Indigenous sovereignty is the supreme law of this land, but it seems that the President has forgotten that fact.

The Trump Administration’s new wave of proposed changes to healthcare recently called for Medicaid recipients to be either working or engaged in volunteer work. While it goes without saying that this imposes incredible administrative costs on an already complex and costly situation, recent exchanges between the Health and Human Services Department and tribal leaders show that a work requirement also cripples Native American sovereignty.

Questioning the status of Native American tribes as sovereign nations, Trump’s cabinet is making moves under the assumption that tribal affiliations constitute racial identity rather than actual political citizenships. If the work requirement is waived for members of federally recognized tribes, the Trump Administration maintains the notion that this could be considered illegal preferential treatment of a group on the basis of race.

Of course, this notion is untrue. Not only do Native Americans deserve healthcare without apology and restriction, tribes exist as political bodies separate from the United States’ jurisdiction. Ruth Hopkins, who herself is Dakota/Lakota Sioux, writes: “The federal government officially recognizes these tribes through treaty, and most recently, through a regulatory process established by the Bureau of Indian Affairs in 1978 … The Trump administration cannot ignore the law, nor the reality of tribes’ existence as sovereign nations that predate the United States. Treaties cannot be sponged away.”

Treaties established between the United States and tribal authorities must all be honored as per this passage from the Constitution: “[A]ll Treaties made, or which shall be made, under the Authority of the United States, shall be the supreme Law of the Land…” Because of this passage, otherwise known as the Supremacy Clause, if the Trump Administration fails to recognize tribal autonomy, then it performs an unconstitutional action.

If lack of tribal recognition isn’t bad enough, Medicaid’s work requirement reinforces adverse policies for Native people. As it stands, American indigenous communities are exempt from coverage fees if they do not have health insurance; they are also eligible for alternative healthcare programs offered by the Indian Health Services. Under the Affordable Care Act, however, the benefits provided by Medicaid have grown significantly in recent years.

When compared to the overwhelmingly underfunded Indian Health Services, Medicaid often serves as a better alternative for Native Americans. If the work requirement on Medicaid is enforced in Native communities, the Trump Administration could limit access to sufficient healthcare due to the high rate of unemployment on reservations. This fact is coupled with the reality that many Native American communities already disproportionately struggle with health problems and have lower life expectancies than non-Native populations.

“The United States has a legal responsibility to provide healthcare to Native Americans.” Cherokee tribal enrollee Mary Smith told Politico. “It’s the largest prepaid health system in the world — they’ve paid through land and massacres — and now you’re going to take away health care and add a work requirement?” Smith, formerly the head of Indian Health Services under President Obama, is among many voices protesting the Trump Administration’s continued abuse of Native Americans nationwide. And just like Smith’s, the voices of the Lakota People’s Law Project also cry out against and wholeheartedly oppose the continued injustices directed at indigenous communities and their allies.