National Indian Health Board cites failed U.S. policies toward American Indians for severe COVID-19 impacts in testimony before U.S. Commission on Civil Rights

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Federal government’s failure to fulfill its treaty obligations to tribes for healthcare and public health discussed

News Release

National Indian Health Board

The National Indian Health Board (NIHB) Acting Chairman William Smith from the Valdez Native Tribe of Alaska testified before the U.S. Commission on Civil Rights as part of a virtual public briefing, titled: COVID-19 in Indian Country: The Impact of Federal Broken Promises on Native Americans. In his oral remarks before the Commission, Acting Chairman Smith discussed the federal government’s failure to fulfill its treaty obligations to the tribes for healthcare and public health, made evident by chronic underfunding of Indian Health Service (IHS), paternalistic oversight over tribal programs and reluctance to expand self-determination and self-governance policies across federal agencies. The federal government’s failure to honor treaty obligations is directly tied to the disproportionate and extreme impacts of COVID-19 in Indian Country.

Pictured: Acting Chairman William Smith, Valdez Native Tribe of Alaska and National Indian Health Board Chairman.
Pictured: Acting Chairman William Smith, Valdez Native Tribe of Alaska and National Indian Health Board Chairman.(Screenshot: National Indian Health Board)

“The Indigenous experience with COVID-19 affirms that colonization continues to function according to its design. The most obvious problem is the underfunding of the Indian Health Service, which is the only federal healthcare system created as the result of treaty obligations and is the most chronically underfunded federal healthcare system,” Acting Chairman Smith said. “Limited funding means rationed health care. We, first Americans, remain last in health care opportunity. This is unacceptable and needs to be remedied.”

The U.S. healthcare system spends about $9,409 per year for one American’s health – but the U.S. only spends just $3,779 per year for one American Indian or Alaska Native person’s health. According to the Government Accountability Office (GAO), from 2013 to 2017, the Indian Health Service annual spending increased by roughly 18% while spending under Medicare and Medicaid increased by 22% and 31%, respectively. Similarly, during the same period, the Veterans Health Administration (VHA), which is the only other federal healthcare delivery system, increased its spending by 32%. The Veterans Heath Administration has a service population that is only three times that of Indian Health Service, but the agency’s annual appropriations are nearly 13 times higher.

Pictured: Participants in the virtual public briefing, titled: 'COVID-19 in Indian Country: The Impact of Federal Broken Promises on Native Americans.'
Pictured: Participants in the virtual public briefing, titled: 'COVID-19 in Indian Country: The Impact of Federal Broken Promises on Native Americans.'(Screenshot: National Indian Health Board)

“This Coronavirus disease continues to disproportionately ravage the disempowered among us and Indian Country is right at its center. But, to understand what is happening to tribes, America must first insist on an honest reckoning of history, for what we are seeing today, is indeed, the offspring of colonization,” said Acting Chairman Smith. “The United States must revolutionize its approach to tribal nations and break new ground by truly honoring its trust and treaty obligations. A good first step is making massive and sustained investment in rebuilding tribal communities and health systems in its response to COVID-19.”

When compounded over time, the impact of destructive federal policies towards American Indians and Alaska Natives like involuntary assimilation, acts of physical and cultural genocide and forced relocation, have resulted in higher rates of historical and inter-generational trauma, adverse childhood experiences, poverty and poor health outcomes across Indian Country.

Acting Chairman Smith also offered the Commission recommendations to remedy the systemic barriers and give tribes a chance to fight COVID-19, which included:

  1. Honor the treaties.
  2. Listen to tribes and act accordingly.
  3. Implement the Indian Self Determination Act in every agency of the Federal Government.
  4. Immediately invest $1 billion in water and sanitation.
  5. Provide emergency funding directly to tribes for COVID-19 intervention.
  6. Permanently reauthorize and fully fund the Special Diabetes Program for Indians.
  7. Make technical fixes to federal Medicaid law that would maximize third party revenue for the Indian health system.
  8. Address mental and behavioral health needs that have been exacerbated by the COVID-19 pandemic.
  9. Stop using a competitive grant mechanisms or other paternalistic funding models with tribes.
  10. Establish the Indian Health Service as an entitlement program that is fully funded.

“As the sole national organization committed to advocating for the fulfillment of the federal government’s trust and treaty obligations for health, National Indian Health Board is dedicated to bringing into fruition the day when Our People can state with dignity that the United States held true to its solemn word,” Acting Chairman Smith said.

Learn more about National Indian Health Board’s advocacy at or visit the National Indian Health Board COVID-19 Tribal Resource Center at to read the full testimony.

National Indian Health Board Mission Statement

Established by the tribes to advocate as the united voice of federally recognized American Indian and Alaska Native tribes, National Indian Health Board seeks to reinforce tribal sovereignty, strengthen tribal health systems, secure resources, and build capacity to achieve the highest level of health and well-being for our People.

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