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- By Elyse Wild
President Donald J. Trump's first 100 days in office have left Native American healthcare reeling.
Since January, the Indian Health Service (IHS) and other federal entities supporting healthcare in Indian Country have been subject to a flurry of budget cuts, layoffs and grant freezes.
Health and Human Services Secretary Robert F. Kennedy, Jr., confirmed on Feb. 13 by a vote of 52-48, courted Indian Country during his confirmation hearing, acknowledging his department's egregious shortcomings regarding IHS and the staggering health disparities Native communities face.
IHS has long been underfunded and understaffed, with a historic vacancy rate of nearly 30% and a budget that falls tens of billions short of its projected need. Native Americans experience the most negative health outcomes across the board, with some of the highest rates of cancer, heart disease, respiratory illness, diabetes, overdose, and suicide. In 2022, the life expectancy for Native Americans was 67.8 years, the lowest of any racial group in the United States and nearly 10 years below the national average of 77.4 years.
During his confirmation hearing, Kennedy emphasized his commitment to supporting American Indian and Alaska Native communities, stating his intent to uphold the department's legal, social and moral obligations. He also outlined plans to address staffing challenges at the Indian Health Service, enhance access to health services for American Indian and Alaska Native women, and ensure that Medicare and Medicaid programs are responsive to the needs of these communities.
“I spent 20% of my career working on Native issues,” he said during his Jan. 20 confirmation hearing. “My father and uncle, Ted Kennedy, were deeply, deeply critical of the functioning of the Indian Health Service back in 1968 to 1980. And nothing's changed. Nothing's gotten better. I'm going to bring in a Native at the assistant secretary level. I'd like to get them actually designated as an assistant secretary for the first time in American history. Make sure that all of the decisions that we make in our agency are conscious of their impacts on the First Nations.”
That sentiment contrasts with slashed programs and decimated budgets that have characterized the past 100 days.
DEI vs. Sovereignty
On Jan. 20, 2025, Trump issued an executive order aimed at putting a stop to “radical and wasteful DEI programs and preferencing.” Another, issued on Feb. 11, 2025, granted authority to the Department of Government Efficiency (DOGE) to “reduce the size of the Federal Government’s workforce through efficiency improvements and attrition.”
The orders created chaos as thousands of federal grants froze, employees were terminated and initiatives operating under Diversity, Equity and Inclusion (DEI) shuttered. While the United States' legal obligation to provide healthcare to tribal nations falls outside of DEI, Native healthcare was swept up in the flurry.
On Feb. 14, 2025, news broke that an estimated 2,500 probationary IHS employees were on the chopping block as a result of the orders. A.C. Locklear, executive director of the National Indian Health Board, told Native News Online that the staffing cuts would have a devastating effect on Native communities.
“When we were experiencing government shutdowns, clinics closed, significantly downsizing services, limiting or eliminating critical access to care has led many times to mortality in our communities,” he said in February.
Native health organizations and nonprofits rallied. That same day, in a letter to Acting Director of Office of Personnel Management Charles Ezell, the NIHB, National Council of Urban Indian Health (NCUIH), National Indian Child Welfare Association and more than a dozen other organizations urged DOGE to exempt employees who are essential to fulfilling trust and treaty obligations to tribal nations. The letter reads in part:
The United States fulfills its trust and treaty obligations through both the direct delivery of Tribal programs and services and through provision of federal funding to Tribal Nations and Tribal organizations serving Tribal Nations. Essential services provided by Federal employees include healthcare services through IHS, law enforcement and public safety through the BIA, and educational services through the BIE—not to mention countless other essential and legally mandated services. These programs are not discretionary; they are legal obligations rooted in treaties, trust obligations, the U.S. Constitution, and long-standing federal statutes.
The next week, Kennedy rescinded the layoffs. In a statement to ICT (formerly Indian Country Today), Kennedy said improving Native healthcare is a priority for the administration, adding that IHS has always been treated as the “redheaded stepchild at HHS.”
"My father often complained that IHS was chronically understaffed and underfunded," Kennedy wrote. "President Trump wants me to rectify this sad history. Indians suffer the highest level of chronic disease of any demographic. IHS will be a priority over the next four years. President Trump wants me to end the chronic disease epidemic beginning in Indian country.”
A month later, the administration announced it would be canceling the leases of 12 IHS offices across the country in a move to reduce federal office space.
The past three months have also seen the gutting of federal programs outside of IHS that support tribal health. At the Centers for Disease Control and Prevention (CDC), a group of programs geared toward reducing overdoses in Native communities was drastically reduced from seven employees to one, according to a source with knowledge of the decision who spoke on the condition of anonymity.
In March, Underscore News reported that the Seattle Indian Health Board, an Urban Indian Organization that provides medical, dental, mental health care, substance abuse treatment and traditional medicine practices, had been locked out of their payment management system since Jan. 28.
The next 100 days appear poised to sow more cuts and confusion. A 64-page Office of Management and Budget passback document, dated April 10, detailed proposed plans for HHS agencies and programs, including $900 million in cuts to IHS.
In an April 17 letter to Kennedy addressing the proposed cuts, NIHB Chairman William “Chief Bill” Smith (Valdez Native Tribe) urged the secretary to consider the repercussions.
“This loss of funding will lead to deaths in our communities from preventable medical incidents, such as precipitous births, cardiac events, untreated diabetes complications, and preventable suicides. We know these impacts because we have lived these outcomes. Before IHS had advanced appropriations, during previous government shutdowns, members of our families died from these exact types of preventable emergencies,” Smith wrote.
Trump has yet to name a permanent director of IHS, a position previously held by Rosalyn Tso (Diné). Benjamin Smith (Diné) is currently the agency’s acting director.
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