RFK Jr. is struggling to keep his promise to protect Native Americans from health cuts

WINDOW ROCK, Ariz. — Navajo Nation leaders took turns talking with the U.S. government’s top health official as they hiked along a sandstone ridge overlooking their rural, high-desert town before the morning sun grew too hot.

Buu Nygren, president of the Navajo Nation, paused at the edge with Health and Human Services Secretary Robert F. Kennedy Jr. Below them, tribal government buildings, homes, and juniper trees dotted the tan and deep-red landscape.

Nygren said he wanted Kennedy to look at the capital for the nation of about 400,000 enrolled members. The tribal president pointed toward an antiquated health center that he hoped federal funding would help replace and described life for the thousands of locals without running water due to delayed government projects.

Nygren said Kennedy had already done a lot, primarily saving the Indian Health Service from a round of staffing cuts rippling through the federal government.

“When we started hearing about the layoffs and the freezes, you were the first one to stand up for Indian Country,” he told Kennedy, of his move to spare the federal agency charged with providing health care to Native Americans and Alaska Natives.

But Nygren and other Navajo leaders said cuts to federal health programs outside the Indian Health Service are hurting Native Americans.

“You’re disrupting real lives,” Cherilyn Yazzie, a Navajo council delegate, told KFF Health News as she described recent changes.

Kennedy has repeatedly promised to prioritize Native Americans’ health care. But Native Americans and health officials across tribal nations say those overtures are overshadowed by the collateral harm from massive cuts to federal health programs.

The sweeping reductions have resulted in cuts to funding directed toward or disproportionately relied on by Native Americans. Staffing cuts, tribal health leaders say, have led to missing data and poor communication.

The Indian Health Service provides free health care at its hospitals and clinics to Native Americans, who, as a group, face higher rates of chronic diseases and die younger than other populations. Those inequities are attributable to centuries of systemic discrimination. But many tribal members don’t live near an agency clinic or hospital. And those who do may face limited services, chronic underfunding, and staffing shortages. To work around those gaps, health organizations lean on other federally funded programs.

“There may be a misconception among some of the administration that Indian Country is only impacted by changes to the Indian Health Service,” said Liz Malerba, a tribal policy expert and citizen of the Mohegan Tribe. “That’s simply not true.”

Tribes have lost more than $6 million in grants from other HHS agencies, the National Indian Health Board wrote in a May letter to Kennedy.

Janet Alkire, chairperson of the Standing Rock Sioux Tribe in the Dakotas, said at a May 14 Senate committee hearing that those grants paid for community health workers, vaccinations, data modernization, and other public health efforts.

The government also canceled funding for programs it said violated President Trump’s ban on “diversity, equity, and inclusion,” including one aimed at Native American youth interested in science and medicine and another that helps several tribes increase access to healthy food — something Kennedy has said he wants to prioritize.

Tribal health officials say slashed federal staffing has made it harder to get technical support and money for federally funded health projects they run.

The firings have cut or eliminated staff at programs related to preventing overdoses in tribal communities, using traditional food and medicine to fight chronic disease, and helping low-income people afford to heat and cool their homes through the Low Income Home Energy Program.

The Oglala Sioux Tribe is in South Dakota, where Native Americans who struggle to heat their homes have died of hypothermia. Through mid-May the tribe hadn’t been able to access its latest funding installment from the energy program, said John Long, the tribe’s chief of staff.

Abigail Echo-Hawk, director of the Urban Indian Health Institute at the Seattle Indian Health Board, said the government has sent her organization incomplete health data. That includes statistics about Native Americans at risk for suicide and substance use disorders, which the center uses to shape public health policy and programs.

“People are going to die because we don’t have access to the data,” Echo-Hawk said.

Her organization is also having trouble administering a $2.2 million federal grant, she said, because the agency handling the money fired staffers she worked with. The grant pays for public health initiatives such as smoking cessation and vaccinations.

“It is very confusing to say chronic disease prevention is the No. 1 priority and then to eradicate the support needed to address chronic disease prevention in Indian Country,” Echo-Hawk said.

HHS spokesperson Emily Hilliard said Kennedy aims to combat chronic diseases and improve well-being among Native Americans “through culturally relevant, community-driven solutions.”

Hilliard did not respond to questions about Kennedy’s specific plans for Native American health or concerns about existing and proposed funding and staffing changes.

As Kennedy hiked alongside Navajo Nation leaders, KFF Health News asked how he would improve and protect access to care for tribal communities amid rollbacks within his department.

“That’s exactly what I’m doing,” Kennedy responded. “Making sure that all the cuts do not affect these communities.”

Kennedy has said his focus on Native American health stems from personal and family experience, something he repeated to Navajo leadership. As an attorney, he worked with tribes on environmental health lawsuits. He also served as an editor at ICT, a major Native American news outlet.

The secretary said he was also influenced by his uncle, President John F. Kennedy, and his father, U.S. Attorney General Robert F. Kennedy, who were both assassinated when Robert F. Kennedy Jr. was a child.

“They thought that America would never live up to its moral authority and its role as an exemplary nation around the world if we didn’t first look back and remediate or mitigate the original sin of the American experience — the genocide of the Native people,” Kennedy said during his visit.

Some tribal leaders say the recent cuts, and the way the administration made them, violate treaties in which the U.S. promised to provide for the health and welfare of tribes in return for taking their land.

“We have not been consulted with meaningfully on any of these actions,” said Malerba, director of policy and legislative affairs for the United South and Eastern Tribes Sovereignty Protection Fund, which advocates for tribes from Texas to Maine.

Alkire said at the congressional hearing that many Native American health organizations sent letters to the health department asking for consultations but none has received a response.

Tribal consultation is legally required when federal agencies pursue changes that would have a significant impact on tribal nations.

“This is not just a moral question of what we owe Native people,” Sen. Brian Schatz (D-Hawaii) said at the hearing. “It is also a question of the law.”

Tribal leaders are worried about additional proposed changes, including funding cuts to the Indian Health Service and a reorganization of the federal health department.

Esther Lucero, president and CEO of the Seattle Indian Health Board, said the maneuvers remind her of the level of daily uncertainty she felt working through the COVID-19 pandemic — only with fewer resources.

“Our ability to serve those who are desperately in need feels at risk,” Lucero said.

Among the most pressing concerns are congressional Republicans’ proposed cuts to Medicaid, the primary government health insurance program for people with low incomes or disabilities.

About 30% of Native American and Alaska Native people younger than 65 are enrolled in Medicaid, and the program helps keep Indian Health Service and other tribal health facilities afloat.

Native American adults would be exempt from Medicaid work requirements approved by House Republicans on May 21. 

After Kennedy summited Window Rock with Navajo Nation leaders, the tribe held a prayer ceremony in which they blessed him in Diné Bizaad, the Navajo language. President Nygren stressed how meaningful it was for the country’s health secretary to walk alongside them. He also reminded Kennedy of the list of priorities they’d discussed. That included maintaining the federal low-income energy assistance program.

“We look forward to reestablishing and protecting some of the services that your department provides,” Nygren said.

As of mid-May, the Trump administration had proposed eliminating the energy program, which remains unstaffed.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.