The federal government has a unique government-to-government relationship with American Indians and Alaska Natives that is based on the U.S. Constitution, treaties, court decisions, statutes and regulations. The government’s unique relationship was first articulated in the U.S. Supreme Court decision of Cherokee Nation v. Georgia (1831) as a trust relationship similar to that of a guardian and his ward. The trust responsibility has been upheld in subsequent court decisions, statutes and executive orders. It forms the underlying basis for federal services to Indian people based on their political status as members of Indian tribes having a government-to-government relationship with the United States.

The provision of health care to Indians dates back to treaties between the United States Government and Indian Tribes that included provisions for medical services, the services of physicians, or the provision of hospitals for the care of Indian people. The Snyder Act of 1921 and the Indian Health Care Improvement Act, which was reauthorized and made permanent as part of the Affordable Care Act of 2010, provide specific legislative authority for ensuring access to health care for Indian people.