The responsibility for the health of Native people transfers from the War Department to the Bureau of Indian Affairs (BIA). Prior to 1849, all Native-U.S. relations were negotiated within treaties dependent on nation-to-nation protocols. By shifting to an internal government department, the United States begins to shift how it formally relates to tribal nations–now, as sovereign nations within the United States, rather than along or bordering the U.S. The BIA oversees the use of congressional appropriations for the establishment of health programs for Native people as part of the new country's infrastructure for managing treaty obligations. For the U.S., this represents the end of land battles and the move towards new strategies of assimilation and erasure.