Welcome to another episode of Impact Unfiltered, where we dive deep into honest conversations with leaders creating real change in healthcare and beyond. In this session, host Stewart sits down at the Self-Governance Conference with Geoff Strommer — an Indian law attorney with 35 years representing tribes, tribal governments, and tribal organizations on self-governance work spanning legislation, litigation, and negotiation.
Geoff Strommer walks through what it actually takes — agency by agency, statute by statute, dollar by dollar — to move authority from the federal government to tribal governments. He details how Alaska’s 27 co-signers built the strongest model of tribal cohesion in the country, why 105(l) leases are a once-in-a-generation game changer for tribal infrastructure, and why a recent New York district court win could unlock self-governance for water and sewer treatment facilities.
With on-the-ground stories of tribes like Jamestown S’Klallam filling rural healthcare voids that the private market simply can’t sustain, this episode is a working tour of how policy becomes lived reality.
Tune in for a conversation about the inch-by-inch fight for tribal self-governance, the next legislative frontiers, and why tribes are now operating the most sophisticated public health systems in the country.
1. Introduction to Impact Unfiltered and Episode Overview
- The podcast’s mission: real conversations with leaders driving change in healthcare, business, and community
- Setting the scene at the Self-Governance Conference
- Introduction of guest: Geoff Strommer, Indian law attorney
2. Background and Role of Guest (Geoff Strommer)
- 35 years representing tribes and tribal organizations on self-governance
- Work spans legislation, litigation, and negotiation
- Fingerprints on most major stages of the self-governance arc
3. Why It’s a Fight Inch by Inch
- The original Indian Self-Determination and Education Assistance Act primarily affected IHS and BIA
- Neither agency was interested in transferring money or authority to tribal governments
- Both were paternalistic and made assumptions about what tribes couldn’t do
- Every step has been a fight to fully implement Congress’s vision
- 35 years of litigation and amendments to force agencies to comply
4. The Eight-Generation View
- Tribal leaders Geoff Strommer works with are visionaries — often planning eight generations out
- Big-picture concepts from 25 years ago have become today’s reality
- Long shots get achieved in this space — long shots will keep getting achieved
5. Alignment Among Tribes: From Friction to Cohesion
- Early in self-determination, alignment was a real obstacle
- For the past 10–15 years, alignment has not been a significant factor
- The movement was born in the late 1980s from 15–20 tribal leaders fed up with bureaucratic implementation
- Despite massive geographic, size, and rural/urban differences, tribes found common ground
- Quote: “It’s working together that has made it work.”
6. The Alaska Model: 27 Co-signers, One Agreement
- When IHS opened 10 demonstration slots in 1992, Alaska organizations asked for just one slot
- They committed to working it out together rather than competing
- Today, that single agreement has 27 co-signer organizations
- Covers the entire state’s IHS system
- 7,500 people from across the state negotiate together, twice a year, in the same room
7. The National Picture: Cohesion Strengthening Every Year
- Cohesion has been consistent for 15–20 years — and continues to strengthen
- Historic tension between self-governance tribes and Title I contracting tribes has narrowed
- 65–70% of tribes participate in IHS self-governance/contracting in some form
- At its core, this is a political movement — administrative and funding wins flow from political success
8. The Two Biggest Wins of the Last Five Years
- 105(l) leases: created by litigation roughly 10 years ago, now fully funded — from $300–400K in 2016 to nearly $900M today
- Contract support costs: 30 years of litigation and four Supreme Court cases established 100% entitlement
- Combined effect has completely changed the tribal financial picture
- Physical landscape of tribal facilities looks completely different than 10 years ago
9. The Untapped 105(l) Opportunity
- Only 25–30% of tribes are accessing 105(l) leases
- The ceiling hasn’t been fully explored
- A recent district court win for the St. Regis Mohawk Tribe (10 days before recording) could expand 105(l) to water and sewer treatment facilities
- Major infrastructure breakthrough if upheld
10. The Reality of Rural Tribal Infrastructure
- Geoff Strommer underscores what’s at stake: there are communities in rural Alaska and on Navajo with no water or sewage systems at all
- Residents carry sewage in buckets and melt snow for drinking water
- This is the reality in the United States in 2026
11. Cutting Red Tape: The Original Motivation
- One of the biggest motivators of self-governance was eliminating report-writing for reports that meant nothing
- The work is still more technical than it needs to be
- Simplification remains an active priority
12. What’s Next: Mandatory Funding and Non-IHS Agencies
- Move contract support costs and 105(l) lease funds to mandatory appropriations
- Currently drawn from discretionary appropriations, creating pressure on the rest of the discretionary budget
- Expand self-governance into Fish and Wildlife Service, National Parks, and other resource agencies
- Jamestown S’Klallam example: signed agreement with US Fish and Wildlife to take over the Dungeness National Wildlife Refuge
- Quote: “Invariably they are more culturally connected to those lands than anybody else in this country, and they’re better stewards of them.”
13. What He Wants Everyone to Walk Away Knowing
- Self-governance works, and works quite well
- The more flexibility and authority transferred, the better tribes perform
- Tribes are operating some of the largest, most sophisticated public health systems in the country
- Quote: “Tribes are operating some of the largest, most sophisticated public health systems. Because they are truly the last public health system in this country.”
14. Tribes as Rural Healthcare Anchors
- Rural healthcare across the U.S. is breaking down
- Most tribes are in rural parts of the country — natural community leaders
- Jamestown S’Klallam built a clinic serving four surrounding rural counties on the Olympic Peninsula
- Residents who used to drive two hours for care now drive 15 minutes
15. Closing Remarks and Gratitude
- Host recognition of Geoff Strommer’s 35 years of work
- Appreciation for the legal infrastructure he and his peers have built
- Encouragement for tribes to keep fighting for every square inch
