-cries
of the various subcultures... not that those are bad things; they aren't, and they are needed. But - the
American Indian Cultures from southern-most tip of South America to the northenmost tip of Canada and
Alaska are left behind, an afterthought, a mote of dust caught up in the tornado of "progress"...
Relegated to symbolic and denegrating mascots for sports teams, insulting icons for various holidays, and
stereotypical villains for the movie industry; shoved off - out of site and out of mind - to die out on
reservations. Spiritual and cultural genocide by default and by intent, by marketing and media
pressures, by willful and knowing ignorance... It is so easy to turn aside while saying "not my
problem"...

164
I.H.S. Affirmative
A2: SQ model solves

The international community, led by the United States, ignores self determination crises
in the status quo, leading to violence
Bose, professor of international and comparative politics at the London School of
Economics and Political Science, 08
(Sumantra, Kosovo to Kashmir: the Self-Determination Dilemma, May 22,
http://www.opendemocracy.net/article/kosovo-to-kashmir-autonomy-secession-and-democracy. EKC)
The debate over Kosovo has highlighted deep divisions in the international system on the issue of selfdetermination of peoples. Solutions to self-determination disputes lie in compromises that embody a mix
of realpolitik and principle, says Sumantra Bose.Consider this sequence of events. The central government
of a country removes the political leadership of an autonomous province of the country in a purge-like
act. It then sets about revoking the self-rule powers of the province, which has a different ethno-religious
majority from the population of the country as a whole. Public protests in the province are met with heavyhanded police tactics. A repressive regime is instituted in the province, with both democratic institutions and
the civil rights of citizens effectively suspended. Sumantra Bose is professor of international and comparative
politics at the London School of Economics and Political Science (LSE). His books include Bosnia after
Dayton: Nationalist Partition and International Intervention (Oxford University Press, 2002), Kashmir: Roots
of Conflict, Paths to Peace (Harvard University Press, 2003) and Contested Lands: Israel-Palestine, Kashmir,
Bosnia, Cyprus, and Sri Lanka (Harvard University Press, 2007) Eventually, political radicalisation sets in
and some among the misruled province's younger generation pick up the gun to fight for "liberation". The
nascent insurgency draws a fierce response from the state's military and police organs. The security forces
crack down hard, and in so doing victimise the civilian population. Massacres of civilians and other
serious abuses occur. The militants are not stamped out; instead, their struggle evokes large-scale
popular support. A major crisis has developed.
This may read like a potted history of Kosovo between 1989 and 1999. It is, however, a potted history of
Indian policy towards Kashmir, and its consequences, between 1953 and 1990. So do the United States and
its allies in Europe support self-determination for Kashmir, and threaten multilateral intervention to that end?
Of course not. The oft-stated American position on Kashmir is that India and Pakistan should negotiate a
bilateral solution to the Kashmir dispute while taking into account the wishes of "the Kashmiri people" (a
description that itself grossly over-simplifies the society and politics of Kashmir, which contains a diversity
of regions, religions, ethnicities and languages, and whose citizens are split into pro-independence, proPakistan and pro-India segments).
Nonetheless, the caution and circumspection that define the stance of the United States and major
European Union countries towards the Kashmir dispute are typical of the attitude of the
"international community" and its dominant players towards claims to self-determination. The record of
the international order since 1945 is that self-determination movements tend to receive a sceptical hearing
at best, and no hearing at all in many cases. The vague and somewhat outdated principles of
international law relevant to the issue of secession are broadly supportive of the territorial integrity of
states, and recognise the legitimacy of self-determination only in situations of colonialism. Between
1945 and 1990 the only fully realised case of national self-determination outside the decolonisation
framework was Bangladesh in the early 1970s, facilitated by an Indian military intervention that resulted in
the total defeat of Pakistani forces in the former East Pakistan. During those decades, dozens of other selfdetermination movements struggled in vain.
This status-quo proclivity of the international system is not surprising. The most influential member-states of
the international system have an obvious interest in not rocking the boat, and this is reflected in the behaviour
of international institutions. The international system is apprehensive of encouraging, or seeming to
encourage, instability and fractiousness. It is alive to the sensitivities and clout of major states, such as
India or China, that contain groups seeking self-determination. It is acutely conscious of the risk of
regional destabilisation - the blocked independence aspirations of the Kurds of northern Iraq are a case in
point. And it is reluctant to admit new members to the club of sovereign states except in instances of a fait
accompli on the ground - such as Bangladesh, Eritrea in the early 1990s, the break-up of the Soviet Union, or
the "velvet divorce" of the Czechs and Slovaks.

165
I.H.S. Affirmative
A2: SQ model solves

The US has set a precedent for ethnic external self-determination, and this trend will
continue if nothing changes. Kosovo proves
Bose, professor of international and comparative politics at the London School of
Economics and Political Science, 08
(Sumantra, Kosovo to Kashmir: the Self-Determination Dilemma, May 22,
http://www.opendemocracy.net/article/kosovo-to-kashmir-autonomy-secession-and-democracy. EKC)
The recognition of Kosovo as sovereign by some of the wealthiest and most prominent states in the
international system, including its sole superpower, is (as was the recognition of Slovenia and Croatia in
early 1992) a validation of an ethno-nationalist claim to self-determination based on the will of the
majority ethnos. Two crucial factors here are the overwhelming extent of this majority (it is doubtful that
the Ahtisaari proposal could have been floated if Albanians were a 67% majority of Kosovo's people, as they
were in 1961 according to the Yugoslav census of that year, rather than the 90% majority of today); and the
unanimous and adamant insistence of that huge majority on the maximal version of self-determination.
President Bush's praise of the Kosovo Albanian leadership's "embrace of multi-ethnicity as a principle of
good governance" in his letter to Kosovo's president endorsing the declaration of independence, puts no more
than a poor gloss on this reality. Multi-ethnicity as a principle of governance was extinguished across the
region of the former Yugoslavia more than fifteen years ago.
In this respect, the European commission's statement after the disturbances in the Serb-dominated part of the
northern Kosovo town of Mitrovica on 17 March 2008, a month after the declaration - "Violence is
unacceptable. All parties should work together to build a multi-ethnic Kosovo based on the rule of law and
respect for democracy" - can be read as an expression either of naivete or evasion. Condemning the Serbs of
northern Kosovo who attacked border-posts between Kosovo and Serbia manned by international personnel,
or protested in Mitrovica, for trying to force the "partition" of Kosovo betrays a one-sided perspective. These
Kosovo Serbs are agitated over what they regard as the partition of their state and national homeland,
Serbia, with the complicity, as they see it, of powerful Euro-Atlantic states.
Contested sovereignty
Sovereignty has two aspects: the juridical (which depends on international recognition) and the empirical
(which depends on the capacity of the state's authorities to control and administer its territory). Both aspects
are political battlegrounds in the Kosovo controversy. The world is divided on the juridical issue, and there is
a minority group of dissenters even among the EU states. Belgrade's rejection of the 17 February 2008
declaration in Pristina is a crucial factor reinforcing the divide.
Within the last decade, East Timor's internationally supervised independence (1999-2002) was made possible
by Indonesia's acquiescence to that process. Three decades ago, Pakistan's recognition of Bangladesh's
sovereignty - given in February 1974, just two years after the end of armed hostilities, once Pakistan received
guarantees about the repatriation of its 90,000 prisoners of war from the December 1971 conflict - paved the
way to Bangladesh's membership of the United Nations in September 1974. As long as Serbia continues to
declare Kosovo a renegade province, on the lines of China's position vis--vis Taiwan, the juridical issue
cannot be settled.
The juridical dispute is, of course, closely intertwined with the empirical dimension - the existence of the
Serb-populated area in northern Kosovo, and the enclaves dotted across the rest of Kosovo in which twothirds of Kosovo's Serbs reside. It is possible that this tangled skein of conflicts can be constructively
addressed only through renewed regional and international diplomacy.
The case for compromise
The global controversy over Kosovo has aroused much excitement among aspirants to selfdetermination worldwide, and, concurrently, considerable alarm in capitals where such state-seeking
movements are a long-term headache, from Ottawa and Madrid to Delhi and Beijing (see Fred Halliday,
"Tibet, Palestine, and the politics of failure", 9 May 2008). But both the excitement and the alarm are
unwarranted.

166
I.H.S. Affirmative
Modeling Internal Links

Internal self-governance enables American Indians to participate in international struggles
for indigenous rights the US is a key test case for self-determination
Barsh, 1993
(Russel Lawrence, The Challenge Of Indigenous Self-Determination, 26 U. MICH. J.L. REFORM 277, 311)
American Indian tribal leaders could play a pivotal international role as the voice of conscience,
reason, and generosity within the United States itself, not only with respect to the fate of other
indigenous peoples, but the fate of the planet, too. Instead, they continue to be preoccupied with
domestic issues, competing with one another for larger shares of federal program dollars and-bigger
bingo halls. Global consciousness, which was central to aboriginal religion and philosophy, has collapsed
into competitive capitalism.
II. DECOLONIZATION WITHOUT COMMITMENT
Apart from their potential role as American citizens and voters in restraining the immature political excesses
of non-Indian Americans abroad, do American Indians have a substantive contribution to make to the
liberation and development of other indigenous peoples? Answering this question leads unavoidably to
another. Have American Indians any special wisdom or successful experience to share in rebuilding other
indigenous societies racked by racism and colonialism? The answer to that question depends on whether
American Indians genuinely have succeeded in liberating or decolonizing themselves. Anticolonial
struggles are preoccupied with wresting power from the colonizer. Little serious thought is given to the
problem of what to do with power once it is obtained. A vacuum lies at the end of nearly every revolution
which quickly fills with borrowed slogans and ideas. There is some truth in Ambrose Bierce's observation,
nearly a century ago, that revolution is "an abrupt change in the form of misgovernment."51 Indigenous
peoples everywhere like to believe that the critical difference, in their case, is culture. Traditional cultures,
which are diametrically opposed to the competitive individualism and insatiable appetite of
industrialized societies, supposedly will insulate leaders from the corrupting influences of power and the
"demonstration effect" of Western prosperity. But Africa's leaders made the same arguments a generation ago
when they launched the idea of "African socialism," the beautiful dream behind which a number of
oppressive dictatorships have safely lurked. Will the world's indigenous peoples escape Bierce's futile
loop? The United States is a critical test case. American Indian tribes are wealthier and have enjoyed
greater powers of internal self-government far longer than indigenous peoples anywhere else. The
rhetoric of sovereignty, antimaterialism, and traditionalism is stronger here than anywhere else. But is this
rhetoric meaningful, or is it merely rhetoric? To what extent have American Indian tribal governments
achieved the ideals of community responsibility and ecological stewardship so often expressed in public
debates? Are they truly decolonized at all? The answers to these questions explain American Indian
tribes' marked isolationism in world affairs, and pose a serious challenge for future generations of
indigenous leaders in all countries.

167
I.H.S. Affirmative
Modeling Internal Links

US treatment of indigenous people is modeled internationally
Sills and Morris, PhD International Relations/professor of political science at the
University of Colorado at Denver, 1996
(Marc and Glenn, Spring/Summer, US Model of Indigenous Rights Subverts Inter-sessional Working Group,
Fourth World Bulletin, University of Colorado at Denver. EKC)
Because of its role as the one surviving super-power at the end of the Cold War, with the financial
leverage to determine the future of the United Nations, the US has inordinate control over the way the
Draft Declaration is being worded and what exactly the document will imply as policy. The United
States intends that its own model for treatment of indigenous peoples should be emulated by other
states, and therefore that the Draft Declaration should reflect the order of US Indian Law. The agenda
is not merely to define a simple moral order; more important, the US is attempting to create a broader,
more encompassing hegemony that minimizes the possibility that indigenous peoples might actually be
protagonists of their own destinies.The rationale behind US policy is quite apparently that, as the biggest
stakeholder in the world economic system, it believes it has the right to limit the number of nations
that can achieve independent statehood. Each new state that comes into the system taxes the managerial
resources of the system, because each one expects to increase its political and economic power. Each new
state demands the perquisites that correspond to becoming truly independent, to be treated as a legitimate
"people" in control of its own destiny, thus demonstrating to non-state actors like indigenous peoples that
self-determination might also be within their reach. Each new state must be kept at least marginally satisfied
in economic rewards, in order to be kept from returning to the socialist competition that has been abandoned
for the past five years. And all states in the private club that is the United Nations expect that the
"unruly mob" of hundreds of indigenous peoples that also aspire to control their own destinies will be
kept at bay with a general policy designed to mollify them.
US indigenous policies are modeled

Suagee, JD University of North Carolina, 1992
(Dean, Self-Determination for Indigenous Peoples at the. Dawn of the Solar Age, 25 U. Mich. J.L. Reform 671)
Those who would defend the human rights of indigenous peoples can draw many lessons from the long
history of the relations between the United States and the indigenous tribes and nations of North America.
Although the autonomy possessed by Indian tribes in the United States is less than ideal, tribes do exercise a
broad range of governmental powers, and the simple fact that more than 500 federally recognized tribes
continue to exist in the United States' suggests that positive as well as negative lessons may be drawn. Two of
the most important lessons are: (1) forced assimilation does not work and (2) local autonomy and selfgovernment can work. In my view, these two lessons are fundamental for the survival of indigenous peoples
throughout the world." The next part of this Article examines tribal autonomy in the United States in some
detail, with an emphasis on tribal authority for protection of the environment and the preservation of tribal
cultures.

168
I.H.S. Affirmative

169
I.H.S. Affirmative
Secessionist Conflicts Coming

Emerging ethnic nationalism makes secessionist conflicts likely in the future
Muller, Professor of History, Catholic University, 2008
(Jerry Z. Us and Them: The Enduring Power of Ethnic Nationalism
http://www.foreignaffairs.com/articles/63217/jerry-z-muller/us-and-them)
SINCE ETHNONATIONALISM is a direct consequence of key elements of modernization, it is likely to
gain ground in societies undergoing such a process. It is hardly surprising, therefore, that it remains among
the most vital--and most disruptive--forces in many parts of the contemporary world. More or less
subtle forms of ethnonationalism, for example, are ubiquitous in immigration policy around the globe.
Many countries--including Armenia, Bulgaria, Croatia, Finland, Germany, Hungary, Ireland, Israel, Serbia,
and Turkey--provide automatic or rapid citizenship to the members of diasporas of their own dominant ethnic
group, if desired. Chinese immigration law gives priority and benefits to overseas Chinese. Portugal and
Spain have immigration policies that favor applicants from their former colonies in the New World. Still
other states, such as Japan and Slovakia, provide official forms of identification to members of the dominant
national ethnic group who are noncitizens that permit them to live and work in the country. Americans,
accustomed by the U.S. government's official practices to regard differential treatment on the basis of
ethnicity to be a violation of universalist norms, often consider such policies exceptional, if not abhorrent.
Yet in a global context, it is the insistence on universalist criteria that seems provincial. Increasing
communal consciousness and shifting ethnic balances are bound to have a variety of consequences,
both within and between states, in the years to come. As economic globalization brings more states into
the global economy, for example, the first fruits of that process will often fall to those ethnic groups best
positioned by history or culture to take advantage of the new opportunities for enrichment, deepening social
cleavages rather than filling them in. Wealthier and higher-achieving regions might try to separate themselves
from poorer and lower-achieving ones, and distinctive homogeneous areas might try to acquire sovereignty-courses of action that might provoke violent responses from defenders of the status quo. Of course, there are
multiethnic societies in which ethnic consciousness remains weak, and even a more strongly developed sense
of ethnicity may lead to political claims short of sovereignty. Sometimes, demands for ethnic autonomy or
self-determination can be met within an existing state. The claims of the Catalans in Spain, the Flemish in
Belgium, and the Scots in the United Kingdom have been met in this manner, at least for now. But such
arrangements remain precarious and are subject to recurrent renegotiation. In the developing world,
accordingly, where states are more recent creations and where the borders often cut across ethnic boundaries,
there is likely to be further ethnic disaggregation and communal conflict. And as scholars such as Chaim
Kaufmann have noted, once ethnic antagonism has crossed a certain threshold of violence, maintaining
the rival groups within a single polity becomes far more difficult. This unfortunate reality creates
dilemmas for advocates of humanitarian intervention in such conflicts, because making and keeping
peace between groups that have come to hate and fear one another is likely to require costly ongoing
military missions rather than relatively cheap temporary ones. When communal violence escalates to
ethnic cleansing, moreover, the return of large numbers of refugees to their place of origin after a ceasefire has been reached is often impractical and even undesirable, for it merely sets the stage for a further
round of conflict down the road. Partition may thus be the most humane lasting solution to such intense
communal conflicts. It inevitably creates new flows of refugees, but at least it deals with the problem at issue.
The challenge for the international community in such cases is to separate communities in the most humane
manner possible: by aiding in transport, assuring citizenship rights in the new homeland, and providing
financial aid for resettlement and economic absorption. The bill for all of this will be huge, but it will rarely
be greater than the material costs of interjecting and maintaining a foreign military presence large enough to
pacify the rival ethnic combatants or the moral cost of doing nothing. Contemporary social scientists who
write about nationalism tend to stress the contingent elements of group identity--the extent to which national
consciousness is culturally and politically manufactured by ideologists and politicians. They regularly invoke
Benedict Anderson's concept of "imagined communities," as if demonstrating that nationalism is constructed
will rob the concept of its power. It is true, of course, that ethnonational identity is never as natural or
ineluctable as nationalists claim. Yet it would be a mistake to think that because nationalism is partly
constructed it is therefore fragile or infinitely malleable. Ethnonationalism was not a chance detour in
European history: it corresponds to some enduring propensities of the human spirit that are heightened by the
process of modern state creation, it is a crucial source of both solidarity and enmity, and in one form or
another, it will remain for many generations to come. One can only profit from facing it directly.

170
I.H.S. Affirmative
Secessionist Conflicts Coming

Without accommodation, emergent separatism will fracture nation-states
Muller, Professor of History, Catholic University, 2008
(Jerry, Separatism's Final Country, Foreign Affairs, Jul/Aug2008, Vol. 87 Issue 4, p. 150)
I leave aside the purely legal and philosophical issues, since the "right" to self-determination, like so many
others, often conflicts with other purported rights. Representatives of existing states are strongly disposed
against the redrawing of borders and the formation of new states. They see self-interest in maintaining
the international status quo, which may or may not be justified by prudence. To recognize that national selfdetermination does provide satisfactions of its own and may well result in viable states is not to say that the
endless creation of new states is either viable or desirable. Yet there are dangers both in supporting
ethnonationalist claims and in denying them prematurely. One danger of the international recognition of
insurgent ethnonationalist claims to sovereignty is that it may lead to unilateral secession (as in the recent
case of Kosovo) as opposed to mutually agreed separation. Secession without ethnic partition usually means
that the new political entity will include a substantial minority of people whose co-ethnics dominate the state
from which the new state has seceded. This provides a ready source for new ethnic tensions within the new
state and international tensions between the new state and the old. Mutually agreed partition that separates
the rival ethnic groups may be preferable in order to minimize the likelihood of future conflict. Another
danger of a greater international willingness to recognize ethnonationalist movements is that it may create an
incentive for the governments of existing countries to violently crush incipient ethnic political movements
before they can organize.There are perils, however, in a blanket refusal of the international community
to recognize the claims of legitimate ethnonationalist movements. For having deemed secession an
impossibility, governments may feel no incentive to respond to the desire of ethnic groups for greater
power and self-determination within the confines of the current states. To recognize the enduring
power of ethnic nationalism is not to support it or provide a ready recipe for action but to offer a more
realistic appreciation of the dilemmas that will continue to arise in the twenty-first century.

171
I.H.S. Affirmative
Self-determination Impacts Everything

Self determination bad leads to global instability, proliferation, AIDS, terrorism,
environmental destruction, global war, and population explosion
Gottlieb, director of a pre-diplomatic Middle East Peace Project conducted by Stanford
University, 93
(Gidon, Council on Foreign Relations, Nation Against State: A New Approach to Ethnic Conflicts and the Decline of
Sovereignty, 1993, http://books.google.com/books?
id=hBw49OofkEkC&printsec=frontcover&dq=NATION+AGAINST+STATE:+A+NEW+approach+to+ethnic, 710-09, WPW)
Self-determination unleashed and unchecked by balancing principles constitutes a menace to the society
of states. There is simply no way in which all the hundreds of peoples who aspire to sovereign
independence can be granted a state of their own without loosening fearful anarchy and disorder on a
planetary scale. The proliferation of territorial entities poses exponentially greater problems for the
control of weapons of mass destruction and multiplies situations in which external intervention could
threaten the peace. It increases problems for the management of all global issues, including terrorism,
AIDS, the environment, and population growth. It creates conditions in which domestic strife in
remote territories can drag powerful neighbors into local hostilities, creating ever widening circles of
conflict. Events in the aftermath of the breakup of the Soviet Union drove this point home. Like Russian
dolls, ever smaller ethnic groups dwelling in larger units emerged to secede and to demand independence.
Georgia, for example, has to contend with the claims of South Osse- tians and Abkhazians for independence,
just as the Russian Federation is confronted with the separatism of Tartaristan. An international system made
up of several hundred independent territorial states cannot be the basis for global security and prosperity.

172
I.H.S. Affirmative
Self-determination Impacts Environment

Indigenous self-determination facilitates soft alternative energy development preventing global
environmental collapse
Suagee, JD University of North Carolina, 1992
(Dean, Self-Determination for Indigenous Peoples at the. Dawn of the Solar Age, 25 U. Mich. J.L. Reform 671)
The global environmental crisis is real-unless we make some fundamental changes in the ways that our
global economy extracts resources from the earth and gives off pollution and wastes, the natural systems that
support human societies will collapse. Even if we do succeed in expeditiously making the fundamental
changes that are necessary, there still is no guarantee that we can avoid the widespread collapse of ecosys
tems.7 In his bestselling book on the global environmental crisis, Senator Albert Gore includes some
indigenous peoples among examples of "resistance fighters" who are on "the front lines of the war against
nature now raging throughout the world,"' Senator Gore argues that the global environmental crisis is "rooted
in the dysfunctional pattern of our civilization's relationship to the natural world," in which people have lost
their sense of connection to the natural world. He believes that healing the damage we have done to the earth
and changing our dysfunctional civilization into one that is based on stewardship rather than exploitation
must be, in essence, spiritual endeavors.1" Indigenous peoples, where their cultures remain substantially
intact, have not lost their spiritual connections to the natural world. Rather, they maintain connections to the
earth which are fundamentally sacred in nature, and they know a great deal about stewardship that could be
of benefit to the rest of humankind." Over the next several decades, sustainable energy technologies will
figure prominently in a worldwide social movementthe "sustainability revolution"--that will change human
life on earth as profoundly as did the agricultural revolution of eight thousand years ago or the industrial
revolution of two hundred years ago.' The natural world will be changed profoundly in any event, through
global warming, the loss of biodiversity, the thinning of the ozone layer, and other global trends that are
already underway. If humankind is to accomplish the sustainability revolution, we need to be able to envision
a future world in which we would like to live and which we would wish for future generations."3 Our
collective vision of a sustainable future also must include room for the remaining indigenous peoples of the
world to carry on their ancient cultures and to decide for themselves how much of the "modern" world to
allow into their cultures. In addition to challenging readers to help make the principle of self-determination a
reality for indigenous peoples, this Article challenges indigenous leaders, especially those in the United
States, to help formulate our collective vision of a sustainable future and to provide leadership in making that
vision a reality.14 The United Nations has designated 1993 the International Year for the World's Indigenous
Peoples,' and this event will provide tribal leaders with opportunities to have their voices heard. Tribal
leaders in the United States should take full advantage of these opportunities and step to the forefront of the
movement to hasten the dawning of the solar age.

173
I.H.S. Affirmative
Self-determination Impacts Secession/Violence

The denial of self determination causes secession and violence.
Casetllino, Gilbert, 2003
(Joshua, Jeremie, Macquire Law Journal, Self-Determination, Indigenous People, and Minorities, 2003,
http://www.austlii.edu.au/au/journals/MqLJ/2003/8.html, AD: 7/10/09, MEL)
However, this categorical denial of self-determination to minorities is not as clear-cut as it might seem. Though international instruments
suggest that minorities do not have a right to self-determination, it is important to remember that self-determination as a
concept is based on the ideal of protecting oppressed peoples living under external oppression. In this
sense, one of the arguments for a right to self-determination for minorities is based on the 1970 Declaration as examined above.
[57] Passed within the decolonisation process, the declaration invites states to respect the principle of equal rights and
self-determination of peoples. Though it reaffirms the fundamental importance of states territorial integrity, the Declaration
strongly insists on the duty of states to respect self-determination drawing a line linking equality and self-determination. As Wright
highlighted, the Declaration seems to imply that if a government is not properly representative of all the constituent ethnic groups within
its society, self-determination might be the tool to redress the imbalance between majorities and minorities.[58] Thus, self-
determination could be viewed as a remedy for minorities or the last recourse to rebellion against
tyranny. This view is reaffirmed by the Vienna Declaration of 1993:
[The right to self-determination] shall not be constructed as authorising or encouraging any action
which could dismember or impair, totally or in part, the territorial integrity or political unity of
sovereign and independent States conducting themselves in compliance with the principle of equal
rights and self-determination of peoples and thus possessed of a Government representing the whole
people belonging to the territory without distinction of any kind.[59]
This paragraph suggests that people living under a regime that is not respecting equality and nondiscrimination might, as a last resort, have a right to break away, thus creating some room for oppressed
minorities to make some claim towards people-hood. This indicates that the distinction between a minority and an
oppressed people is not always clear. The distinction is blurred further when externally imposed boundaries are factored in. The
distinction between peoples and minorities were not considered when boundaries were first drawn in foreign offices in Paris or
London under colonial foreign policies. Several minorities within post-colonial states are in minority situations within the existing
boundaries of their post-colonial countries as a pure result of colonial boundaries drawn for administrative reasons, having been
transformed into international boundaries. As a result, they still claim to be under external oppression.
The Working Group on Minorities has recognised this difficulty in the context of more recent ethnic conflict in the former Yugoslavia.
As Jos Bengoa, one of the members of the Working Group, put it:
In recent years the line of demarcation between groups which have declared themselves national and other
groups, referred to as ethnic groups, which are not entitled to self-determination has become blurred to
such an extent that it is difficult to distinguish between the two.[60]
There is no definitive answer to the question as to whether minorities are peoples entitled to self-determination in the face of
oppression by their governments.[61] The only expectation is that self-determination both as a principle, and as a
right, must allow for a right to be governed without discrimination. To what extent such a principle might entitle
minorities to become a people if the state government is discriminating against them remains ambiguous. One of the chief reasons for
the narrow interpretation of the right of minorities to external self-determination is the fact that it is states that consent to international
human rights treaties; the very states that could potentially be vulnerable to claims for self-determination made by minorities.[62]
One argument that could be put forward in light of the increased importance of the human rights agenda is
that if minorities remain victims of serious injustice, and if there is no other remedy available, they
might be entitled to secede. This is referred to in theory as the remedial right to self-determination, and has never been
practically enforced, though the situation that resulted in the creation of the state of East Timor through a UN sponsored plebiscite
arguably comes closest to articulating such a notion

174
I.H.S. Affirmative
Self Determination Impacts Democracy

Internal self-determination is key to democracy
Morris, graduate cum laude of Suffolk University Law School and staff attorney with the
Immigration Unit at Greater Boston Legal Service in 97
(Halim, Intl & Comp, Self-Determination: An Affirmative Right or Mere Rhetoric? <
http://www.tamilnation.org/selfdetermination/97moris.htm#_ftnref53>, MAG)
The practice of assuming that where one finds internal self-determination one will certainly find a
representative government stems from various international treaties. For example, article 25 of the
International Covenant on Civil and Political Rights provides that: [e]very citizen shall have the right
and the opportunity, without any of the distinctions mentioned in Article 2, and without unreasonable
restrictions: a) To take part in the conduct of public affairs, directly or through freely chosen
representatives; b) To vote and to be elected at genuine periodic elections which shall be by universal
and equal suffrage and shall be by secret ballot, guaranteeing the free expression of the will of the
electors; c) To have access, on general terms of equality, to public service in his country.
Democracies dont starve

Sen, Nobel Prize winner, Master of Trinity College, Cambridge and Lamont University Professor Emeritus at
Harvard University, 2001,
(Amartya , The Global Divergence of Democracies, p. 7-8, MAG)
I have discussed elsewhere the remarkable fact that, in the terrible history of famines in the world, no
substantial famine has ever occurred in any independent and democratic country with a relatively free
press. We cannot find exceptions to this rule, no matter where we look: the recent famines of Ethiopia,
Somalia, or other dictatorial regimes; famines in the Soviet Union in the 1930s; Chinas 195861 famine
with the failure of the Great Leap Forward; or earlier still, the famines in Ireland or India under alien rule.
China, although it was in many ways doing much better economically than India, still managed (unlike
India) to have a famine, indeed the largest recorded famine in world history: Nearly 30 million people
died in the famine of 195861, while faulty governmental policies remained uncorrected for three full
years. The policies went uncriticized because there were no opposition parties in parliament, no free
press, and no multiparty elections. Indeed, it is precisely this lack of challenge that allowed the deeply
defective policies to continue even though they were killing millions each year. The same can be said about
the worlds two contemporary famines, which are occurring in North Korea and Sudan. Famines are
often associated with what look like natural disasters, and commentators often settle for the simplicity of
explaining famines by pointing to these events: the floods in China during the failed Great Leap Forward, the
droughts in Ethiopia, or crop failures in North Korea. Nevertheless, many countries with similar natural
problems, or even worse ones, manage perfectly well, because a responsive government intervenes to help
alleviate hunger. Since the primary victims of a famine are the indigent, deaths can be prevented by
recreating incomes (for example, through employment programs), which makes food accessible to potential
famine victims. Even the poorest democratic countries that have faced terrible droughts or floods or
other natural disasters (such as India in 1973, or Zimbabwe and Botswana in the early 1 980s) have been
able to feed their people without experiencing a famine. Famines are easy to prevent if there is a serious
effort to do so, and a democratic government, facing elections and criticisms from opposition parties and
independent newspapers, cannot help but make such an effort. Not surprisingly, while India continued to
have famines under British rule right up to independence (the last famine, which I witnessed as a child,
was in 1943, four years before independence), they disappeared suddenly with the establishment of a
multiparty democracy and a free press.

175
I.H.S. Affirmative
Self Determination Impacts Democracy

Famines cause war
Marc J. Cohen, Special Assistant to the Director General, International Food Policy Research Institute and Per
Pinstrup-Andersen is Director General of the International Food Policy Research Institute (IFPRI), Spring
1999, ( Marc J. & Per, Social Research,
http://www.findarticles.com/p/articles/mi_m2267/is_1_66/ai_54668884/pg_10, MAG)
In Central America, civil wars followed protracted food crises and human rights abuses, with demands for
land, social justice, and democracy key to the conflicts (MacDonald, 1988; Barraclough, 1989). Tensions
ripen into violent conflict especially where economic conditions deteriorate and people face subsistence
crises. Hunger causes conflict when people feel they have nothing more to lose and so are willing to
fight for resources, political power, and cultural respect. A recent econometric study found that slow
growth of food production per capita is a source of violent conflict and refugee flows (Nafziger and
Auvinen, 1997). In Ethiopia, Rwanda, and Sudan, governments were finally toppled when they
inadequately responded to famine situations they had helped create. Unfortunately, none of these wars
immediately improved subsistence conditions; instead, all magnified suffering and food shortages.

176
I.H.S. Affirmative
Self-determination Impacts Kashmir

Strong US model of self-determination prevents conflict in Kashmir
Carley, United States Institute of Peace, 1997
(Patricia, U.S. RESPONSES TO SELF-DETERMINATION MOVEMENTS: Strategies for Nonviolent Outcomes
and Alternatives to Secession, Report from a Roundtable Held in Conjunction with the Policy Planning Staff of the
U.S. Department of State, http://www.usip.org/pubs/peaceworks/pwks16.pdf)
Although the Kashmir issue involves both Indias domestic politics and its relations with neighboring
Pakistan, the immediate problem is the insurrection in Kashmir itself. Kashmirs inclusion in the state of
India carried with it provisions for considerable autonomy, but the Indian government over the decades has
undermined that autonomy,a process eventually resulting in anti-Indian violence in Kashmir in the late
1980s. A lasting solution to the Kashmir problem is unlikely unless that autonomy issue is addressed.
Pakistan and India have gone to war more than once over the Kashmir issue, and the two countries are
currently polarized in their positions; indeed, the primary concern for the United States on this issue has been
to avoid another Indo-Pakistani war. To that end, the United States may have to exert more effort to solve the
problems inside. Kashmir, which will probably not be possible without some return to the autonomy
established in the original accession agreement.

177
I.H.S. Affirmative

Countries in South Asia, Kashmir in particular, are choosing to model United States policy.
Chadda, India Daily writer, 2005
(Sudhir, India Daily writer, India Daily, A new concept from Kashmir separatists United States of Kashmir, 6-112005, http://www.indiadaily.com/editorial/3107.asp, 7-1-09)EM
The world is experiencing a new wave of freedom, peoples wish of less Government, less tax and above
all less of politicians! That is true in America, in Europe, in China and in South Asia. The people in
Kashmir now are eager to have their land and culture back to them. Like in US, the model makes
decentralized Governments working as part of a larger Federation. The model can work in Kashmir,
in all of India and Pakistan even in the rest of the world. According to media reports, Moderate Hurriyat
faction chairman Mirwaiz Umar Farooq has propounded a new concept for resolving the Kashmir issue
- one of the ''United States of Kashmir'' in which people would be able to move freely. "- and we desire
India and Pakistan to give a free hand to the Kashmiri leadership to come up with new proposals," he said
adding the Hurriyat conference has decided to take the initiative. He was addressing a "Symposium on
Kashmir: looking towards the future'' organised by Pakistani daily Dawn in collaboration with the Human
Rights Commission of Pakistan, the Pakistan peace coalition and the Islamabad council for World Affairs in
Karachi on Saturday. "I don''t want to take the bus 20 years down the line, I want to fly to New Delhi,
Islamabad or Tashkent. We want to move beyond the traditional line," he said without elaborating. Farooq
said "Conversion of the LOC into a permanent border or the status quo was not acceptable. Apart from
these two, we are ready to explore other options. Decisions should not be imposed from New Delhi or
Islamabad". As India was not ready for tripartite negotiations, the moderate Hurriyat leader said, "A way out
could be triangular talks between Kashmiris and Pakistan, between Kashmiris and India and between
Pakistan and India." Farooq said the United Nations, the organisation of Islamic Conference and the
international community have failed to address the Kashmir issue and mitigate the "agony" of the people of
Kashmir. "We should forget about the international community and the people of Kashmir should choose
their own course," he said. The "people of Kashmir were never in favour of a violent course, the situation
was imposed on us," he said adding the Hurriyat supported the peace process. He also sought to clarify that
their visit to Pakistan did not mean that there was a complete unanimity of views on the issue. JKLF
chairman Yasin Malik said it was not for New Delhi or Islamabad to represent the people of Kashmir
or to decide who was their leader. "Kashmiris should be included in the dialogue process as equal
partners". Former Hurriyat chairman Abdul Ghani Bhat said sensitivities of India and Pakistan had to be
taken into consideration in resolving the issue but the two countries cannot move ahead unless they took the
Kashmiris into confidence and engaged them as equal partners in the dialogue process.

178
I.H.S. Affirmative

Kashmiri secession will result in nuclear violence between India and Pakistan.
BBC News, 2001
(BBC News, India and Pakistantense neighbors, 12-16-01, http://news.bbc.co.uk/2/hi/south_asia/102201.stm, 71-09) EM
Ever since the partition of the sub-continent more than 50 years ago as the British dismantled their
Indian empire, India and Pakistan have been arch rivals. Their animosity has its roots in religion and
history, and has recently escalated into a dangerous arms race. Despite attempts to establish a regular
dialogue and resolve outstanding issues, relations remain tense. There is increasing international concern
that the continuing hostility between the two countries could spark a major conflagration in the region
and beyond. And apart from the threat it poses to security, many analysts believe that the animosity
between the two nuclear-capable powers is preventing the region from realising its full potential.
Independence and partition. When India gained its independence from Britain on 15 August 1947, the
Asian sub-continent was partitioned into Hindu-dominated India and the newly-created Muslim state
of Pakistan. But with partition came massive rioting and population flows as Muslims and Hindus found
themselves on the wrong sides of the newly-drawn border. Around half a million people died in extensive
violence and communal rioting. The death toll was highest in Punjab, which was split in two. Part of it
became an Indian state and part of it became a Pakistani province. The most problematic region was
largely Muslim Kashmir. The Pakistanis argue that Kashmir should have become part of Pakistan in
1947 because the majority of its population are Muslims. They say that numerous United Nations resolutions
mean that Kashmiris should be allowed to vote in a plebiscite to decide between India or Pakistan. India says
that Kashmir belongs to them because of the Instrument of Accession signed by the Maharaja in October
1947, which handed over to Delhi powers of defence, communication and foreign affairs. Kashmir's special
status within the Indian constitution was confirmed in 1950, allowing it more autonomy than other
Indian states. Under the Indian constitution, Jammu and Kashmir is a state, and went to the polls as a
state. Delhi says that under the terms of the Simla Agreement of 1972 both countries have agreed to solve the
Kashmir question through bilateral negotiations, and not through international forums such as the UN. It also
says a plebiscite should not be held in Kashmir because elections have been held which demonstrate that
people living there want to remain part of the Indian union. Going to war India and Pakistan have twice gone
to war over the territory, in 1947-8 and in 1965. In 1971, India and Pakistan fought again over
Bangladeshi independence, and during this time there was also some conflict between the two sides in
Kashmir. And in the summer of 1999, the two countries came to brink of another war after Pakistani-backed
forces infiltrated Indian-controlled Kashmir. A bitter two-month conflict along the Line of Control only
ended when Pakistani forces withdrew. Today, roughly one third of the western part of Kashmir is
administered by Pakistan. Most of the remainder is under Indian control. The insurgency in Indianadministered Kashmir began around 1989. Since then India has constantly maintained that Pakistan has
been training and supplying weapons to militant separatists. Pakistan insists it only offers them moral
support. The nuclear race India first began building its own nuclear weapons in the mid-1960s, after
China began nuclear tests. In 1974, India conducted its first nuclear test - the so-called "Smiling
Buddha" detonations in the Rajasthan Desert. A few years later, Pakistan began to develop its own
programme of nuclear weapons. Both countries were also developing and testing both short-range and
intermediate-range missiles. In April 1998, Pakistan finally tested its new Ghauri intermediate-range
nuclear missile, named after a 12th century Muslim warrior who conquered part of India. This test is
thought to have prompted India's nuclear tests the following month. On Monday May 11, India
announced it had conducted three underground tests at Pokhran in the northern state of Rajasthan. Two
days later it announced that another two explosions had taken place. India's actions were widely
condemned by the international community and Pakistan was urged not to retaliate. But on May 28,
Pakistan announced that it had conducted five nuclear tests of its own in south-western Baluchistan. The
tests were widely criticised throughout the world, and led to the imposition by some countries of sanctions.
Last month, the US lifted economic and military sanctions. But despite strong American pressure, neither
side has so far signed the Non-Proliferation Treaty or the Comprehensive Test Ban Treaty. Pakistan once seen as an important ally in the Cold War years - went on to have a problematic relationship with the
US. The 11 September attacks on the US brought a rapprochement as the US tried to bolster support in
countries bordering Afghanistan for its strikes against the ruling Taleban and Osama Bin Laden's al-Qaeda
network. Now that relationship is under strain again as Pakistan's President, General Pervez Musharraf, faces
strong domestic criticism for his backing of the strikes.

179
I.H.S. Affirmative

The India-Pakistan conflict over Kashmir will escalate to become a nuclear war.
Kapur, 2005
(Paul, an associate professor in the Department of National Security Affairs at the U.S. Naval Postgraduate School and a faculty affiliate at
CISAC, EBSCOHost, India and Pakistans unstable peace Fall 2005, http://web.ebscohost.com/ehost/pdf?vid=2&hid=2&sid=c4367412-2b1a403d-b502-b5afe42bd7fc@SRCSM2, 7-1-09)EM
The presence of nuclear weapons in South Asia threatens to make regional conflict catastrophically
costly. Nonetheless, the subcontinent remains volatile, with recent violence ranging from a Pakistansupported guerrilla war in Indian Kashmir to protracted combat between Indian and Pakistani armed
forces. Given the risks inherent in such confrontation between nuclear-armed adversaries,
policymakers have sought to stabilize the Indo-Pakistani security relationship at both the strategic and
the tactical levels, thus minimizing the danger of nuclear war while reducing the likelihood of lower-level violence.
For example, the 1999 Lahore Declaration, signed by Indian Prime Minister Atal Behari Vajpayee and Pakistani Prime Minister Nawaz
Sharif, states that India and Pakistan will adopt policies aimed at the prevention of conflict in both the nuclear and conventional
fields.1 And as Indian and Pakistani officials prepared for high-level peace talks in early 2004, they considered the negotiation of a
joint agreement to lower the threat of a nuclear or conventional war between the two countries.2 While the goals of promoting
strategic and tactical stability are desirable in themselves, an important tension may exist between
them; policies seeking to maximize strategic stability in South Asia could make the Indo-Pakistani
nuclear relationship safer, but they could also significantly increase the likelihood of lower-level
conflict on the subcontinent. Most scholars attribute ongoing violence in the region to a phenomenon
known as the stability/instability paradox. According to the paradox, strategic stability, meaning a low
likelihood that conventional war will escalate to the nuclear level, reduces the danger of launching a
conventional war.3 But in lowering the potential costs of conventional conflict, strategic stability also
makes the outbreak of such violence more likely.4 This article asks whether continuing violence in a
nuclear South Asia has in fact resulted from the stability/instability paradox. The answer to this question has
important implications for the regional security environment. If the stability/instability paradox is
responsible for ongoing conflict, attempts to stabilize Indo-Pakistani relations at both the nuclear and
the subnuclear levels could be futile, or even dangerous, as increased strategic stability allows more low-level conict.
If, by contrast, ongoing violence in South Asia has not resulted from the stability/instability paradox, then ongoing conict would not
demonstrate any necessary incompatibility between tactical and strategic stability in the region, or suggest that danger inheres in current
attempts to minimize the likelihood of nuclear war. Determining the stability/instability paradoxs impact on South
Asia also has implications well beyond the region. If the paradox does explain ongoing South Asian violence, it would
suggest that the relationship between strategic and conventional stability that held for the United States and the Soviet Union during the
Cold War also applies to emerging nuclear-conflict dyads.5 But if continuing Indo-Pakistani conict runs counter to
the expectations of the stability/instability paradox, then the relationship between strategic and tactical
stability, and its resulting dangers, may be different for future proliferants than it was for the United States and
the Soviet Union. The stability/instability paradox does not explain continuing conf8ict in a nuclearized South Asia. Recent violence has
been characterized both by aggressive Pakistani attempts to revise territorial boundaries in the region and by relatively restrained Indian
efforts to preserve the status quo; Pakistani forces or their proxies have repeatedly crossed de facto international borders to launch
limited conventional attacks on Indian territory, while India has refused to retaliate with cross-border strikes of its own. Contrary to the
expectations of the stability/instability paradox, a small probability of lower-level conict escalating to the nuclear threshold would not
encourage such behavior. A low likelihood of nuclear escalation would reduce the ability of Pakistans
nuclear weapons to deter a conventional attack. This reduction in deterrence would leave weaker
Pakistan less protected from Indias conventional advantage in the event of conict, and thus would
discourage Pakistani aggression. Simultaneously it would encourage vigorous Indian action to defend the
status quo and defeat Pakistani adventurism. Pakistani boldness and Indian restraint have in fact resulted
from a different strategic environment, in which instability in the nuclear realm encourages instability at
lower levels of conict. In this environment, limited conventional conflict is unlikely to provoke an
immediate nuclear confrontation.6 However, in the event that a limited conventional confrontation
subsequently spirals into a full-scale conventional conict, escalation to the nuclear level becomes a
serious possibility. This danger of nuclear escalation allows nuclear powers to engage in limited
violence against each other. In the South Asian context, weaker Pakistan can undertake limited
conventional aggression against India, in hopes of altering regional boundaries while deterring a full-scale
Indian conventional response. In addition, nuclear danger draws international attention, potentially
securing for weaker Pakistan third-party mediation of its territorial dispute with India and a diplomatic
settlement superior to any that Pakistan could achieve on its own.

180
I.H.S. Affirmative

Kashmiri secession will trigger a nuclear war in South Asia.
Hagerty, 2005
(Devin T. Hagerty, Ph.D. Associate Professor and Chair of Political Science Department at the University of Maryland. Baltimore County,
South Asia in World Politics, p. 161,)EM
South Asia is often described as the most dangerous place on earth, the likeliest place where a nuclear
war might be fought in the future. Such concerns center on India and Pakistans unabated rivalry over
Kashmir and the continuing low-intensity, or subconventional, war in the region amid vertically
proliferating nuclear capabilities. As discussed in chapters 1 and 2 of this book, the Indo-Pakistani
dispute over Kashmir stretches back to the founding states in 1947. India and Pakistan were partitioned
out of the remains of the British Indian Empire on the basis of two rival ideological principles: India as a
secular homeland for Hindu majority and other religious minorities and Pakistan as a homeland for the
subcontinents Muslims. Since Partition, New Delhi has considered the successful incorporation of
Kashmir, Indias only non-Muslim majority province, critical to affirming the success of its secular
experiment. Likewise, in the absence of Kashmirs incorporation, Islamabad regards Pakistan as
incomplete. In the first two decades after Partition, India and Pakistan fought two wars to try to settle
their claims over Kashmir. The first war in 1947-1948 led to Kashmirs division into Pakistani- and Indianadministered sections, with India gaining control over roughly two-thirds of the territory. In 1948 India
unwittingly internationalized the dispute by seeking UN mediation. The original UN formula called for a
plebiscite, over time it diluted that commitment and tried to make Kashmirs accession to India permanent.
Faced with a growing conventional disparity with India and frustrated by the failure of the UN and U.S.British third-party mediation efforts to resolve the dispute, in 1965 Pakistan made a military grab for
Kashmir. That effort failed; subsequently, New Delhi and Islamabad reaffirmed their commitment to the
status quo under the 1966 Tashkent Agreement.
Kashmir has the right to secede, it would be the best option for them.
Ganguly and Bajpai, 2008
(Sumit Ganguly holds the Rabindranath Tagore Chair in Indian Cultures and Civilizations at Indiana University, Bloomington. and
Kanti Bajpai is an expert on India's security and a regular commentator in the Indian media, Opinion Asia, Secession in Kashmir: Dj
vu All Over Again, 9-2-08, http://www.opinionasia.org/SecessioninKashmir, 7-109)EM
Over the last several weeks, large crowds of Kashmiri Muslims have defied curfews, scorned Indian
security forces and marched through the streets of its summer capital demanding freedom. The catalyst
was the Jammu and Kashmir government's decision to transfer public land to create shelters for Hindu
pilgrims on their annual pilgrimage to the historic Shri Amarnath shrine in the state. This move gave
separatist leaders, who had steadily lost political ground over the past decade, a chance to resurrect the
secessionist call for "azadi" or freedom from India. Indian opinion across the spectrum has categorically
rejected secession. But the recent agitation has caused some leading commentators in the country to think
about the unthinkable - the secession of Kashmir. While fatigue with Kashmir is understandable, it is not
defensible. The international community is conservative about the creation of new states, particularly in
volatile geopolitical and political environments. While secession cannot be ruled out altogether, the society
of states quite rightly approaches the issue with great caution. Secession is never a purely internal matter
since its consequences are likely to be beyond the immediate setting. The international community
therefore has a right to ask some very hard questions of secessionists. The most compelling argument for
secession is genocide. If a government is killing its people as a way of exterminating them, secession is
justifiable under international law and custom. What is India's record? It has certainly made many
cultural faux pas in Kashmir, has been politically insensitive to Kashmiri wishes, and has treated dissidents
harshly. It has used force to quell disturbances and terrorist threats, and there have been excesses. While all
this is true, what is happening in Kashmir today, and what has occurred in the past, is clearly not part of a
policy of genocide and extermination. A people might also rightfully secede when subjected to "ethnic
flooding"--that is, the loss of ancestral lands through a conscious policy of population transfers. Here,
the Indian government's record is clean. Despite demands from Hindu zealots, New Delhi has refused to
dismantle constitutional provisions that prohibit non-Kashmiris from acquiring land in the state, and at no
time has the government encouraged migration to Kashmir. A third reason for secession is if there is
massive discrimination against a people. In the case of Kashmir, the opposite is the case: Article 370 of the
Indian constitution grants the state special political privileges. New Delhi has clearly fiddled around with

181
I.H.S. Affirmative

Ganguly and Bajpai, 2008 (Continued)
Article 370 over the years, but these changes do not justify secession. Economically, while Kashmir is not
one of India's strongest economies, it is far from the worst. Geography, education levels, malgovernance,
poor infrastructure, and lack of industrialisation have kept Kashmir poor, but this could be said for many
other Indian states. In fact, poverty levels in Kashmir are amongst the lowest in India, and the state receives
amongst the highest levels of per capita aid from national coffers. The human rights record of the Indian
government over the past twenty years, since the violence in Kashmir began, is certainly questionable and
might be grounds for secession. There is no doubt that unauthorised arrests and detention, torture, and the
killing of innocents have occurred in substantial numbers. However, New Delhi has also taken remedial
measures. The Indian military has court-martialed a number of officers and men and others have faced civil
prosecution for human rights abuses. The government has tried to educate the Indian army and paramilitaries
on better human rights practices. In 1995 and 2004, it allowed TADA and POTA, respectively, two draconian
preventive detention measures, to lapse (though this still leaves some special measures in place). Despite its
earlier electoral follies, the government has attempted to ensure free and fair elections, and it has consistently
allowed the media and NGOs to report human rights violations and corruption in high places. Even if the
Indian record is not bad enough to justify secession, one might still argue for Kashmir to go its own way if
those who argue for secession can show that separation will substantially improve the lives of
Kashmiris. Are the secessionists capable of providing good democratic governance? Will they ensure
human rights, free and fair elections, and just administration? Will minorities in an independent
Kashmiri state be safe under a Kashmiri government? In other words, is there evidence that those asking
for rights have a robust "culture of rights"? The pronouncements and actions of the All-Party Hurriyat
Conference, the umbrella group that claims to enjoy the support of a large section of Kashmiris, as well as
the role of militants, are not reassuring. The Hurriyat has been rather coy about its political values including
the future of ethnic and religious minorities and the nature of an independent Kashmir (secular or Islamic?),
and it has no record of electoral politics, while the militants have attacked not just the armed agents of the
Indian government but also unarmed civilians, Muslims and Hindus, with great regularity. If these are the
future rulers of a putatively independent Kashmir, then secession promises more not less pain for the state.
Finally, since secession is about independence, it is reasonable to ask if an independent (and landlocked)
Kashmir would be truly independent in a geopolitical setting of contending regional great powers,
namely, China, India and Pakistan? Surely the prospects are not encouraging. Would an independent Kashmir
encourage peace between these three? If Kashmir was the only issue dividing them, perhaps yes. But clearly,
the suspicions and quarrels between them go far deeper than the status of this small state. Nor are the effects
of Kashmiri secession likely to be restricted to the subcontinent. It might encourage others near and far to
hive off, might energise Islamic militants in other parts, and might convulse both India and Pakistan. In short,
it might well be a recipe for international calamity rather than calm.

182
I.H.S. Affirmative
Trust Doctrine Solvency

A. The trust doctrine is broken now
Affecting Tribal Lands and Resources, Utah Law Review 109. EKC)
II. Methodology for Establishing Standards of Fiduciary Care in the Indian Trust Context
As a jurisprudential matter, successfully developing a clear, cohesive, and predictable body of law from embryonic principles requires courts to employ a
the body of Indian trust law has evolved without a

guiding theoretical paradigm, resulting in a scattered and often inconsistent set of decisions. This section
suggests [*114] a foundational structure for developing fiduciary standards appropriate for the Indian
trust context. Because the very nature of Anglo-American law requires judges to borrow concepts and rules from established law, this discussion
sound and consistent interpretive and decisional methodology. Unfortunately,
offers guidance on sifting the illuminating threads of precedent from the ill-suited ones.
B. Plan reestablishes the primacy of the trust doctrine

Marquez 2001
Rationed care and fewer resources plague Indian Country regardless of the current political wish to decrease
health disparities. There are factors internal to the systems operated by many I/T/Us that bear review
and upgrading prior to further participation in the managed health care arena. These factors include
recognition of risk adjustment for the patient population served, limited on-site patient service
contracts, assumption of risk for a limited number of patients by tribal and urban Indian health
clinics, and recognition of the legal relationship that exists between the tribes and the federal
government regardless of the right of the tribes to assume control of their health facilities promulgated
under the Indian Self-Determination and Education Assistance Act of 1975 (25 U.S.C. 450 et seq.).
There remains, too, the inherent conflict between the historically acknowledged trust responsibilities to
federally recognized tribes, specifically the provision of health care, versus the federal governments
resistance to honor these treaty rights.

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I.H.S. Affirmative
A2: Paternalism I.H.S. Turns

Turn I.H.S. Funding Solves Paternalism
A. Non-unique poverty makes tribes dependent on paternalism now there is only a
risk we make it better
Despite these apparent economic options, most reservations lack thriving economies, and instead remain
in a state of grinding poverty. n165 Forty-five percent of Indians living on reservations have incomes
below the poverty line. n166 Nearly half of all Indian adults are unemployed, n167 and some
reservations experience eighty to ninety percent unemployment. n168 Of those Indians who are
employed, a majority earn less than $ 7000 per year. n169 A significant percentage of reservation
Indians live in substandard housing. n170 Indeed, the economic condition of many tribes has not
substantially improved since 1970 when President Nixon declared "on virtually every scale of
measurement--employment, income, education, health--the condition of the Indian people ranks at the
bottom." n171 [*152] Most tribes are still far from attaining self-sufficiency and depend on the
federal government for funding of basic governmental services. n172 Tribal leaders attribute poor
economic conditions to their lack of an adequate land base, education, and capital. N173
B. Federal funding of Indian health care reduces tribal dependence and enhances
sovereignty
One of the most significant changes in the Indian health system has been the Indian Self-Determination
and Educational Assistance Act of 1975 (PL 93- 638; 88 Stat 2203; 42 USC 450-458), which allows tribes
to manage the health programs in their community previously managed by the IHS.6 The number of
tribes that have opted to manage their health programs has grown rapidly, and approximately half of the IHS
budget is now managed by tribes.4 A recent survey showed that tribes that manage their own health
programs, on average, were able to provide more new health programs, build more new facilities, and
collect more third-party reimbursements than had been the case under IHS management.7Evidence is
growing that tribal management of health programs can be successful and can lead to better ways to
address the health problems of American Indians and Alaska Natives.
Another positive change has been the recognition that Indian communities must play a central role in
improving their health. As sovereign nations, tribes are now asserting their rights and taking
responsibility for their health. Many tribes are establishing wellness programs and fitness centers and
are relearning their tribal traditions related to health. Tribes are also taking more control over the
research that is conducted in their communities and are establishing institutional review boards to ensure
that the research benefits their tribes, addresses their own research priorities, and involves the community at
all levels of the researchdesign, conduct, and interpretation of the results.9,10 It is no longer acceptable
for researchers and public health workers to enter Indian communities without the approval and
participation of the tribe, collect data, and leave.

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I.H.S. Affirmative

I.H.S. encourages Indian communities control reservation health programs the plan
enhances their decision-making powers
The role of tribes in the provision of health services has increased significantly since passage of the
Indian Self-Determination and Education Assistance Act of 1975. Building on IHS policy, the SelfDetermination Act and amendments give tribes the option of managing and staffing IHS programs in
their communities under self-determination contracts and, more recently, self-governance compacts;
the Self-Determination Act also provides funding for improvement of tribal capability to contract under the
Act. Self-determination contracts permit tribes to administer a full spectrum of IHS services, including
both direct care and contract care programs, facilities construction, community health representatives
programs, mental health and drug abuse services, and health education initiatives. Most of these services are
reservation based. Self-governance compacts with tribes provide enhanced decision-making powers for
tribes and encourage development of an expanded resource base.
I.H.S. involvement is necessary for tribal self-governance of health services

Efficiency considerations, of course, also require recognition of potential diseconomies of scale.
Diseconomies of scale exist when a larger operation results in higher per unit costs of production.
Diseconomies are likely to arise as a result of problems associated with managing a large scale operation.
Tribal self-governance may be an appropriate response to such problems by providing a mechanism
for injecting even greater decentralization into the management process than that which characterizes
the IHS. If adequately funded, tribal programs may also permit more appropriate response to unique
tribal concerns and encourage tribal initiative. Limited ventures in tribal self governance, with
continued reliance on the IHS for guidance and collective purchasing, provide a balance between
diseconomies and economies of scale.
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I.H.S. Affirmative

Federal I.H.S funding facilitates tribal control
THE PUBLIC HEALTH RESPONSE
As public health professionals, we have new responsibilities to support these positive changes in Indian
health that provide hope and create opportunities to restore the health of Indian communities. We must
learn more about the health challenges and disparities in Indian communities and about the specific tribes we serve. In our public health
efforts we must insist on the full participation of the tribes and community in all phases of planning,
implementation, and evaluation of programs, services, and research. We also must resist the temptation to
enter Indian communities as experts who will control programs and outcomes. A more productive role is to
be a resource to the community and to help build local capacity. We also must help educate others, especially our
countrys leaders, on the severe levels of underfunding and lack of resources in the Indian health
system and the need for more funding for Indian health care. The federal government has a responsibility
to provide health care for American Indians and Alaska Natives, and it is time for all of us to respect the
sovereignty of tribes, help build capacity in Indian communities, and help reduce the health disparities that
affect this population.
I.H.S. programs trade-off with private tribal hospitals that are crucial for breaking federal
dependence
Khadjenoury, CEO of Vista Springs Behavioral Health Network, 2008
(Siamak, Indian Country Today, Privatize mental health care on
http://www.indiancountrytoday.com/archive/28217809.html , 6-28-09, ESM)
reservations, 9-10-08,
The recent wave of concerns associated with health care services in Indian country raise a fundamental
issue whether the status quo should be maintained at all cost or whether it is time to explore other
options. For many larger tribes the question is a Shakespearian one: "To 638 or not to 638." For the people
living on those reservations, it may literally be the difference between life and death. The dilemma
presents the tribal members with a choice between the Indian Health Service and their own tribal
government to run their hospitals and accredited mental health programs. The fact that nowhere in the
discussions, planning sessions or legislative process is the private sector represented, is a testimony to
the tunnel vision dominating many tribal administrations. A glance at the American health care industry
reveals that a majority of the hospitals and behavioral health organizations are privately run entities.
Many regional and county hospitals are also being managed by private organizations. Our co-dependent
attitude towards the federal government often prevents us from empowering private citizens,
organizations and networks from providing high quality, professional, efficient and nationally
accredited services. For all the community and economic development offices throughout just about any
reservation, most do not fully understand or embrace the basic idea behind privatization: cut the red
tape, find solutions, start providing services and bring in monies from off the reservation. It is that simple. It
does not require funding, just vision and the commitment. Most communities lose millions of dollars on a
regular basis to border towns and other off-reservation providers simply because tribal bureaucracies and turf
are designed to stifle internal solutions. They perpetually make it unbearable for entrepreneurs to implement
businesses as a general rule, and health care is certainly no exception to that rule. Specific to the behavioral
health for children and adolescents, there are numerous tribal members in various acute psychiatric
hospitals, residential treatment centers and group homes mostly in the major metropolitan cities. Since
there are no options available on their reservations, case managers, probation officers and parents have no
choice but to seek these services wherever they find professional, quality facilities. In doing so, we often risk
providing disjointed services, apart from their support network. Many visionary leaders during the past
decade have realized the importance of dealing with these issues and thus began applying for federal funding
to implement programs and services. These efforts included a rush to build inpatient and outpatient facilities
on various reservations. As they soon discovered, tribal departments lacked the expertise, consistency,
flexibility or the professional standards needed to operate these facilities on a nationally acceptable, billable
level. Many of these multi-million dollar facilities sit vacant, shrouded in controversy, used sparingly or for
non-intended purposes. As the CEO of a Behavioral Health organization specializing in treating Native
American youth through a network of reservation and off-reservation based services, I encourage the tribal

186
I.H.S. Affirmative

Khadjenoury, CEO of Vista Springs Behavioral Health Network, 2008 (Continued)
leaders to think outside the box: Native American children should be entitled to the same health-care
rights and options as any other child in any state. If our programs perform to the highest degree of
qualifications and expectations, each and every child will receive all treatment available under the state law.
Below is an outline blueprint on how to achieve this task: ? Study the feasibility of privatizing the mental
health system; ? Empower leaders within the community through training and financial resources to study
the private health care systems; ? Hire reputable organizations currently providing these services with a
proven record of sensitivity to Native American cultural and spiritual requirements for a limited number of
years (five to seven years) to operationalize and manage the facilities. This will allow recruitment and
training of professionals, implementation of strict professional and quality assurance standards, the obtaining
of state and national licensing and accreditation and finally, the ability to bill the state or any other third party
payer; ? If the corresponding state is unwilling to license facilities on the reservation, create your own
regulatory commission based on HCFA standards; ? Once the facility or program is able to bill "fee for
service," it will no longer require a financial commitment from the tribe or dependence on the feds; ?
After these organizations are privately operated by private entities and all the wrinkles have been ironed
out, tribes can assume the management and enjoy the benefits. As with anything else, it is crucial to keep
tribal politics away from the operation of such facilities and programs. Professional and objective direction
based on standards will be the guarantors of success. This blueprint should not be limited to psychiatric
hospitals but include a continuum of behavioral health services including residential treatment centers,
therapeutic group homes, day treatment and intensive outpatient programs and many other services.
Additionally, juvenile justice services such as management of correctional facilities can become turnkey
operations. This is particularly a unique time. Tribes are in the position of creating a stable, professional and
high quality behavioral, as well as general, healthcare infrastructure to serve their membership as well as
potentially bringing additional revenues into their communities. Siamak Khadjenoury is the chief executive
officer of Vista Springs Behavioral Health Network whose headquarters are located in Sierra Vista, Ariz.
Vista Springs is a nationally accredited network of behavioral health and management services throughout
the United States specializing in the treatment of Native American youth on or off the reservation. Vista
Springs Traditions programs provide a continuum of behavioral health services throughout the Navajo
Nation.
The Indian Health Care Improvement Act increases American Indian self-determinationits one of its stated objectives.
The reauthorization of IHCIA attempts to accomplish these tasks through a series of procedural changes
to the established system and the adoption of seven health care objectives identified by the National
Indian Health Board: 1. Health Objectives. Adopts the policy, for the first time, that health improvement
objectives must be the same for American Indians and Alaska Natives as for all other Americans. 2. SelfDetermination & Self-Governance. Updates the Act to recognize that, since 1992, tribes and tribal
organizations are operating more than half of IHS programs.

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I.H.S. Affirmative
A2: Paternalism - General

A majority of American Indian nations support the plan denial of health care outweighs
the link
Pallone, member of the Native American Caucus of the U.S. House of Representatives, 04
(Frank, Indian Country Today, Pallone: Passage of the Indian Health Care Improvement Act is Vital, 12/23/04,
Without a doubt, the incompetence of the Republican party to fulfill their legislative duties has consequences
for all Americans, including Native peoples. In particular, the failure of Congress to reauthorize the
Indian Health Care Improvement Act (IHCIA) has had the greatest consequence for American Indians
and Alaskan Natives.For those of you around Indian country who fought persistently for its passage, this is
undeniably a demoralizing blow. Since 1999, tribal health advocates have been working hard to achieve
consensus between the health needs of Indian country and the amount Washington is willing to pay to meet
those needs. While attempts to reauthorize the legislation came remarkably close in the waning days of this
congressional session, these efforts were ultimately defeated.One of the primary reasons for the inaction was
that the IHCIA reauthorization languished for far too long in both the House and Senate chambers.
Legislation reauthorizing the IHCIA was introduced in both chambers in early 2003, the beginning of the
108th Congress. In the House, bill H.R. 2440 was introduced by Rep. Don Young, and in the Senate, S. 556
was introduced by retiring Senator Ben Nighthorse Campbell. With the exception of a few congressional
hearings, very little action was taken on either bill after they were introduced. That all changed with the
opening of the National Museum of the American Indian. Indeed, it was the opening of the museum, and the
presence of millions of Native peoples from across the Americas that provided an impetus to move the
reauthorizing legislation forward. During this time a flurry of activity took place on Capitol Hill. Advocacy
groups such as the National Congress of American Indians, the National Indian Health Board and the smaller
area health boards led the effort to make Indian country's voice heard. As a result, on Sept. 22 both H.R. 2440
and S. 556 were quickly and unanimously approved in the Senate Committee on Indian Affairs and the
House Resources Committee. It is worth mentioning that Indian country wanted to reauthorize the IHCIA
so badly that it was also willing to remove portions of the original legislation deemed objectionable by
the Bush administration and/or Congressional Republicans. Indeed, entire sections dealing with Medicare
were deleted from the original legislation in an attempt to pacify administration concerns and move the
legislation forward. I believe that it is a gross injustice to ask American Indians, who suffer from a
wholly inadequate health care system, to make any further concessions. The purpose of the Indian
Health Care Act is to raise the standard of health care in Indian country to the level of care afforded to
every other American. This goal cannot be achieved through cheap incremental reforms. A substantial
investment is needed in order to improve the health status of America's first peoples. Unfortunately, the
Republican Party lacks the wherewithal to achieve this goal. Ultimately, legislation reauthorizing the IHCIA
died in the 108th Congress because too little time was left to bridge the gaps that existed between tribal
leaders, congressional Republicans and the White House. In spite of this outcome, I am optimistic that
legislation can be passed when lawmakers reconvene in January for the 109th Congress. However, it's going
to take a lot of hard work.There is a quote from Lone Man of the Teton Sioux Indians that I am often
reminded of, ''I have seen that in any great undertaking it is not enough for a man to depend simply upon
himself.'' Indeed, no one man is going to be able to reauthorize the IHCIA; it is going to take the help of key
lawmakers in Congress, administration officials, tribal leaders, health advocates and all of Indian country in
order to accomplish this goal. I am committed to this goal and look forward to joining you in the fight to
reauthorize the IHCIA in the 109th Congress.

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I.H.S. Affirmative
A2: Paternalism - General

Natives support Congressional funding of and jurisdiction over the I.H.S.
Larson, member of the Gros Ventre tribe and director of American Indian Studies at Idaho
State University, 2005
(Sidner J., Making Sense of Federal Indian Law, Wicazo Sa Review, Spring, 20.1: 9-21. EKC)
Despite the complexities involved, it still seems beneficial for the Court to return to Congress more
responsibility for balancing the interests of Indians and non-Indians on reservations as well as
establishing policy for other issues.35 If a more careful balance could be struck, Congress might then
be better encouraged to strengthen tribal courts in certain ways. Increased funding would, of course, be
enormously helpful, but something like a special Court of Appeals for Indian Affairs would be a tremendous
help in balancing the existing perception that non-Indians cannot get a fair trial in Indian courts.36 Certainly
Indian lawyers should continue to coordinate with the Tribal Supreme Court Project set up by the National
Congress of American Indians and the Native American Rights Fund (NARF) and work to make sure only
winning cases go up to the high court. The most interesting possibility, however, and the one with the most
far-reaching potential to quiet the existing chaos in Indian Country, would be for Congress to enact an
Unallotment Act. Bruce Duthu37 once discussed a federal statute that would provide that, after the
passage of a certain amount of time, perhaps a decade, all nonmembers who remain in Indian country
would be subject to full tribal territorial sovereignty . . . Congress might provide the tribe with a right
of first refusal concerning any transfer of fee simple land within the reservation, so that the tribe
would have the privilege of purchase . . . A more aggressive program would recognize a tribal power 20
of eminent domain concerning fee simple reservation land . . . such efforts may have a significant chance
of success on some Indian reservations today, which because of depopulation trends by non- Indians have an
increasingly Indian character.38
The American legal system and its related complex of federal Indian law have traditionally sought to position themselves as objective,
authoritative, politically neutral entities standing somehow above and outside the dynamics of living communities. The reality of the
situation, however, as reflected in the present state of affairs in Indian country, is that the law consists of all- too- human practitioners
attempting to straddle cultures that are contested, that are always in production, where meaning is plural and always open, and where
there are politics at every turn.
What might be of more use than the unilateral creation of biased common law by the Court is a
constructive conversation among Congress, tribes, and states that includes fair and equitable
consideration of nonmembers in Indian Country, even if that ultimately means an offer to nonmembers to
join in common government of an area or to accept an offer from the tribes to sell land back to them.
Dialogue and compromise leading to pragmatic solutions such as those described above would certainly
be a vast improvement over the doctrinal confusion and practical chaos that now exists; furthermore, such
solutions should become a priority item for unified Indian action as soon as possible.

189
I.H.S. Affirmative
A2: Paternalism Trust Doctrine Turns

Proper enforcement of the trust doctrine is key to sovereignty and protection from federal
encroachments on Indian affairs
This Article explores the use of the Indian trust doctrine to protect against federal agency action adversely
affecting Indian lands and resources. The trust doctrine is a common law doctrine which courts invoke to
review federal action affecting native interests. Though it features prominently in Indian law, the trust
doctrine has not yet received adequate attention as a tool for protecting the underlying interests of
tribes in maintaining their separate, land-based existence within an increasingly intrusive majority
society. The doctrine suffers from a lack of standards tailored to meet the unique characteristics of
native sovereignty, and that deficiency has crippled effective use of the doctrine in addressing many of
the modern problems faced by tribes. This Article offers a reconstituted doctrinal model to respond to these
concerns. A companion article, Indian Land and the Promise of Native [*112] Sovereignty: The Trust
Doctrine Revisited, n1 explored the nature of the trust doctrine and its potential role in modern litigation to
protect the native land base from adverse federal agency action. It characterized the trust responsibility as
an obligation which arose from the original cessions of land by the tribes to the federal government.
Those cessions were made against a framework of federal promises which guaranteed native
separatism and federal protection of the tribes' ability to continue their way of life. The article
characterized the legal regime resulting from this understanding as "a sovereign trusteeship" which imposes continuing legal obligations
on the federal government to protect native separatism. While the government has breached that bargain innumerable times, the article
concluded that the basic obligation of protecting the tribes' unique interests still survives as a central feature of Indian jurisprudence. It
concluded that, while courts are still reluctant to enforce the trust responsibility against Congress due to the "plenary power" doctrine
which affords Congress almost unfettered latitude in dealing with tribes, the trust doctrine remains a potentially
powerful tool for protecting tribal interests against adverse federal agency action. In a modern era
where federal agencies control activities affecting land, air, water, and wildlife, use of the trust doctrine to
restrict adverse agency action may well rival the congressional context in terms of its importance to many
tribes.
Application of federal law causes assimilation the trust doctrine is key to legally
preserve tribal interests
This Article seeks to bring definition to the doctrine by developing standards of application. Part II begins by
suggesting an appropriate methodology to guide judicial development of doctrinal standards. The discussion
points out that, in defining the trust obligation, courts are naturally inclined to borrow familiar principles
from the areas of constitutional, statutory, and private trust law. However, direct application of these
principles is inappropriate, because standards which derive from these sources of law are largely designed
to protect the interests of individuals in the majority society and often do not reflect the unique
sovereignty interests of tribes. Reducing the trust obligation to the minimalist standards found in these
other areas of law may well perpetuate a subtle form of assimilation whenever tribes seek relief from
adverse agency action. Part II suggests that courts should instead develop standards suited to native
sovereign interests, looking to foundational principles reflected both in treaties and in these other areas for
broad guidance.

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The trust doctrine is key to maintaining tribal sovereignty and balancing tribal and other
interests
While acknowledging the complexity of this tension, the discussion in Part III suggests that the core
principle of the trust doctrine remains a duty to protect a viable native separatism and tribal
sovereignty, and that this duty should serve as the guiding compass for judicial development of trust standards. This Part identifies four "attributes of
sovereignty" which are necessary to native separatism and warrant protection as beneficiary interests under the trust doctrine: (1) a stable, separate land
base; (2) a viable tribal economy; (3) self-government; and (4) cultural vitality.
Parts IV through VII address these attributes in turn. Each of sovereignty and describes its role in modern tribal society, discusses the basis in existing law
for treating the attribute as an appropriate tribal beneficiary interest, and then suggests factors courts should use in determining whether federal action
compromises the particular attribute. Finally, Part VIII addresses broad issues which inevitably arise in the trust context, such as whether agencies should
the doctrine should resolve the many inevitable direct conflicts

between the interests of tribes and the interests of constituencies in the majority society to whom the
government may also be accountable.
receive deference in interpreting their trust obligation, and how
The trust doctrine is key to tribal interests: status quo problems are caused by the courts ignoring
it
Wood,
assistant professor of law at the University of Oregon, 1995
(Mary
Christina, Protecting the Attributes of Native Sovereignty: A New Trust Paradigm for Federal Actions
The organizing principle for developing a coherent body of Indian trust law must center on defining
the Indian interest. Trust law in any context draws its substance and meaning from the identified interests of the beneficiary class.
n2 At the core of the Indian trust doctrine is the federal government's duty to serve the "best interests"
of the tribe and its members. n3
However, the "best interest" principle is at best a compass, not a map. Alone, it fails to define appropriate fiduciary behavior at a level of
specificity necessary for consistent application in a variety of contexts. n4 Indeed, after two centuries of political, economic, and cultural
subjugation, identifying the best interests of Indian nations and their people presents a weighty challenge.
Unfortunately, the courts have largely sidestepped this challenge by interpreting fiduciary duties
according to standards of conduct found in other areas of law. The discussion below evaluates the drawbacks of that
approach.
1. Applicability of Private Fiduciary Standards
When faced with Indian trust law issues, courts instinctively [*115] gravitate toward private trust
law, a body of jurisprudence which has engendered a generous set of standards by which to assess private fiduciary conduct. n5
Many courts have imported such standards into the Indian law context, n6 but usually without much
reflection on their suitability. The Supreme Court has offered little useful guidance in this area, noting in one case that the
government is held to the "most exacting fiduciary standards," n7 yet in another stating that the government could not be held to the
"fastidious standards" of a private fiduciary. n8 The Court's failure to discern the appropriate instances in which
private fiduciary duties should apply to Indian trust law leads to confusion and contradiction.

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I.H.S. Affirmative

The trust doctrine is key to sovereignty: other law focuses solely on financial interests
Due to significant differences between public and private trustees and beneficiaries, it is inappropriate to
apply private trust standards in cookie-cutter fashion to the realm of public trust law. n9 While all trust law
requires fiduciaries to act in the best interests of the beneficiary, at least two factors set private trust law apart from Indian trust law. The first factor involves
the unique interests of the sovereign tribal beneficiary. While
an individual beneficiary in the private context primarily

has financial interests which trust law protects, the Indian tribal interest nearly always implicates a
host of factors relating to the tribe's sovereign status that are not encountered in the individualbeneficiary context. These interests include maintaining a separate land base, a viable tribal economy, tribal self-government, and cultural vitality.
n10 Accordingly, direct comparisons between the "best interests" of an individual and those [*116] of a native nation are often far too simplistic.
Private trust law fails Indian trust doctrine is key to tribal interests
In contrast, private fiduciary standards are misplaced in contexts where the tribe's interest is more
complex than that of an individual beneficiary, or where there are other competing public
constituencies to whom the government is accountable. A particularly ill-founded application of private
fiduciary standards is found in United States v. Sioux Nation of Indians. n16 There, the Supreme Court
presumed that the government's confiscation of tribal land in violation of a treaty could be justified as an
exercise of its fiduciary duty, n17 relying upon the settled principle of private trust law that a fiduciary may
alter the nature of the assets in the trust. n18 Yet reliance upon a private fiduciary's standard of care relating
to transmutation of property is singularly inappropriate for judging governmental action of this sort. Tribal
land holdings such as the Sioux Nation's sacred Black Hills hardly equate with "liquid" private trust
assets which a trustee may freely exchange for currency. Tribal lands are integral to native economies,
culture, and religion, and therefore involve sovereignty interests which reach far beyond the interests
of an individual beneficiary in the private trust context. By suggesting otherwise, Sioux Nation leaves an
ugly scar on the landscape of Indian trust law and illustrates well the danger of importing private trust
standards into the Indian trust context.
The trust doctrine is disappearing in the status quo: we must act now to prevent its
disappearance or risk assimilation and dependence
Other courts have appropriately declined to interpret trust standards as coextensive with general environmental or administrative standards. n30 However, as
a ballooning set of administrative and statutory prescriptions continues to displace common law in modern jurisprudence, courts may more often hesitate to
base decisions exclusively on the common law Indian trust doctrine. Indeed, recent opinions suggest that courts are using the trust doctrine largely to
There is a growing danger that trust duties will gradually

metamorphose into standards of statutory construction or statutory gap-fillers. But for the reasons
described, courts should resist any approach which merely assimilates the trust doctrine--and the
unique interests it protects--into the broader statutory framework designed to further the often
minimalist interests of the majority society. n32
complement existing statutes in upholding native interests. n31
Even when construing statutes that directly address Indian interests, such as those dealing with federal management of Indian lands and resources, courts
should exercise their independent judgment in defining the trust obligation. Such statutes often contain [*121] broad or vague directives, n33 which some
courts may view as pockets of agency discretion to which judicial deference is owed. However, particularly in the land management context, the executive
branch's functions are so extensive that Congress could not possibly arrive at a detailed statutory mandate addressing all of the circumstances facing
individual tribes. Therefore, the sometimes sweeping language in such statutes should not provide refuge from the settled principle that agencies are to be
Courts should draw upon the trust doctrine to measure

agency performance where statutes provide inadequate directives. Moreover, a court's trust analysis
should stretch beyond the market-based approach so ingrained in the Anglo-American system of laws -held accountable to "the most exacting fiduciary standards." n34
an approach that defines a beneficiary's interest in strictly monetary terms. While some of the statutes and regulations governing
management of Indian land reflect this approach, n35 the trust doctrine should not be held hostage to the conventional defining
assumptions and norms underlying the non-Indian system of laws. N36

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The trust doctrine is empirically key to prevent public interests from overpowering tribal
interests
2. Statutory Standards as Substitutes for Fiduciary Obligations
In attempting to define the federal trust responsibility, courts may be inclined to equate governmental fiduciary standards with
applicable statutory or regulatory requirements which bind executive action. n19 A dramatic example is the North Slope Borough
v. [*118] Andrus case. n20 There, members of the Inupiat native community challenged the Secretary
of the Interior's decision to issue oil leases in the Beaufort Sea region. The region serves as migratory
habitat for the bowhead whale, an endangered species upon which the Inupiat people rely for
subsistence. n21 The Inupiat plaintiffs argued that the oil leasing would present a risk of oil spills which could harm the whales and jeopardize the
community's subsistence economy. n22 The Inupiat contended that the Secretary's decision to issue the leases was illegal under both section 7 of the
Endangered Species Act ("ESA") n23 and the Indian trust doctrine. n24 Addressing the statutory claim, the court found that the government complied with
section 7 of the ESA, which prohibits federal agencies from taking any actions that are "likely to jeopardize" the continued existence of any listed species.
n25 Having found that the statutory claim posed no barrier to the government's oil leasing activities, the court separately addressed the trust claim, but it
refused to interpret the trust duty as imposing any obligations distinct from the statutory mandates of the ESA. Interpreting the statutory and trust duties as
the court noted:

[W]here the Secretary has acted responsibly in respect of the environment, he has implemented
responsibly, and protected, the parallel concerns of the Native Alaskans. In sum, the substantive interests
of the Natives and of their native environment are congruent. The protection given by the Secretary to one, as
we have held, merges with the protection he owes to the other. n26
Interpreting governmental fiduciary standards as coextensive with express statutory obligations in
general laws is inappropriate. The Indian trust obligation centers exclusively on native interests,
whereas environmental protection statutes as well as other general [*119] welfare statutes are enacted to
protect the broader public interest. Often the statutory standards enacted to benefit the general public
are inadequate to protect the unique interests of tribes.
For example, the ESA provision which formed the basis of the Inupiat's statutory claim is designed to
prevent the federal government from taking action which could cause the wholesale extinction of a
species--a drastic result by any measure. n27 The ESA's protection does not even begin to apply until the
species faces a likelihood of extinction. n28 This level of protection hardly assures a whale population
sufficient to meet the ongoing subsistence needs of a native community such as the Inupiat. n29 The North
coextensive,
Slope Borough approach of relegating the protected interests of native people to the more minimalist interests of the general population
ignores the fundamental thrust of Indian trust law--to ensure that the special needs of the native community will stand protected against
intrusions by the majority society. Absent an express and direct conflict with a statutory provision, the trust doctrine should
serve as a [*120] common law overlay to statutory regimes, supplying higher standards of protection
where appropriate.

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Intervening in issues which are under tribal sovereignty is acceptable in order to ensure the
safety of outsiders.
Levy, MA and PhD in Politics, professor of political theory, AB, LL.M, 2008
(Jacob T., Self-Determination, Non-Domination, Federalism, Hypatia, Vol. 23, no. 3, July September, MEL)
Young discussed two cases in a sufficiently sustained way to help us see how she thought self-determination
as non-domination might play out in the world. First was the conflict between the Skull Valley Band of
Goshutes and the state of Utah over whether the former may decide to lease out part of their
reservation (which is surrounded by Utah) as a repository for nuclear waste.5 Young observes that the
Goshutes have a legal right to make such a decision without consulting the state of Utah, but suggests
that the legal right is more than can be morally justified because the decision implicates the health and
safety of the non-Goshute citizens of Utah. The reality of interconnectedness means that outsiders must
be heard and negotiated with; the legitimate right of self-determination in the Goshute means that the
decision may not simply be taken out of their hands and placed into those of Utahs government. Young
takes this as an important illustration of the idea that self-determination as non-interference would leave
tribes with too much authority and not enough solicitude for the interests of affected outsiders. The
legitimate demand of the Goshute to be able to self-determine in matters of culture, land use, and so on
does not extend to actions that might affect the health and safety of outsiders. Outsiders are
affected and therefore have a legitimate claim to have their interests and needs taken into account

194
I.H.S. Affirmative

The constitution is inadequate for addressing tribal sovereignty needs - The trust
doctrine is key to upholding treaties
3. Constitutional Standards
Some courts have reverted to constitutional standards in defining the government's fiduciary obligation by
equating, for example, the trust duty to protect native culture with the First Amendment's protection of
religion. n37 This approach is equally flawed. The Constitution [*122] primarily organizes the powers
and rights of three parties: the federal government, the states, and the individual citizens. Its only direct
reference to tribes is in the Indian Commerce Clause, which grants Congress the power to regulate commerce
"with the . . . Tribes." n38 The assignment of rights and obligations between the federal government and
the tribes was accomplished through bilateral negotiations resulting in treaties. n39 The Constitution
incorporates such treaties into the federalist system through the Supremacy Clause, which provides that
treaties, along with the Constitution, are the "supreme Law of the Land." n40 The treaties, therefore, reflect
the principles that should guide the formulation of fiduciary standards for the Indian trust obligation.
n41
Of course, rights derived from the Bill of Rights and elsewhere in the Constitution are secured to
Indian individuals as a result of the grant of citizenship in 1924. n42 But these protections of the rights
of individuals offer scant illumination of the fiduciary obligations owed to sovereign tribal entities.
Various scholars have noted constitutional deficiencies with respect to protection of group rights generally,
n43 and the same shortcomings are even more pronounced in the tribal context. The sovereign interests of
tribal self-government, perpetual use of land and resources, economic viability, and the ability to
continue cultural and community traditions, find no expression in the Constitution. n44 Protection for
such interests [*123] should be doctrinally developed through federal common law, yet accorded
supremacy within the Constitutional framework.
Getting rid of the trust doctrine causes assimilation. The trust doctrine is the best thing
ever
In sum, standards of conduct arising from private trust, statutory, and constitutional law are not
tailored to, and often do not adequately protect, the full-bodied nature of native sovereignty interests.
Adopting such standards to define the contours of the Indian trust doctrine essentially risks reducing
native interests to the interests of an average individual citizen in the majority society. This approach
further detaches federal Indian law from the realities and needs of the supposed beneficiaries and may have a strong
assimilationist effect over time. Due to its common law nature and its still undefined scope and reach, the Indian trust
doctrine provides a potentially fertile realm in which native litigants and courts may craft standards
not found in other sources of law to protect a fuller range of native interests.

195
I.H.S. Affirmative

The trust doctrine upholds treaty obligations and sovereignty
B. The Role of Foundational Law in Developing a Trust Model
Undoubtedly, courts require legal reference points in developing law to shape the Indian trust doctrine. While other areas of law may not
provide specific standards appropriate to the trust context, broad, underlying principles may provide foundational law which establishes
appropriate guideposts. Building a cohesive trust paradigm will entail weaving together existing but diverse strands of judicial thought.
At least four sources of law provide broad foundational principles courts may draw upon in developing the Indian trust doctrine.
The first source is treaties. Many duties which comprise the trusteeship are perhaps best expressed by these first documents delineating
federal and tribal relations. n45 While treaties are directed [*124] toward individual tribes and differ in their
specific terms, they indicate a pattern of general obligations owed by the federal sovereign to the native
nations. Just as courts have liberally construed treaties to adapt to modern times, n46 so should courts
refer to the principles and understandings evident in these early documents when fashioning modern
federal fiduciary standards. N47
The trust doctrine protects tribal sovereignty from state governments

Third, courts may draw on other judicial doctrines now well-established in Indian law. For example, past cases have recognized
that tribes maintain inherent governmental powers which provide some insulation against various
intrusions by state government. n53 A court could infer from that jurisdictional principle that tribal self-government is a
protected interest under the trust doctrine. On the other hand, because of the inconsistent and disjointed nature of federal Indian
law, courts are likely to encounter principles at opposite ends of every spectrum. Developing a trust model from existing Indian law
inevitably involves choices, and the selection should be guided by the underlying purpose of the native sovereign trusteeship. N54
Natives love the trust doctrine, and don't want to get rid of it
[*128] Of course, one may legitimately question whether courts ought to provide the forum in which such choices are made, given the
overall lack of consensus in Indian Country as to what is beneficial for tribes in particular circumstances. It may appear that such
determinations far surpass the ability of judges to provide principled guidance. Nevertheless, it bears noting that the Indian trust
doctrine is woven tightly into two centuries of Indian law, and its persistence and continued use by
native litigants presumes some consensus as to what duties steer the trust obligation. To maintain that
defining the "real" Indian interest in today's more complex world is beyond the realm of judicial
competence is equivalent to dispensing with the trust doctrine altogether as a tool to restrain
congressional or executive action affecting the tribes. Such a drastic proposition should be approached with utmost
caution and, at the very least, only after a thorough and diligent effort has been made to explore this linchpin of trust analysis.

***Topicality/DA/K/CP answers***
196
I.H.S. Affirmative

197
I.H.S. Affirmative
A2: Topicality Social Service

Social Services include health care
Kochhar and Kramer, Kochhar has a Ph.D. in Economics, Brown University, worked as a senior economist,
George Washington University, Washington DC Assistant Professor, is Deputy Director at the Asia and Pacific
Department of the International Monetary Fund, and Kramer is Chief of the North American Division of the
International Monetary Fund, 09
(Kalpana and Charles, India: Managing Financial Globalization and Growth, p. 66-67, SP).
First we verify whether the state revenue expenditure on social services is associated with more inclusive
growth. Social services include health care, education, water supply, housing, urban development,
nutrition and various welfare schemes for economically disadvantaged groups. As the majority of these
services are targeted at poorer households, one might expect the inclusiveness of growth to be positively
correlated with states social spending.
Health care is a type of social service

UN ESCAP, United Nations Economic and Social Commission for Asia and the Pacific, 02
(UNESCAP online site, Access to Social Services by the Poor and Disadvantaged in Asia and the Pacific: Major
Trends and Issues, http://www.unescap.org/esid/psis/publications/spps/11/chap1.pdf, accessed 7/1/09, SP)
The types of social services provided by countries in Asia and the Pacific are invariably the same as those in
developed countries. The organization of these services within a Government modelled after a Western
bureaucratic structure would inevitably produce the same categories of services. In a modern societyorganized government rationality, government policy is expected to deal with social needs and social
problems. Thus, public policy governs services to meet needs or to eradicate social problems. From
this stance, social services are seen to have a broad coverage and serve different aspects of lives in
modern society. These include education, health care, social security and personal social services,
housing, law and order, social recreation, sewage and hygiene, transport and environment, and others.
However, with the prevailing ideologies of community care, shared responsibility and market consumerism
in social services, Governments often tend to focus on their responsibility principally in health, education,
social security and social care (personal social services). Other areas are, in general, considered to be more or
less the responsibilities of the community, family and individuals. Health services can be broadly classified
into primary, secondary and tertiary services. In the region, most are curative (medical) rather than preventive
services. Primary care includes those services provided in the community, close to and generally accessible
by potential patients. Secondary services such as clinics and other facility-based services provide somewhat
higher quasi-hospital services, while the tertiary/quaternary hospital services provide increasingly specialized
ranges of general and specialist medical and surgical care (Phillips 1990).
Health care benefits are considered social service

Walker, writer for Indian Country Today, 06
(Richard, Indian Country Today, John Daniels Jr. named to Seattle magazines most influential list, 2/1/06,
http://proquest.umi.com/pqdweb?index=2&sid=3&srchmode=2&vinst=PROD&fmt=3&startpage=1&clientid=10553&vname=PQD&RQT=309&did=1001156841&scaling=FULL&ts=1246571990&vtype=PQD
&rqt=309&TS=1246572212&clientId=10553, accessed 7/1/09, SP)
The tribe has developed long-term partnerships with local school districts, state agencies and local
municipalities to provide services to both tribal members and surrounding communities. Being selected one
of the top 25 influential people is recognition of the tribe's growing role in our region and the contribution all
Muckleshoot people make to the community each and every day." The Muckleshoot reservation is six square
miles and is located about 40 miles southeast of Seattle on a plateau between the White and Green rivers. It
has an on- or near-reservation population of 3,300. Its economic portfolio includes the White River
Amphitheatre, Muckleshoot Casino, Muckleshoot Bingo, and Muckleshoot Market and Deli. Its educational
programs include the Muckleshoot Childcare Development Fund, Muckleshoot Child Development Center,
Muckleshoot Tribal School and Muckleshoot Tribal College. Its social services include a medical center
with clinical services, pharmacy, community health program, behavioral health program and dental
services.

198
I.H.S. Affirmative

Native American tribes count health services as social services
Fort Apache Scout, 92
(Fort Apache Scout, Arizona tribes file federal suit; action taken against the State and. Governor, 1/24/92,
http://proquest.umi.com/pqdweb?index=1&sid=4&srchmode=2&vinst=PROD&fmt=3&startpage=1&clientid=10553&vname=PQD&RQT=309&did=540710161&scaling=FULL&ts=1246573187&vtype=PQD&rqt
=309&TS=1246573208&clientId=10553, accessed 7/2/09, SP)
Arizona tribes file federal suit; action taken against the State and. Governor PHOENIX -- A coalition of
Arizona Native American tribes has filed a federal lawsuit against the State of Arizona and Gov. Fife
Symington. The tribes, including the White Mountain Apache Tribe, the Tohono O'odham Nation, Cocopah
Indian Tribe, San Carlos Tribe and Pascua Yaqaui Tribe, operate gaming centers on their reservations and
seek enforcement of provisions of the Indian Gaming Regulatory Act. The U.S. Attorney's Office has
threatened to shut down the gaming centers due to the lack of tribal/state compacts. The tribes fund social
service programs on their reservations with revenue generated from gaming operations. These social services
include health, education, employment and economic development programs. Gaming revenue has also
helped the tribes become more self-sufficient by supporting many of their own social services
Social service includes giving health care

Goyal, International Herald Tribune writer, 06
(Kartik, International Herald Tribune, India expects to sustain growth of 7% BUSINESS ASIA, 1/3/06,
index=0&did=953881401&SrchMode=2&sid=4&Fmt=3&VInst=PROD&VType=PQD&RQT=309&VName=PQD
&TS=1246573187&clientId=10553, accessed 7/2/09, SP)
India expects to maintain an economic growth rate of more than 7 percent, backed by higher investment in
infrastructure, agriculture and social services, Finance Minister P. Chidambaram said Monday. The economy
grew 8 percent in the quarter that ended Sept. 30, after expanding 6.9 percent in the full year to last March.
The government expects economic growth of as much as 7.5 percent in the 12 months ending this March.
"The only way to make growth more inclusive is to sustain a rate of growth in excess of 7 percent over the
next few years and I am confident the year 2006 will continue the trend," Chidambaram said in a statement.
"This will involve stepping up investment, particularly in infrastructure, agriculture and the social sectors,"
he said. Social services include health care and education. Prime Minister Manmohan Singh's government
wants more overseas investment to help achieve annual economic growth in excess of 7 percent in the next
10 years. Singh aims to cut the budget deficit and improve the lives of Indians, one in three of whom earn
less than $1 a day, according to the World Bank.
Social Services include health care

Kochhar and Kramer, Kochhar has a Ph.D. in Economics, Brown University, worked as a senior economist,
George Washington University, Washington DC Assistant Professor, is Deputy Director at the Asia and Pacific
Department of the International Monetary Fund, and Kramer is Chief of the North American Division of the
International Monetary Fund, 09
(Kalpana and Charles, India: Managing Financial Globalization and Growth, p. 66-67, SP).
First we verify whether the state revenue expenditure on social services is associated with more inclusive
growth. Social services include health care, education, water supply, housing, urban development,
nutrition and various welfare schemes for economically disadvantaged groups. As the majority of these
services are targeted at poorer households, one might expect the inclusiveness of growth to be positively
correlated with states social spending.

199
I.H.S. Affirmative

Health care is a type of social service
UN ESCAP, United Nations Economic and Social Commission for Asia and the Pacific, 02
(UNESCAP online site, Access to Social Services by the Poor and Disadvantaged in Asia and the Pacific: Major
Trends and Issues, http://www.unescap.org/esid/psis/publications/spps/11/chap1.pdf, accessed 7/1/09, SP)
The types of social services provided by countries in Asia and the Pacific are invariably the same as those in
developed countries. The organization of these services within a Government modelled after a Western
bureaucratic structure would inevitably produce the same categories of services. In a modern societyorganized government rationality, government policy is expected to deal with social needs and social
problems. Thus, public policy governs services to meet needs or to eradicate social problems. From
this stance, social services are seen to have a broad coverage and serve different aspects of lives in
modern society. These include education, health care, social security and personal social services,
housing, law and order, social recreation, sewage and hygiene, transport and environment, and others.
However, with the prevailing ideologies of community care, shared responsibility and market consumerism
in social services, Governments often tend to focus on their responsibility principally in health, education,
social security and social care (personal social services). Other areas are, in general, considered to be more or
less the responsibilities of the community, family and individuals. Health services can be broadly classified
into primary, secondary and tertiary services. In the region, most are curative (medical) rather than preventive
services. Primary care includes those services provided in the community, close to and generally accessible
by potential patients. Secondary services such as clinics and other facility-based services provide somewhat
higher quasi-hospital services, while the tertiary/quaternary hospital services provide increasingly specialized
ranges of general and specialist medical and surgical care (Phillips 1990).
Health care benefits are considered social service

Walker, writer for Indian Country Today, 06
(Richard, Indian Country Today, John Daniels Jr. named to Seattle magazines most influential list, 2/1/06,
http://proquest.umi.com/pqdweb?index=2&sid=3&srchmode=2&vinst=PROD&fmt=3&startpage=1&clientid=10553&vname=PQD&RQT=309&did=1001156841&scaling=FULL&ts=1246571990&vtype=PQD
&rqt=309&TS=1246572212&clientId=10553, accessed 7/1/09, SP)
The tribe has developed long-term partnerships with local school districts, state agencies and local
municipalities to provide services to both tribal members and surrounding communities. Being selected one
of the top 25 influential people is recognition of the tribe's growing role in our region and the contribution all
Muckleshoot people make to the community each and every day." The Muckleshoot reservation is six square
miles and is located about 40 miles southeast of Seattle on a plateau between the White and Green rivers. It
has an on- or near-reservation population of 3,300. Its economic portfolio includes the White River
Amphitheatre, Muckleshoot Casino, Muckleshoot Bingo, and Muckleshoot Market and Deli. Its educational
programs include the Muckleshoot Childcare Development Fund, Muckleshoot Child Development Center,
Muckleshoot Tribal School and Muckleshoot Tribal College. Its social services include a medical center
with clinical services, pharmacy, community health program, behavioral health program and dental
services.

200
I.H.S. Affirmative
A2: T- In means throughout

We meet - health services are not based on BIA geographic limitations the plan applies to
throughout the U.S.
Ruiz applied to the BIA for general assistance benefits under the Snyder Act during a prolonged strike at the
mines. The BIA denied benefits, citing a provision in the BIA Manual133 that limited eligibility to Indians
living "on reservations" and in BIA jurisdictions in Alaska and Oklahoma. After failing to secure benefits
through administrative appeals, Ruiz instituted a class action against Morton, Secretary of the Interior,
claiming entitlement to general assistance as a matter of statutory interpretation and challenging the BIA
eligibility provision as a violation of Fifth Amendment Due Process and the Privileges and Immunities
Clause of Article 4, Section 2 of the Constitution. The district court's summary judgment for the Secretary
was reversed on appeal on the basis that the BIA's residency limitation was inconsistent with the broad
language of the Snyder Act. Congress intended general assistance benefits to be available to all Indians,
and congressional appropriations for the BIA general assistance program did not ratify the BIA
residency limitation as argued by the BIA. The appellate court concluded that, short of clear congressional
action, geographical limitations were precluded by the Snyder Act's provision for assistance to Indians
"throughout" the U.S. Without addressing the question of whether Congress intended assistance to be
available to all Indians, regardless of residence and assimilation, the U.S. Supreme Court affirmed the
Appellate Court's decision on the narrower basis that the Congress intended benefits for full-blooded,
unassimilated Indians living in an Indian community near their native reservation who maintain close
economic and social ties with that reservation.

201
I.H.S. Affirmative
A2: Politics (Obama Good)

Anti-abortion amendment was responsible for I.H.S. funding cuts Congressional allies
can be rallied to support the plan
Capriccioso, Indian Country Today Staff Writer, 08
(Rob, Indian Country Today, Some blame NCIA for lack of health bill passage, Oct 17, 2008,
http://www.indiancountrytoday.com/home/content/31167799.html, Accessed 6/28/09, CAF)
As Indian Country Today previously reported, the reauthorization, which passed the Senate in February,
largely failed to make headway in the House of Representatives due to anti-abortion language added to
the bill by Sen. David Vitter, R-La. His amendment forbade the use of federal funds to pay for
abortions under the reauthorization.One lobbyist familiar with the situation, said he believes the biggest
strategic error on behalf of NCAI and its lobbyists was not realizing that Democratic supporters would
not take a stand against pro-lifers to encourage the bills passage.I was stunned that traditional
Democratic allies in the House believed that it was more important for them to make a point on [abortion]
choice than reauthorizing Indian health care, the lobbyist said. Tribal leadership really needs to think long
and hard about how it wants to move forward [in dealing with House leadership].When Vitter posed his
amendment early this year, he inserted support letters from the National Right to Life, Family Research
Council, and Concerned Women for America organizations into the congressional record. It was a move that
some say should have immediately set off alarm bells, especially given the stature of Rep. Nancy Pelosi, DCalif., as the first female House leader.Given that backdrop and the hindsight of the bills lack of progress
some tribal advocates are now saying that NCAI officials failed to anticipate the vast problem the
Vitter amendment would pose, and should have worked harder with congressional allies to ultimately
get that language quashed, so as not to become a sticking point in the House. The reality is that from
the moment Sen. Vitter tacked on his anti-abortion language to the Indian bill, it was doomed, said
another Washington lobbyist and former House staffer who believes that NCAI and its lobbyists dropped the
ball in dealing with the situation.
Bipartisan effort to reach out to Native Americans- key to reelection

Brown, political commentator for Politico, 2008
(Carrie Budoff, Yahoo News, Dems. Woo Native American Vote, May 29, 2008,
http://news.yahoo.com/s/politico/20080529/pl_politico/10676, 7-2-09, WPW
The rarely publicized meetings are one piece of what Indian Country leaders describe as an unprecedented
effort this year by the presidential field to pay heed to this small and historically overlooked voting bloc. In
the past two weeks alone, Obama, Sen. Hillary Rodham Clinton and her husband, former President Bill
Clinton, campaigned on Indian reservations across South Dakota and Montana as Sen. John McCain
met with tribal leaders in New Mexico. I would like to believe these efforts reaching into Indian
Country are truly altruistic and for the large part, they are but these candidates know that in order
to win, Indian Country can be a deciding factor, said Kalyn Free, an Oklahoma superdelegate and
founder of the Indigenous Democratic Networks List, a political organization that mobilizes the Indian vote
and recruits, trains and funds Native American candidates.

202
I.H.S. Affirmative
A2: Politics (Obama Good)

Democrats support pro Native American legislation- multiple warrants
Fogarty, staff writer Indian Country Today, 2004
(Mark, Indian Country Today, Democrats Court Native Vote, 10-27-04, http://proquest.umi.com/pqdweb?
index=8&did=755640341&SrchMode=2&sid=4&Fmt=3&VInst=PROD&VType=PQD&RQT=309&VName=PQD
&TS=1246553731&clientId=10553, 7-2-09, WPW)
WASHINGTON - Looking to prompt American Indians to come to the polls this Election Day and support
their candidates, House Democrats have published a Native American agenda emphasizing recognition
of tribal sovereignty and reinforcement of the federal government's trust responsibility to tribes. The
Democrats have also pointed to a dozen bills they have sponsored in the current Congress to help Indians
on issues such as health, housing, economic development and education. "With this agenda, Democrats
pledge to work together with Native Americans to improve education, create jobs, and provide good
health care for our nation's first citizens," said Rep. Pelosi. On the health front, the initiative supports
the reauthorization of the Indian Health Care Improvement Act "to increase funding for health care and
improve health delivery services."
Republicans support Native American healthcare- prefer our evidence it is predictive

Capriccioso, staff writer Indian Country Today, 2008
(Rob, Indian Country Today, GOP Platform Includes Native Specific Language and Goals, 9-5-08,
http://www.indiancountrytoday.com/living/27907429.html , 7-2-09, WPW)
WASHINGTON Delegates and leaders of the Republican National Convention have approved a
national party platform for the next four years that includes several Indian-focused provisions.
Republicans reject a one-size-fits-all approach to federal-state-tribal partnerships and will work to expand
local autonomy where tribal governments seek it, according to the platform. Better partnerships will help
us to expand opportunity, deliver top-flight education to future generations, modernize and improve the
Indian Health Service to make it more responsive to local needs, and build essential infrastructure.
Indian lobbies will rally allies to support the plan

Other principal committees of jurisdiction on the bill House Natural Resources under Rep. Nick Rahall, DW.Va.; Senate Indian Affairs under Sen. Byron Dorgan, D-N.D.; and Senate Finance under Sen. Max Baucus,
D-Mont. performed exceptionally well on the bills behalf, Rodgers said. As the 110th Congress
approached recess, the failure of the Indian Health Care Improvement Act reauthorization left an angry
mood among its advocates. Theyre bitter, very bitter, said Gregory Smith, of Smith and Brown-Yazzie
LLP in Washington, D.C. The National Congress of American Indians had made the bill its top legislative
priority. NIHB, the National Council of Urban Indian Health, the National Steering Committee on
Reauthorization of the Indian Health Care Improvement Act, the California Rural Indian Health Board, a
host of other organizations and tribes, tribal leaders and individual Native people, lawmakers and
legislative staff and lobbyists by the score have poured their efforts into refining the bill and passing it,
many of them for years running. Theyll try again next year, Rodgers said, with new strategies for the new
political landscape of the next Congress.

203
I.H.S. Affirmative
A2: Politics (Obama Bad)

Republicans are anti- Native American
Graham, Founder of United Native America, 2006
(Mike, American Chronicle, Republican Party Declares Economic War Against Native Americans 8-4-06,
http://www.americanchronicle.com/articles/view/12126, 7-2-09)
From the time republicans took over the U.S. House and Senate, Native Americans have had to deal
with the extreme anti-Indian right wing of the republican party. Under the leadership of President Bush,
elected republicans, federal and state, have been given a green light to block any legislation that would
benefit the economic development of Indians living on and off reservations. That includes the antiIndian actions of republican lobbyist Jack Abramoff! President Bush made it a point in his budget to cut
funding for Indian education programs. Bush also found it in his "God" loving heart to end funding of
Indian health services. His action would bring about the closing of over 36 Indian health clinics around the
country. President Bush did not see fit to cut funding of any other ethnic group's health services. President
Bush stood before Americans and announced that the U.S. would send billions of taxpayers' money to Africa
for their AIDS problem, knowing full well that AIDS is a growing problem in the Indian community right
here in America. Diabetic health problems are out of control within the American Indian community.
Obviously President Bush is more concerned about the health of people in other countries!
The Plan is unpopular with energy and health lobbies they will overwhelm native lobbies
Lead organizations and lobbyists have admitted the defeat of efforts to reauthorize the Indian Health
Care Improvement Act. Declaring efforts to enact the bill shut down in Congress, the National Indian
Health Board stated on its Web site Sept. 29 that it will continue to pursue strategies for enacting the reauthorization bill during what
little remains of the current 110th Congress. But already by the evening of Sept. 26, a longtime lobbyist on Indian health issues,
speaking on condition of anonymity when anything could still happen, said key congressional committee staff had put its chances of
passing at slim to none. By then, as recounted by NIHB, attempts to attach the bill (H.R. 1328 in the House of Representatives) to a
continuing resolution on the budget i.e., a measure to fund the federal government until Congress can pass a national budget had
faltered. The bills chances didnt improve over the weekend of Sept. 27 28. In the process of trying to move smaller parts of a larger
bill that has faltered through the legislative system separately, the bills advocates tried to strip out Title II of the larger bill the section
providing enhanced Native access to Medicare, Medicaid and the State Childrens Health Insurance Program as a stand-alone bill.
Kind of like taking apart an automobile, as Blackfeet lobbyist Tom Rodgers of Carlyle Consulting described it. But when that process
gets started, he said, its not long before the separate parts add up to less than the sum of the whole. Unfortunately, NIHB summarized
on its Web site (www.nihb.org), House [l]eadership was not able to fund the first five years of the bill in an amount of $53 million.
That was for the proposed stand-alone bill comprised of Title II. Though the Congressional Budget Office had estimated the original
reauthorization bill to cost $129 million over 10 years, funding had become a problem for the bill as Congress arranged the well-known
$700 billion bailout bill for the financial credit system, along with at least $1 billion in tax giveaways and a $25 billion loan package for
Detroit automakers. On Sept. 24, as conditions in credit access built toward the $700 billion crisis, Rep. Tom Cole, R-Okla., enrolled
Chickasaw, urged passage of H.R. 1328. Budgetary pressures in 2009 could work against even modest new
expenditures, he warned. But House leadership had decided not to offer the bill for a vote in the first instance because of the
abortion issue. An amendment forbidding the use of federal funds to pay for abortions under the reauthorization had been added to the
Senate version of the bill by Sen. David Vitter, R-La. House Republicans, despite what NIHB calls Indian countrys consistent position
that abortion is inappropriate to an Indian health bill and already restricted under current law on federal funding, now wanted to attach
the Vitter amendment to the House version. In addition, NIHB relates, the National Right to Life Committee threatened to score votes
on the bill as pro- or anti-abortion if the amendment were not permitted. Because the committee would score a vote on the amendment in
any case, the political calculus boiled down to this for House leadership: to bring the bill forward would be to register a vote on abortion
little more than a month before every member of the House faced the voters on Nov. 4. Lawmakers are generally allergic to making
choices so close to an election, Rodgers explained. The abortion amendment dominated and clouded the whole debate, he added. He
cited another reason for the bills setback. Indian country needs to have more allies on the [House] Energy and
Commerce Committee. It is basically an urban committee which does not reflect historical ties to
Indian country. Indian country, especially health care advocates and professionals, must work to address
the problem substantively and procedurally as Nov. 4 approaches, he said. Thats what elections are for. ...
You do that by embracing your friends and punishing your enemies, and that can only be done by hard
work.

204
I.H.S. Affirmative
A2: Politics (Obama Bad)

Politicians do not support Native American Policy
Gipp et al, President of United Tribes Technical College, 2003
(David, Tribal College Journal, Contract With Native Americans, Winter 2003,
http://web.ebscohost.com/ehost/detail?vid=7&hid=103&sid=dee62c71-1f36-4656-b747-eb76274f64cb
%40sessionmgr109&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d
%3d#db=aph&AN=11712180#db=aph&AN=11712180, 7-3-09, WPW)
However, with some notable exceptions, the parties and politicians are still not responding sufficiently to
Native American needs. Despite their potential voting and financial clout, Native Americans have not
always been able to count on politicians to represent their interests once elected. Democrats often have
taken the Native American vote for granted. With the exception of certain individual, progressive
candidates, Republicans have regarded the Native American vote as either insignificant or not worth
pursuing, assuming votes are going to the Democrats.
No link - Native issues are a low priority in Congress

It is here, in America. In our own backyard. Yet beyond these bleak statistics, there is very little discussion
of the causes of Native American poverty and what to do about it. The sad truth is only a handful of
policymakers give Native Americans priority on the national agenda. Few even know that November was
Native American Indian Heritage Month and that, by Congressional resolution, the Friday after Thanksgiving
is Native American Indian Heritage Day.

205
I.H.S. Affirmative
A2: Spending DA
The cost of the plan is insignificant in light of the federal bailout
If providing better health care to Native Americans during a time of Wall Street bailouts seems too
costly, we should recognize that we currently spend 30 percent more per capita on health care in
American prisons than on Native Americans, whose ancestors aided the Pilgrims, fed the soldiers
freezing in Valley Forge, helped Lewis and Clark explore our nation, and proudly hoisted the flag on
Iwo Jima. In fact, Native Americans most recently served their country by playing the first and leading role
in exposing one of the largest congressional corruption scandals in history: the Jack Abramoff scandal.
The plan is a drop in the bucket a 50% increase be less that % of the HHS budget
On March 11, 2004, in a floor speech preceding a Senate vote on an amendment to increase the budget for
the IHS by $3.44 billion, Senator Tom Daschle observed that the IHS budget makes up only one-half of
one percent of the HHS budget. That means that the health system with the sickest people and the
greatest need gets the smallest increases. The Senate rejected the amendment, approving only an increase
of $292 million, despite the fact that the provision of adequate clinical services for eligible Indians alone
would require an increase of $9.079 billion.
206
I.H.S. Affirmative
A2: States CP
The states have no authority over Indian nations, and, and attempting to exert authority
would result in conflicts and undermines the trust doctrine
American Indian Policy Center, 2002
(American Indian Policy Center [President: John Poupart Masters of Public Policy (MPA), Harvard University, Cambridge, MA, 1980. BA,
Criminal Justice, University of Minnesota, 1977. Leadership Seminar, Hubert H. Humphrey Institute, 1983. Paradox of Leadership, 1985]
State-tribal relations, 2002, EM, http://www.airpi.org/projects/statetrb.html, accessed: 7-5-09)EM
The devolution of congressional authority to the states in the last two decades has impinged on the
government to government relationship Indian tribes have with the federal government. In the early
'80s, Ronald Reagan's policy of New Federalism began the trickle-down of regulatory and taxation authority
to the state level. Despite Democratic control of the White House, that trickle has become a torrent. From the
state government's frame of reference, it doesn't make sense that the state can't assume regulatory and
taxation authority over Indian country, just like every other area. Conflicts over resource management,
taxation and regulation erupt because state governments fail to understand or recognize the
sovereignty of tribes. The U.S. Supreme Court clearly defined the relationship between Indian tribes
and state governments in 1832. In Worchester v. Georgia, Chief Justice Marshall wrote, "The
Cherokee Nation, then, is a distinct community, occupying its own territory, with boundaries
accurately described, in which the laws of Georgia can have no force, and which the citizens of Georgia
have no right to enter, but with the assent of the Cherokees themselves, or in conformity with treaties, and
with the acts of congress. The whole intercourse between the United States and this nation, is, by our
constitution and laws, vested in the government of the United States." The framework set forth in this
case (and two others that comprise the Marshall trilogy) make it clear that states are specifically excluded
from relationship between two sovereign nations. These cases echo the constitution which specifically
prohibits any state from entering into a treaty with another nations, and, through the commerce clause, gives
congress the sole authority to deal with Indian nations. That a state government would try to exert
taxation or regulatory authority over an Indian nation makes no more sense than if that same state
government tried to tax Canada. It is clear that the governments closest to Indian tribes need the most
education. State government jealousy and resentment over casino revenues often cloud a clear point of
view. In small group discussion to address tribal-state relations, gaming kept surfacing. According to moderator Roy Taylor, gaming
"takes us back to the ignorance displayed by all the players. This ignorance is based on racism, bigotry, power, etc. Because gaming is
revenue related, it is the reason for its continued surfacing." The missing element, according to Taylor, is governance in an appropriate
manner. It is up to us to inform the general public. Our Congress has to be educated and needs to become even more knowledgeable
about Native Americans in order for us to get their help, said Lorraine Rosseau, former tribal chair from South Dakota. Rosseau
encouraged the group to go back the their homelands and to do something. There is still a "Hollywood" image of Native Americans left
from the '50s and '60s This ignorance and negative view needs to be counteracted, one woman said. Native Americans must out organize
and communicate to survive and prosper. With a strategic plan, Native American can become more proactive, another participant said.
She added that Native Americans must invite all, like in native tradition. We must offer gifts and talk over dinner with the hope that this
will enhance the relationship.
Perm do both - states empirically follow federal regulations on IHS when they work
together
Marquez 2001
According to Clain, the IHS situation is further complicated because tribes and states may operate
under different understandings of the current Medicaid reimbursement practices. Presently, IHS and
tribal clinics are allowed the federally qualified health center rate or 100% of the federal medical
assistance percentage (FMAP), which is the rate received by the state. The IHS rate is not set in stone
and is left to the discretion of each state to negotiate with its tribes (Clain 2000). However, most states
with sizable AI/AN populations have reimbursed tribes at the 100% FMAP rate. Very few states have
chosen to ignore the IHS rate. For some tribes, though, the rate may not fully cover their expenses so that
return to the federally qualified health center negotiated rate may be preferable to tribal health providers.
207
I.H.S. Affirmative
A2: States CP
Greater state authority over tribes in the area of social services undermines tribal sovereignty
state governments will expand their authority and rollback Native protections
Johansen, Professor of Native American Studies, University of Nebraska, 2000
(Bruce E., The New Terminators: A Guide to the Anti-Sovereignty Movement,
http://www.ratical.org/ratville/NewTerminators.html)
Measures that would impose state taxes on Native businesses are only the tip of the proverbial iceberg
of anti-sovereignty efforts in the House and Senate. The American Indian Research and Policy Institute
(AIRPI) of Minneapolis-St. Paul issued a detailed report, "Contemporary Threats to Tribal Sovereignty From
Congress," describing anti-sovereignty legislation in Congress during the 1990s. The report found that
"Much of this legislation is designed to strip tribal authority and to grant states more regulatory power
in Indian Country." The report found that legislative attempts to curtail Native sovereignty fell into several
areas, including proposed amendments to existing laws affecting the Child Welfare Act (1978); proposed
amendments to the Indian Gaming Regulatory Act (1988); proposed taxation of Indian gaming; extension of
state sales taxes to non-Indians on trust lands, and proposed amendments to regulatory authority of Indian
tribes in the name of environmental protection. The AIRPI noted that "the federal government has
historically carried out its trust responsibility to Indians in education, health and welfare via federal
social programs. As devolution proceeds and social programs are transferred to states, many Indian
programs at the federal level risk being similarly transferred. . . . The intent of this legislation is to move
people off welfare and into the job market. The point is lost in Indian Country where most reservations have
little economic base and there are few jobs for Indian people." For example, funds for Indian social
programs have been defined as discretionary spending, not as an obligation mandated by treaties and
the trust obligation. Also during the 105th Congress, Sen. Slade Gorton introduced a provision to the fiscal
year 1998 Department of Interior appropriations bill that would have imposed a means test for federal
funding. The means test translated into cuts or reduction of federal funds for tribes exceeding a pre-set level
of independent tribal income. The funding cuts would have affected tribes with income from gaming,
resource extraction and tribe-imposed taxes. This provision was dropped after pressure from reservation
governments. Gorton also proposed waiving sovereign immunity for Native nations, but this was defeated in
the Senate. Another of Gorton's proposals would require tribal governments to purchase tort liability
insurance, and would place jurisdiction over tribal liability suits in federal district courts, bypassing tribal
courts. (Keeping Watch) The devolutionists have other ideas as well. One of them, H.R. 325 (1997), would
amend the Indian Gaming Regulatory Act (1988) to grant states greater leverage in compact negotiations,
as well as the capacity to tax gaming revenue. H.R. 334 (1997), "The Fair Indian Gaming Act," sought to
shift the burden of proof from the states to Native nations in gaming-compact negotiations. This bill, another
example of devolution at work, would have transferred IGRA oversight from the Interior Department to the
governor's office or a given state's legislature. This proposal also called for a two-year moratorium on class
III gaming. The bill also contained increased record-keeping requirements for Indian gaming establishments.
State attorneys general also are directed to investigate Native gaming -- an extension of state legal
jurisdiction.
208
I.H.S. Affirmative
A2: States CP
Greater state authority over tribes in the area of social services undermines tribal sovereignty
state governments will expand their authority and rollback Native protections
American Indian Policy Center 2000
(Contemporary Threats to Tribal Sovereignty From Congress,
http://www.airpi.org/research/st98cont_congress.html)
As Indians continue to exercise their sovereign rights as nations and demand accountability from the United
States to fulfill its trust responsibility, there are continuing attempts by non-Indians to contest sovereignty.
Three major forums through which these challenges are currently being mounted are the court system, U.S.
Congress, and state governments. Current efforts to erode Indian sovereignty are perhaps significantly
more subtle than previous overt anti-Indian policy and assimilation. These most recent policy efforts
incorporate sophisticated legal and political tactics which do not use the words assimilation and termination,
yet the consequences for Indian people may be just the same.
Threats from the U.S. Congress
The United States Congress has the authority to set Indian policy despite the sovereign status of Indian
nations. This is called the plenary power doctrine. A consequence of the plenary power doctrine is that courts
do not review legislation in Indian affairs on the basis of whether it has a negative impact on tribes. Congress
has the authority to pass laws in Indian affairs and therefore federal legislation is a "political judgement"
which is not, in the court's opinion, itself subject to judicial review. Therefore, Congress can enact legislation
which impacts Indian tribes in negative ways and still be within their Constitutional authority. However,
Congress also has the responsibility to protect the resources and sovereign status of Indian tribes.
Legislation passed by Congress that negatively affects Indian tribes is in direct conflict with the trust
responsibility of the U.S. government. Congress is supposed to work for the benefit of Indian nations,
including the protection of sovereignty and treaty rights. This dual responsibility-- the plenary power doctrine
on the one hand, and the trust obligation on the other, creates a condition of ambiguity between Indian
Country and the U.S. Congress that remains unresolved. Policy consequences of this ambiguity swing back
and forth: sustaining sovereignty in some actions and dismantling sovereignty through other actions. Careful
monitoring and action by tribes is crucial for protecting tribal sovereignty during this politically volatile era.
The National Congress of American Indians at its 53rd annual convention stated that, "anti-Indian bills
introduced in the 104th Congress should serve as a reminder that tribal sovereignty and tribal rights
require constant attention by the tribes in the legislative and judicial arenas" (National Congress, 1996, p.
142). Examples of legislative action in recent Congresses include the following:
* Devolution of federal welfare programs to the states.
* Proposed amendments to policies affecting Indian tribes including the Indian Child Welfare Act (1978) and the
Indian Gaming Regulatory Act (1988).
* Proposed taxation of Indian gaming and sales taxes to non-Indians on trust lands.
* Proposed amendments to regulatory authority of Indian tribes in the name of environmental protection.
209
I.H.S. Affirmative
A2: States CP
State devolution in the area of social services expands state control of tribes AND state programs
exclude Native input
The 104th Congress continued a decade-long national trend of shifting federal administration of social and
regulatory programs to the states. This devolution has significant implications for tribal governments. The
federal government has historically carried out its trust responsibility to Indians in education, health and
welfare via federal social programs. As devolution proceeds and social programs are transferred to
states, many Indian programs at the federal level risk being similarly transferred. As a consequence
tribes face the task of negotiating with states for Indian programs which should legitimately fall under
the trust responsibility of the U.S. government. In the 1930's, the federal government began funding this
trust obligation through general assistance and welfare programs. The implications of this 1930's policy will
affect Indian Country in the 1990's. Douville says, "this shift in distributing treaty funds is a major problem
because these treaty benefits suddenly became part of the welfare and general assistance programs that are
generally regarded by the working class as handouts and a burden to the taxpayers" (Douville 1996, A5).
While many tribes "strenuously" objected to the Personal Responsibility and Work Opportunity
Reconciliation Act (1996), there was no consultation with tribes and no means for tribal intervention to
mitigate the potential damage. A Tribal Leaders Statement, from the Partnership for the Future Conference
held in Seattle in October 1996, warned that Indian tribes have not had the opportunity to get themselves
ready to implement these reforms. The effects of welfare reform will be devastating to some tribes. The intent
of this legislation is to move people off welfare and into the job market. The point is lost in Indian Country
where most reservations have little economic base and there are few jobs for Indian people. Many tribes
assert that amendments to the bill will be necessary if Congress is to comply with its trust responsibility and
obligation. The 105th Congress continued many of the efforts of its predecessor. Some members of Congress
wanted to curtail discretionary spending as much as possible, and it is likely that entitlement programs will
continue to be restructured or cut back. Because funds for Indian programs have been placed under the rubric
of discretionary spending, instead of a separate category befitting the trust obligation, it is likely that efforts
to decrease funding will continue to impact tribes and their members. In the effort to reduce federal
spending, no distinction is being made between the government's trust obligation to Indian tribes and
social spending for non-Indians. Last session, Title VI was passed which gave tribes authority over and
access to funding for housing assistance. This session, House of Representatives Resolution 2 (1997) was
introduced to decrease funding assistance for public rental housing. It is of little importance to have authority
over spending money that does not exist. In lieu of the upcoming hardship, Congress has amended the Social
Security Act and created the Temporary Assistance for Needy Families program. This program will be
implemented by the states with tribal government participation which places tribes in the situation of
adhering to state regulations. If this bill is passed, assistance will be dispersed at the discretion of a
state council. There are no requirements to include Indian representation on the council.
210
I.H.S. Affirmative
A2: States CP
Federal control restrains states from undermining the trust doctrine
Wilkins & Lomawaima, Professor of Political Science, University of Minnesota & Associate
Professor of Native Studies, University of Arizona, 2002
(David & Tsianina, Uneven Ground: American Indian Sovereignty and Federal Law, p. 181-183).
States, particularly the western states that are home to most Indian nations, have tended to disregard
disclaimer clauses. Congress holds the responsibility to remind all states (those with and without
disclaimer clauses) that under the Constitution the political branches of the federal government exercise
and administer this nations Indian policy. Congress must also let states know that they cannot
cavalierly disregard their fundamental laws absent a modification of the treaty or trust relationship or
without tribal and federal consent. This chapter analyzes the historical, legal, and political import of state
disclaimer clauses and argues the federal government must reclaim its role as the government vested
with constitutional authority to treat with indigenous nations. We begin by examining and redefining the
notion of federalism, the political mode of the relationship between federal and state governments.
States will use means testing to restrict tribal social services the federal government will not
Also during the 105th Congress, Senator Slade Gordon introduced a provision to the fiscal year 1998
Department of Interior appropriations bill that would impose a means test for federal funding allocated to
Indian tribes. Ultimately, this provision was dropped as a result of pressure from tribal governments,
however, the bill authorizes a tribal task force to allocate some of the increases in funding. Despite the high
levels of unemployment and poverty on many, if not most, reservations, federal funding allocations for
social welfare programs are not based on needs. Rather, those resources are part of the trust
responsibility of the United States government toward Indian tribes. Means testing for such programs
violates the treaty responsibilities and federal trust relationship (National Congress of American Indians,
Policy Alert, October, 1997).
Amendments to Key Policies Affecting Indian Tribes
During the 104th Congress, a number of legislative amendments were proposed which could result in
weakening the sovereign status of tribes in a variety of ways. States would gain greater leverage in gaming
negotiations from a proposal in an appropriations bill waiving tribal sovereign immunity, from
amendments to ICWA (1978) that weaken tribal rights to define membership, and from amendments to IGRA (1988). Amendments were
also proposed to the Clean Water Act (1977) that would strip tribes of their authority to regulate water policies on reservations.
Federal control is the only way to restrain state encroachment on tribal sovereignty
(David & Tsianina, Uneven Ground: American Indian Sovereignty and Federal Law, p. 177).
We argued that the federal government should reclaim its role as the lone constitutional authority to
deal with indigenous nations. Disclaimer clauses are an important but often overlooked tool in the
arsenal available to tribes to assert their own sovereignty against state threats and to privilege the
tribal government-to-federal government relationship over any inappropriate intrusion by the states.
Tribes and states have been contentious political sparring partners since the beginning of the American
republic, the tribes and colonies were often at odds before that as well. British taxation and lack of political representation in British
government were not the only discontents that led of the American Revolution. The colonies also resented and ignored royal regulations
of affair with Indian nations. The British colonies had for some time object to royal injunctions against English settlement west of the
Royal Proclamation line of 1763 basically, west of the Appalachians injunctions that were intended to prevent illegal encroachment
on Indian lands and thus help preserve the peace. English colonists also objected to strict royal control over the Indian trade and traders.
211
I.H.S. Affirmative
A2: States CP
The CP undermines the Indian Health Service and Indian autonomy
Services for Indians are potentially affected by the outcome of any national election. The proposed transfer
of numerous federal programs to states via block grants and limitations on the growth of federal
spending threaten the structure and financing of the IHS. Current proposals to consolidate federal
programs and block grant them to states make no provisions for Indian programs. If block grants
materialize and if grants do not go directly to tribes, the federal government's trust relationship with
Indians will become a sham far greater than the empty promises that have resulted from budgetary
restrictions.
Federal support is key to Native American Self-determination

Indian Country Today, 2008
(Indian Country Today, Assessing the past and future of self-determination, 3-7-08,
http://www.indiancountrytoday.com/archive/28409419.html, 6-28-09, KS)
The self-determination policy is a period of major social movement among tribal leaders, communities
and activists. It is a period characterized by an increase of Native self-identity, community
mobilization, cultural revival, uneven economic development and greater national attention to tribal
sovereignty. Since the 1980s, congressional funding, legal support in the courts and administrative policy
have not been as favorable as they were in the late 1960s and ;70s. Self-determination policy was
generated by tribal actions and is still in formulation. Tribal communities have a central role to play in
the future direction of self-determination policy. The expression ''self-determination'' is an outgrowth
of the movement to impede termination policy during the 1960s. In some ways, self-termination policy
is a way of articulating and reaffirming tribal government powers and community cultures. If left to
the policy-makers of the Truman and Eisenhower administrations during the late 1940s and '50s, Indians
would have become full citizens of the United States and reservations would now be artifacts of the past.
Indian communities and leaders led the opposition to termination policy and formulated an alternative
policy leading eventually to self-determination. At the 1961 American Indian Chicago Conference, Indian leaders and
community members met to formulate a statement outlining the conditions of their people. As chair of the steering committee, D'Arcy
McNickle, a Cree and Salish-Kootenai adopted member at the Flathead Reservation, authored a new Indian policy titled ''Declaration of
Indian Purpose,'' which proposed solutions to many of the problems. McNickle was an anthropologist by profession and worked with
John Collier, commissioner of Indian Affairs, during the New Deal era in the 1930s. He brought many unrealized ideas from the New
Deal, but now aided with mobilized national Indian organizations and groups looking for an alternative to termination policy. The
discussions and reports of the Chicago Conference were presented in 1962 to President John F. Kennedy in the White House by the
members of the National Congress of American Indians. Indian activists, community members and program leaders lobbied Congress in
the summer of 1964, and gained inclusion of tribal governments as program clients for Community Action Programs and the Office of
Economic Opportunity. Their efforts opened the door for tribal governments to direct funding with many federal agencies, bypassing the
BIA. In 1968, President Johnson, in consultation with Indian leaders, formulated in a special policy statement to Congress, ''The
Forgotten American,'' in which he grafted anti-poverty programs and advocated individual and tribal policy choices. He used the
expression ''self-determination,'' but it was not central to his presentation. President Nixon's special policy statement to Congress in 1970
was again formulated from recent tribal experiences in tribal program management and based on extensive consultation with tribal
leaders. Nixon suggested that Congress officially end termination policy, and encouraged tribal governments to take greater management
of programs and funding. Sen. James Abourezk, D-S.D., having lived on the Pine Ridge reservation, moved many self-determination
hearings and reports through Congress. He also worked for passage of The Self-Determination and Education Act of 1975. The self-
determination and anti-poverty programs funneled funds to and engendered greater empowerment for
tribal governments. In most reservation communities, the tribal governments as we know them today
were formed as a result of these policies of the 1960s and '70s. Tribal governments started working
directly with many federal agencies, and funds were made available directly to tribal communities.
212
I.H.S. Affirmative
A2: States CP
Indian Country Today, 2008 (continued)
Self-determination, as a federal policy, meant the administration of federal programs with federal
funding. For many tribes, local management and control of resources led to the more effective and
culturally sensitive delivery of services to tribal members. Nevertheless, without significant
autonomous resources generated from a tribally managed reservation economy, most tribal
communities remained dependent and federal funding and administrative resources. For the most part, tribal
communities do not object to tribal government integration into federal government programming, but know that dependency on federal
resources limits cultural and community strategies. Decisions, goals and processes of implementation often do not originate in the tribal
communities, and therefore often are not good fits for tribal aspirations for cultural and political autonomy and community renewal.
Further restraints to self-determination arose in the 1980s and later, owing to increasingly conservative
and less favorable court cases and declining federal budgets, as well as less favorable attention to
Indian affairs by U.S. presidents. The self-determination policy has many legal, political, legislative
and bureaucratic constraints. The hope for further renewing tribal communities lies in mobilization
and activism. We commend those communities that are working to develop culturally informed solutions to economic development,
political autonomy and democratic and consensual relations with the U.S. government. The future of self-determination policy will
consist of give-and-take with federal and international policies, but its most creative and sustained means will rely upon the aspirations,
work and visions of the tribal communities and leaders.
The federal government must be the only actor when dealing with American Indian
services in order to allow for the federal-tribal trust relationship to exist
Mitchell, Attorney for NARF, 02
(Michele, Capital Hill Hearing TestimonyTribal Federal Recognition, 9-25-02, Lexis-Nexis, MEL)
Good morning, I thank the Committee for inviting me here today. My name is Michele Mitchell. I am a staff attorney with the Native
American Rights Fund. The Native American Rights Fund (NARF) is a non-profit organization that has been providing legal
representation and technical assistance to Indian Tribes, organizations and individuals nationwide since 1970. I am here today to
provide testimony on HR 992, a bill that would authorize the Secretary of Interior to provide grants to
local governments to assist them in participating in certain decisions related to Indian groups and
Indian Tribes NARF strenuously opposes this bill. The principle defect, which pervades every aspect of the
bill, is that it ignores more than two centuries of history and law that govern the relationship between
the federal government and Indian Tribes. Since the beginning of the Republic the federal government has had a
government-to-government, trust relationship with the Indian Tribes. While at once recognizing the Indian Tribes as "distinctive
political" entities, or sovereign governments, the United States government has guaranteed to protect the rights,
property and existence of Indian Tribes. Indeed, the trust relationship or trust responsibility, has been described as "one of
the primary cornerstones of Indian law." Felix S. Cohen, Handbook on Federal Indian Law, 122 (1982 ed.). As stated in the Indian Policy
Review Commission Final Report submitted to Congress in 1977: "The Federal trust responsibility emanates from the unique
relationship between the United States and Indians in which the Federal government undertook the obligation to
insure the survival of Indian Tribes. It has its genesis in International Law, colonial and United States
treaties, agreements, federal statutes and federal judicial decisions." This bill directly contravenes that trust
relationship. This bill would provide funding to "local governments" in order to finance their opposition to acknowledgment and
recognition of Tribes, applications to put land into trust on behalf of Tribes, land claims to recover land lost in violation of federal law,
and any other "action or proposed action . . . likely to significantly affect the people represented by that local government." The bill does
not appear to include Tribes among the "local governments" to which grants may be provided. If this is the case, it is our interpretation
that the purpose and effect of the bill will be nothing more than to provide funding to non- Indian governments to oppose tribal
governments. Even if the bill were adjusted to address this inequity, it would still be at odds with the government's trust relationship with
Indian Tribes. A trustee simply does not fund opposition to its beneficiary. To make matters even worse, this money would likely come
from money that would otherwise go to fund Indian programs. In short , such actions would be at odds with the
government's trust relationship with the Indian Tribes and the bill should be rejected on that basis alone. However,
NARF has additional concerns with respect to the bill's effects as set forth below. Concerns Regarding Acknowledgment and
Recognition Decisions Numerous Indian tribes have survived intact as identifiable Indian Tribes, but are not federally recognized.
Lack of federal recognition deprives the Tribes of their rightful government-to- government
relationship with the federal government and the benefits and services which accompany that
relationship. Federal recognition does not create new Tribes. It acknowledges that Tribes that have always existed as Tribes are
entitled to the same government-to-government relationship with the United States as other, similarly-situated Tribes. It is a rigorous
process, designed to eliminate political pressures on the process and to eliminate unfounded claims. The process is designed to allow
federal recognition decisions to be made by experts based upon objective criteria. To provide funding for the politicization of the process
is not in anyone's best interest.
213
I.H.S. Affirmative
A2: States CP
States ignore Native American Treaties
Wilkins, Professor of Native American Studies at the University of Minnesota, Richotte,
Professor of Indian Law at the University of North Dakota, 03
(David E., Keith, Oxford Journals, The Rehnquist Court and Indigenous Rights: The Expedited Diminution
of Native Powers of Governance summer 2003, http://www.jstor.org/stable/3331165, AD 7-5-09,
WPW) The important, if sporadic native victories, have tended to occur when (1) explicit treaty
provisions or jurisdictional powers were under direct assault by state governments in clear violation of
treaties or state constitutional disclaimer clauses, or were under attack by private individuals or corporate
interests;'4 (2) individual Indians had attained property that had been vested to them as American citizens;'5
or (3) federal administrators had directly violated trust obligations involving Indian resources.
States have taken advantage of their authority over natives, Federal action key
WPW) The combined effect, then, of the Court's recent rulings indicates that the judiciary has largely
abandoned its historical role ofjudicial deference to the political branches in Indian affairs and no longer
views tribal nations as governing entities entitled to exercise the measure of self-governance and selfdetermination heretofore admitted. Additionally, the Court's views on federalism and states' rights,
insofar as tribal nations are concerned, is such that tribes can rarely expect to be victorious in any
litigation that pits a tribal power against state power. Their only hope for victory appears to rest on
whether the federal government is supporting the tribe in its capacity as trustee of a given natural
resource or the case does not involve a tribal. government's efforts to extend its jurisdictional reach over a
substantial number of non-Indians or state officers acting in their official capacity.
States limit Native American rights

WPW) As the Court has turned more conservative, as federalism has been redefined to allow the
resurrection of a powerful states' rights agenda, and as the Court wrestles with the very nature of tribal
sovereignty, which includes a racial-ethnic and a political-governance dimension, indigenous rights,
both collectively and individually, have suffered accordingly. In general, and certainly within the last six
years, the Supreme Court has made it clear that tribes will rarely win many cases involving non-Indians,
tribal-state relations, or federal power vis-a-vis tribal governments. A tribe may sometimes achieve a
victory if a clear treaty provision is involved (Mille Lacs), or if the federal government is acting in its trust
capacity regarding a tribal resource (Idaho and White Mountain Apache), but even when these conditions
are met, tribes cannot rest assured that their sovereignty will be respected by the Supreme Court, unless
the tribe or the Indian persons can directly connect the power they are exercising to an express act of
Congress. In any event, the conservative majority on the Court appears to be sealing the borders of tribal
sovereignty, reducing tribal governments to polities that may only wield a minimal amount of
jurisdictional clout over their own enrolled citizens and virtually no one else.
214
I.H.S. Affirmative
A2: States CP
Interactions between state governments and tribes fail- empirically they end up causing
more problems than they resolve
Mason, Associate Professor of Social Sciences at the University of New Mexico Gallup, 98
(W. Dale, Tribes and States: A New Era in Intergovernmental Affairs, The Journal of Federalism, 28:1, Winter,
Pages 111-112 MAG)
Intergovernmental relations involve relationships of power between and among sovereigns. The study of
federalism and intergovernmental relations has traditionally focused on the power relationships between the
federal and state governments and between state and local governments. There is, however, another set of
power relationships existing in American federalism often overlooked by scholars, if not by practitioners.
More than 300 federally recognized American Indian tribes in the lower 48 states exercise government
powers that increasingly put them in positions of conflict and cooperation with state governments.
Overall, the history of tribal-state relations has tended to be one of conflict rather than partnership.
Daniel McCool has noted, "One of the most divisive intergovernmental conflicts in the history of the
United States has occurred between state governments and Indian tribes."' Others have written: One of
the clearest and most persistent themes involving Indian sovereignty has been the continuous struggle
by the states to assert greater control over Indian reservations, either at the expense of the federal or
tribal governments. The pace of the struggle, the form that it takes, and the forum in which the struggle
occurs have changed over time. Historic issues involving competing claims of states (or territories) and tribes
included removal of Indians from their traditional homelands, the admission of new states into the union, the
discovery of natural resources on Indian lands, and the "opening" of Indian lands through war and the
allotment process. Contemporary issues of controversy between tribes and states have included attempts by
states to impose taxes on transactions in Indian Country; the extent of state criminal and civil jurisdiction and
law enforcement in Indian Country; the sovereign immunity of tribal governments against lawsuits; and
disputes over treaty rights such as have occurred in Wisconsin and Washington in recent years. Many of
these disputes are the result of changing congressional policy and of inconsistent and often
contradictory decisions by the U.S. Supreme Court.
The CP devolves control in one area without devolving treaty and trust protections ensuring
that the states can unilaterally terminate the tribes
(David & Tsianina, Uneven Ground: American Indian Sovereignty and Federal Law, p. 177).
Of course, in a few instances Congress has acted to delegate its constitutionally vested authority over
Indian affairs to states. We argue that Congress cannot legitimately make such delegation to a state
without attaching the existing treaty and trust protections that tribes legally and morally expect from
the United States. If the states, the subnational governments, are indeed constitutionally intertwined with
the national government, then the treaty and trust commitments of the United States as a nation
towards tribes cannot be unilaterally terminated simply by delegating those commitments to the states
(termination of such commitments would require a mutually agreed upon treaty modification with the tribes
informed consent).
215
I.H.S. Affirmative
A2: States CP
States authority over American Indian nations kills sovereignty- states view it as a zerosum game and will encroach on Indian authority whenever possible.
Page 115 MAG)
Thus, jurisdictional disputes involving territory and people become the focus of tribal-state conflict. States
continually battle to extend their criminal and civil jurisdiction and power of taxation into Indian
Country. They also fight to prevent their non-Indian citizens from falling under the jurisdiction of
tribal law or tribal courts, arguing that non-Indians should not be subjected to tribal jurisdiction
because they are not entitled to participate in tribal political processes. The tribes resist these efforts to
diminish their sovereignty whenever and wherever they arise. A 1981 U.S. Civil Rights Commission
report on Indian tribes points to a third related source of tribal-state conflict. The report noted that:
"Governments with common territorial boundaries are likely to clash over authority to govern a resource of
common interest." The resources at issue have historically included land, water, minerals, and income earned
in Indian Country. States tend to view Indian control of resources as a zero-sum game; tribal control
and profits mean a loss of control and profit by the state. Gloria Valencia-Weber argues that:
Contemporary practices of some state governments attempt to shrink Indian country....States
aggressively ask the courts to legitimate their state regulation, coupled with taxation, in an effort to
change the size and status of Indian lands so that state power can overcome tribal governance.
State policymakers have no incentive to keep American Indian interests at heart.

Page 115, MAG)
For nearly 20 years, the most broadly contentious issue between tribes and states has been gambling
operations run on Indian lands by tribal governments. This issue has demonstrated all of the above-listed
sources of conflict. While there have been sporadic and intense legal, and sometimes physical, battles over
treaty rights and taxation, these have tended to involve specific tribes, treaties, and statutes. Indian gaming,
however, increasingly became the crucial battleground on which the extent and limits of sovereignty
was fought. This controversy has highlighted the inherent conflict between tribal and state sovereignty.
In addition, an important truth of Indian policy has been apparent in the Indian gaming controversy. Indian
policy is often made in the wake of larger ideological and political considerations that, on the surface,
have nothing to do with Indian policy itself. A corollary of this is that most lawmakers, whether in the
Congress or in state legislatures, do not understand Indian issues because they don't have to; they do
not depend on Indian votes to get reelected. This in turn means that powerful legislators and powerful
non-Indian interest groups can often overpower Indian interests.
216
I.H.S. Affirmative
A2: States CP
Relinquishing power from the federal government to the states leads to states
encroachment on American Indian sovereignty
Pages 118-119, MAG)
Indian tribes saw the question of federalism from an entirely different perspective. Repeatedly, tribal
leaders and representatives of Indian organizations stressed the need to protect tribal sovereignty.
Alvino Lucero, chairman of the Southern Pueblos Governors' Council told Andrew's committee that "[s]tate
assumption of civil and/or criminal jurisdiction over Indian reservations has serious implications for
erosion of tribal sovereignty." Tesuque Pueblo Governor Jim Hena, representing the Gaming Pueblos of
New Mexico, told the House Committee on Interior and Insular Affairs that: "I want to point out to you that
the United States Constitution envisions a federal system which has as its component parts. The
opposing views had supporters in the Congress. Senator Chic Hecht (R-NV) told the House Interior and
Insular Affairs Committee that: "Legal gaming on Indian Lands should be subject to the same rules and
regulations which non-Indian games must abide. Indian gaming should also be taxed the same way." The
Indian position had bipartisan support in Senator John McCain (R-AZ) and Representative Morris Udall (DAZ). McCain told the same House Committee that: "Imposing State jurisdiction on tribes, I believe, I am
convinced, violates" congressional responsibility to Indian tribes, and "cuts across the grain of past
Congressional policies encouraging self-determination and self-government." Udall, chairman of the
Interior and Insular Affairs Committee, consistently asserted that while seeking ways to regulate Indian
gaming and accommodating competing interests, he would allow nothing to diminish tribal sovereignty.
Devolution leads to states exerting their power over American Indian sovereignty.
Pages 130, MAG)
Although the political trend is to strengthen state governance and return governing authority to
localities, those goals are not necessarily at odds with strengthening tribal governance and tribal-state
intergovernmental relations. What remains to be seen is whether the historic tribal-state conflict can
be alleviated and replaced by a new era of trust and cooperation. Tribes and states have much in
common and share many of the same problems and resources. Cooperation is not a zero-sum game and
does not mean that either tribes or states have to divest themselves of sovereignty. In its 1988 final
report, the Special Committee on Investigations of the Senate Select Committee on Indian Affairs spoke of a
"New Federalism" that would include tribal governments: Now is the time to embark on a new era of
negotiated agreements between Indian tribes and the United States that abolish federal paternalism but ensure
federal support by launching a New Federalism for American Indians. We will reaffirm our faith
Publius/Winter 1998 in the extraordinary vision of those who created this unique Republic while redeeming
the promise made long ago to its first people. Intergovernmental conflict over Indian gaming
demonstrates the complex place of tribal governments in American federalism. Grounded in the
inherent sovereignty of Indian tribes and the United States Constitution, and given substance by the
political environment, tribes have a role in the sharing of government functions. As their role continues
to expand and as ideas about American federalism continue to evolve, tribal-state intergovernmental
relations will become more common, although not necessarily less conflictive. In the current era of selfdetermination, tribal governments have begun to take their place in the system of American
federalism. The basis for this is the U.S. Constitution and the political determination by the federal
government that tribes do have a place in that system. Tribal recognition was also reflected in President Bill
Clinton's Executive Order 13084 issued on 14 May 1998 and entitled "Consultation and Coordination with
Indian Tribal Governments
217
I.H.S. Affirmative
A2: States CP
States will roll-back tribal sovereign immunity to steal their land
Wetzel, Staff Writer, 02
(Dale, Associated Press, N.D. High Court Rules on Indian Land, May 16th,
http://www.citizensalliance.org/links/pages/news/National%20News/North_Dakota.htm, Accessed 7/11/09, JS)
In a case involving property rights and the power of tribal governments, the state Supreme Court ruled that a
county water board may force an Indian tribe to sell land for a dam to control flooding. The decision Tuesday
sets a national precedent in some circumstances when a state or local government wants to purchase Indian
land outside the tribal reservation, attorneys said. The board wants 1.43 acres of land in Cass County's Maple
River valley in east-central North Dakota as part of a dam project. The Turtle Mountain Band of Chippewa
bought the land in July 2000 and say the land includes some Chippewa burial grounds. "Under these
circumstances, the state may exercise territorial jurisdiction over the land ... and the tribe's sovereign
immunity is not implicated," Neumann wrote.
States have a vested interest in taking native land Devolution of authority would
eradicate the tribes
Mason, Associate Professor of Political Science at the University of New Mexico, 98
(W. Dale, Publius Vol. 28 No. 1, Tribes and States: A New Era in Intergovernmental Affairs, pl. 111-130)
A 1981 U.S. Civil Rights Commission report on Indian tribes points to a third related source of tribal-state
conflict. The report noted that: "Governments with common territorial boundaries are likely to clash
over authority to govern a resource of common interest." The resources at issue have historically
included land, water, minerals, and income earned in Indian Country. States tend to view Indian
control of resources as a zero-sum game; tribal control and profits mean a loss of control and profit by
the state. Gloria Valencia-Weber argues that: Contemporary practices of some state governments attempt
to shrink Indian country....States aggressively ask the courts to legitimate their state regulation,
coupled with taxation, in an effort to change the size and status of Indian lands so that state power can
overcome tribal governance.'4 For nearly 20 years, the most broadly contentious issue between tribes and
states has been gambling operations run on Indian lands by tribal governments. This issue has demonstrated
all of the above-listed sources of conflict. While there have been sporadic and intense legal, and sometimes
physical, battles over treaty rights and taxation, these have tended to involve specific tribes, treaties, and
statutes. Indian gaming, however, increasingly became the crucial battleground on which the extent and
limits of sovereignty was fought. This controversy has highlighted the inherent conflict between tribal and
state sovereignty. In addition, an important truth of Indian policy has been apparent in the Indian gaming
controversy. In- dian policy is often made in the wake of larger ideological and political considerations that,
on the surface, have nothing to do with Indian policy itself. A corollary of this is that most lawmakers,
whether in the Congress or in state legislatures, do not understand Indian issues because they don't have to;
they do not depend on Indian votes to get reelected. This in turn means that powerful legislators and powerful
non-Indian interest groups can often overpower Indian interests.

218
I.H.S. Affirmative
A2: States CP w/ Federalism NB

The states use their sovereignty to mess up the federalism balance and avoid Supreme
Court rulings on natives
Gey, Florida State University Law Professor, 02
(Steven G., Florida State Universiy; School of Law, The Myth of state sovereignty, Feb 2002,
http://law.hofstra.edu/pdf/facwor_gey_paper.pdf , accessed 07-11-09, ET)
It is now apparent that the United States is in the midst of a constitutional revolution. It is a quiet
revolution, for the most part. The issues around which the revolution is being fought are so esoteric that
anyone not possessing an unnatural strong interest in the structural aspects of constitutional law will have a
difficult time staying awake long enough to understand the details of what is happening. In short, during the
last ten years a narrow but steadfast fivemember majority of the Supreme Court has used a broad
conception of state sovereignty to expand the power of state government (and simultaneously to
restrict the power of the federal government) in virtually every area in which the two governments
operate. The battle over the new theory of state sovereignty has occurred on four fronts. First, the five
states'-rights Justices have asserted the concept of state sovereignty as the rationale for broadening the
states' Eleventh Amendment immunity from lawsuits brought by private litigants in federal court to
redress state violations of federal law. Second, these Justices have used the concept of state sovereignty
to restrict the federal government's ability to require state officials to enforce national social and
environmental policies. Third, similar state sovereignty concerns have motivated the majority of the
Court to greatly expand the scope of Younger abstention and related doctrines restricting federal court
equitable authority to enforce federal law. Finally, the five states'-rights Justices have used the concept
of state sovereignty as a primary justification for reversing a fifty-year trend of judicial deference and
invalidating several federal statutes enacted under the Commerce Clause. As these examples indicate,
the new constitutional limitations on federal power have spread quickly to several different
constitutional areas, but these decisions are united by the First, in Seminole Tribe v. Florida, 517 U.S.
44 (1996), the Court closed one window for holding states accountable in federal court for violating
federal law by prohibiting Congress from using its Commerce Clause authority to abrogate states'
Eleventh Amendment immunity. Thus, Congress cannot by statute subject states to federal court
jurisdiction in any legislation that is not passed under the Court's increasingly narrow conception of
the Fourteenth Amendment. See Bd. of Trustees of the Univ. of Alabama v. Garrett, 531 U.S. 356 (2001)
(rejecting statutory abrogation of states' Eleventh Amendment immunity in federal Americans with
Disabilities Act on the grounds that the statute was not a valid exercise of Congress' Fourteenth Amendment
enforcement authority)
No link - Congress has the sole authority to administer Indian health care
Wilkins, Professor of History, University of Minnesota, 2006
(David, American Indian Politics and the American Political System, p. 49)
Plenary power, like the trust doctrine, has prove to be a mixed blessing for Indian peoples. On the positive
side, Congress, under its plenary exclusive and preemptive power, has been able to pass legislation that
accords Indians unique treatment that other groups and individuals are ineligible for medical care,
Indian preference hiring practices in the BIA, educational benefits, housing aid, tax exemptions, etc. Such
legislative and policy action is possible, again, because of the extraconstitutional status of tribes, which
places them outside the protections of the Constitution. Tribal members are entitled to these distinctive
considerations, and Congress is empowered to exercise a great deal of authority in Indian affairs
because it must be immune from ordinary challenges which might otherwise hamper the wise administration
of Indian affairs.

219
I.H.S. Affirmative
A2: Medicaid CP
Medicaid inclusion would weaken the federal governments obligation to Native
communities I.H.S. services are a superior option
Ruth J. Katz, JD, MPH, George Washington University, 2004
Addressing the Health Care Needs of American Indians and Alaska Natives, American Journal of Public Health
January; 94(1): 1314
Strategies that have improved access to health care for other underserved populations need to be identified
and studied. Medicaid is one possible mechanism for reaching low-income American Indians/Alaska
Natives, but the community itself will have to decide whether to pursue this approach. Relying on a
state-administered, means-tested entitlement program, as well as on appropriations, may provide greater
financial stability. On the other hand, Medicaid itself is under stress, and such a shift could inadvertently
weaken the federal governments obligation, contained in treaties and case law, to provide health care
to American Indians/Alaska Natives. Other options to explore might include conducting an assessment
of how the IHS deploys its limited resources or proposing federal legislation, accompanied by adequate
appropriations, to redefine the scope of IHS services or expand eligibility criteria.
Expanding Medicaid coverage does not solve the trust doctrine advantage
IHS serviceswhich can include hospital care, outpatient services, or contracted care from private sector
health care providers are provided free of charge to eligible American Indians and Alaska Natives.19
However, there are limitations on eligibility for IHS services. Persons of Indian descent must belong to
the Indian community served by the local facilities and program.20 These eligibility rules effectively
exclude most urban Indians, due to their distance from home reservations.21 Although urban Indians can
avail themselves of alternative health care programs, such as Medicaid and Medicare, they must
qualify for those programs in order to receive care they would ordinarily receive from IHS solely based
on their status as Indians. Furthermore, complete reliance on Medicaid and Medicare denies Indians the
special services to which they are entitled by their former treaties, and thus the federal governments
continuing trust obligation.
Indians would refuse Medicaid cover or not seek treatment only the I.H.S. is trusted
enough to provide coverage
Many Indians who move into urban areas typically do not sign up for health care benefits such as
Medicaid even when eligible. Some Indians feel that it is the federal governments obligation to provide
them with Indian-specific care and so they should not have to enroll in health care programs for the
general population. Some refuse to undergo the Medicaid application process, feeling that it is too
intrusive. Others are misinformed about the nature of coverage through Medicare or Medicaidmany have
been told incorrectly that they are only entitled to apply to IHS for health care services. Still other
obstacles include the expense, time, and skill necessary to complete proper documentation as it is demanded
by various Medicaid enrollment forms, and the varying costs of co-payment requirements, which in some
cases results in the application of liens on patients property when they cannot afford to pay their medical
bills.142

220
I.H.S. Affirmative
A2: Medicaid CP
Medicaid leads to gaps in coverage for urban Indians
Despite these barriers, Medicaid has become an increasingly important financial resource for urban Indian
health providers of direct clinical services.143 Unlike the limited funds available to IHS, Medicaid is an
open-ended entitlement program and has become increasingly essential to funding for many IHS, tribal, and
urban programs. Medicaid provides financial incentives for states to encourage the use of IHS and tribal
health facilities because the federal government provides a matching rate of 100% for services provided
by Tribes or nonurban IHS facilities.145 The 100% reimbursement rate is in contrast to the 57% average that
the federal government typically pays to cover a given states Medicaid costs.146 Not only does the 100%
reimbursement rate remove any financial disincentive a state might otherwise face in paying for covered
services provided to Native American Medicaid beneficiaries. . . because a state doesnt have to commit any
of its own funds, but the matching rate also provides a financial incentive for states to encourage Native
American beneficiaries to use IHS and tribal providers. Unfortunately, services provided by urban Indian
programs do not receive the same 100% reimbursement rate. The effect of this rule leaves urban
Indian health programs in a Medicaid provider category that is less favorable from the states
standpoint.
Medicaid would require Indian programs affiliated as Managed Care Organizations to

receive reimbursement draining resources for services and reducing the availability of
culturally-specific care
As many state Medicaid programs are shifting from fee-for-service to managed care organizations
(MCOs) or primary care case management organizations (PCCMs), urban Indian facilities face significant
challenges as they lack the financial resources or the expertise to become Medicaid MCOs. When urban
Indian facilities cannot reorganize as MCOs, they can either subcontract with a Medicaid MCO in their
service area or remain unaffiliated with any MCO. Both these options would seriously affect patient
volume and Medicaid revenues. While the only practical option may be to subcontract with one or more
Medicaid MCOs or PCCMs, there is no assurance that urban Indian health programs will be able to
affiliate on terms that are favorable to their organization. If urban Indian programs received the 100%
reimbursement rate that other IHS and tribal providers receive, then they would stand a greater chance of
successively qualifying as MCOs or PCCMs. The likely result of these structural changes to Medicaid is
to force Medicaid-eligible Indians to enroll in an MCO or PCCM that is not affiliated with the IHS or a
tribe. Consequently, an urban Indians ability to choose a culturally appropriate provider would be either
greatly reduced or eliminated.
Medicaid raise malpractice insurance for urban Indian providers jacking coverage
Finally, urban organizations are not protected by the Federal Tort Claims Act.Providers of urban
Indian health care must therefore bear the high cost of malpractice insurance, creating a major barrier
in efforts to become direct medical service providers. Proposals for further improvements in the urban
Indian health care network have been included in the most recent reauthorization draft of the IHCIA, which
will be discussed in Part V.

221
I.H.S. Affirmative
A2: Medicaid CP
Indian participation in Medicaid causes I.H.S. funds to be slashed
For the last half-century, increasing numbers of Native Americans have lived far beyond the borders of
reservations. Their heritage and status as American Indians remains unchanged, as does the federal
governments obligation to fulfill the promises made to their tribal ancestors. Federal budget proposals
have, in the past, used the amount collected from public insurance programs to artificially inflate the
amount of federal dollars appropriated for Indian health care. This practice contributes to low
participation rates in Medicare and Medicaid because many American Indians fear that participation
in these programs will lead to the gradual elimination of the IHS .

222
I.H.S. Affirmative
A2: Private Actor CP

1. Private actors do not solve our genocide advantage because it does not alleviate US
responsibility to act AND private philanthropy is siphoned off or refused through federal
bureaucracy
Valentine, PhD Candidate, Sociology, Texas A&M, 2008
(Shari, The Genocide that Never Ends: Bush to Veto Indian Health Services Bill, Racism Review,
http://www.racismreview.com/blog/2008/02/03/the-genocide-that-never-ends-bush-to-veto-indian-health-servicesbill/)
Outside philanthropy is bureaucratically prohibited. Some years ago I worked with an organization that
donates medical equipment and supplies to underserved populations. A retiring doctor wanted to donate
cutting edge mammogram, catscan and MRI machines as well as some other equipment to serve Native
Americans. A national corporation agreed to transport the equipment free of charge and a medical supply
company agreed to set it up and service it. The appraised value of the equipment was over 3 million dollars.
For months working with then Senator Ben Nighthorse Campbell, we waded through red tape and forms to
get permission for the equipment. In the end, the equipment was sent abroad because the Bureau of Indian
Affairs would not approve the $575 necessary to build a pad for the MRI machine and $700 to upgrade a
room for the catscan. When we raised the money to pay for these items, we were told that the individual
clinics could not accept contributions and the BIA would need more than 9 months to process the
contributions and could not guarantee expenditure of the funds on the purpose for which we were raising
them. In spite of the investigation and recommendation of the Civil Rights Commission the President
will continue this long tradition. Native Americans have only the Indian Health Service. No amount of
public concern or private philanthropy can even be offered to mitigate the health effects of the
governments centuries of racist policy. The American public likes to think that tactics like giving smallpox
infested blankets to native people are history. The centuries old oppression and systematic extermination
of Native Americans continues and remains invisible to most Americans. In Germany, Turkey, Sudan, we
call that genocide.
2. Doesnt solve trust doctrine - government intervention is necessary to preserve rights

The objections to socioeconomic rights as non-rights embodied in the traditional view has little merit and
persuasiveness. Focusing on the characterization of socioeconomic goods as "positive" rights necessitating
government help as opposed to political-civil rights considered "negative rights" or rights against government
interference, Professor Sunstein has eloquently demonstrated that no rights can be guaranteed by laissezfaire, but rather that all rights, political-civil rights as well as socioeconomic rights, including the right to
private property, require governmental assistance without which these rights do not exist. n135
Sunstein also dispelled, as baseless, objections to socioeconomic [*439] rights on the "pragmatic" ground
that "it would give citizens an unhealthy and even destructive sense of entitlement." n136 The distinction
between domestic U.S. law and international law embodied in the traditional view is also an artificial
one that has little basis in reality. As earlier indicated, international human rights instruments provide "a
common standard of achievements for all peoples and all nations" that no country - neither the U.S. nor Asian
countries parrying and pleading "Asian values" - can exempt itself from. But as worrisome as they are, none
of these problems afflicting the traditional view is the purpose of this section. Instead, its main point is to
show the extent to which the traditional view discounts the U.S. contributions to socioeconomic rights.

223
I.H.S. Affirmative
A2: Private Actor CP

Private companies are contracting with the IHS now, means all the advantages are
disadvantages to the counterplan
Warne, Clinical professor Indian legal affairs program, 2009
Donald, Wicazo SA Review, The State of Indigenous America Series Ten Indian Health Policy Challenges for
the New Administration in 2009, Spring 2009,
http://muse.jhu.edu/journals/wicazo_sa_review/summary/v024/24.1.warne.html, 6-29-09, WPW
Due to signifi cant underfunding, many specialty care services are not available in IHS and tribal
programs. In this setting, IHS and tribes utilize Contract Health Services (CHS) to purchase services
from the 13 S P R I N G 2 0 0 9 W I C A Z O S A R E V I E W private sector. In this way, IHS acts more like an
insurance company that purchases health care services through contracts with private
sector providers as opposed to a direct provider of services. Unfortunately, due to
underfunding, the CHS budget for most service units cannot keep up with demand for services,
resulting in rationing of health care services and dire life or limb requirements for access to
services toward the end of the fi scal year.

224
I.H.S. Affirmative
A2: Tribal Delegation CP

Direct tribal control of health services drains economic resources and waters down health
care the I.H.S. is necessary to self-governance
American Indian Law Review, Volume 21, p. 238-9)
Congress has provided that the trust responsibility remain in self-governance and has been explicit in its
direction that self-governance not be implemented at the expense of tribes receiving IHS services directly.
There has, nonetheless, been no attention given to the fact that, as the IHS downsizes, services to tribes
receiving direct services can only diminish. This in turn exerts tremendous pressure on those tribes
who wished to receive their services directly from the IHS. They naturally feel compelled to join in selfgovernance for self protection, whether they believe it is in their best health care interests or not.
Unfortunately, tribal self-governance in the provision of health care does nothing, in and of itself, to
increase and enhance the very limited pool of health care resources available in many isolated rural
and reservation areas where Indians live. Tribal provision of health care not only threatens to disrupt
the highly integrated system of services provided by the IHS, but may also result in increased costs of
production as tribes compete within and among themselves for these limited resources. Furthermore,
any disproportionate increases in IHS resource allocations to contracting and compacting will reduce
the proportion of resources - and therefore services - available for those tribes which do not participate
in contracts and compacts. This could force tribes to participate in what were intended to be voluntary
programs.
Not all tribes desire control over social services delegating tribal control will cause the
government to withdraw all funding and support for Indian health care and the likelihood
of terminating their federal status
Yet, despite its seeming popularity, not all tribes have rushed to implement administrative selfdetermination. The response has been mixed, with some tribes transitioning rapidly into self-governance
and others more hesitant, in recognition of their lack of experience in the delivery of health care
services.82 Some tribal leaders fear that contracting or compacting may lead to termination by
appropriation, wherein it would be possible for the federal government to deny responsibility for all
aspects of the programs other than funding and subsequently to cut funding. As tribes have already
witnessed with the IHS, it is easy for Congress to cut funding for federal programs.
Continued tribal delegation will collapse the I.H.S.

Another perceived downside to the self-governance trend is that, as tribal shares are removed and the
IHS is necessarily downsized, direct services for tribes remaining with the IHS are systematically
diminished. This decreases a tribes incentive to stay with IHS; otherwise non-self-governing tribes are
pressured to protect themselves by opting for self-governance, regardless of the effect on their health
care, which in turn pressures still other tribes to leave the IHS.114 Thus, the fragmentation of the IHS
delivery system results in a significant downsizing of the entire IHS administrative structure.115 The
downscaling of the IHS is no secret; IHS itself reports that it will continue to downsize relative to the
continued increase in self-determination activity and the transfer of IHS resources to tribal
governments.

225
I.H.S. Affirmative

Tribes do not have the funds to assume immediate and direct control of health services
In Thompson v. Cherokee Nation of Oklahoma,175 the Federal Circuit Court of Appeals ruled that the HHS
breached contracts with the Cherokee Nation by failing to pay the full indirect costs of administering federal
programs.176 Although the contracts require HHS to pay the indirect costs incurred in connection with
program operations, HHS did not pay the amounts in full, blaming the failure on insufficient funds.177
Tribes have argued, from the introduction of the federal Indian self-determination policy, that
indirect cost shortfalls have undermined the policy by forcing tribes to use scarce funds to pay the
administrative burden of federal programs.178 The court in Thompson agreed.
The federal government would cause the CP to withdraw I.H.S. funds

Several features of the ISDA (and its implementation) appear to have opened the door for the federal
government to eventually cease, or at least substantially reduce, financial support for Indian health
care, using tribal self-governance as their ticket out. Sensing this subtle, multi-fronted assault on the
federal governments trust obligation, many tribes have undertaken the task of strengthening that trust
obligation. Prompted by a November 2001 Bush proposal to create a new agency to handle Indian trust
assets, tribal leaders rushed to protect the existence of the BIA.185 Calling the BIA their ugly baby in need
of fixing, tribal leaders argued that without the BIA there was no trust responsibility.186 Since November
2001, several major trust duties have been transferred out of the BIA and into the Office of Special Trustee
(OST), headed by Ross Swimmer.187 Records, probate, data cleanup, and trust systems, all pertaining to the
undervaluation of Indian lands, were given to the OST. The removal of programs from the BIA to OST and
elsewhere prevents tribes from exercising greater control over their affairs because DOI officials are
unwilling to compact and contract for programs outside the BIA.188 Tribes want to be able to contract and
compact for appraisal services. Swimmer determined that the OST will retain the budget for the Office of
Appraisal, but asserted that tribes will still have the ability to contract and compact with OST for the
appraisal function. Many tribes and tribal advocates, however, express growing concern over the expansion
of the OST. An editorial published by Indianz.com, a major forum and source of news for Indian Country,
went so far as to surmise that the White House is conspiring with Congress to undermine the trust
relationship.190 Senator Tim Johnson, a member of the Senate Indian Affairs Committee, recently requested
that the General Accounting Office (GAO) investigate the management and administrative system of the
OST.191 Reports from the GAO and independent accounting firms disagree on the amounts owed to tribal
and individual Indian beneficiaries, with one audit showing that the OST is holding back at least $121 million
from individual Indians, in contrast with the $62 million previously reported.192 Johnsons letter also
challenged the OSTs recent expansion, which has resulted in an increase of 54% in the agencys budget
during the last two years, despite cuts in funds for reservation-level programs at the BIA.193 Members of
the Administration, including Secretary of the Interior Gale Norton, prefer to portray these initiatives as
pro-tribal sovereignty and therefore something that they had expected tribes to endorse eagerly.

226
I.H.S. Affirmative

Devolving control to the tribes will lead to gaps in coverage for urban Indians
The position of urban Indian health care could not be more vulnerable. If the gradual shift towards tribal
self-determination continues, it is unclear what will happen to the already-weak Urban Indian Health
Program within the IHS. It seems likely that tribes will be responsible for providing aid and resources to
urban Indians. If this is so, urban Indian health care may face an even more severe reduction in funding.
Urban Indians, particularly those who have lived in cities for generations, often develop pan-Tribal
communities. Ties with respective tribes tend to wither with time and distance. Many urban Indians struggle
with their identity, never having been completely accepted by the tribes and finding no place in the
Whitemans world.195 The relationship between tribal leaders and their urban counterparts varies widely
from tribe to tribe. Professor Rennard Strickland, founder of the Center for the Study of American Indian
Law and Policy at the University of Oregon, observes that substantial differences exist in tribal attitudes
towards their on and off-reservation compatriots. Some tribes go to great lengths to reach out to urban
Indians, some do not. The decision or ability to do so may depend heavily on the kind of resources to
which each tribe has access. Hence, if tribes are left scrambling for money due to unforeseen shortfalls
in the changeover from IHS to self-determined health programsas were the Cherokees in the indirect
cost contract litigationnot only will the reservation health care program suffer, but off-reservation
urban Indians could potentially risk losing all their federal funding.
The CP excludes 70% of all Indians in the U.S.

The scarcity of resources is certainly a threat to the health of all American Indians, but when nearly
70% of the Indian population resides in cities, the existence of urban Indian health projects cannot
depend on the discretion of tribes, whose interests will surely be in conflict.
Under self- governance Indian Nations get less funding

Carlyle, Ak Chin Indian Community council chairwoman, 06
(Delia M., Hearing Before the Committee on Indian Affairs United States Senate one Hundred ninth congress
second session on oversight hearing on tribal self-governance: obstacles and impediments to expansion of selfgovernment , Us Government Printing Office, , Sept 20, KEH)
Mr. Reinfeld. Well, it depends on the particular program. Federal Highway funds is one of those. The
methodology for contract support and welfare assistance gets to the tribe in two installments, so some
of it gets later in the year when there is a better knowledge of the needs, the full need level that could be
funded. Those are capped appropriations, so the tribe does not get 100 percent, but there is a pro-rata
reduction to keep it within the appropriation limit. The Chairman. Let me get this straight. The tribe
enters into a contract with somebody to provide a certain service and they agree to pay that contract to
that organization, whatever it may be, only they don't get the full amount of money to pay it. Now, if I
were a tribe, I would say to heck with that. I will just let the Government pay it. Mr. Reinfeld. The
appropriation language does limit the amount that can be spent for the contract support and for the welfare
assistance. So to keep within that appropriated level or ceiling, it is pro-rata reduced for all the tribes. The
Chairman. The IHS tells us that approximately one-half of its budget goes to tribes through selfgovernance contracts and compacts. I think that in your written testimony, you tell us tribes have only
contracted for $300 million in the BIA programs. It seems to me IHS has been more successful than the
BIA. Is that a legitimate comment? Mr. Skibine. I am not familiar with the IHS program and funding, Mr.
Chairman.

227
I.H.S. Affirmative
A2: Tribal Delegation CP/Consult CP

Turning policy over to tribal councils ensures exploitation the are corrupt, controlled by
federal officials, and do not represent their people
Barsh, 1993
Tribal electoral politics today is dominated by a rotating spoils system. Coalitions of strongmen and
their families take turns on the council, where they pass out jobs, subsidized housing, and grants until
opposing families demand their turn at the table. There are few long-term policies because the electorate
has grown cynical, and has little confidence that tribal leaders can improve the quantity or quality of
their economy sustainably. The goals of political action are largely distributive, rather than aimed at
structural improvement. This feeds itself relentlessly. Reformers must promise pork to get elected. They
serve an average of only two years in office, and may be recalled even sooner if they fail to reward their
supporters. Moreover, federal officials can easily terminate the careers of any genuine reformers by
reducing discretionary aid flows after their election. In terms familiar to liberal political theory, traditional
tribal systems were designed, in their structures and rituals, to include all relevant parties in decisions-even
animals and the unborn. European parliamentary systems exclude all relevant parties except adult living
citizens, and condition effective participation on having the leisure, literacy, and financial resources to make
politics a profession. Those present and voting are free to steal from the unrepresented.76
Tribal councils are controlled by the BIA and are a vehicle for social control
Barsh, 1993
Historically, tribal councils and courts were organized by Indian agents to help them manage the
Indians on reservations. They were the instruments of colonial administration. Although they did not
always do what they were told, and sometimes even were disbanded or punished for their disobedience,
nineteenth century councils and courts were designed to control Indians and promote assimilation, not to
serve them. While the adoption of the 1934 Indian Reorganization Act was heralded in the nation's capitol as
the end of paternalism, this official fanfare did not prevent the Bureau of Indian Affairs (BIA) from designing
"reorganized"councils along the same basic structural lines as their predecessors. Reorganization simply
achieved greater standardization. The BIA retains residual control through discretionary funding and its
veto power over constitutional amendments (and to varying degrees, tribal legislation). Arguably, tribal
governments have grown stronger and somewhat more independent since 1934, but decision-making
processes have changed little. Rooted in problems of social control rather than the promotion of
families, justice, or equity, tribal governments are ideal vehicles for self-serving elites and
"strongmen."
Tribal governments are a sham the use political violence and arbitrary power to
manufacture consent
Barsh, 1993
The bottom line is power without legitimacy. Tribal governments can collect taxes, lease land, build
housing projects, and jail Indians, but they cannot mobilize Indian people or give voice to their
cultural and spiritual aspirations. Instead, they intensify conflict, disregard civil rights, and even resort
to political violence to suppress dissent. Tribal governments view all possible political competition with
suspicion or hostility: formal political parties, trade unions, social and religious organizations, private
businesses. All criticism is met with admonitions of the need for unthinking loyalty to "the tribe," or
charges that the critics are undermining "tribal sovereignty." Who is "the tribe" if not its citizens-who
after all, are, mostly relatives? The separation of "the tribe" from the people in contemporary American
Indian political rhetoric is a disturbing development, which hails the emergence of "the state" as an entity
with rights and privileges quite distinct from living, breathing human beings. Indians have grown very
Westernized, indeed, if they accept the existence of such an imaginary Leviathan within communities of a
few thousand people! In fact, what has emerged is the one-party state, which condemns dissent as
foreign-inspired subversion and limits politics to personality disputes among a clique of strongmen.

228
I.H.S. Affirmative
A2: Courts CP
Courts epically fail on issues of tribal sovereignty. Even if they fiat the court rules in their
favor this time, it will cause them to waste resources in other court cases that they will lose
With regard to Indian land claims and in the Indian Gaming Regulatory Act, McSloy emphasizes that
Indians should stay out of court, unless, for whatever reason, the federal government is clearly on the
Indians side. He goes on to conclude that Indians should make deals instead of becoming all- ornothing litigants, stating flatly that Indian nations should get out of the sovereignty talk, get out of the
rights talk, and get out of the constitutional talk, because it is not going to work before the current
Supreme Court. Litigation is only one weapon in the arsenal of tribal sovereignty it should not be a tribal
way of life. The best way for the canary to survive is to stay out of the mine.3 Various aspects of current
ambivalence toward federal Indian law can perhaps be better understood by considering the possibility that
majority domination often finds its ultimate expression in the legal system, which is troubling in a very
fundamental way, especially if that law can be said to echo the colonial experience of American Indians. If
lawyers and ultimately the Supreme Court are now in fact the ultimate decision makers regarding social,
economic, and environmental 11 issues, it means the least democratic branch of the American
decisionmaking process has control of American society and culture. Furthermore, if that branchs
decision making is significantly biased, society and culture cannot shift and grow, making them vulnerable
to the consequences of failing to understand the complexities of intercultural interaction. Needless to say,
such complexities are now recognized as integral to very serious matters such as conflicts with Middle
Eastern cultures. Understanding and dealing effectively with such complexity appears increasingly
subordinated to the overriding authority of lawyers and a maelstrom of judicial freewheeling that
leads in a direction that has proven very problematic for tribal peoples. Within this paradigm the legal systems
analogical exercises seem more ad hoc than adept, more Anglo- centric than analytical. Furthermore, it reflects a kind of narcissism that
not only controverts the values upon which this nation was founded, but tends to affirm that the United States is yet another colonizing
entity in the violent and destructive tradition of so many others who have gone before.
Nowhere is this more apparent than right here at home, in relations between the mainstream and American Indians, where
congressional responsibility for decision making has been displaced by judicial freewheeling that has
created a form of common law that favors the mainstream over Indians. The most obvious examples are
those where large numbers of non- Indians have managed to ensconce themselves in Indian Country,
usually motivated by profit, and where they then enjoy overwhelming support from the mainstream
legal system, which finds ways to rule in their favor, often against both precedent and reason. Such an assertion can be demonstrated
by examples such as that of the Ninth Circuit Court of Appeals, which has jurisdiction over the western states probably most
representative of the complex notion of Indian Country. That court has consistently protected tribal sovereignty, from its 1981 ruling in
United States v. Montana, in which the court affirmed tribal rights to regulate hunting and fishing on reservation fee land, to its 2001
ruling in Atkinson Trading Co. v. Shirley, in which judges ruled that tribes could tax non- Indian businesses on reservation fee land. The
United States Supreme Court, however, overturned both decisions, in addition to many other American Indian cases decided by the
Ninth Circuit, which is a reflection of its ad hoc common law approach.

229
I.H.S. Affirmative
A2: Courts CP
The courts deal with Native Americans on stereotypical and problematic grounds, enticing
them into legal strategies undermines sovereignty
For example, it is of great concern why the Court would so consistently ignore contrary statutory language as
well as legal precedent in refusing to allow Indian people to exercise jurisdiction over non-Indians on their
own reservations. One conclusion that can be drawn is that the problem the Supreme Court has with Indians
exercising such jurisdiction is based on negative stereotypes.
Although associating stereotypic thinking with an entity such as the Supreme Court is troubling, precedent for such an assertion exists
12 in the fact that the Supreme Court affirmed establishment of concentration camps for Japanese Americans during World War II. When
one of those Japanese Americans, Fred Korematsu, challenged that policy, the government defended by citing a list of racial stereotypes,
including assertions that Japanese Americans were emperor worshipers who kept to themselves in cliquish communities, refusing to
assimilate, and thus could not be trusted.4
Whether it is true that American Indians continue to be perceived to a certain degree through stereotypes, it does seem possible there is
some basis, going back as far as the mythological sale of Manhattan for sixteen dollars worth of beads, to say nothing of the language
found in the first great case of U.S. Indian law, Johnson v. McIntosh: On the discovery of this immense continent, the great nations of
Europe were eager to appropriate to themselves so much of it as they could respectively acquire. Its vast extent offered an ample field to
the ambition and enterprise of all; and the character and religion of its inhabitants afforded an apology for considering them as a people
over whom the superior genius of Europe might claim an ascendancy.5 The subsequent doctrine of discovery as well as the
congressional plenary power doctrine come from this language of Johnson v. McIntosh, which is thought to have established the
rationale for affording Indians inferior rights because of their character and religion. It might also be asserted that, when the language
of savagery was eliminated during the Warren Court years, the Indians won in court. The Rehnquist Court of the present time, however,
has reintroduced problematic language. For example, in Oliphant v. Suquamish Indian Tribe, in 1978, the Rehnquist Court
stated:
The effort by Indian tribal courts to exercise criminal jurisdiction over non- Indians . . . is a relatively
new phenomenon. And where the effort has been made in the past, it has been held that the jurisdiction did
not exist. Until the middle of this century, few Indian tribes maintained any semblance of a formal court
system. Offenses by one Indian against another were usually handled by social and religious pressure
and not by formal judicial processes; emphasis was on restitution rather than punishment.6
Whether or not tribes maintained court systems in the past, the Suquamish certainly did at the time of
Oliphant, which has come to stand for the implication that white people must be protected from Indian
jurisdiction because the Indians and their systems are inferior. Although 13 such thinking needs to be confronted,
both in and out of court, Indian court systems must also take care not to play into it as well, such as when they seem reluctant to
cooperate with mainstream legal and business communities. As a result, it is important that Indian people take the time to explain
cultural traditions and the ways they do things in order to avoid replicating the kinds of behavior they find insensitive in others.
Although understanding the role problematic thinking may have played in allowing the Supreme Court to develop common law doctrine
is necessary, it is equally important to understand the history and evolution of that doctrine. Such comprehension begins with the fact
that, by law, Indian tribes retain all aspects of sovereign nations except the ability to bargain with
foreign countries or to transfer lands on their own. The tribes can bargain with the U.S. government, which they have,
and they are subject to Congresss plenary power over them, although it takes an Act of Congress to activate that power, according to
the law.7 Tribal sovereignty is based on three principles: first, prior to European contact, a tribe possessed all the powers of any
sovereign state; second, European conquest terminated external powers of the tribe, e.g., its power to enter into treaties with foreign
nations, but did not affect the internal sovereignty of the tribe, e.g., its powers to govern itself; third, tribes retain internal sovereignty
subject to treaties and by express legislation of Congress, construed narrowly to protect tribal interests and interpreted as the Indians
would have understood them.8 This can be confusing because it can be interpreted, from some angles of vision, that tribal sovereignty
has consistently been upheld from the time of Worcester v. Georgia in 1832, including Talton v. Mayes in 1896 and in Lone Wolf v.
Hitchcock, where the Court also concluded that Congress had plenary power over Indians, a power the Court deemed political and not
subject to control by the judicial branch of government.9 In other situations, however, sovereignty has gone by the wayside.
The basic respect for tribal sovereignty reflected in the foundations of Indian law should not be overstated, however, given the fact the
tribes were not left with much over which to be sovereign at the end of the early stages of colonization of American Indians by western
Europeans. Nevertheless, it was considered politic to advertise trust and cooperation as the hallmarks of relations between the colonizers
and the tribes, to the point that, for years, treaties and statutes were described as being construed narrowly to preserve tribal sovereignty
except in the case of clear statutory language or congressional intent. Tribal sovereignty, on its face, would seem to
clearly give Indians authority over everything they have not lost due to original contact, ceded in
treaties, or lost by clear congressional action, including jurisdiction over non- Indians who enter Indian
country. This has not proven to be the case, however; in fact, the Supreme Court has consistently
supported nonmember complaints over tribal authority.

230
I.H.S. Affirmative
A2: Courts CP
Courts consistently rule against Native Americans and undermine their self-determination
the court is the primary instrument of American colonialism
Canonical legal process in federal Indian law means Indian lands can be diminished only by clear
congressional intent. Furthermore, the Court insists that it has not abandoned the canonical method, and, in a
sense, it has not. To understand this, however, it is necessary to look behind the veil of stated policy. To
begin, it is necessary to understand and accept the fact that the American justice system is an instrument of
colonial government engaged in an ongoing displacement of indigenous peoples.
Support for this exists in the argument that, where there are significant populations of non-Indians in
Indian country, the Court consistently favors non-Indian interests over tribal legal autonomy and
geographical sovereignty, even going so far as to reduce geographical sovereignty by changing
reservation boundaries so that non-Indians are free from tribal control.
The Court has also seriously undermined tribal sovereignty by ruling that tribes have no criminal and
only limited civil jurisdiction 16 over nonmembers found on reservations.17 For example, cases
involving tribal authority and criminal and civil jurisdiction over non-Indians are significantly
inconsistent, with some affirming tribal authority, some denying it, and others contradicting earlier
rulings. Williams v. Lee18 and United States v. Mazurie19 are civil cases supporting tribal authority over both Indians and nonIndians in disputes arising on reservations. Three years after Mazurie, in Oliphant v. Suquamish Indian Tribe,20 the court held that
Indians do not have criminal jurisdiction over non-Indians absent affirmative delegation of such power by Congress.21 Duro v. Reina
22 subsequently held that the tribe lacked criminal jurisdiction over an Indian who was not a member of the tribe bringing the suit.
Following its rulings precluding criminal jurisdiction, the Court took up civil jurisdiction again in Montana v. United States, 23 Brendale
v. Confederated Tribes & Bands of the Yakima Indian Nation,24 and South Dakota v. Bourland.25 In between addressing civil
jurisdiction in these three cases, the Court had also considered tribal taxation of nonmembers in Washington v. Confederated Tribes of
the Colville Indian Reservation26 and Merrion v. Jicarilla Apache Tribe.
The Supreme Court is the leader in the erosion of tribal sovereignty by removing a variety of
tribal rights
Riley, J.D, B.A, attorney, professor of law at UCLA, Justice of the Supreme Court of the
Citizen Potawatomi Nation of Oklahoma, 2008
(Angela, (Tribal) Sovereignty and Illiberalism, California Law Review, Vol. 95:799, MEL)
Despite an early history of affirming tribal sovereignty, the Supreme Court has also had a hand in its
diminishment. Several scholars now contend that "it is the Court, not Congress, that has exercised frontline responsibility for the vast erosion of tribal sovereignty."^'* In the past few decades, the Court has
significantly deviated from the early principles of federal Indian law to erode tribal rights.^'^ For
example, despite ICRA's robust protections for defendants subject to tribal criminal prosecutions,^'^ the
Court has held that tribes do not have the ability to prosecute non-Indians who commit crimes on
tribal lands,^'' resulting in serious challenges for law enforcement on reservations.^^" Recent cases by
the Court also reflect a trend towards diminishing tribes' civil jurisdiction over nonmembers as well.
For example, the Court has held that a tribal court lacked civil jurisdiction over both a tribal member's
wrongful search and seizure claim against state officials acting on tribal land,^^^ and a tort action arising
from nonmembers' automobile accident on a state highway running through the reservation. These decisions
reflect the growing gap between the Court's current Indian law jurisprudence and the realities of
tribal life.Congress's ambitious use of its plenary powerupheld by the Court served as an early
assimilative force and threat to tribal sovereignty. ^^^ Today, the Supreme Court's role in shrinking the
boundaries of tribal sovereign authority has resulted in a renewed assault on Indian nations. ^^* As the
pendulum swings to and fro in regards to Indian policy, the current vulnerability of tribal sovereignty is
evident. ^^^ But limitations on tribal sovereignty, however damaging, have not destroyed the living
sovereignty of Indian nations.

231
I.H.S. Affirmative
A2: Courts CP
The American Indian never wins when courts get involved. The legal system is built to
maintain the status quo.
Meister & Burnett, Associate Professor of Communication, and Associate Professor of
Womens Studies, both of North Dakota State University, 2004
(Mark & Ann, Rhetorical Exclusion in the Trial of Leonard Peltier American Indian Quarterly, Volume 28,
Numbers 3 & 4, Spring/Summer Issue, Pages 735-736. MAG)
An examination of the U.S. v. Leonard Peltier trial transcript reveals that Peltier and other American
Indians were rhetorically excluded through language that emphasized that American Indians are
different, that created fear for the American Indian, that painted a picture of a trial that was
prejudicial and confusing, and that degraded and demonstrated little respect for the American Indian.
In addition, we have extended the notion of rhetorical exclusion by focusing on the trial transcript, the
official record of the trial that has been used countless times in appeals and dismissals of this case. Each time
this official record is used, American Indians and Peltier are further de-legitimized. While countless
advocates have claimed for years that Peltier was denied a fair trial based on the lack of fairness on the part
of the trial judge, this article demonstrates two ways in which Peltier was robbed of his power. First, trial
participants, including the judge, many of the attorneys, and jurors, came to perceive Peltier as different from
them, an Other. By disallowing critical testimony and allowing the prosecution free rein with their sometimes
tainted and slanted evidence, the dominant hegemony was able to mask its identity as the law and to
portray Peltiers identity as the violent savage. As a result, the federal authorities had power and control over
Peltier and the American Indians in the trial. To some extent, this power and control were reflected in the
overt lack of respect given to American Indians throughout the trial and ultimately was reflected in the
verdict and sentencing. Second, the U.S. legal system in the Peltier case inadequately accounted for
American Indian conceptions of power and legitimacy. The voice of the law, as dictated by Judge Benson,
was enough to silence any cultural intrusion inconsistent with the legal consciousness of the federal court
system. The rationality of the federal court system contains a vast number of legal rules, arguments,
theories, and hierarchies that seem foreign to those without a vested interest in maintaining the
institutional power that these communicative constructs support. Moreover, the law constitutes a
competition between sides whose tactics include evidence, decorum, communication style, and money.
The competitive nature of the law reinforces the distinction between mainstream American culture and
that of American Indian culture. American culture is comfortable with competition and gamesmanship.
Reinforcing this emphasis on competition is a complex set of legal and legislative rules and theories
that provide reassurance and comfort to members of the dominant Caucasian American culture.
The courts will terminate tribal sovereignty

Haskew, Managing Attorney, DNA-People's Legal Services, Navajo Nation, 2000
(Derek C., Federal Consultation with Indian Tribes: The Foundation of Enlightened Policy Decisions, or
Another Badge of Shame? American Indian Law Review, Vol. 24, No. 1 (1999/2000), pp. 21-74)
Whether this development is an anomaly, or a determined change of course remains to be seen. Given these
trends, however, to say that the Court is probably hostile to Indian interests in tribal sovereignty risks vast
understatement. This trend gives Native Americans and tribes a strong incentive to stay out of federal court:
"One can only hope that Rehnquist loses his majority before his judicial agenda completely devastates tribal
sovereignty."62

232
I.H.S. Affirmative
A2: Consult Natives CP

Counterplan doesn't solve. It doesn't go far enough to challenge existing power
structures.
07
(Sandra Lee, Culture and cash: how two New Mexico pueblos combined culture and development, Alternatives:
Global, Local, Political, January 1, Page 9, 32:1, EKC).
Critics of participatory approaches argue that the focus on dialogue and process ignores power,
institutions, and the limited ability of indigenous and minority peoples to stake a claim on their
interests. (16) Another unstated problem is that culture is framed only as epistemology and is therefore
interpreted as a set of perspectives, stories, or values that can be shared in the planning process
without attention to the role of social and cultural institutions in transmitting, retaining, and applying
indigenous knowledge. Although social learning approaches to planning addressed some of the cultural
hubris of 1960s modernization theory, which assumed traditional societies must follow a linear and linked
psychological, social, and economic process of development, Friedmann claims that only radical planning
can challenge the power structures and epistemologies of rational planning. (17) Friedmann's radical
planning and alternative development, however, assume a universal political solution to asserting minority
knowledge and goals--civic society and democratic institutions that empower households. (18) Lane and
Hibbard recently applied the radical-planning lens to indigenous cases of negotiated natural-resource
management because these communities identified and implemented strategies to confront institutionalized
oppression. (19) Rather than describing how these communities applied their political systems to planning,
however, they assumed a participatory internal process while focusing on the importance of state-recognized
rights to empowerment. Identifying this process as radical planning may obscure more than it reveals.
Consultation is a method of manufacturing consent and betraying Indian nations

The image of an Indian and a white man meeting to talk is evocative of the romanticized negotiations of
yesteryear. This image in turn is inextricably linked to lore of the Indian, defeated by fate yet participating in
good faith, and the white man's subsequent betrayals. I will not examine the lore,9 but offer the image as a
starting point for the argument that consultations may be one method by which that betrayal is
perpetrated today. By this view, the purpose of consultation requirements is to satisfy the desires of Native
Americans to be involved in decisions that affect them, while not binding the government to anything
resembling a commitment. Consultations, therefore, may confuse the real consent of Indian communities
to federal actions with the procedural illusion of participation, in which Indian consent is never really
asked for, and advice is never really heeded. A more savory view of consultations is that government
recognizes the wisdom of considering the unique perspectives of Native Americans during policy debate, and
is making every effort to incorporate those views and interests in federal planning. Or, finally, consultations
might be described in both of these ways, depending on which players and which projects are being
discussed. Whichever view we choose to adopt at the outset of this inquiry, it should be clear that what may
be at stake in consultations is the heart of this nation's relationship with its indigenous population.

233
I.H.S. Affirmative

Consultation undermines federal-tribal relations
The fact that the vague term "consultation" is used to indicate two distinct types of requirement one
enforceable, the other not is elusive. Nowhere is that distinction laid out except implicitly (and, as illustrated,
the federal appellate courts have not resolved the issue between themselves). Interested parties are unlikely to
have a comprehensive understanding of the source of the authority and of the legal weight of the various
federal policies, regulations, internal management documents, case law and statutes wherein the consultation
requirements are found (assuming to begin with that such a reader ? or an Indian law practitioner, for that
matter ? had the savvy to know how and where to access the relevant documents). Because there are no
differences in the term's common usage, there are also no clues to prompt such a search for the precise
meaning of the term unless one is prompted to do so by the details of a legal battle. In the meantime,
everyday usage is apt to confuse the two referents. The fact that "consultation" has entered into the
terminology of federal-tribal government relationships means that confusions will likely continue. As a
result, consultation requirements ultimately will damage federal-tribal relations.19 Tribes know that
consultations can be beneficial, as they may be the sole means of official communication between a tribe and
an agency whose actions may impinge on tribal interests. However, to the extent that an agency is legally
able to ignore its own "internal management" policies which is to say, to the extent that the policies or
rules do not create legally enforceable rights a federal agency's poor behavior may reduce the tribes'
willingness to work with the agency, whether the consultations are "enforceable" or not.
Consultation causes federal dependence

The problem with confused and confusing meanings is dwarfed by the larger problem with consultations,
which is the fact they are merely procedural by nature. If tribal suggestions and requests are disregarded,
discounted, misunderstood or ignored when they are solicited, federal-tribal interactions are apt to be
viewed ever more suspiciously by tribes. This is a familiar phenomenon, perhaps especially to tribal
authorities. Like the parable of the boy who cried wolf, the government that clamors for "consultation"
without providing substantive influence on the decisions is likely to soon be viewed with greater and
greater indignation, and then ignored. The wolf-crying metaphor works on both levels of the problem,
with reference to the confusion over the meaning, and with reference to the results of the consultation effort.
Worse, tribes may develop a "learned helplessness" response, after years of being taught that whatever
they say, the only thing worth spending energy on is learning to cope with the imposition of
unacceptable alternatives. The federal agency may in turn interpret the resulting tribal nonresponsiveness
as intransigence, or hostility (appropriately), and may in the end make decisions in reaction to those
interpretations instead of in reaction to tribal suggestions (inappropriately). Obviously any combination of
these possible results is likely to further damage the interests of the tribe. So this remains the everpresent criticism of consultation: even in instances where there is a statutory duty to consult, there is no
duty to be bound by the suggestions of the consult?es, and therefore consultations are ultimately
worthless. However accurate that conclusion may be, the specific failures of consultations require more
careful attention.

234
I.H.S. Affirmative

The BIA will redefine consultation to avoid implementing tribal suggestions
The court then found that even if the Guidelines had binding effect, the BIA had substantially complied, and
gave this definition of consultation: "Consultation is not the same as obeying those who are consulted. The
Hupas were heard, even though their advice was not accepted."
The BIA uses tribal conflicts during the consultation process to justify inaction and slow
implementation
Consultations may be used by federal bureaucracies to hinder progress by their very existence. One
long-time tribal official reported to a Senate committee: We may have reached a point at which the
Bureau [of Indian Affairs] has discovered that its best defense is the very thing it has for so long feared
tribal consultation. The Bureau is now able to use the apparent conflicts among the views of different
tribes as an irrefutable reason for inaction. Another observer reported to the same committee, "the
Bureau of Indian Affairs has no consistent philosophy regarding the obligation of consultation and the
provision of information to Indian tribes and people."
The BIA will reinterpret Indian interests in the consultation process to reflect BIA interests
While the scope of these problems is debatable, the frustrations could not be more clear. Further, the charges
leveled against the BIA can be read in the context of the agency's widely known reputation for
exemplifying the worst stereotypes of bureaucratic inertia. Given what has already been noted about
the uncertain nature of consultation requirements, it is not surprising to find evidence that they may be
twisted to fit the uses of government bureaucrats. There is, however, testimony to the effect that these
problems are avoidable: "[E]arly consultation with the public and affected States and Tribes ... can help save
money by identifying important issues and avoiding unnecessary or insufficient analyses. We anticipate cost
savings from these initiatives of at least $9.0 million over the next five years. Consultations may lead to
enlightened policy choices, but perhaps this result occurs only when consultations are overseen by those
already aware of and interested in pursuing ? their most laudatory exercise. The fate of Indian interests
should not pivot on the random chance that consultations will be overseen by enlightened civil
servants.

235
I.H.S. Affirmative

There are no formal mechanisms for consultation nothing guarantees implementation of
tribal interests
An agency that carefully, and in good faith, considers every decision it makes is not necessarily equipped, by
that effort alone, to make the best or even the right decisions. However, a certain amount of human error in
decision making is acceptable. Additionally, there is no reliable mechanism available to measure the
wisdom of a decision, and even apparently wise decisions may sometimes render the least favorable
results. Nevertheless, we take exception to egregious errors, and have codified remedies. But what if we
have no reliable mechanism available to alarm us to egregious errors? That is, what if we make egregious
errors, consistently over time, yet we fail to appreciate the errors as such? This situation could arise
from a system that has no checks and balances or self-regulating mechanisms. Or, it could result from a
fundamental lack of understanding of the decision being made; that is, one option is not fully appreciated
by the decision maker and is thus dismissed prematurely in favor of the more familiar option. I briefly
discuss both issues, and address this latter problem as a question of "incommensurability."
Consultation takes a long time to implement

There are several problems with this system. First, exhausting administrative remedies can be a long,
expensive process that may be incompatible with the flow of indigenous lifeways. Second, procedural errors
may be hard to find, and the remedies do not necessarily include a change in the decision. Third, only under
the "arbitrary or capricious" standard will the merits of the case be the focus of the hearing by a federal
judge.226 However, even then, this is a relatively high hurdle, especially in view of the fact that
consultations are nonbinding, for advisory purposes only. These factors may mean that judicial review
remains a remote possibility in most cases, which undermines administrative legitimacy to the extent of that
remoteness.
The trust doctrine solves any net-benefit garnered by consultation

As noted above, regardless of consultations, federal agencies are always responsible to abide by the federal
trust responsibility to Indians. The trust responsibility creates in the federal government a heightened
responsibility to Indian nations with respect to federal decisions that affect Indian trust assets. However, it is
unclear to what extent the trust relationship limits federal discretion, or by what mechanism adherence to that
responsibility is enforced.
Tribal consultation causes interbranch conflict undermining sovereignty

Indian law commentators observe that there is a tension between Congress and the Supreme Court on issues
of tribal sovereignty.52 I argue that one effect of this tension may be that federal-tribal consultation is
important in a way that it never has been before. If so, this newly assumed role for consultation as a central
element of federal-tribal relations, issues regarding consultation will continue to become more contentious
and divisive until some clear resolution is reached.

236
I.H.S. Affirmative

Even in genuine consultation the BIA will not fairly take into account Indian interests
With regard to the second element, consultations involve whatever presentation to the federal agency the
tribe calculates will benefit its interests, and that certainly may include "proofs and reasoned argument."
Whenever possible, tribes argue that a project infringes interests protected by statute, treaty or long-standing
custom. However, there may be a problem with "reasoned argument" insofar as the other party to the
consultation ? the decision-making agency ? may be unable to consider Indian advice fairly and
evenhandedly. That is, the "participation through reasoned argument loses its meaning if the arbiter of the
dispute is inaccessible to reason because he . . . has been bribed, or is hopelessly prejudiced." It has already
been discussed how agencies may be subject to bias that is objectionable in any context, and that would be
fatal to proper adjudications.
Bias prevents genuine consultation

In light of the problems with federal agency administration of consultations, there are significant problems
that correlate with each of Fuller's two requisites for quality adjudications. First, it is not clear that
consultation requirements always, in most cases, or even in a sizable minority of cases, create an
enforceable right in the Indian parties to participate. Second, assuming Indian parties do participate, it
is perhaps even less clear that there is a bona fide opportunity to present arguments that stand a
chance of persuading the decision maker. Federal agency decision makers may be, in Fuller's words,
"hopelessly prejudiced." So it would seem that consultations fail to meet the requirements for either of the
two prongs of Fuller's definition of a "true" adjudication. This does not necessarily show that the consultation
process is not a species of adjudicative proceeding.
Consultation is only lip-service and results in encroachments on Native sovereignty

Given the problems outlined here, and given the ever-present fact that consultation rights where they do
exist ultimately create no substantive duty on the part of the agency, it is difficult to avoid the
conclusion that "consultation" is the latest federal codeword for lip service. But the evidence suggests
that they amount to something worse. By mimicking substantive participation, consultations have the
disquieting effect of masking larger problems with the manner in which the United States government deals
with Indian nations. Consultation requirements bookmark places where federal decision-making
infringes on Indian trust assets, and at present that infringement occurs with inadequate hearing or
review. Consultations undermine, demean and displace a thorough commitment to the federal trust
responsibility, which itself is an archaic and inadequate protection for Indian interests.

237
I.H.S. Affirmative

Consultations provide a weak venue for tribal venues the plan avoids the bureaucratic
inertia of consultation and solves the impact of tribal sovereignty better
Consultations subject Indian interests to conflicts of interest within federal agencies, workaday
political log-rolling, and may be the source of bureaucratic inertia. Unsurprisingly, perhaps, the evidence
suggests that few consultation policies have been formulated in consultation with Indians. For all these
drawbacks, the big payoff that consultations provide is the meager opportunity for Native Americans to
express their opinions and desires ? with no guarantee that their input will be fully considered or even
respected. The process of government-to-government communication suggested by current federal Indian
policy is a laudatory goal. However, an ill-defined consultation policy is no substitute for increased
recognition of tribal sovereignty, or substantive federal commitments to defend tribal interests. While
consultations may be inadequate to provide native nations the voice they deserve, it is staggering to consider
the many decades that Indians were not even allowed this much say in the policies that so intimately affect
their lives. Consultation requirements are seemingly part remedy for and part symptom of these years of
neglect. Congress must recognize that mere consultations are not enough by way of remedy, and that
problems with consultations evidence a much broader malaise that must be addressed.
Consultations are a bigger risk to tribal sovereignty than just enforcing the trust
relationship
The more drastic, and perhaps more difficult, course would be to recognize "consultations" for the
dangerous disservice to Native American interests that they are, and root out this spurious procedure
wherever it is found. This would force a hard look at what rights and responsibilities Congress meant to
give to tribal nations in the first place, and what corresponding rights Congress is willing to cede. This option
lands the discussion squarely in the realm of political maneuvering, which is where perhaps all Indian issues
have historically been decided, so often for the worse. However, whatever features the resolution of this
problem may include, it would seem that the best way to determine the future course of federal-tribal
relations must surely be to formulate the solutions in partnership with Indian nations.

238
I.H.S. Affirmative
A2: Tribal Devolution CP / K alternative

Don't be fooled by their rhetoric of promoting their interests by getting rid of the trust
doctrine it's code for stealing their land and assimilating them. Only the trust doctrine
adequately addresses questions of sovereignty
The competing assimilation paradigm which has dominated other chapters of Indian policy and law during significant periods of history,
n76 is suspect. Granted, some contend that the Allotment policy--perhaps the policy most destructive of Indian sovereignty n77 --was
prompted by genuine advocates of Indian interests who felt that converting Indian people to a Christian, agrarian, "civilized" way of life
and assimilating them into the great American melting pot was a virtuous endeavor and in the tribes' best interests. n78 There is no doubt
that assimilationist pressures persist today. n79
[*131] However, assimilationist policies, even though historically promoted as acts of federal
benevolence toward the Indian people, were in all likelihood prompted at least in part by the majority
society's persistent and insatiable demand for land. n80 Further, as a practical matter, the assimilationist
approach to the "best interests" question presumes only a transitory role for the trust doctrine, and for
tribes themselves. n81 Theoretically, upon full assimilation the law ceases to differentiate between
Indians and the rest of majority society. n82 As a fundamental matter, the trust doctrine cannot be
invoked to [*132] destroy the very entities to which the government holds a fiduciary duty--the tribes
themselves. Assimilationist goals--because they countenance destruction of the tribal entity--are conceptually
inconsistent with Indian trust analysis.
In addition, defining the trust doctrine to embrace tribal separatism and sovereignty is critical to
preserving freedom of choice for native people. As recognized citizens of the United States, Indian
people have the option of assimilation at hand. For those who choose assimilation, civil rights statutes
and constitutional guarantees offer protection of their interests as individuals and as racial minorities.
But for those who seek to maintain a tribal way of life, the range of laws securing individual liberties is
inadequate. Tribal interests find unique expression in notions of sovereign trusteeship and in treaty
promises. Reducing the trust doctrine to standards which promote assimilationist tendencies over
separatism effectively deprives native people of the freedom to choose their own lifestyles within the
larger society.
239
I.H.S. Affirmative
A2: Gifts K
Gifts and protection do not undermine dignity and reflect democratic ethics
Richard A. Couto, Professor of Leadership Studies at Antioch College and Stephanie C.
Eken, Adolescent Psychiatry & Pediatric Psychiatry, 2002
(To Give their Gifts: Health, Community, and Democracy, p. 217-218).
Through the gift relationship, which meets the needs of strangers and expresses our mutual
responsibility for each other, communities and individuals can work to narrow the gap between
democratic values and actual practices. We conclude with reflections on innovative democratic
leadership, the democratic prospect of community, and the democratic premise of the worth and dignity of
every person.

240
I.H.S. Affirmative
A2: Capitalism
The plan promotes indigenous economies that defend against capitalist exploitation
http://www3.interscience.wiley.com/journal/120706827/abstract, p. 30-1)
Embedded in the many dimensions of 500 years of colonization, articulating a political sovereignty that
continues to expand and provide opportunities for self-determination, and facing the realities of significantly
reduced Federal Trust allocations, American Indian communities, then, find themselves at a crossroads. Some
Native leaders like Tom Goldtooth, spokesperson for the Indigenous Environmental Network, assert that the
decisions of the present are as significant as the "ones we had to make 200 years ago when our chiefs were
forced to accept small plots of land" as reservations.16 Duane Champagne, Director of the American Indian
Studies Center at UCLA, suggests that "threats to Indian nations are greater in 21st century than in previous
times, and the need to create an intellectual, cultural, and philosophical justification for self determination" is
paramount, as is the necessity and opportunity for an Indian or indigenous capitalism. Just as sovereignty will
be defined and articulated by individual tribes (rather than "Indians" per se), so would the precise practice of
an indigenous capitalism. The impact of and participation in capitalism is, of course, nothing new for
American Indians; yet the particular contemporary opportunities do present different challenges and options
(Fixico 1998). Thus far, some of the more prominent means of economic development in Indian Country
over the past two decades (beyond simple resource extraction) have involved embracing two of the central
new ventures in capitalism: gambling and garbage (Comaroff and Comaroff 2000). Put differently, late
industrial society has afforded Native peoples new economic niches. Indian gaming, of course, has been an
important means of generating significant income for a good number of tribes, and the passage of the 1988
Indian Gaming Regulatory Act forced greater state and federal regulation of it (Mason 2000). Although
gaming has allowed some tribes to generate significant levels of income, relative to the 550-plus federally
recognized tribal communities in the U.S., only a handful derive truly substantial amounts of income. A key
factor in whether Indian gaming can become a significant economic activity for a particular tribe revolves
around the reservation's proximity to a larger population. Many tribes, of course, live in remote areas, and
thus gaming has not been a significant factor in generating income. One option already discussed for these
tribes has been to take in various forms of garbage from late industrial society. In a sense, the reservation
becomes a sort of "landed corporation," leveraging the unique status of the reservation (legally, politically,
geographically) to provide access to governments and corporations in dealing with something that has
escaped (other) adequate political and/or scientific solutions in dominant society.
Housing these forms of garbage on reservations "off-shores" it in a way not dissimilar to the
ways factories are increasingly located in underdeveloped nations to escape labor, environmental, and other
regulatory issues, or the increasing use of prison populations in the U.S. by corporate America (where wages,
benefits, etc., are likewise slashed).19 More succinctly, the transformations of the nature of political
sovereignty and economic processes in the world over the past decades have created greater opportunities for
indigenous resistance, survival, and self-determination and greater opportunities for indigenous colonization
and exploitation.

241
I.H.S. Affirmative
A2: Capitalism
Indigenous reappropriation of capitalism enables decolonization and resistance to Western
economic exploitation
http://www3.interscience.wiley.com/journal/120706827/abstract, p. 32)
The history of the Skull Valley Goshutes has given them very difficult and health-threatening circumstances
to deal with today. On the one hand, housing nuclear waste on the reservation may afford them opportunities
to partially right some of these circumstances. On the other hand, the Goshute bidand the broader
marketing of nuclear waste to American Indians as means of economic developmentis part of a larger set
of dynamics entailed in the continuing incorporation of American Indian land and life into the shifting
cultures of neo-liberalism. Indeed, the Skull Valley Goshute bid to house nuclear waste as a means of
economic development embodies many of the complex elements of new capitalism: greater sovereignty for
Native communities, marketization of forms of garbage, and the nuclear utility consortium seeking "access"
to Indian lands for storage of the highly radioactive spent fuel rods. One of the hallmarks of the new
capitalism lies in its triumphalist and liberationist rhetorics. The promotions of this most recent application of
market logics often take on a quasi-religious nature, presenting "a capitalism that, if rightly harnessed, is
invested with the capacity wholly to transform the universe of the marginalized and disempowered"
(Comaroff and Comaroff 2000: 292).Can there be an "indigenous capitalism" that would serve an important
role in the further decolonization of Indian communities? Of course. Can the embrace of an indigenous
capitalism be partial in the sense that individual tribes can choose how to engage in marketization? Yes. Yet it
seems to me that the issue is more complex than simply one of rational choice. As Comaroff and Comaroff
(2000: 305) observe: "Neoliberalism aspires, in its ideology and practice, to intensify the abstractions
inherent in capitalism itself: to separate labor power from its human context, to replace society with the
market, to build a universe out of aggregated transaction." Put differently, it is important to see that neoliberalism and marketization are not merely a set of economic principles and practices, but a cultural
orientation that pervades many aspects of a given community's participation in them.

242
I.H.S. Affirmative
A2: Capitalism
Development is good: it solves their economy and dependency on the federal government
White 07
Act, EKC)
CORE CONCEPTS OF THE NATIVE AMERICAN CHALLENGE
The proponents of the Native American Challenge Demonstration Project Act (Native American Challenge) seek to re-invigorate Native
economies by replicating the concepts and principles of the Millennium Challenge Corporation in the form of a demonstration project to
be housed in the U.S. Department of Commerce.The objectives of the Native American Challenge are simple: to
enhance the long-term job creation and revenue generation potential of Native economies by creating
investment-favorable climates and increasing Native productivity.
The Native American Challenge would also seek to administer Federal economic development
assistance in a novel manner to promote economic growth, eliminate poverty, and strengthen good
governance, entrepreneurship, and investment in Native communities.
A corollary, but equally important, objective is to improve the effectiveness of existing Federal economic
development assistance by encouraging the integration and coordination of such assistance for the
benefit of Native economies. Accordingly, the Act requires that any assistance provided must be coordinated with other Federal
economic development assistance programs for Native Americans.
To avoid any ambiguities in the proposed operation of the Native American Challenge, the Act provides that economic development
funds appropriated to the following agencies which eligible entities otherwise benefit from shall be transferred at the request of the
eligible entity to the Secretary for purposes of inclusion in compacts to be entered with eligible entities.
(a) Department of Agriculture;
(b) Department of Commerce;
(c) Department of Energy;
(d) Department of Health and Human Services;
(e) Department of Housing and Urban Development;
(f) Department of the Interior;
(g) Small Business Administration; and
(h) Such other agencies and instrumentalities of the United States government as the Secretary determines appropriate.
Assistance may be provided in the form of grants or technical assistance but may not take the form of
loans. Additionally, assistance under the Act may not be provided for any project relating to gaming or
gaming-related activities conducted pursuant to the Indian Gaming Regulatory Act, 25 U.S.C. 2701 et seq.
Consistent with the philosophy of the Millennium Challenge Corporation, the rationale for the Native
American Challenge is to acknowledge that communities that have made the threshold decision to
improve their economic conditions and evince a readiness for development are precisely those that
show marked signs of economic progress because of increased investment and economic activity.
Indigenous economic development solves poverty and paternalism

White 07
Act, EKC)
A development-ready community is one that has taken steps on a number of fronts that are proven to
encourage local entrepreneurship and attract outside investment such as improving schools and
education, reducing legal and regulatory barriers to business and community development, and
reducing violent crime within the host community. The Native American Challenge is intended to provide Federal
assistance, over and above the funding that is currently available, to those Native communities that are determined to be eligible
entities by the Secretary of Commerce (Secretary) and are therefore poised to negotiate and enter into a bilateral compact with the
United States. The Native American Challenge would be a novel Federal initiative with the mission of
reducing poverty in Native communities. It will rest on four key principles that are as relevant to
Native communities as they are to the developing world.
1. Reducing poverty through vigorous private sector economic growth is a proven method of success;
2. Rewarding constructive policies that are initiated and followed by the host government is a
legitimate tool of United States policy;
3. Operating as true partners with eligible entities increases the chances of success by maximizing
communication and identifying and pursuing whatever mid-course corrections might be needed in
tailoring an eligible entitys development plan; and
4. Focusing on clearly-articulated criteria and concrete results by funneling Corporation attention and
resources on those countries that have clear objectives, are willing and able to measure progress, and
can therefore ensure accountability in their development plan.

243
I.H.S. Affirmative
A2: Capitalism
Tribal control over economic development solves the link - integrating aspects of the
western economics helps preserve Native American culture
Champagne and Goldberg, professor of sociology/on the Faculty Advisory Committee for
the Native Nations Law & Policy Center at UCLA, and law professor at UCLA, 2005
(Duane and Carole, Changing the Subject: Individual versus Collective Interests in Indian Country Research,
Wicazo Sa Review, Spring, 20.1: 49-69. EKC)
Many contemporary Native governments and communities are starting to assert their inherent right to land and self-government by
meeting the economic, political, and cultural challenges of the twenty-first century. While resources and opportunities vary considerably
among the hundreds of Native communities in North America, most Native nations are striving to gain greater
responsibility over their communities through strategies of economic development, renegotiating

relations between tribal and federal governments, and reintroducing Native history and culture into
reservation institutions, education, and government. Native communities, generally, wish to participate in the rapidly changing
and globalizing world but want to approach the future through the vehicle of their own values, culture, and history. In many ways, the challenges of the
future are both exciting and dangerous. Native communities may develop many creative ways to preserve their communities and cultures, while
accommodating to the intensity and globalization of the world economy, culture, and technology. On the other hand, the forces of markets, globalized
culture, technology, and information may threaten to undermine the institutions and values of Native communities.
Research, science, technology, and information are all issues that Native communities will need to
confront more directly than ever before to avoid becoming victims of the new and changing world
order. For example, who should have access to and financial benefit from Natives traditional
knowledge about the medicinal uses of plants found in their ancestral territories? Who should have access to and
financial benefit from DNA information about members of Native nations, when that information might prove useful for the prevention or treatment of
diseases? Who should have access to and financial benefit from research conducted on the remains of Native nations ancestors, research that might bear on
matters of health, diet, and group history? Who
should have access to and financial benefit from Native stories, songs,
and ceremonies that have sacred value to their communities but also artistic or academic value to
outsiders? Over the past century, Native nations have witnessed such information taken without their
consent and not for their benefit. Should this experience make these communities reflexively resistant
to research, science, technology, and information, placing obstacles in the way of researchers wherever
possible? Such a stance will surely operate to the detriment of the outside researchers and global consumers
of their work. But it will jeopardize Native nations as well. In order to survive and persist, Native
communities will need to manage technology and science and use it to their advantage. For the
immediate future, the globalization process will not go away, and no community, no matter how isolated, will
be able to hide away and avoid influence. The pace and intensified globalization of the twenty- first
century may make the threats to Native communities even greater and more subtle than the federal
policies of the last centuries. In order to not become victims of technology, which can be used by forces
whose values, interests, and goals conflict with those of Native communities, Native nations will need to
adopt and manage technological and informational change as a means to defend their land, rights to
self- government, and cultures.

244
I.H.S. Affirmative
A2: Capitalism
Turn - Tribal economic development enables self-sufficiency within and against Western
capital
Champagne and Goldberg, professor of sociology/on the Faculty Advisory Committee for
the Native Nations Law & Policy Center at UCLA, and law professor at UCLA, 2005
(Duane and Carole, Changing the Subject: Individual versus Collective Interests in Indian Country Research,
Wicazo Sa Review, Spring, 20.1: 49-69. EKC)
The conscious nation-building strategies emerging within Native communities belie the widespread belief among non-Indians that Natives were acted upon
rather than active in their own recent history. Generally, nation-state policy makers have believed that they would prevail to transform and detribalize Native
communities and individuals, who would assimilate into the rapidly changing modern world. In recent decades, however, Native
communities
have been actively seeking self-sufficiency and community/cultural preservation. These Native
communities face the challenges of creating more functional governments, preserving and reviving
culture and language, accommodating to the demands of the market economy, and retaining and
building durable community institutions in the new global environment. Science, research, and information are key
elements in the new world order, and Native nations will need to address how they will manage and utilize research about Native peoples.1 Obtaining good
information and research about Native communities will help attain many Native goals of cultural, political, and economic survival.
Research, science, utilization of technology, and distribution of information will serve Native nationbuilding efforts and goals. Much of the research potentially useful to Native communities will necessarily be undertaken by
researchers who are not tribal members. A question arises about whether the goals and values of the nontribal
members will prevail, or whether the research will in fact prove to be of value to the Native community. The general perception
within the Native communities for many years has been that scientists, often anthropologists, have been exploitive
about information collecting on reservations. Many individual anthropologists and other scientists
have been friendly and longtime political allies to Native communities and tribal members. Nevertheless,
especially during the 1930s through the 1960s, Native communities concluded that too many anthropologists and social scientists took valuable information
and artifacts from them without using this material to benefit the communities themselves. Many Native communities were under considerable duress
during this period, when children were sent to boarding schools, and most Native social and political institutions were under the control of the Department
of the Interior. Native communities were being disassembled by assimilation policies, and the perception persisted that anthropological, historical, and social
science information was used to develop theories and strategies aimed at destroying Native institutions, culture, land rights and government.2 Sacred
objects, art, the remains of ancestors, pottery, and many other objects were collected by professionals and nonprofessionals, resulting in a massive
desecration that ignored Native traditions and understandings.3
Turn the alternative to the trust doctrine enables private corporate interests only the
affirmative protects tribal interests against capitalist exploitation
The second factor involves the complexities posed by potentially competing interests in the Indian trust context. Unlike the realm of
private trust law where a fiduciary's obligation is owed exclusively to the individual beneficiary, the government's role as a
fiduciary often involves simultaneous accountability to competing constituencies. This is true, for
example, where the government manages shared resources, such as water or wildlife, in which a sector
of the non-Indian public and a tribe may have rivaling interests. The Indian trust doctrine must
therefore incorporate a standard to weigh or prioritize the obligation owed to the tribe against these
countervailing public interests. The absence of such a standard leaves tribal interests vulnerable to de
facto subordination through political processes traditionally dominated by powerful non-Indian
constituencies. N11

245
I.H.S. Affirmative
A2: Representation Ks
The 1AC use the term American Indian strategically to build racial alliances to stop
exploitation
Lipschitz,, 2005
(George, Footsteps in the Dark: The Hidden Histories of Popular Music, p. 204)
Strategic essentialism has been a particular effective way for antiracist activists to effect affiliations and
alliances grounded in interethnic ideologies, epistemologies, and ontologies. Gayatri Spivak defined strategic
essentialism as the tactical embrace of a single social identity in order to advance collective claims for social
justice. Under conditions when the things that unite members of a particular group are more compelling than
the things that divide them, strategic essentialism makes sense. When racial profiling causes police officers to
stop African Americans for driving while Black, a unified response from the Black community is warranted,
regardless of the communitys heterogeneity and diversity. When pervasive domestic violence threatens the
safety, security, and dignity of all women, however, Black women may well want to speak out as women, a
strategic essentialism that for the moment emphasizes gender commonalities, even across racial lines.
American Indian as a strategic essentialism that recognizes terms are problematic but
necessary to forge political alliances to challenge colonization
Dourish, Donald Bren School of Information and Computer Sciences, 2005
(Paul Points of Persuasion: Strategic Essentialism and Environmental Sustainability,
http://www.pervasive2008.org/Papers/Workshop/w2-05.pdf)
Postcolonial scholar Gayatri Spivak (1987) coined the term strategic essentialism to refer to the ways in which
subordinate or marginalized social groups may temporarily put aside local differences in order to forge a sense
of collective identity through which they band together in political movements. Post-war resistance movements
to colonial rule often relied on just such mechanisms by which particular forms of ethnicity or nation-hood
were used to align disparate groups towards common goals. Spivaks observation is that, while such terms as
indigenous peoples or similar labels result in problematic and unstable groupings that erase significant
differences and distinctions (rethinking colonial categories), nonetheless these acts of identity formation support
important political ends. So while terms such as Indian, African, or Native American may be manufactured
and suppress highly significant differences, they nonetheless do important work.

246
I.H.S. Affirmative
A2: Statism/Biopower
Tribes can work with outside groups (like the government) without sacrificing culture, Zia
Pueblo proves
07
A primary goal reflected in the pueblo's first comprehensive plan of 1980 was land acquisition. Using income and negotiations, the
pueblo has expanded its 1980 boundaries, comprising approximately 190 square miles (117,000 acres), to include 150,000 acres in trust
status, including most areas of historic use and occupation. (39)
Unlike some other tribes that used federal funds and consultants in this era to develop only planning data
and written reports, Zia Pueblo appointed and retained a planning committee of tribal members and
employees. The committee considered professional advice before presenting its own recommendations
to the tribal council, which is comprised of all adult men in the pueblo and who serve for their lifetime within the broader
authority of the pueblo's cacique and other religious officials. Committee members participated in a 1988 session to update the plan,
which was again updated a decade later. The plan includes all aspects of pueblo development from enhancing cultural pride through
archaeological research of ancient village sites and establishing a tribal museum to securing water rights and buying more rangeland. A
second village incorporates elements of historic design found in the excavated village below.
The pueblo did not assume that development meant it would invite business onto its land. Because many tribal members can commute
to jobs, tribal administration viewed economic development as a way to finance tribal government and
thereby protect the land and water resources necessary to the future of the tribe as a whole. Development goals
included:
* Earn income with minimal disturbance to renewable resources
* Learn business by investing off-reservation with equal partners
* Purchase and sustainably manage additional resources
* Build self-reliant and educated youth who can hunt, farm, work outside the community, and contribute to sustaining the way of life
Since urban jobs may not always be available, Zia Pueblo officials felt it was essential that youth learn Pueblo
ways and that all families have access to a garden and to sufficient grazing land for one or two cattle,
a long-term economic practice at Zia. (40) The formal planning process augmented customary practice with outside
expertise to consider how opportunities and proposals could best meet cultural as well as economic goals.
Cash-and-Culture Decisionmaking
Federal programs in the 1980s defined tribal economic development as creating a climate for businesses to grow or relocate to
reservation lands that required separating tribal governance from business-management institutions. (41) Zia Pueblo's tribal
administrator, Peter Pino, holds an MBA. He understood the needs of the business community,but he also felt some business needs
conflicted with Pueblo lifeways. Despite being the first in the FSIP consortium to establish a community-development corporation,
Zia Pueblo did not invite businesses to locate within the pueblo's trust lands or near the village--"the holy
land." "Why rush?" Pino deliberated. "Business is more responsibility than a marriage and not something everyone understands the way
a person understands hunting." (42) He felt that a decision to get into business should be made with the full understanding of all that is
involved.
Although some pueblos in the area established successful casinos, Zia Pueblo did not want to introduce gambling or other enterprises
into the community that would require a work day that might directly compete with members' commitment to the ritual calendar and
their community obligations. The planning committee considered that when tribal members work in the city, rather
than at full-time jobs within the pueblo, they adapt to these requirements while at work and shed those
values for community life when at home. (43)
Between 1985 and 2000, the pueblo entered into short-term leases and contracts for tribal revenue. Pino, noticing that New Mexico
was promoting its landscape to the film industry for location filming, joined the New Mexico film commission. Within a few years, four
films were partially shot at Zia, and several tribal members and youth had parts as extras. In contrast to the early Hollywood
representation of Indian lifeways in film, the pueblo adopted rules to ensure that the historic village and sacred
sites would not be filmed, thereby controlling the impact of these development choices. (44)
The growing city of Rio Rancho borders Zia Pueblo to the south, an area where a company requested a
twenty-year lease to test explosives and construction materials. Although the project offered an
important income stream, such land disturbance was contrary to Pueblo values toward the land. On the other
hand, there was a potential benefit of discouraging housing adjacent to this land. Rather than accept or reject
the project, Zia used the criteria in its plan and added technical research to propose a shorter lease with
reclamation fees. On further consideration of the pueblo's land appeals to nearby housing developers as an
open-space amenity, Zia Pueblo subsequently permitted construction of a television transmittal tower on the
mesa overlooking Rio Rancho homes in order to discourage home construction on the pueblo's border.

247
I.H.S. Affirmative
A2: Statism/Biopower
Government-tribe compromises are key otherwise, Natives will continue to be exploited
because they are uninformed about business deals
Pinel, assistant professor of Conservation and Social Sciences at Idaho State University 07
Tribal members educated in both worlds are critical to the pueblo's ability to choose and modify
development strategies. Since 1978, Peter Pino has been tribal treasurer and administrator for Zia Pueblo.
He has maintained that community-based comprehensive planning provides a way to walk in two
worlds, stay in control and "get everyone's ownership" so there is a long-term commitment by the
tribal council to plan implementation. (46) He has tried to buffer the business and Pueblo worlds
psychologically--a difference he described as "looking out for number one" and "share and share alike." He
has also tried to create a buffer zone for himself: "One also needs time for what makes a person less of a
square and more of a circle ... like getting out there in my holey t-shirt and tennis shoes to clean the irrigation
ditches each spring," he told me. "It is important after long days behind a desk to know one can still carry
a harvested deer on one's back." (47) In his position, he has constantly translated between two
worldviews and thus can act as knowledge and cultural mediator with business executives.
Pino has been hesitant to bring into the community businesses in which the mentality and full-time
devotion to profit required for success would compete with Pueblo epistemology. However, he also
earned the respect of the business community by using his education to understand the needs of
business. Pino has represented the pueblo in the Rio Rancho Chamber of Commerce and monitored regional highway plans so that
the tribal council could anticipate impacts and opportunities from the growth of Rio Rancho and metropolitan Albuquerque. While tribal
governors change annually, the position of tribal administrator continues to provide continuity in management and information, thus
increasing the business community's confidence in tribal leadership without changing the customary political forms of authority.
The tribal administrator also brokers indigenous and technical knowledge throughout the "rational" planning process. He convinced
professional range managers to consider the rational basis of customary range-management practices during a tribal council meeting
called to decide whether or not to adopt a rangeland management ordinance proposed by the Bureau of Indian Affairs to prevent
overgrazing. (48) The rangeland-management experts proposed an ordinance that would limit thetotal number of cattle by charging a fee.
The tribal council determined that each family should have access to land on which to graze a few cattle and teach husbandry to young
people. US Bureau of Indian Affairs (BIA) staff expressed doubt that the pueblo would ever adopt anordinance to limit access because
the decision makers, the tribal council members, are also cattle owners whose self-interest might affect their willingness to reduce
grazing. The BIA proposed an ordinance to charge for permits that was based on the economic theory that raising prices will reduce
resource use. Some council members objected toa fee-based permit because it would create inequalities and favor wealthier tribal
members.
Pino introduced the discussion by reminding the council of its obligation to preserve the land for future generations, thus focusing the
decision on long-standing community values, rather than personal interests. One tribal councilman proposed that the ordinance limit the
total number of cattle grazed by each tribal member. (49) Subsequently, the pueblo has invested revenue from other projects to buy more
grazing land and to improve the quality of the range so that all families would continue to have access to grazing land. The final adopted
ordinance combined quotas and fees and was implemented over a three-year period so that people would become accustomed to paying
for these and other resources. The BIA specialists had proposed a solution based on economic theory. Zia Pueblo, on the other hand,
used its plan and the knowledge of its council members to propose an alternative to reach the same goal, while retaining equal resource
access and customs.
In summary, Zia Pueblo has defined development as security, control, and education of youth into
Pueblo lifeways. Zia Pueblo used comprehensive planning to combine indigenous knowledge of the
elders with the analysis of technical experts. The pueblo has gradually assumed control of BIA
programs and increased its revenue while minimizing changes to life within the community. Recently,
the tribal council was poised to invest in commercial development near urban centers while it considered
difficult questions of sustainability--questions such as who will fill Pino's role with cultural integrity,
understanding of business, time to run the investment corporation, and willingness to forgo employment
benefits offered by outside employers.

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A2: US out of Indian Country

American Indians desire separatism or external statehood
Deloria, 2003
(Philip, Professor, University of Michigan, 2004-present, Yale University, Ph.D. 1994, American Studies, American Indians, American Studies,
and the ASA, American Quarterly, 55:4, 4-19-03, p. 669-674)EM
In preparing her 1997 Native American Studies presidential address, Mary Helen Washington talked to people across
the spectrum of ASA membership about the relationship between the organization and the intellectual work coming
out of traditional ethnic studies concentrations. We chatted for some time, mostly about the ways in which ASA
was and was not capable of serving scholars of color as an intellectual home, a powerful theme in her address, and
one frequently present at that conference. Indeed, this issue of homes and homelessness seemingly laid out the
agenda for the 1997 ASA conference session, The Future of Native American Studies in American Studies, a
discussion that can be seen as ancestral to the 2002 panel from which these pieces are drawn, American (Indian)
Studies: Can the ASA Be an Intellectual Home? Why, Washington asked six years ago, have so few Native
scholars and scholars of Indian America found in the ASA the same type of intellectual home as scholars of African
American, Latino/a and Asian Pacific American studies? The basic outlines of this question have not changed
substantially since then; obviously it is an issue worth revisiting. To begin, as weve seen in the debates surrounding
categories of race and ethnicity in the latest census data, demography may not be destiny, but it matterssometimes
a lot. Native people reached the nadir of their population in the early twentieth century and have been
increasing ever since. If you count the self-identification boom that has accompanied the last two censuses,
you could argue that Indian population numbers are now increasing exponentially. Widen the category to
indigenous and throw in various kinds of global immigrations and you might find yourself talking about vast
multitudes of people, right? Wrong. Indian people continue to make up a relatively smaller portion of the population
of the United States. No matter how you parse the numbers concerning race and ethnicity, the 2000 Census lists
American Indian and Alaska Native populations as less than 1 percent of the total population of the United States.1
As a resultand all complicated questions of differential educational opportunities and cultural prompting aside
Native America simply generates fewer academic intellectuals. The smaller pool of academic Native intellectuals
(and I dont deny the existence of any number of organic Indian intellectuals) means greater demands on each, as
they try to represent, in various ways, native constituencies in universities, presses, professional organizations,
museums, and the like. A nearly infinite workload is spread among a very finite group of people, each of whom is
forced to eliminate many choices while pursuing only a few. (This is an argument made by other scholars of color as
well, though one wonders if the problem is relatively more acute for Native people. In any case, it does not mark a
promising beginning.) As we weigh the demographics, it is also worth reminding ourselves once again that Indian
people are qualitatively different from other ethnic and racial groups in the United States in that they have
ongoing treaty relationships with the Federal government. That means thatas communities and as individuals
they have to deal in structured relationships with federal bureaucracies like the Bureau of Indian Affairs
and the Indian Health Service. They have to wrangle with Congress and argue in the court system. They have
to understand and negotiate forms of tribal governance that hybridize local knowledge with American
constitutional models, and that exist in government-to government relations. Now more than ever, those
relations are not only with the federal government, but with often-predatory state and local governments as well.
Almost immediately, we can take the pool of prospective American Indian academic intellectuals and eliminate the
sizeable number who commit themselves to these particular aspects of Native struggle by choosing, for example, a
three-year law degree or a two-year M.A. in public policy over a six-year Ph.D. program. These political and legal
realities also feed back into the academic world, for they suggest that American Indian studies programs often train
Native studies students differently than do American studies programs and departments. Interdisciplinary might
mean political science, law, education, health, and language as much as it does history, literature, film, performance
studies, and cultural theory. The rich interdisciplinarity that brings a wide range of ethnic studies scholars into the
ASA fold can sometimes seem less intellectually relevant to those in some Native American studies programs. Look
through recent programs, for example, for Indian studies panelists coming to the ASA from the University of
Arizona, arguably one of the most native-centric American Indian studies programs in the country. If my own quick
survey is any indication, youll do so in vain, for they tend to find their intellectual sustenance and outlet elsewhere.
Demography, political use-value, and academic training are only part of the story. American studies presents a set of
intellectual challenges, even to those Native American studies scholars willing to consider a rapprochement.
Consider what I take to be two of the more important general organizing categories of the field: America in all its
complexity; and culture as a central principle for thinking about identity, subjectivity, meaning, and all manner of
social, political, and legal relations. As a physical location, America can hardly help

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but be compelling for scholars pursuing questions arising from experiences of immigration and diaspora. As an
analytical site, it is no less compelling for those who would understand society and politics. As a subject indeed,
the ur-subject of the fieldit has inspired countless explorations of the ideological contradictions underpinning the
nations tantalizing promises of security and equality and the excesses and harsh realities of its systems of social
inequality. One of the historical goals of many social groups has been the acquisition of equal rights and citizenship
in the United States, and intellectual work has often seemed to assist in that goal. Many American studies scholars
engage in intellectual work for its own sake but also to explore and advance a vision of a just American society.
Although there have been many moments when tribal peoples and societies have argued for equal rights and
citizenship, these have in fact not been the primary goal for most Indian people. Citizenship has generally
meant more when attached not to the United States but to ones tribal nation. And equal rights under the
American rubric may sometimes be a good thing, but it has also meant the supercession of 672 AMERICAN
QUARTERLY tribal understandings of social order and political self-governance. For many Indian people,
integration into the rights and equalities of American citizenship has as often looked more like assimilation to
a repressive social order than a brand of liberation in which an American political structure built around
citizenship offers refuge from institutionalized social and cultural oppression. American studies, of course, has
been deeply engaged in a critical project of its own, focused on decentering the United States as national subject. It
has done so by thinking in terms of the global flow of information, capital and people, of the imaginative
construction of national affiliation, of the diverse social collectivities built within and in reaction to the national, and
of historical and contemporary practices of colonialism and imperialism. Even this problematizing of the national,
however, can be rooted in a frame that does not always mesh well with some tribal sensibilities. On one side,
indigenous scholars like Rotinohshonni writer Taiaiake Alfred use America or Canada primarily as an object,
the outside referent for a history of colonialism. Alfred would reject even the key notion of sovereignty (which
inevitably resides within the American/ nationalist frame) as part of a western discourse of power that
continues to colonize Native North America. Although the deconstruction of nation matters to Alfred, hed as
soon talk about Rotinohshonni understandings of social and cultural collectivity. On the other side, many Native
scholars have pointed out that the decentering of nation comes at a particularly inauspicious time for
Indian people, who have invested a great deal of political and intellectual energy building a careful argument
in courts, Congress, and regulatory agencies that treaty rights and sovereignty rest upon an acknowledgement
of themselves as nations. Wherever one stands on these debates, they suggest that American studiesno matter
how broadly conceived or how deconstructionistis not necessarily a natural home for scholarship concerned with
Indian nationhood and motivated by a half-realized dream of political autonomy.2 If America is vexed, then so too
is the accompanying abstraction of culture, a word that enfolds a range of intellectual histories, political claims,
and interpretative uncertainties. The blending and blurring together of cultural elements in the swirl of global
exchange has led to a desire to understand what Mary Helen Washington called the cultural menudothe
production of new cultural texts, performances, AMERICAN INDIANS 673 and meanings in trans-cultural settings.
And while some of this work has always focused on questions of cultural maintenance within the menudo, American
studies has developed a stronger reputation for investigating the hybridities of global and inter-ethnic cultureproduction, particularly as these have engaged the worlds of the social and the political. At first glance, one imagines
a place of sympathetic overlaps, particularly with the numerous scholars and writers of American Indian literature
who pursue issues of mixed-blood heritage and identity. (Indeed, one might argue that, among Native American
studies scholars, literary critics and writers have found the most congenial home in American studies.) Like other
ethnic and diasporic literatures, mixedblood hybridities rely powerfully on well-patrolled racial and national
boundaries. Even as Indian mixed-blood characters and critiques concern themselves with the interstice and
the overlap, however, in the end they are as likely to point powerfully to Indian distinctiveness (even as a
mixture) as to the hybrid invention of the new. Indeed, the debates that surround this literature suggest the
inescapable importance of the question of Indian legal and political status. Creek writer Craig Womacks Red on
Red, for instance, argues for a literary criticism that is not only Indian but more specifically Creek, and he insists
on the interwoven relationship between the sovereignties of tribal nation and tribal narration. Cherokee author Louis
Owenss Mixedblood Messages, on the other hand, uses criticism, autobiography, and family history to paint a
complex portrait of a mixed-blood identity that can remain every bit as fiercely loyal to Indian legal and political
struggle. Owenss book, one might argue, is centered around this assertion of political loyalty amidst cultural
complexity, for much of the text seems to function as a response to Lakota critic Elizabeth Cook-Lynn, who has
attacked mixed-blood writing for accommodating Western colonialism and failing to offer useful expressions of
resistance.3

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Indigenous objectives such as self-determination provide necessary empowerment and can
be accomplished through electoral representation.
Murphy, 2008
(Michael, Associate Professor and Canada Research Chair, University of Northern British Columbia, Representing
Indigenous Self-determination, University of Toronto Law Journal, p. 185-186)EM
Discussions of indigenous1 self-determination traditionally have not had much to say about electoral politics
or about the idea of including indigenous representatives in the legislative institutions of the modern state.
There are good reasons for this. Self-determination is usually understood as a means of gaining distance or
protection from rather than inclusion in state institutions. Indigenous peoples frequently express a profound
sense of alienation toward these institutions, which carry the stigma of colonial domination. Legislative bodies
are regarded with particular suspicion, and even hostility, conjuring up memories of historic disenfranchisement or
strategies of electoral inclusion linked to assimilation and the loss of indigenous rights and identities. As a means of
advancing indigenous objectives, moreover, electoral representation at best seems to offer a token and
ineffective presence in institutions dominated by non-indigenous majorities, and at worst can be viewed as a
form of co-optation, whereby indigenous representatives are brought inside state institutions, where their
concerns will remain marginalized, while energy and resources are simultaneously diverted away from the
goal of greater autonomy or self-government. In spite of these reservations, the idea of electoral representation has
begun to attract some positive attention among both indigenous and non-indigenous leaders and academics. My own
contribution to this emerging debate is to argue that indigenous representation in shared-rule institutions such as
national legislatures need not be seen as a means of short-circuiting indigenous self-determination; instead, this
form of political voice can be viewed as part of a broader strategy for advancing indigenous self-determination
by targeting a variety of parallel and complementary access points to political power. My argument is
grounded in a relational model of self-determination that speaks both to the importance of self-government
and to the need for modes of shared and cooperative decision making capable of governing the complex
interdependence characteristic of the relationship between indigenous and non-indigenous populations in so many
countries around the globe. While I acknowledge that there are many serious shortcomings of the electoral route to
indigenous self-determination, my sense is that opposition to the electoral option is frequently based on unrealistic
expectations of what this form of political voice can or should deliver. Hence, one of my key objectives is to clarify
the various functions that representation in central institutions can and cannot perform. My conclusion is that,
although we should not expect too much from indigenous legislative representation, it is a mistake to dismiss this
political strategy outright. The discussion is divided into three substantive sections, followed by a brief conclusion.
Focusing on Australia, Canada, and New Zealand, Part II briefly illustrates how historic policies of exclusion or
coercive inclusion of indigenous peoples in electoral processes created a significant and enduring legacy of
suspicion and hostility toward notions of enfranchisement and representation. Nevertheless, this section also
attempts to 186 UNIVERSITY OF TORONTO LAW JOURNAL explain more recent attempts to rethink this
historic legacy of suspicion and hostility and to reconsider the utility of an electoral pathway to indigenous
empowerment. Part III contrasts the more purely autonomist understanding of self-determination with a concept of
relational self-determination that emphasizes both autonomy and interdependence oriented modes of governance.
Here I also seek to answer the standard charge that the ends of electoral representation and self-government are, at
best, logically in tension, if not directly incompatible. Part IV canvasses some of the primary strengths and
weaknesses of the indigenous electoral option in relation to the broader goals of self-determination and indigenous
empowerment.

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I.H.S. Affirmative

Giving back the land would collapse the U.S.
Corlett, Assistant Professor of Philosophy at San Diego State University, 2000
(J. Angelo, Secession and Native Americans, Peace Review; Mar2000, Vol. 12 Issue 1, p7-14)
A constitutional right to secede would grant Native American nations such as the Dine nation an institutional
means by which to effect adequate reparations in the form of a secession settlement. Yet it is easy to see that
if the right to secede from the U.S. was claimed by every Native American nation, then it would spell
the end of the U.S. as we know it. This would be too costly for U.S. "democracy." Apparently, genuine
democracy (insofar as this amounts to, at the very least, governmental respect for citizens and their
autonomy rights) would prove too costly for U.S. government and its citizenry. It would appear that a
genuine democracy must guarantee its citizen collectives the right to secede. And simply because a state
faces possible, even probable, dissolution in the face of respecting freedom and corrective justice in no way
counts against the fact that authentic democracy demands that the right to secede be guaranteed under certain
circumstances, namely, the ones set forth in the analysis of the moral right to secede (that is, the three
conditions discussed above). To argue that such a "drastic" or "radical" proposal is unrealistic and falls short
of satisfying the criterion of "moral realism" is simply to fail to satisfy the criteria of fairness and rationality.
It begs the moral question by presuming a certain kind of utilitarianism in arguing that the U.S. need not
guarantee a right to secede if the exercise of that right would spell the end of the U.S., especially when
the demise of the U.S. might well be deserved in light of the unjust foundations on which it was built.

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A2: Nuclear War Impacts (Kato)

Nuclear extinction rhetoric excludes the reality of the ongoing thermonuclear war being
waged against the American Indians.
Kato, Professor of Political Science at the University of Hawaii, 1993
(Masahide "Nuclear Globalism: Traversing Rockets, Satellites, and Nuclear War via the Strategic Gaze,"
Alternatives: Global, Local, Political. Page 339, MAG)
Nuclear war has been enclosed by two seemingly opposite yet complementary regimes of discourse:
nation-state strategic discourse (nuclear deterrence, nuclear disarmament, nuclear non-proliferation and so
on) and extra-nation state (or extra-territorial) discourse (antinuclearism, nuclear criticism, and so on). The
epistemology of the former is entrenched in the possible exchange(s) of nuclear warheads among
nation states. The latter which emerged in reaction to the former, holds the possibility of extinction
at the center of its discursive production. In delineating the notion of nuclear war, both of these
discourses share an intriguing leap: from the bombings of Hiroshima and Nagasaki to the possible
nuclear explosions in an indefinite-yet-ever-closer-to-the-present-future. Thus any nuclear explosions
after World War II do not qualify as nuclear war in the cognitive grid of conventional nuclear
discourse. Significantly, most nuclear explosions after World War II took place in the sovereign
territories of the Fourth World and Indigenous Nations. This critical historical fact has been contained in
the domain of nuclear testing. Such obliteration of the history of undeclared nuclear warfare by nuclear
discourse does not merely posit the deficiency of the discourse. Rather, what it does is reveal the late
capitalist form of domination, whereby an ongoing extermination process of the periphery is blocked
from constituting itself as a historical fact.
Capitalism necessitates the destruction of parts of society that are not beneficial to the
system. Nuclear testing and dumping is done on reservations because American Indians are
viewed as useless members of the periphery.
The vigorous invasion of the logic of capitalist accumulation into the last vestige of relatively autonomous
space in the periphery under late capitalism is propelled not only by the desire for incorporating every
fabric of the society into the division of labor but also by the desire for pure
destruction/extermination of the periphery. The penetration of capital into the social fabric and the
destruction of nature and preexisting social organizations by capital are not separable. However, what we
have witnessed in the phase of late capitalism is a rapid intensification of the destruction and
extermination of the periphery In this context, capital is no longer interest in incorporating some parts
of the periphery into the international division of labor. The emergence of such pure
destruction/extermination of the periphery can be explained, at least partially, by another problematic
of late capitalism formulated by Ernest Mandel: the mass production of the means of destruction.
Particularly, the latest phase of capitalism distinguishes itself from the earlier phases in its production of
the ultimate means of destruction/extermination i.e., nuclear weapons.

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There is an ongoing nuclear war being perpetrated against the Indigenous peoples of the world in
the name of nuclear testing. The creation of the doomsday nuclear scenario by nuclear critics
has only helped to enhance the First Worlds strict definition of nuclear war.
Let us recall our earlier discussion about the critical historical conjecture where the notion of strategy
changed its nature and became deregulated/dispersed beyond the boundaries set by the interimperial rivalry.
Herein, the perception of the ultimate means of destruction can be historically contextualized, The only
instances of real nuclear catastrophe perceived and thus given due recognition by the First World
community are the explosions at Hiroshima and Nagasaki, which occurred at this conjuncture. Beyond
this historical threshold, whose meaning is relevant only to the interimperial rivalry, the nuclear
catastrophe is confined to the realm of fantasy, for instance, apocalyptic imagery. And yet how can one
deny the crude fact that nuclear war has been taking place on this earth in the name of nuclear
testing since the first nuclear explosion at Alamogordo in 1945? As for 1991, 1,924 nuclear explosions
have occurred on earth. The major perpetrators of nuclear warfare are the United States (926 times), the
former Soviet Union (715 times), France (192 times), the United Kingdom (44 times), and China (36 times).
The primary targets of warfare (test site to use Nuke Speak terminology) have been invariably the
sovereign nations of Fourth World and Indigenous Peoples. Thus history has already witnessed the
nuclear wars against the Marshall Islands (66 times), French Polynesia (175 times), Australian Aborigines (9
times), Newe Sogobia (The Western Shoshone Nation) (814 times), the Christmas Islands (24 times), Hawaii
(Kalama Island, also known as Johnston Island) (12 times), the Republic of Kazakhstan (467 times), and
Uighur (Xingjian Province, China) (36 times). Moreover, although I focus primarily on nuclear tests in this
article, if we are to expand the notion of nuclear warfare to include any kind of violence accrued from the
nuclear fuel cycle (particularly uranium mining and disposition of nuclear wastes), we must enlist Japan and
the European nations as perpetrators and add the Navaho, Havasupai and other Indigenous Nations to the list
of targets. Viewed as a whole, nuclear war, albeit undeclared, has been waged against the Fourth
World, and Indigenous Nations. The dismal consequences of intensive exploitation, low intensity
intervention, or the nullification of the sovereignty in the Third World produced by the First World
have taken a form of nuclear extermination in the Fourth World and Indigenous Nations. Thus, from
the perspectives of the Fourth World and Indigenous Nations, the nuclear catastrophe has never been
the unthinkable single catastrophe but the real catastrophe of repetitive and ongoing nuclear
explosions and exposure to radioactivity. Nevertheless, ongoing nuclear wars have been subordinated to
the imaginary grand catastrophe by rendering them as mere preludes to the apocalypse. As a
consequence, the history and ongoing processes of nuclear explosions as war have been totally wiped
out from the history and consciousness of the First World community. Such a discursive strategy that
aims to mask the real of nuclear warfare in the domain of imagery of nuclear warfare in the domain of
imagery of nuclear catastrophe can be observed even in Stewart Firths Nuclear Playground, which
extensively covers the history of nuclear testing in the Pacific: Nuclear explosions in the atmosphere
were global in effect. The winds and seas carried radioactive contamination over vast areas of the fragile
ecosphere on which we all depend for our survival and which we call the earth. In preparing for war, we were
poisioning our planet and going into battle against nature itself. Although Firths book is definitely a
remarkable study of the history of nuclear testing in the Pacific, the problematic division/distinction
between the nuclear explosions and the nuclear war is kept intact. The imagery of final nuclear war
narrated with the problematic use of the subject (we) is located higher than the real of nuclear
warfare in terms of discursive value. This ideological division/hierarchization is the very vehicle
through which the history and the ongoing processes of the destruction of the Fourth World and
Indigenous Nations by means of nuclear violence are obliterated and hence legitimatized. The
discursive containment/obliteration of the real of nuclear warfare has been accomplished, ironic as it
may sound, by nuclear criticism. Nuclear criticism, with its firm commitment to global discourse, has
established the unshakable authority of the imagery of nuclear authority of the imagery of nuclear
catastrophe over the real nuclear catastrophe happening in the Fourth World and Indigenous almost
on a daily basis.

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Anti-nuke activists have perpetuated the strict definition of nuclear war that has allowed
the war against the Indigenous people to be labeled as anything but what it is- full-out
extermination.
Alternatives: Global, Local, Political. Page 349 & 350, MAG)
Reflecting the historical context mentioned above, in which nuclear critique gained unprecedented
popularity, one can say that nuclear criticism has been shaped and structured by the logic of superpower
rivalry. The superpower rivalry has distracted our attention from the ongoing process of
oppression/violence along the North-South axis. After all the superpower functioned complementarily in
solidifying the power of the North over the South. Therefore, nuclear criticism has successfully mystified the
North-south axis as much as the superpower rivalry. Just as the faade of superpower rivalry (or
interimperial rivalry in general for that matter) gave legitimation to the strategy of global domination of
capital, nuclear criticism has successfully legitimated the destruction of periphery through nuclear
violence. What is significant here is to locate the discourse in a proper context, that is, the late capitalist
problematic. To do so, we need to shift our focus back to the questions of strategy and technology discussed
earlier. Let us recall our discussion on the genealogy of global discourse. The formation of global discourse
has been a discursive expression of the formation of technological interfaces among rockets, cameras, and
media furnished by the strategy of late capitalism. In a similar vein, nuclear criticism, whose
epistemological basis lies in the exchange of nuclear ballistic missiles between superpowers, emerged
from yet another technostrategic interface. Significantly, the camera on the rocket was replaced by the
nuclear warhead, which gave birth to the first Inter Continental ballistic Missile in the late 1950s both in the
United States and the former Soviet Union. Thus, the discourse of nuclear criticism is a product of
technostrategic interfaces among rocket, satellite, camera, photo image, and nuclear warhead. I net
decipher the discourse of global capitalism (globalism) interwoven throughout nuclear criticism by linking
the technostrategic interface to the formation of discourse.

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I.H.S. Affirmative

The negs framing of a global nuclear war that ends in extinction delocalizes nuclear war
and ignores the fact that nuclear catastrophe is a local event for the Indigenous populations
of the world.
Alternatives: Global, Local, Political. Pages 350-352, MAG)
Nuclear criticism finds the likelihood of extinction as the most fundamental aspcct of nuclear
catastrophe. The complex problematics involved in nuclear catastrophe are thus reduced to the single
possible instant of extinction. The task of nuclear critics is clearly designated by Schell as coming to grips
with the one and only final instant: human extinction- whose likelihood we are chiefly interested in finding
out about. Deconstructionists, on the other hand, take a detour in their efforts to theologize extinction.
Jacques Derrida, for example, solidified the prevailing mode of representation by constituting extinction as a
fatal absence: Unlike the other wars, which have all been preceded by wars of more or less the same type in
human memory (and gunpowder did not mark a radical break in this respect), nuclear war has no precedent.
It has never occurred, itself; it is a non-event. The explosion of American bombs in 1945 ended a classical,
conventional war; it did not set off a nuclear war. The terrifying reality of the nuclear conflict can only be the
signified referent, never the real referent (present or past) of a discourse or text. At least today apparently.
By representing the possible extinction as the single most important problematic of nuclear
catastrophe (posing it as either a threat or a symbolic void), nuclear criticism disqualifies the entire
history of nuclear violence, the real of nuclear war is designated by nuclear critics as a rehearsal
(Derrik De Kerkhove) or preparation (Firth) for what they reserve as the authentic catastrophe. The
history of nuclear violence offers, at best, a reality effect to the imagery of extinction. Schell
summarized the discursive position of nuclear critics very succinctly, stating that nuclear catastrophe
should not be conceptualized in the context of direct slaughter of hundreds of millions of people by
the local effects. Thus the elimination of the history of nuclear violence by nuclear critics stems from
the process of discursive delocalization of nuclear violence. Their primary focus is not local
catastrophe, but delocalized, unlocatbale, global catastrophe. The elevation of the discursive vantage
point deployed in nuclear criticism through which extinction is conceptualized parallels that of the point of
the strategic gaze: nuclear criticism raises the notion of nuclear catastrophe to the absolute point
from which the fiction of extinction is configured. Herein, the configuration of the globe and the
conceptualization of extinction reveal their interconnection via the absolutization of the strategic gaze.,
The in the same way as the fiction of the totality. In other words, the image of the globe, in the final instance,
is nothing more than a figure on which the notion of extinction is being constructed. Schell, for instance,
repeatedly encountered difficulty in locating the subject involved in the conceptualization of extinction,
which in turn testifies to its figural origin: who will suffer this loss, which we somehow regard as supreme?
We, the living, will not suffer it; we will be dead. Nor will the unborn shed any tears over their lost chance to
exist; to do so they would have to exist already. Robert Lifton attributed such difficulty in locating the
subject to the numbing effect of nuclear psychology. In other words, Lifton tied the difficulty involved here
not to the question of subjectivity per se but to psychological defenses against the overwhelming possibility
of extinction. The hollowness of extinction can be unraveled better if we locate it in the mode of perception
rather that in nebulous nuclear psychology: hollowness of extinction is a result of confusing figure with the
object. This phenomenon, called the delirium of interpretation by Virilio, is a mechanical process in which
incorporeal existence is given a meaning via the figure. It is no doubt a manifestation of technosubjectivity
symptomatic of late capitalism. Hence, the obscurity for the subject in the configuration of extinction results
from the dislocation of the subject by the technosubject functioning as a meaning-generating machine.

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The imaginary nuclear war is an effort of self-preservation in which the Indigenous peoples
of the world are not included into the circle of the we. The nuclear war the neg predicts
will save the First World, but leave the Fourth World to die.
Nuclear criticism offers preservation of self and matter as a solution to its own imaginary/ideological
construct of extinction (as manifested in the buzzword freeze). Accordingly, preservation of self and
matter as an alternative to the inertia of the unthinkable cannot be anything but an imaginary/ideological
construct. It is in this fantasy that one can find the ideological content of globalism. The proposition of
preservation as a solution to the imagined extinction at the same time involves redefinition of the
notion of humanity. The image of extinction drove even a Marxist, namely, E.P. Thompson, to
abandon class analysis, embracing humanity instead: extermination itself is not a class virtue: it is a
human issue. In this sense, nuclear criticism recreates the Renaissance in the early capitalist era in its
reinvention of humanity through technosubjectivity. Robert Lifton defined the collectivity in danger of comparing the
treat of extinction with the hostage taking, which in turn entails a very revealing redefinition of humanity: But unlike ordinary hostage
taking, nuclear terror encompasses everyone. Precisely for that reason it throws us back on our collective humanity. In calling into
question the idea of human future, it raises equally ultimate questions about our evolutionary equipment for shaping the threatened
future. But what does humanity designate? Who are we? Sontag also encountered this obscure notion of humanity created by the
photo images, and she deciphered it as a quality things have in common when they are viewed as photographs. Again, we cannot
escape from finding the figural origin (i.e., photo image of the globe) of the construction of humanity. Herein the interpretative
delirium proceeds with the disguise of universalism, establishing a total deregulation in exchanges among what are reconstructed
as objects by way of figure. The regime of the absolute subject (i.e., technosubject) governs this deregulated image economy where
heterogeneous existence of subjectivity (whose epistemological basis is anchored in locality) is reduced to one of many objects. The
notion of humanity is thus a reification of the regime of the absolute technosubject cloaked in pseudo-universality. Let us probe further
into this process of displacement by analyzing the ways in which self and matter are reconstructed in nuclear criticism. Matter to be
preserved and hence not to be exploded is interchangeably designated as the earth, the ecosphere, life
(humans and nonhumans), environment, the unborn, and the future. The notion of humanity facilitates
the dissolution of self matter but humanity is also matter. The dissolution demarcates the total mimesis
between self and matter. This may sound similar to Indigenous Peoples conceptualization of their group
identity in relation to their locality, Mother Earth. However, this mimesis, in fact, stands in a
diametrical opposition to that of the Indigenous Peoples. The mimesis in the globalist discourse is none
other than a result of the technological process of displacement whereby matter is simultaneously reduced to
a photo image and given a new meaning and totality but the point of the strategic gaze (the vantage point of
technosubjectivity). In other words, as we have already discussed in the case of configuration of extinction, it
is again the figurality of the globe that realizes the mimetic relationship between self and matter. The
vantage point of technosubjectivity, however, is not void. We must analyze further the nature of self that is
assimilated into matter in order to decipher the ideological implication of the mimesis. Derrik De Kerhoves
words reveal the linkage between individual identity and planetary identity: We are beginning to
acquire a sense of a planetary body-image, much in the way that we acquire our own individual identity as
we begin to perceive the limits of our own bodies. Schell also reconstructs such linkage in his thesis on earth.
The earth, according to him, is a special object to be regarded as a single living entity, [because] like a
person, the earth is unique, it is sacred, and like a person, it is unpredictable by generalizing law and
science. Furthermore, the following passage, in which Robert Lifton conceptualizes the relationship
between self and world in reference to the exultation in the antinuclear movements, also reveals the true
nature of the notion of self: that exultation has to do with a new sense of integrity- or of the possibility
of integrity-in ones relationship between self and world. No longer bound to nuclear distortions only
half believed, ones world seems to open out into new personal options. It is clear from the language
individualism in the statements above that the image of the globe (and other incorporeal bodies) is the
outcome of the projection of late capitalist private existence (i.e., the life world of the First World) onto
the level of generality. The self in question is not the self (the life world of the Third World, Fourth
World, and Indigenous Peoples) that has been endangered already by nuclear wars. The subjectivity of
the periphery, as discussed earlier in this article, has been rendered matter (e.g., natural resources)
through satellite surveillance. Under the regime of technosubjectivity, the First World self assumes an
unprecedented form of domination by assimilating itself into matter, and thereby it conquers matter.

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I.H.S. Affirmative

Nuke-speak and images of the coming apocalypse allows for the First world to speak for
future generations and the individuals living in the periphery.
The latest form of domination through the mimetic relationship between (the First World) self and the matter
via technosubjectivity unveils its uniqueness in the mode of propertization. Technosubjectivity materializes
the condition in which the First World self establishes property relationship with what has not been
coded in the conventional space and time parameters (e.g., the earth, the ecosphere, life, environment,
the unborn, the future). For example, by using apocalypse, nuclear critics set up a privileged discursive
position whereby the First World self is authorized to speak for amorphous future generations. This
discursive position entails a colonization of temporality by the First World self. The colonization of
future has an immediate effect: the preservation of unborn generations as a case against extinction
endorsed by some nuclear critics, for instance, cannot be isolated from the extension of patriarchal self
over womens bodies. In a similar vein, the nuclear critics assertion regarding the preservation of the
ecosphere or the identification of an individual with the earth as an antithesis to extinction betrays the
extension of the First World self over the space configured by the image of the globe. One should not, on
the one hand, discount the political significance of the environmentalism emerged from the nuclear
discourse; on the other hand, however, one should also be alert to the fact that such environmentalism
and also the notion of futurity discussed earlier are a structural counterpart of the globalization of
space and time by capital (both are linked through technosubjectivity). The extension and propertization in
terms of both time and space proceeds instantaneously from the micro level to the macro level and vice
versa; the earth, like a single cell or a single organism, is a systemic whole. The holism reconstructed here
is a discursive translation of the instantaneous focal change (from the image of the whole to the image of the
spot) from the point of the absolute strategic gaze. Overall, the nuclear critics position in freezing the status
quo- that is, the existing unequal power relationship-produces nothing short of an absolute affirmation of the
latest forms of capitalist domination mediated by mechanically reproducible images. Thus dissolution
between self and matter via technosubjectivity demarcates the disappearance of the notion of territoriality as
a boundary in the field of propertization/colonization of capital. The globe represented as such in the age of
technosubjectivity clearly delineates the advent of nonterritorial space, which distinguishes it from the earlier
phases of capitalism. According to David Harvey, the Enlightenment conceptualization of the globe had a
territorial demarcation, which corresponds to the hierarchical division between self and the other: I do not
want to insist that the problem with the Enlightenment thought was not that it had no conception of the
other but that it perceived the other as necessarily having (and sometimes keeping to) a specific place in
a spatial order that was ethnocentrically conceived to have homogenous and absolute qualities. Therefore,
what is characteristic of the global spatial order in late capitalism is a total eradication of the other by
abolishing the notion of territory. As I have already discussed, what matters for the First World is no
longer the relationship between self and other but self and matter, which is nothing but a tautological
self-referential relation with self. This ontological violence against the other underwrites the physical
violence against the Third World, Fourth World, and Indigenous Peoples.

258
I.H.S. Affirmative

The First World has decided that the Fourth World is not economically viable; the nuclear
war waged on them is a manifestation of capitalisms desire to destroy what it cannot use.
Frederic Jamesons proposed formula to cope with the global strategy of late transnational capitalism is for us
to gain a firmer grip on global space so that such space is brought to the social level. According to him, in the
process of socializing this latest spatial horizon (becoming Symbolic of the Imaginary to use Lacanian
terminology), we may again begin to grasp our positioning as individual and collective subjects and again a
capacity to act and struggle which is at present neutralized by our spatial as well as our social confusion.
Nevertheless, let us not forget that the Symbolic in the global configuration of space and time is none other
than the discourse of technosubjectivity. The construction of global space and time, accordingly, has been the
ontological horizon of the transnational capital/state with its control over the ultimate form of violence. The
social and spatial confusion (which again resonates in Liftons formulation of the numbing effect) in the
postmodern aesthetics that Jameson urges us to overcome, stems not so much from the inadequate
socialization of global space as from the very meaning- generating machine of technosubjectivity. Thus
Jamesons formula has a strong possibility of legitimating technosubjectivity, which leads us nowhere
but to a further global integration of capital with its increased power of pure destruction. The dialectic
(if it can be still called such) should be conceived in terms of resistance to and possibility of reinventing
space. The nuclear warfare against the Fourth World and Indigenous peoples should be viewed in this
context. It is not their expendability or exclusion from the division of labor; rather it is their spatialtemporal construction that drives transnational capital/state to resort to pure destruction. In other
words, what has been actually under attack by the nuclear state/capital are certain political claims
(couched in the discourse of sovereignty) advanced by the Fourth world and Indigenous Peoples for
maintaining or recreating space against the global integration of capital. The question now becomes: Can
there be a productive link between the struggles of the Fourth World and Indigenous Peoples against
the exterminating regime of nuclear capital/state, and First World environmentalist and antinuclear
social movements? This link is crucial and urgent for a subversion of the global regime of capital/state.
Nevertheless, we have not yet seen effective alliances due to the blockage that lies between these social
movements. The blockage, as I have shown in this article, is produced primarily by the perception and
discourse of the social movements in the North, which are rooted in technosubjectivity. The possibility of
alliances, therefore, depends on how much First World environmentalist and antinuclear movements
can overcome their globalist technosubjectivity, whose spatio-temporality stands in diametrical
opposition to the struggles of the Fourth World and Indigenous Peoples. In other words, it is crucial for
the former to shatter their image-based politics and come face with the real of the latter.

259
I.H.S. Affirmative
Rhetorical Exclusion K
The way the neg discusses relations of power creates a violent form of domination and
exclusion. The way that the law views American Indians and the way that we discuss these
laws reinforces the Otherizatoin of American Indians
The classic view of power entails two parties, in which A has power over B. In this view, power becomes
metaphorical: power is an object, a location, a force, or a control that is up. In recent years, however,
some scholars have recognized that power entails much more than four simple metaphors. For example,
Foucault, well-known for his work on power, argues that power is not with, in, or present in one side or
interest; power is dynamic and relates more to conduct than confrontation. Power is viewed as a
process; the subordinate is both an effect of a system of power and a vehicle of its production.
Because we live socially, we automatically become involved in power relations. Agents in the system
subject themselves to power by simply having the basic knowledge of how the system operates. Bachrach
and Baratz expand upon the notion of power by arguing that power goes beyond concrete decisions and
activity. When a makes decisions that, in effect, limit Bs participation in the political system, B is
unable to bring up relevant cultural issues. Such power may also be characterized as integrative power.
Boulding suggests that integrative power can be productive or destructive. Integrative power has the
capability of building organizations and developing legitimacy but it also has the capacity of alienating
people. The integrative power to which Boulding refers includes social groups, institutions, and traditions.
Certainly, the stereotypical nature of the language describing and reinforcing these institutions
maintains the power of these institutions, and Boulding notes: The hierarchy of respect is often
reflected in language and gestures. When we witness an occurrence, we identify the event with an
institution, such as the courts, the church, or the workplace. Youth are socialized into our institutions, partly
through what Habermas would term symbolic reproduction or repetition of particular terms or language. In
fact, Charland states that the moment we enter the world of language, we are subjects of power. McGee
contends that we endow our institutions and traditions with human-like qualities that become coercive. This
personification is particularly true of the law. For example, the law is more than simply statutes; the
embodiment of the law is manifested by those who enforce it, interpret it, and change it. Fish claims that
the law is powerful because to distinguish the forces it opposes is difficult; the law is compelling
because the reasons for which we do something or refrain from doing something are reasons only by
virtue of the preconceptions and predispositions we already have. Fish suggests there is always a gun at
your head, meaning that a reason, a purpose, a desire, a need, a law, or an internalized power will always be
a form of coercion. Laws become part of mundane everyday life, which allow the power to continue and
reproduce other power relations.23As a result, we create a public, shared vision of what the law is and
acquiesce to the dominant power. Language is the key to maintaining power in society. Power resides in
naming or, in Foucaults words, in a society such as ours... there are manifold relations of power
which permeate, characterize and constitute the social body, and these relations of power cannot
themselves be established, consolidated, nor implemented without the production, accumulation,
circulation and functioning of a discourse. In an American Indian context, Stuckey and Murphy
agree, arguing that political language aided in colonizing North America; language facilitated
oppression and created a negative identity of native peoples. Edelman argues that language usage is
strategic, that language is used to interpret the social order so that power is legitimized. Legitimation
occurs, partly, out of knowledge and acceptance of the dominant ideology; the dominant impose their
own definition of the world order through the totality of their practices, including verbal practices, and
thereby justify their power. U.S. v. Leonard Peltier demonstrates how the legal system inculcates, through rhetoric, values that
reinforce power. Specifically, our analysis shows that Peltier and the Indian culture were Othered during the trial. Presently in
rhetorical scholarship, the Other refers to all people the Self perceives as mildly or radically different.
Therborn contends that domination is achieved when the dominated resist the Other and when the
dominating can mold the dominated according to a particular image. McKerrow discusses Othering in his
notion of critical rhetoric that seeks to unmask or demystify the discourse of power. The aim is to understand the integration of
power/knowledge in societywhat possibilities for change the integration invites or inhibits and what intervention strategies might be
considered appropriate to effect social change. To understand how the language of the U.S. legal system delegitimized Peltier in his
federal case, we first profile Indian cultural conceptions of power and legitimacy.

260
I.H.S. Affirmative
The framing of the legal system is not in line with the American Indian way of life. The law
delegitimizes this lifestyle and perpetuates racist notions of Indian inferiority.
The American Indian conception of cultural power and legitimacy differs greatly from the power
imposed by the U.S. federal court system. Lakes notion of American Indian power is consummatory,
meaning that the instrumental function of protest rhetoric, for example, is coupled with the purpose of
enactment. Beasley describes power and legitimacy in American Indian culture as spiritual power. Morris
outlines the concept of sovereign power and details the U.S. governments legal, political, and economic
strategies of Indian subversion. Regarding the Indian construct of spiritual power, 2000 Green Party vicepresidential candidate and American Indian activist Winona LaDuke, among others, argues that a connection
exists between humanity and all living things. Legitimacy and power in American Indian culture is based
on its collectivistic cultural values that reflect a valuing of heritage, nature, modesty, stability, and
respect for differences in social positions. Therefore, American Indian conceptions of power are
markedly different from the dominant cultural views of power. American Indian rhetoric reveals
conceptions of power and legitimacy. For example, Carbaugh concludes that for the Blackfeet,
communication is based primarily on listener-active silence and interconnectedness. Later in 1999
Carbaugh notes that listening in Blackfeet culture is complex because listening provides a traditional way of
actively co-participating in a largely non-oral, non-verbal, yet real and spiritual world. Listening provides
the Blackfeet with an enhanced sense of power and place within the world. Basso notes that for the
Western Apache American Indian, keeping silent is a response to uncertainty and unpredictability in social
relations, and Wieder and Pratt conclude that modesty and permissible, required silence are characteristics
of American Indian communication behavior. In sum, the sovereign power, which Morris profiles as vital to
the rights of American Indians, is based on silence, modesty, and thanksgivinga conception that may
not mesh with the rational and argumentative workings of the U.S. legal system. Kenneth Burkes
insights on how the law classifies, masks, and manipulates are significant in theorizing about cultural
differences. According to Burke, Law also provides the proper culture for heresy, sect, and schism, as it
provides a bureaucratic body of thought so complex that groups can stress one aspect and neglect other
aspects. Law becomes a way of dramatizing, of symbolizing, ideals. Threats to the law and the
cultural comfort it upholds are negated, delimited, and masked. The legal scientist, Arnolds term
for individuals who articulate the law, is compelled by the climate of opinion in which he finds himself to
prove that an essentially irrational world is constantly approaching rationality; that a cruel world is constantly
approaching kindliness; and that a changing world is really stable and enduring, and that the function of the
law is not so much to guide society as to comfort it. In the legal context, the American Indian is situated
in an irrational, cruel, and unstable world, without much hope for comfort. According to Sanchez,
Stuckey, and Morris, rhetorical exclusion consists of defining outsiders as inherently destructive of
governmental power. As a result, the law masks Indian cultures as allegedly inferior in relation to
the prevailing lifestyle of [the] Euro-American. The legal system may impose masks on the American
Indian, such as framing the Indian as warlike, or the legal system may put a mask on itself, such as
taking the role of the court or the law.

261
I.H.S. Affirmative
Government support of tribes is the source of rhetorical exclusion
In the legal context, the American Indian is situated in an irrational, cruel, and unstable world, without much
hope for comfort. According to Sanchez, Stuckey, and Morris, rhetorical exclusion consists of defining
outsiders as inherently destructive of governmental power.43As a result, the law masks Indian cultures as
allegedly inferior in relation to the prevailing lifestyle of [the] Euro-American.44The legal system may
impose masks on the American Indian, such as framing the Indian as warlike, or the legal system may put a
mask on itself, such as taking the role of the court or the law.45 In particular, Wilkins asserts that U.S.
Supreme Court decisions have masked the American Indian throughout history. Such legal masking,
notes Noonan, is conceived as a set of communications and as magical ways by which persons are
removed from the legal process. For example, in 1883 the United States Supreme Court, in recognizing
the right of tribes to govern themselves, held that they had exclusive authority to try Indians for criminal
offenses committed against Indians. According to the Supreme Court: It [the non-Indian court] tries them, not
by their peers, nor by the customs of their people, nor the law of their land, but by superiors of a different
race, according to the law of a social state of which they have an imperfect conception, and which is opposed
to the traditions of their history, to the habits of their lives, to the strongest prejudices of their savage nature;
one which measures the red mans revenge by the maxims of the white mans mortality [emphasis added].
The Supreme Court of Washington state, in a 1916 case, provides another example of masking and racist
stereotyping: The Indian was a child, and a dangerous child, of nature, to be both protected and restrained. . . True, arrangements took the form of treaty and terms like cede, relinquish, reserver. But
never were these agreements between equals... [but rather] that between a superior and an inferior. Such
racist reasoning portrays American Indians as wards of the government who need the protection and
assistance of federal agencies. The governments obligation is to recreate American Indian governments,
conforming them to a non-Indian model, to establish their priorities, and to make or approve their
decisions for them. As such, American culture views American Indians as subservient and inferior,
without the capacity to govern themselves through their own means of cultural power, hierarchy, or
legitimacy. To dismiss the above federal and state court rulings as insignificant would be easy, given that
they were decided years prior to the civil rights movement in America. Certainly, American society has
become more enlightened and more willing to demonstrate its tolerance for American Indian ways. Perhaps
the government has changed its position between 1883, 1916, and the Peltier trial. Still, even today, without
federal recognition American Indians are seen legally as dependent people. As Hsu recently reported, the
Virginia state legislature dismissed a proposal to grant federal recognition to eight American Indian tribes in
Virginia. By not granting autonomy to the tribes, the government reinforces legal dependency. In 2000
Virginia state representative James P. Morgan introduced legislation that would acknowledge the partial
autonomy of eight tribes whose presence in the state since pre-colonial times is uncontested. Those
opposing federal recognition feared that legally defining the eight tribes as sovereign could someday
introduce legalized casino gambling into the commonwealth of Virginia. Although tribal leaders at the time
of Hsus report had said they were not interested in gambling, many political leaders opposed federal
recognition because future chiefs may think otherwise. The opposition was significant because it
essentially guaranteed legal dependence for years to come.

Indian+Health+Services+Aff Pointer Kelly Corrigan GDI09

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Gonzaga Debate Institute 2009

Indian Health Service Affirmative

Gonzaga Debate Institute 2009

Inherency Lack of Funding......................................................................................................39

Gonzaga Debate Institute 2009

Health Impacts Mental Health................................................................................................ 73

Gonzaga Debate Institute 2009

Gonzaga Debate Institute 2009

Trust Doctrine Impacts US Leadership................................................................................142

Gonzaga Debate Institute 2009

A2: Politics (Obama Good).......................................................................................................176

Gonzaga Debate Institute 2009

A2: US out of Indian Country.................................................................................................. 213

Gonzaga Debate Institute 2009

Indian Health Service 1ac

Gonzaga Debate Institute 2009

Indian Health Service 1ac

Gonzaga Debate Institute 2009

Indian Health Service 1ac

Gonzaga Debate Institute 2009

Indian Health Service 1ac

Gonzaga Debate Institute 2009

Indian Health Service 1ac

Gonzaga Debate Institute 2009

Indian Health Service 1ac

Gonzaga Debate Institute 2009

Indian Health Service 1ac

A continued trend of devolution of I.H.S. responsibilities will provide Congress with a

Gonzaga Debate Institute 2009

Indian Health Service 1ac

Gonzaga Debate Institute 2009

Indian Health Service 1ac

U.S. self-determination policies are modeled by other countries encouraging global

Gonzaga Debate Institute 2009

Indian Health Service 1ac

Gonzaga Debate Institute 2009

Indian Health Service 1ac

Gonzaga Debate Institute 2009

Indian Health Service 1ac

Finally, self-determination conflicts go nuclear

Gonzaga Debate Institute 2009

Indian Health Service 1ac

Gonzaga Debate Institute 2009

Indian Health Service 1ac

Gonzaga Debate Institute 2009

Indian Health Service 1ac

Funding for culturally-specific dramatically improves health care services

Gonzaga Debate Institute 2009

Indian Health Service 1ac

Gonzaga Debate Institute 2009

Indian Health Service 1ac

Gonzaga Debate Institute 2009

Inherency Reauthorizing the IHCIA

Gonzaga Debate Institute 2009

Inherency Reauthorizing the IHCIA

Gonzaga Debate Institute 2009

Inherency Lack of Funding

Gonzaga Debate Institute 2009

Gonzaga Debate Institute 2009

Inherency Lack of Funding

Gonzaga Debate Institute 2009

Inherency Lack of Funding