Funding for the Indian Health Service has increased over the past decade but the agency remains underfunded, which affects both the health and culture of South Dakota tribes.

In 2021, the life expectancy of a Native American or Alaska Native in the U.S. was just over 65 years. That's 11 years less than non-Hispanic white people, and the biggest gap since 1940.

Damon Leader Charge, director of tribal outreach for the Sanford School of Medicine at the University of South Dakota and former Tribal Health Administrator for the Rosebud Sioux Tribe said the Indian Health Service must provide health care for Native people but noted in a panel discussion care can be hard to get.

He noted people in his tribe who want to use the Indian Health Service to give birth have to travel 90 miles to Pine Ridge.

"We're not having our babies within our tribal homelands," Leader Charge pointed out. "If our young parents don't have those type of teachings, in terms of maternal child health, that baby -- that Wakanyeja, that sacred being -- is going to really start off on the wrong foot."

Indian Health Service funding has increased 68% over the past decade, but experts said it is still too low. In 2017, spending per capita was less than half the spending for veterans and less than one-third for Medicare, according to the National Council of Urban Indian Health.

DenYelle Kenyon, associate dean of community health and engagement at the University of South Dakota, said the problems are multipronged, so the solutions must be, too.

"In our state, the tribal lands have a 'double whammy' of facing both the historical piece and being rural," Kenyon observed. "We really need to not only grow the hospitals and the providers, but approach this from that health equity lens."

She stressed it means looking at social determinants of health, which include other qualities of life that relate to health like access to healthy food, and educational and economic opportunities.


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A January report shows that in rural counties home to large numbers of American Indians, including in Montana, people are more likely to rely on Medicaid for health insurance across all age groups. About 23% of Montanans rely on Medicaid for their health coverage. But the four counties with the highest rates - roughly 40%- are all home to American Indian reservations. That's according to a report from the Georgetown Center for Children and Families on Medicaid's role in rural areas.

Joan Alker, executive director of the Georgetown Center for Children and Families, says that's a national pattern.

"This is important because if Congress moves ahead to make large cuts, these areas and Indian Country more generally will be in big trouble," she explained.

Alker added that documents leaked from the House Budget Committee show it's considering cuts to Medicaid between $200 -billion and $2.3 trillion. She added that the cuts are not a "foregone conclusion." This week, a Montana bill to start phasing out the state's Medicaid expansion was voted down by the Senate on Tuesday and a bill to remove the program's June sunset date passed the House on Monday.

Jason Smith, executive director of the Montana Consortium for Urban Indian Health, said Medicaid provides health coverage for individuals while being a critical source of revenue to the Urban Indian Organizations to help sustain their operations.

"I would say the UIOs, particularly, had a lot of revenue coming from Medicaid. So it's really a great secondary source of funding that has helped their organizations run and provide services for the communities," he contended.

As of January, more than 14,000 American Indians in Montana were enrolled in Medicaid expansion.


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Nevada's only sitting Indigenous legislator has introduced a bill to recognize Indigenous Peoples' Day on what she calls the "correct day," the second Monday in October.

Gov. Joe Lombardo issued a proclamation designating Aug. 9 as Indigenous Peoples' Day in Nevada.

Asm. Shea M. Backus, D-Las Vegas, said it does not pay Indigenous communities the recognition or respect they deserve. She explained Assembly Bill 144 would align both dates, as is celebrated across the nation.

"Indigenous Peoples Day isn't just about a day of recognition, it is about placing Indigenous voices at the forefront of decisions that shape the future of this state," Backus emphasized. "It is this deep cultural connection that has shaped the character of the state of Nevada, and should be celebrated."

Backus noted opponents of the bill see it as an attempt to remove Columbus Day, a federal holiday, from the books. She rejected the notion, pointing out the second Monday in October could instead be shared between both holidays.

Asm. Richard Delong, R-Reno, in the bill's first hearing on Tuesday, questioned the precedent the change of date could be setting for the state.

"Under state law, there are no overlaps," Delong pointed out. "This would be the first time that the state ever decides to have a period of observance that you have two of them coinciding on the same day. So in that sense, it is unique and different."

But backers of the bill aid banks and other establishments already recognize the October date both as Indigenous Peoples Day and Columbus Day, and see the bill as a formality to codify the joint recognition into law.

Noé Orosco, government affairs manager for the advocacy group Make the Road Nevada, said his organization supports the measure. He stressed Indigenous history and stories have been overlooked or distorted, and the bill is a way to help rectify it.

"This bill is not just a symbolic gesture, it is an opportunity for reflection and celebration," Orosco contended. "By formally recognizing Indigenous Peoples Day, we encourage a more complete and accurate understanding of our collective histories."


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Montana's 69th legislative session begins today and advocates for the state's Native population will be at the Capitol, tracking bills ranging from paid sick leave to Indian language and education.

Two key issues the Indigenous advocacy organization Western Native Voice will focus on this session are health care and voting access. A bill to ensure every reservation has a satellite voting office failed in 2021.

Keaton Sunchild, director of government and political relations for the organization, said the Native American Voting Rights Act will be brought again this year. He pointed out long distances and difficulty registering with tribal IDs are some of the biggest barriers Native Americans face in voting.

"For me, living in Great Falls, it's a five-minute drive at most to the elections office if something went wrong," observed. "For somebody living on the Fort Peck reservation, that could be a two-hour drive, one-way."

In 2024, Montana's Supreme Court ruled two voting bills were unconstitutional and disproportionately affected Native people. One would have ended Election Day registration and the second would have outlawed paid, third-party ballot assistance.

Sunchild noted health bills he will be tracking include requiring paid sick leave, the right to contraception and vitally, the status of Montana's Medicaid expansion, which is set to expire in June, unless lawmakers renew it.

"Making sure, at the end of the day, that Native communities and American Indians living off reservations are not harmed by any policies put in place," Sunchild emphasized.

The state's American Indian population has made up 20% of Medicaid expansion enrollment since 2016, according to the Montana Healthcare Foundation.