The Kashia Pomo Tribe, like many Native American communities, faces significant healthcare challenges, with the nearest hospital nearly two hours away. Now, proposed budget cuts to the Indian Health Service (IHS) by the Department of Government Efficiency (DOGE) could further strain an already struggling system, tribal leaders warn.
“These cuts are jeopardizing a system that’s working,” said Ron Allen, chairman of the Jamestown S’Klallam Tribe. “They don’t understand how essential these services are to our communities.”
IHS, the federal agency responsible for Native American healthcare, received $8 billion in funding for fiscal year 2025—far below the $73 billion tribal leaders estimate is necessary. The cuts threaten critical services and could lead to layoffs of up to 2,500 employees, according to the National Indian Health Board (NIHB).
Healthcare Crisis Deepens
Tribal health systems operate in two ways: Some tribes receive direct services from IHS, while others manage their healthcare with allocated funds. However, many facilities already lack overnight services, emergency care, and obstetric care. The impending budget reductions could further limit these essential offerings, leaving patients with no choice but to travel long distances for urgent medical attention.
“This isn’t a trickle-down effect—it’s a tidal-wave effect,” said Reno Keoni Franklin, chairman of the California Rural Indian Health Board. “It happens instantly.”
DOGE has already shut down at least 12 IHS offices, including those that provided water and food safety inspections. Franklin warns that without these services, tribal communities risk deteriorating infrastructure, including outdated drinking water and wastewater systems.
Staffing Shortages and Federal Uncertainty
The IHS is already struggling with a 30% vacancy rate for healthcare workers, including a 36% shortage of physicians. The federal hiring freeze has further complicated staffing issues, particularly for hospital administrators who play a crucial role in securing third-party reimbursements from Medicaid and Medicare—programs that Congressional Republicans have also targeted for cuts.
“There are administrative costs to IHS that should be examined before making sweeping workforce reductions,” said Jerilyn Church, president and CEO of the Great Plains Tribal Leaders Health Board.
Additionally, the U.S. Department of Health and Human Services (HHS) recently offered a $25,000 early retirement buyout to employees, raising fears of losing experienced staff. Church confirmed that at least one healthcare provider at the Oyate Health Center has already decided to leave.
Concerns Over Federal Commitment
The federal government has a legal trust obligation to provide healthcare to Native American tribes in exchange for land agreements. However, leaders fear that DOGE’s budget cuts and recent directives from the Office of Management and Budget (OMB) could violate these commitments.
“Secretary Kennedy understands the trust responsibility,” said Franklin, referencing U.S. Health and Human Services Secretary Robert F. Kennedy Jr. “But will he act on it and ensure increased funding? That remains to be seen.”
Despite ongoing discussions with IHS and federal officials, tribal leaders remain concerned about the future. As the Biden administration navigates budget decisions, they urge policymakers to recognize the critical role IHS plays in Native American health and well-being.
