Many American Indians put their faith in RFK Jr. They're starting to lose it.

Politico

7 days ago

His apparent earnestness prompted the Coalition of Large Tribes, whose members include the Navajo and Blackfeet nations and the Oglala Sioux, to call him 'the most qualified nominee there has ever been, from any Administration, to carry that mantle of responsibility' three weeks before the Senate confirmed him to lead the Department of Health and Human Services.
But with each zealous statement from Kennedy, American Indians leaders have wondered when they'll hear a detailed plan, and they point to President Donald Trump's budget proposal as an example where the administration's actions haven't matched Kennedy's rhetoric.
'We're looking at the lives of real people, Indian people,' said Phyllis Davis, chair of the Great Lakes Area Tribal Health Board. 'I don't know if anybody really knows him well enough to understand what he wants to do, and I wish — for him — that he took more time to learn more about who we are.'
A spokesperson for Kennedy said Americans Indians needn't worry.
'HHS and Secretary Kennedy remain fully committed to supporting the Indian Health Service and its mission to provide high-quality, culturally competent care to American Indian and Alaska Native communities,' HHS spokesperson Andrew Nixon told POLITICO in an email. 'The Department will continue working closely with Tribal Nations to protect health care access and to strengthen delivery systems across Indian Country.'
Congress committed to provide American Indians health care a century ago and created the Indian Health Service within HHS to manage it 70 years ago. By every important metric, it has failed. American Indians live, on average, around a decade less than other Americans, according to the Centers for Disease Control and Prevention.
Kennedy has said he's sincere about changing that.
'It's been an issue that I've been committed to my whole life,' Kennedy told Rep. Mike Simpson (R-Idaho) at a recent House budget hearing, adding that he'd shielded the IHS from cuts led by Trump's so-called Department of Government Efficiency and offered jobs to some of those DOGE had targeted for termination at the IHS.
The agency, he said, was 'chronically understaffed' and needed the help.
But when Trump released his proposed budget for 2026, some Native leaders were disappointed. Unlike the deep cuts the budget called for at other health agencies, the IHS would get a $1 billion increase if Congress agrees, most of which would go toward reimbursing tribes for administrative and facility costs. Still, tribal health leaders told POLITICO that real improvement would take tens of billions more.
The budget proposal also did not include advance appropriations for the IHS — the government has, in recent years, provided the tribes access to their funds early — a provision tribal leaders say helps prevent disruptions to care during government shutdowns.
They also said other programs Republicans are cutting are likely to have a negative impact on their health. The One Big Beautiful Bill Act that Trump signed on the Fourth of July slashes more than $1 trillion over a decade in health care spending, mostly from Medicaid, the federal-state insurer of low-income people on which many American Indians rely.
'Tribes rely on these other agencies to fill the gaps where IHS cannot,' said Jerilyn Church, CEO of the Great Plains Tribal Leaders' Health Board, citing years of inadequate funding.
'In the spotlight'
Native people are more likely than others in the U.S. to die from a host of chronic conditions, including heart disease, diabetes, chronic lower respiratory disease, cirrhosis, stroke, pneumonia, kidney disease and hypertension.
During his 2024 presidential campaign, before he dropped out and endorsed Trump, Kennedy courted the tribes, spending time with Native people and listening to their concerns. He recalled his namesake father, who was a New York senator and attorney general, and uncle Edward, who served 47 years as a Massachusetts Democrat in the Senate, and their advocacy for American Indians. And he brought up his own involvement in the founding of the newspaper Indian Country Today.
During his Senate confirmation hearing in February, Alaska Republican Lisa Murkowski said Kennedy had previously committed to ' immediately triple the budget to support tribes ' and asked for some details.
Kennedy didn't have many. But he said he wanted to designate a Native American as an assistant secretary and that he enjoyed traveling in Alaska. Last month, he swore in Mark Cruz — a citizen of the Klamath Tribes — as senior adviser to the secretary.
Some tribal leaders say, despite some concerns, they're happy with Kennedy so far. That includes OJ Semans Sr., executive director of the Coalition of Large Tribes that endorsed Kennedy's appointment as Health secretary in January.
'He put IHS in the spotlight nationally,' Semans told POLITICO. 'Sometimes we don't get as much and sometimes we get more, but it's having the discussion that counts.'
The IHS supports 21 hospitals, 53 health centers and 25 health stations, and provides care to about 2.8 million Native Americans and Alaska Natives. Some facilities are managed by the federal government, while some are overseen by tribes.
It has suffered from underfunding for years, and slight increases to its budget have not kept up with health care inflation over the past few decades, according to a peer-reviewed article published in the American Journal of Public Health.
The IHS is unable to fully fund some of its facilities and the care provided there, and the difference must be made up by billing Medicare, Medicaid and private insurers.
Cuts to Medicaid in the GOP's One Big Beautiful Bill Act will likely deliver a blow to tribal health. A 2017 analysis by the health care think tank KFF found that Medicaid provides coverage to more than 1 in 4 nonelderly American Indian and Alaska Native adults and half of Native children.
Nixon told POLITICO that the package 'focuses on eliminating waste, fraud, and abuse to ensure Medicaid remains strong, sustainable, and effective for the people who rely on it, including Tribal communities.'
The president's budget proposes funding the IHS at $8.1 billion, a slight increase from the previous year. But the National Tribal Budget Formulation Workgroup — a group of tribal representatives that provide budgetary guidance to the IHS — regularly requests more than five times that after considering how much money fully funding the IHS would require.
That's roughly what it would cost to 'for all tribes in the United States to receive 100 percent of what they need to provide care for their citizens that they serve,' said Davis, who has been part of the work group for more than 10 years representing the Bemidji, Minnesota, area.
'[Trump's budget request for IHS] is still an inadequate dollar amount that keeps programs running, but not in a way that can provide comprehensive and really robust programs and … consistently serve health care needs and eliminate disparities,' Davis said.
IHS transfers stall
At the start of April, HHS sent letters to officials at the CDC, National Institutes of Health, and Food and Drug Administration offering a 'voluntary' transfer to the IHS and putting them immediately on administrative leave.
Kennedy has said he aims to staff up the IHS and touted the transfers as a way to make that happen.
But three months later, four of those former officials told POLITICO that they are still on administrative leave — collecting their salaries — with no more information about their futures. The four were granted anonymity for fear of retribution from the administration.
The original offer listed several locations that the officials, mainly based around Washington or Atlanta, could relocate to, including Alaska and Montana. At the time, some public health officials speculated that the administration was using the offers as a way to prompt high-paid officials to quit.
'It's a mixture of incompetence and ill intent,' one of the four said recently about the offers.
Nixon pushed back on the idea that the offers were meant to push officials out.
'To address staffing needs and support the IHS in fulfilling its mission, HHS invited certain individuals to consider positions within the IHS,' he said.
While the IHS has suffered from understaffing for decades, the agency mainly needs more physicians and nurses, while many of the HHS officials who received offers were running divisions or centers within the agency — not working with patients.
Many of the officials who received the offer responded with questions about job description, salary and relocation — but most received no response, said the people, citing their own experiences and conversations with colleagues.
In May, some of the officials received an email or, in some cases, a letter requesting that they submit an updated resume so the department could consider where to place them in the IHS. But since submitting the resumes, they have not received any more information, they said.
In response to a question about the stalled transfers, Nixon noted that legal challenges have held up the HHS reorganization.
While the IHS would see a slight increase if Congress passes Trump's budget, other HHS programs that supported tribal health would be cut. That includes the CDC's Healthy Tribes program — which, through cooperative agreements, aims to help prevent chronic disease among American Indians and Alaska Natives.
In April, nearly all of the CDC staff working on the Healthy Tribes program were placed on administrative leave pending termination, two people who had worked on the program and were granted anonymity for fear of retribution said.
'[Healthy Tribes] was born out of input from tribal leaders and tribal public health advocates, and it was designed to strengthen cultural connections, prevent chronic disease, and improve overall health and wellness using a holistic approach,' said one of the people.
'Historical trauma has resulted in the deliberate erasure of cultural practices and Indigenous ways of knowing. This, culminated with current systemic and institutionalized inequities, continually perpetuate the non-medical factors that influence health, preventing people from living healthy lives.'
The program oversees two cooperative agreements that funnel millions of dollars to American Indian and Alaska Native communities to help them create programs to prevent chronic diseases — a blend of two topics Kennedy has said are top priorities:Native health and chronic illness.
That includes things like Indigenous community gardens to make produce and healthy foods more accessible.
The third cooperative agreement provides funding to help the IHS pay for Tribal Epidemiology Centers, which investigate diseases and respond to public health emergencies. The agreement provides roughly $6.8 million every year to the 12 centers.
None of the three cooperative agreements — which, combined, totaled more than $30 million yearly — are included in Trump's budget request, though the congressional justification for the Administration for a Healthy America, a new entity the administration plans to create to centralize 'health resources for low-income Americans,' sets aside $19 million 'for tribes, tribal organizations, urban Indian health organizations, and health service providers to tribes serving rural communities experiencing poor chronic disease and maternal health outcomes.'
The AHA congressional justification also proposes a new program to address mental health and substance abuse disorders in tribal communities — but provides little information about how it would operate.
'I know [Kennedy] and the Kennedy family — say they have a commitment — to tribal populations and American Indians, but it's not fully evident that that is the case,' said one of the CDC staffers who'd worked on the Healthy Tribes program. 'I get the impression that this administration says one thing, but is actually doing another.'