1. United States
2. Utah
3. Letter

For generations, American Indian and Alaska Native (Al/AN) communities have grappled with chronic underfunding of federal healthcare programs. Broadly speaking, Al/ANs experience lower life expectancy, higher rates of chronic diseases such as diabetes, and increased risks from COVID-19 and unintentional injuries. These disparities are exacerbated by structural discrimination, historical trauma, and limited access to affordable health insurance. Moreover, many decades of underfunding have resulted in shortages of healthcare providers, inadequate facilities to care for infants, pregnant women and seniors, and limited access to specialists, especially in rural areas. Medicaid and the Indian Health Service (IHS) are critical sources of health insurance and healthcare, respectively, for Al/AN communities. About 2.7 million American Indian/Alaska Native people have Medicaid, including nearly a quarter of all Al/AN adults and almost half of Al/AN children. Threatened cuts to Medicaid would be catastrophic for Native Americans. The Trump administration's intention to cut $900 million from the Indian Health Service (IHS) further endangers indigenous health. The IHS provides inpatient, ambulatory, emergency, dental and preventive healthcare and funds Indian health programs but is not health insurance. IHS must work within yearly budgets approved by Congress and already receives insufficient funds to meet indigenous communities' health needs. Congress must defend Native American health by protecting Medicaid and IHS funding.