Native American Tribes Are Sounding the Alarm Over a Health Care Crisis

Tribal leaders from across the country urged Congress this week to bankroll chronically underfunded programs and crumbling Indian Health Service facilities, a year into the Trump administration’s focus on cutting federal spending.

Dozens of tribal representatives testified in front of the House Appropriations Interior, Environment and Related Agencies Subcommittee. They stressed that anticipated cuts to Medicaid, as well as Native Americans being disproportionately affected by violence and disease, are compounding the already harrowing effects of the insufficient funding of Native American health care.

The federal government has treaty and trust responsibilities to fund many programs for Native nations in exchange for the land the United States took hundreds of years ago. Nearly every tribal representative who testified this week mentioned programs they believe are not properly funded, including health care services, water rights settlements, courts, law enforcement, infrastructure and education.

“We don’t have the president’s budget yet. We can guess and throw darts at how much it’s going to be,” said Chief Allan, chairman of the Coeur d’Alene Tribe of Idaho. “What is fact is that Indian Country has always been historically underfunded in everything.”

Many tribes requested the IHS receive about $73 billion for fiscal year 2027, a figure that the National Tribal Budget Formulation Workgroup says would fully fund the service. IHS received about $8.5 billion for this fiscal year.

Some testimony described the struggle to provide services without adequate federal aid.

Abigail Echo-Hawk, executive vice president of the Seattle Indian Health Board and director of the Urban Indian Health Institute, told lawmakers about an elderly tribal member who was sexually assaulted in a program she oversaw, and the perpetrator was still in the building when Echo-Hawk was notified of the assault. The police did not show up for hours, Echo-Hawk said.

“We ensured that when [the victim] asked for new clothes that we went and sorted through sweatpants. And at the time, because of the lack of funding, we only had size 5X for a small, dainty little elder,” Echo-Hawk, a Pawnee Nation of Oklahoma citizen, said.

“Without the full funding of the Indian Health Service, you’re going to see providers like myself, other people, taking 5X sweatpants and attempting to pull the string so we can just fit them up the legs of a rape victim,” she added.

Charles Riley, governor of the Pueblo of Acoma in New Mexico, said his tribe was “essentially forced to take over” an IHS facility last year that “critically needed repairs” and lacked personnel and services.

“Due to chronic underfunding, the facility lacked hot water, in a hospital,” Riley said.

Riley’s tribe requested $7.6 million to offset the costs they’ve taken on to repair the facility.

Tohono O’odham Nation Chairman Verlon Jose said the hospital in Sells, Arizona, “is one of the oldest IHS facilities, and it can only handle minor medical issues.”

“The replacement facility has been on the IHS facilities priority list for over 30 years, and yet it continues to receive only limited funding allocations. Congress must appropriate more funding to complete the health care facilities on the list in a reasonable time frame,” he added.

In February, Health Secretary Robert F. Kennedy Jr. pledged $1 billion to IHS infrastructure repairs, prioritizing facilities from a 1993 priority list.

Kennedy said he reviewed a construction backlog that amounted to $8 billion for IHS facilities.

“I walked through facilities that badly needed renovation or reconstruction or just replacement,” he said at the time. And he admitted, “we allowed that backlog to grow for too long.”

While many tribal representatives were thankful for the secretary’s pledge, many were skeptical at this week’s hearing.

“Think about how far $1 billion is going to go. That’s not very far. Think about the fact that we have a priority list from 1993,” said Esther Lucero, a Diné Native American and CEO of the Seattle Indian Health Board.

“I hate to even bring up the $1 billion investment in infrastructure because urban programs are not eligible, and I never, ever want to take resources from our tribal partners. They’ve been waiting since 1993,” Lucero said. “At the same time, our urban programs are trying to serve those 76% of American Indians and Alaska Natives living in urban areas.”

House Appropriations Chairman Tom Cole, a Chickasaw Nation member, said Kennedy “has made some interesting” hospital infrastructure proposals.

“We’ll see if he can do that,” Cole said. “I certainly would be supportive of it, and we’ll see what else we can do. But this health care challenge isn’t going away, it’s going to take long-term, sustained effort. This committee has done that. I think it’s steadily increased health care expenditures, but we’re so far behind. And again, the demands on this budget outstripped the size of the budget.”

The Department of Health and Human Services told NOTUS in a statement that projects on the 1993 list “are funded in priority order as resources become available, subject to congressional appropriations. IHS is required to allocate Health Care Facilities Construction appropriations to projects on the Priority List until all are fully funded.”

Anticipated cuts to Medicaid also had some tribal representatives on high alert. Donna Thompson, chair of the governing body of the Shoshone-Bannock Tribes of Idaho, explained that those using IHS services often rely on Medicaid to make up for a lack of funding. But Medicaid is run by states, which don’t have the same responsibilities to tribes as the federal government does, she said.

With roughly half of her tribe on Medicaid, any cuts would “affect us very deeply,” Thompson said.

Republicans passed over $1 trillion in Medicaid cuts as part of last summer’s reconciliation bill. These cuts will phase in over a decade and are set to begin in late 2026.

Rep. Chellie Pingree of Maine, ranking member of the subcommittee, said she was “also very worried about what will happen when these Medicaid cuts kick in.”

“We’ve gotten very dependant on having tribal members be covered by Medicaid, and I don’t know how we should be thinking about that in this year’s appropriations cycle, but if there’s ways we could write some language in there to help protect that, whatever we can do to sort of prevent disaster when there’s suddenly a huge pool of unfunded people,” Pingree said.

In a later hearing, Aaron Hines, chair of the Northwest Portland Area Indian Health Board, urged lawmakers to “hear our words.”

“These words have been shared time and time again, year after year, the same message over and over, yet there’s little to no action that has a great impact,” Hines said.

Some tribal representatives mentioned increases in cancer and terminal diseases on their reservations throughout the hearings, which is compounding their funding needs.

Several years ago, the subcommittee secured advance appropriations for IHS, meaning funds would still flow in the event of a government shutdown. Many tribal representatives urged the subcommittee to continue implementing advance appropriations, which the subcommittee committed to, in light of a recent pattern of government shutdowns. They also noted the president’s 2026 budget proposal didn’t include language for advance appropriations, an idea the subcommittee was quick to thwart last year.

“I will assure you, advanced funding will not be in jeopardy, no matter what the president’s budget says when it rolls out, probably later this month,” Cole said in the hearing.

Several tribal leaders requested that Congress convert the IHS to permanent, mandatory funding.

“The current system results in unpredictable funding levels,” said Jonas Hill, councilman of the Oneida Nation, “which, in turn, make it more challenging for tribal governments to manage their own budgets and plan for the future.”

But Congress would have to pass special legislation to make IHS funding permanent, like Medicare or Social Security, rather than being discretionary funding that requires a yearly vote and is subject to policy changes

Rep. Mike Simpson, chair of the subcommittee, supported that idea. And Cole said switching IHS to mandatory funding is “something I think we should look at.”

“Indian Health Service is older than all the mandatory programs we have,” Cole said. “It was one of the few areas the federal government actually had an obligation to provide health care because of treaty and trust responsibilities, before Medicaid, Medicare and all those programs, so it never got pulled into the system.”

“I don’t know how you get there, given the size of the budget and the range of responsibilities this subcommittee has, although it’s done pretty valiant efforts,” he added.