By: Dr. Karen Mancera-Cuevas, DrPH, MS, MPH, MCHES, Senior Director, Health Equity and Jeremy Grabiner, MPP, Associate Director of Policy

Native American Heritage Month provides an opportunity to explore policy and health care issues affecting American Indian/Alaskan Native (AI/AN) communities. This includes understanding the importance of advance appropriations for the Indian Health Services (IHS), the implications of the Continuing Resolution (CR) and the demographic trends that shape federal level efforts.

Advance Appropriations for the Indian Health Service

Prior to the inclusion of advance appropriations for IHS in the FY23 appropriations bill, the Indian Health Care system was the only major federal health care provider funded through annual appropriations. As such, in previous shutdowns, clinic staff had to go without pay, some facilities would reduce services, while others had to shut down completely. These impacts were severe and long lasting in Native communities. The IHS advance appropriations for FY26 was instrumental in ensuring services were maintained through the entire 44-day shutdown. Unfortunately, advance appropriations for IHS is not permanent and must be reauthorized annually to guarantee continuity of care.

Current Funding Implications

On November 12, 2025, Congress passed and the President signed the https://appropriations.house.gov/committee-activity/enacted-legislation/fiscal-year-2026-enacted-legislation. For Tribal Nations and Tribal health systems, this Continuing Resolution (CR) prevents immediate disruptions to care while Congressional leaders work toward a final funding agreement.

The CR extends the Special Diabetes Program for Indians (SDPI), providing flat funding of $53.15 million through January 2026. Medicare telehealth flexibilities, Community Health Centers, the National Health Service Corps, and Hospital-at-Home programs were also extended through January 31. In addition, a $235 million for the Food Distribution Program on Indian Reservations (FDPIR), a $70 million increase over FY 2025 levels.

Demographics, Health Outcomes & Coverage

AI/AN people continue to experience significant health disparities. They have the lowest life expectancy at birth among all racial and ethnic groups in the United States. According to the Centers for Disease Control and Prevention (CDC), in 2023 the average estimated life expectancy at birth for non-Hispanic American Indians and Alaska Natives was 70.1 years (73.5 for females and 66.7 for males), compared to 78.4 years for all races, (85.2 for Asian Americans, 81.3 for Hispanic/Latinos, 78.4 for Whites, and 74.0 for Black/African Americans). In 2024, 24% of people who identify as American Indian or Alaska Native alone reported being in fair or poor health, the highest rate among all racial groups.

In 2023, the leading causes of death in non-Hispanic American Indians and Alaska Natives were heart disease, cancer, unintentional injuries, chronic liver disease, and diabetes. According to the American Cancer Society estimates, in 2024 approximately 45% of non-Hispanic American Indians and Alaska Natives alone had private health insurance, compared to 67% of the total US population.  Nearly half relied on public health insurance, while 16% had no coverage at all, twice the rate of the overall U.S. population.

Native Initiative & Future Directions 

Tribal communities continue to lead efforts to address health disparities through culturally grounded initiatives. For example, tobacco prevention programs in Wisconsin highlight the importance of acknowledging tobacco’s ancestral role in Native communities when developing policies and prevention strategies tailored to community needs.

Federal commitments remain important to sustaining and expanding these efforts. While prevention and access initiatives will continue through IHS, the lack of an extension of the Enhanced Premium Tax Credits (EPTC) in the CR means marketplace premiums are expected to increase for an estimated 318,000 American Indian and Alaska Native people. Continued federal partnership and adequate funding will be essential to support Tribal Nations and Tribal health systems as they navigate these challenges.

The health challenges facing American Indian and Alaska Native communities underscore the ongoing need for strong, patient-centered federal policies. As part of our commitment to advancing equity, access and affordability, the National Health Council continues to advocate for solutions that close coverage gaps and support Tribal health systems—including extending the EPTCs to prevent premium spikes for AI/AN families