The Effects of Self-Governance: Evidence from PL 638 Compacts on Native American Health Outcomes


The 1975 Indian Self-Determination and Educational Assistance Act of 1975 (ISDEAA) aimed to expand self-determination opportunities for indigenous tribes in the United States. Specifically, under Title V tribes can compact with the federal government to receive funding to provide their own services. Beginning in the 1990s, tribal governments have successfully petitioned to compact for health resources. By 2020, ~47% of all tribal healthcare facilities were compacted, including ~36% of hospitals. I add to the literature by providing an empirical estimate of the effect of compacting on mortality outcomes using a stacked difference-in-differences approach and a national dataset. Further, I examine heterogeneity over time using an event study as well as additional heterogeneity by facility type. These results will shed light on the effectiveness of compacting to improve health outcomes and add to the tribal self-governance and local control literatures.

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