Promises to Keep: Public Health Policy for American Indians and Alaska Natives in the 21st Century

Promises to Keep explains the changes that are occurring in the Indian health care delivery system as it evolves from a federal government program to a health care system that increasingly is operated by tribes. Policy-makers, public health professionals and health care financing administrators in both federal and state governments often have questions: Why do Indians have free health care? Why are Indians treated differently than other minority groups? What is tribal sovereignty? What is the federal trust responsibility? Who is considered an Indian? Why are there different rules for urban Indians than for Indians living on reservations? Who is paying for Indian health care? How do we work with tribes? Won’t Indians receive better health care if they are enrolled in private sector HMOs? What do tribes want?

Promises to Keep describes the history, legal basis, financing, and organizational structure of the complex health care delivery system that is intended to serve American Indians and Alaska Natives. Building on 25 years of experience with tribally-operated health care systems, Promises to Keep charts a course for public policy that would reduce the disparities in funding and health status among American Indians and Alaska Natives.