There are 574 Tribes1 recognized by the U.S. federal government, which manage Tribal health departments that are responsible for the health and welfare of millions of Native Americans.2 Tribes are sovereign nations with their own laws and governance systems. They have broad and inherent authority over their internal affairs, including authority to protect the health and welfare of their citizens through public health policy and services.3

The generally understood definition of preemption does not apply to the government-to-government relationship between the federal government and Tribal Nations, which is governed by the federal trust responsibility.4 However, the Indian preemption doctrine describes the dual roles of federal authority and Tribal sovereignty in preempting state regulation5 of Tribal lands and peoples.6 And, Tribal law may provide for preemption of actions among internal governing bodies

  • The History of Tribal-State Relations

    “The policy of leaving Indians free from state jurisdiction and control is deeply rooted in the Nation’s history.”7 The United States has long recognized its trust responsibility to Tribal Nations, which includes a duty of protection against state hostility and interference. This can be traced back to the 1832 case Worcester v. Georgia, which was decided during a time when the State of Georgia had passed a series of laws that sought to “annihilate the Cherokee as a political society,” and states and territories generally viewed Tribes as competition for land and resources.8 There, the Supreme Court defended Tribal sovereignty against encroachment from the states, basing its decision on the dual principles that, (1) “the Constitution delegated broad legislative authority over Indian matters to the federal government,” and (2) that the Cherokee had a right to Tribal self-governance within its territory free from state interference.9 This reasoning has persisted, and today, “within Indian country,10 generally speaking, primary jurisdiction rests with the Federal Government and the Indian tribe inhabiting it, and not with the states, but while outside Indian country, state authority is more expansive and tribal authority more restrained.”11


    7 Cohen’s Handbook § 6.01; Rice v. Olson, 324 U.S. 786, 789 (1945).

    8 Worcester v. Georgia., 31 U.S. 515 (1832); see also Roxanne Dunbar-Ortiz, An Indigenous Peoples’ History of the United States at 95-116 (2014).

    9 Cohen’s Handbook § 6.01[2].

    10 18 U.S.C. § 1151 (Indian country defined).

    11 Cohen’s Handbook § 6.01.

  • The Indian Preemption Doctrine

    The Indian preemption doctrine describes how “Congress’s plenary authority over Indian affairs and the tradition of tribal autonomy in Indian country combine to preempt the operation of state law.”12 Rooted in this history of the federal government’s role of safeguarding Tribal Nations from state hostility, “[t]he Indian preemption doctrine started out as a means of balancing conflicting [T]ribal and state interests,”13 conflicts which “have shaped federal Indian law since the nation’s founding.”14 Otherwise described as the federal preemption of state laws that infringe on Tribal sovereignty, it is an essential component of the federal trust responsibility because it safeguards the right of “[T]ribal governments to shape the social, economic, and cultural conditions for their communities to thrive” without undue state interference.15

    The U.S. Supreme Court decision in White Mountain Apache Tribe v. Bracker articulated the balancing test to determine the application of the Indian preemption doctrine, which is that “state jurisdiction is preempted by the operation of federal law if it interferes or is incompatible with federal and Tribal interests reflected in federal law, unless the state interests at stake are sufficient to justify the assertion of state authority.”16 With respect to jurisdiction over Tribal members within Indian County,17 including civil matters such as public health regulation, “state law is generally inapplicable [pursuant to this balancing test], for the State’s regulatory interest is likely to be minimal and the federal interest in encouraging tribal self-government is at its strongest.”18 Regarding a state’s exercise of jurisdiction over non-Indians engaging in activity within Indian country,19 the balancing test must involve “a particularized inquiry into the nature of the state, federal, and tribal interests at stake, an inquiry designed to determine whether, in the specific context, the exercise of state authority would violate federal law.”20

    While the Bracker balancing test recognizes the dual authority of the federal government’s strong interest in preserving Tribal self-governance and the principles of Tribal sovereignty, it has been criticized for its unpredictability.21 It is difficult, for example, to predict whether a “state interest” is “sufficient” to justify an intrusion on Tribal sovereignty. As a result, when Tribal and state laws conflict, one often cannot determine which prevails without working through an often-complex legal analysis. Jurisdictions should consult with attorneys who are familiar with this body of law if they have questions.


    12 Cohen’s Handbook § 6.01.; see also M. Henry Ishitani & Alexandra Fay, Revising the Indian Plenary Power Doctrine, 29 Mich. J. Race & L. 1, 2 (2024) (noting that Congressional plenary authority over Indian affairs with undefined limits has also resulted in paternalistic policies harmful to the exercise of Tribal sovereignty).

    13 Alex Tallchief Skibine, From Foundational Law to Limiting Principles in Federal Indian Law, 80 Mont. L. Rev. 67, 97 (2019).

    14 Cohen’s Handbook § 6.01[1].

    15 Bethany Berger, Preempting Colonialism: The Constitutional & Structural Dimensions of Federal Indian Law Preemption, 58 U.C. Davis L. Rev. 2045, 2046 (2025).

    16 White Mountain Apache Tribe v. Bracker, 448 U.S. 136, 145 (1980); Scope of Tribal Authority, Restatement of the Law, The Law of American Indians § 31 (2022).

    17 Public Law 280 transferred criminal and some civil jurisdiction from the federal government to specific states for crimes and legal issues on Native land. Pub. L. 83-280, 67 Stat. 588 (1953); 18 U.S.C. § 1162; 28 U.S.C. § 1360.

    18 White Mountain Apache Tribe v. Bracker, 448 U.S. at 145.

    19 18 U.S.C. § 1151 (Indian country defined).

    20 White Mountain Apache Tribe v. Bracker, 448 U.S. 136, 145, 100 S. Ct. 2578, 2584, 65 L. Ed. 2d 665 (1980).

    21 Lauren Van Schilfgaard et al., Tribal Nations and Abortion Access; A Path Forward, 46 Harv. J.L. & Gender at 50 (2023).

  • Preemption Provisions Within Tribal Codes

    Tribal Nations’ sovereign authority to organize governments and create laws predates the formation of the United States.22 Tribes vary in size and population and can have centralized governments with the authority to limit political subdivisions within a Tribe. Distribution of authority, including public health authority, within a Tribal government is up to the discretion of the Tribal Nation, and can include the enactment of preemptive laws similar to those discussed throughout this toolkit.


    22 Scope of Tribal Authority, Restatement of the Law, The Law of American Indians § 14 (2022).

    Tribal Code Preemption Example (Navajo Nation Local Governance Act of 1998)

    The Navajo Nation is one of the largest Tribal Nations in size and population. Its central government is comprised of an elected President and Vice President, ten executive divisions, and the Navajo Nation Council which has the authority to enact laws. Throughout the Navajo Nation, there also are 110 Chapters that operate as local governments.23 The Navajo Nation’s Local Governance Act of 1998 (“Act”) delegated Chapters “governmental authority with respect to local matters consistent with Navajo law, including custom and tradition.”24 Chapters have the authority to adopt ordinances “for the general health, safety and welfare of the chapter membership, consistent with Navajo Nation law.”25 In addition to the requirement that Chapter ordinances be consistent with Navajo Nation law, “[a]ll authority exercised by a Chapter, pursuant to th[e] Act, may be preempted by Navajo Nation Council statutes and/or resolutions.”26

     


    23 Navajo Nation Governmental Structure, NAVAJO NATION DIVISION OF COMMUNITY DEVELOPMENT, https://navajochapters.org/about/ (last visited May 5, 2026)

    24 26 N.N.C. § 1(B).

    25 26 N.N.C. § 103(E).

    26 26 N.N.C. § 103(C).

     

  • What Do Public Health Professionals Need to Know?

    Public health practitioners in state and local governments should understand that Tribes are sovereign nations with inherent authority to govern their internal affairs and that state and local jurisdictions are typically preempted by federal law from interfering with that authority. State and local governments should work with Tribes as co-equal partners, and not approach them as if they are governmental subsidiaries. And public health professionals working with or within Tribal nations and Tribal-serving organizations should understand the sometimes nuanced patchwork or laws that impact Tribal sovereignty and authority to ensure they can best advance public health within Tribal communities.

    Tribal public health authority can be impacted by the abrogation of Tribal authority by the U.S. Congress; by situations in which the federal law preemption doctrine permits state laws to impact Tribal authority; and preemption provisions within Tribal laws. Preemption can be a legally nuanced, complicated subject in general, but that is doubly so when applied to Tribes given their unique status as independent sovereign nations within the borders of the United States. Public health professionals and policymakers should endeavor to craft public health policy in a way that respects Tribal Nations’ national and cultural sovereignty. That often means (somewhat paradoxically) relying on federal law to preempt states from regulating Tribes and Tribal members.


    1 While this document prefers primarily to the law of federally recognized Tribes, some information may also be applicable to Tribes with state-recognition in the exercise of their inherent right to self-governance.

    2 Indian Health Service, Indian Health Service Health Equity Report (2024), https://www.ihs.gov/sites/newsroom/themes/responsive2017/display_objects/documents/factsheets/IHS_Health_Equity_Report_FactSheet_2024.pdf; Congressional Research Service, The 574 Federally Recognized Indian Tribes in the United States (2024), https://www.congress.gov/crs_external_products/R/PDF/R47414/R47414.5.pdf.

    3 See United States v. Wheeler, 435 U.S. 313, 322–23 (1978); Cohen's Handbook of Federal Indian Law § 5.01 (2012) (“Perhaps the most basic principle of all Indian law . . . is the principle that those powers which are lawfully vested in an Indian tribe are not, in general, delegated powers granted by express acts of Congress, but rather inherent powers of a limited sovereignty which has never been extinguished.”) (hereinafter “Cohen’s Handbook”); Aila Hoss, A Framework for Tribal Public Health Law, 20 Nev. L. J. at 121 (2019).

    4 U.S. Dept. of the Interior, What is the federal Indian trust responsibility? (Nov. 8, 2017), https://www.bia.gov/faqs/what-federal-indian-trust-responsibility.

    5 Congress enacted Public Law 280 to grant certain states criminal jurisdiction over Native Americans on Tribal lands.

    6 See Barona Band of Mission Indians v. Yee, 528 F.3d 1184, 1188–89 (9th Cir. 2008) (“Unlike traditional preemption, two conceptual barriers have been erected to block State law from regulating Indian behavior: federal enactments and Indian sovereignty.”).