RAPID CITY, S.D. — South Dakota is one of 14 states that has not expanded Medicaid under the Affordable Care Act, a move that would improve healthcare services for the state's large American Indian population, according to one expert.

Nurse Margaret Moss has spent 30 years researching and educating the public about the health of indigenous people. South Dakota has the fourth-largest percentage of Native Americans in the U.S., with rates of death from heart disease, diabetes, pneumonia and other causes that are significantly higher than non-Hispanic whites. And Moss said the numbers have been static for three decades.

"People think American Indians are the past, they're not around anymore,” Moss said. “And if you don't have a very good understanding or view of the history or politics, or culture of American Indians in a state, then you're not going to vote for things."

Gov. Dennis Daugaard appointed a coalition four years ago with the goal of improving healthcare for American Indians. But opposition from fellow GOP lawmakers led him to decide against applying for Medicaid expansion, and the coalition was disbanded last month.

In South Dakota, 36 percent of the 50,000 state residents who would qualify for expanded Medicaid are Native Americans. The state's Argus Leader newspaper recently reported the median life expectancy for Native Americans in South Dakota is 21 years shorter than the state average.

Moss said a huge obstacle for improving healthcare is patient misidentification, which is higher for American Indians than any other group.

"So, if the numbers are all wrong, we don't even really know what are the true death rates, what are the true cancer rates, or admission rates, access rates,” she said. “We don't know a whole lot because nobody asks, or they guess."

In the 1800s, the U.S. government promised to provide health services for tribes in exchange for their land. But Moss said the federal Indian Health Service is chronically underfunded. She noted there are now 573 federally recognized U.S. tribes. But when addressing policymakers, she's found few are familiar with their own state's demographics.

"'Do you know the tribes that are there, and what are they, and whatever?' And no one ever knows!” Moss said. “I said, if you don't know that, how can I even get to the intricacies of their specific problems."

The Indian Health Service is one of several agencies affected by the current government shutdown.


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CORRECTIONS: Washington Gov. Bob Ferguson was not at the 3rd annual taskforce summit. An earlier version incorrectly stated he had attended. In addition, the story now mentions that the American Indian Health Commission organized the summit. (11:12 a.m. PST, June 30, 2025)

Native Americans in Washington state face opioid and fentanyl overdose rates four times the national average and leaders are calling for more investment in treatment centers and transitional housing to address the problem.

While nationally fentanyl overdoses have declined, Native American fatalities have surged since the pandemic.

Rep. Debra Lekanoff, D-Bellingham, is part of the State Tribal Opioid-Fentanyl Taskforce. She serves Whatcom County, where overdose-related fatalities are the highest in the state.

"I can't tell you the number of times that the Native American communities of Lummi Nation and of the Nooksack Tribe have stood next to their graves being in such sadness from the loss of their grandmothers, their mothers, their children," Lekanoff recounted.

During the taskforce's third annual summit, organized by the American Indian Health Commission, tribal leaders and state agencies met for three days and heard from community members in recovery from opioid use disorder.

Last year, Lekanoff noted, the task force partnered with tribal governments and invested in substance abuse treatment facilities based on a successful model created by the Swinomish.

"The model that Swinomish created 12 years ago has now been incorporated into over 20 tribally owned substance abuse disorder facilities that are healing all Washingtonians," Lekanoff explained.

Lekanoff added in the next couple of years the task force will focus on transitional housing for those recovering from substance abuse. She stressed it is a nonpartisan issue and it will take everyone working together to make change.

"It is going to take us recognizing that we're one people, we're one family, we're one community in Washington state," Lekanoff emphasized.


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American Indian and Alaska Native communities in Colorado continue to face significant gaps in health care access, quality and outcomes, according to a new analysis of the Colorado All Payer Claims Database.

While the communities face higher rates of many chronic conditions, they are also not getting important preventive care.

David Wright, data manager at the Denver Indian Center, said fear remains a primary barrier, pointing to decades of mistreatment, including the forced sterilization of women and federal policies forcing medicine men and other spiritual leaders into mental asylums up until 1978.

"Native people, for a long time, have been used to advance medical research without their consent," Wright pointed out. "And so there's a large mistrust within the native communities against the medical profession."

Between 2018 and 2024, American Indian and Alaska Native people were diagnosed with kidney disease, autoimmune, nervous, metabolic and endocrine disorders such as diabetes at rates far above their white peers. Wright noted the analysis, produced in partnership with the Center for Improving Value in Health Care, will be used to create a culturally tailored education program for health providers.

Without additional training, Wright pointed out health professionals are likely to continue to assume chronic conditions are due to an individual's dietary choices. Many do not understand for more than 100 years, tribes had to rely on government rations, typically high in carbohydrates and salt, to get enough calories.

"Because of the forced relocation and the reservation systems, and relying on heavily carbohydrate related rations," Wright added.

Poverty, lack of affordable housing and the breakdown of family systems also disproportionately affect health outcomes. Wright argued better health will require treating the whole person, not just specific medical conditions. When people are out of balance in any one area, he stressed there are ripple effects.

"If we're not able to provide stable housing -- which is not only of mental and emotional and physical importance -- but it also will affect the outcomes and the teachings and the role modeling you need for your children and your family structures," Wright emphasized.


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Ho-Chunk has kicked off its summer internship program in Nebraska after sifting through 600 applicants.

It is opening pathways to higher education and leadership positions within the Winnebago Tribe in Nebraska. The Ho-Chunk Incorporated internship program will mentor nearly two dozen students this summer, 14 of whom are members of the Winnebago Tribe.

Aaron LaPointe, CEO of Ho-Chunk Capital, started as an intern and said the program is an opportunity for interns to learn a business from the ground up - and he has personal experience.

"I was studying agriculture, and the CEO here at Ho-Chunk was like, 'What? We have a tribal member studying agriculture? He's got to run this farm,'" LaPointe recounted.

LaPointe started by running the farm and ascended to head Ho-Chunk Capital, an investment arm of the corporation. He took on several other roles on his way up the ladder, too. The internship program is highly competitive. From hundreds of applicants, only 24 were accepted.

In addition to learning skills they need to be successful in business, LaPointe said, interns also gain the confidence to do their jobs.

"Our interns aren't just sitting in a cubicle off to the side filing," he explained. "They're in the board meetings, they're in the executive board meetings and strategizing business, and we really make it a well-rounded experience."

The internship program runs until Aug. 1.