At a U.S. Senate hearing this week, tribal leaders from across the country spoke out against cuts to the Department of Health and Human Services.
The department announced in March that it would cut 20,000 health jobs, consolidate some of its divisions and close regional offices. That was in response to an executive order from President Trump aimed at "workforce optimization" across the federal government.
The hearing looked at how those cuts could harm the department's programs that benefit Native Americans, including child care, services for domestic violence victims and substance abuse prevention.
"These aren't just federal services," said Sen. Lisa Murkowski, who chaired the hearing. "They're really critical components of the social safety net, and my view is that these programs support family stability, child development and basic dignity."
One of the witnesses at the hearing was Melissa Charlie, the executive director of the Fairbanks Native Association. The association provides a tribal Head Start program to hundreds of children in the Interior, offering educational and cultural activities as well as health screenings and referrals to specialists.
The association also receives HHS funds for emergency shelter and services for survivors of domestic violence. Charlie said more than half of their clients reported family violence last year.
"As women leave a domestic violence situation with just the clothes on their back, they can't afford the temporary housing, not in Fairbanks, and especially in remote Alaska," Charlie said.
Nationally, Native American people face higher rates of violence than other groups. They also experience some of the highest rates of cancer, heart disease, respiratory illness, diabetes and suicide. Their life expectancy is the lowest in the United States.
"I hate being the first place in everything like that – chronic disease, all these negative impacts," said Loni Greninger, the vice Chairwoman at Jamestown S'Klallam Tribal Council in Washington. "I want to be able to fix that."
Greninger said disruptions within the Health and Human Services Department create more obstacles for improving the health of Native Americans. For example, she said workforce reduction affected employees who have experience working with the tribes. Additionally, she said those changes were carried out without proper communication.
"Everybody's gone," Greninger said. "And this was all done without consultation and very little warning, not only to the tribes, but also to the staff."
The senate hearing focused on HHS programs that are not part of the Indian Health Service, which is an agency within the department. Robert F. Kennedy Jr., the secretary of the department, had said that the Indian Health Service would be exempt from several executive orders. Still, the agency might be facing some changes.
The Trump administration budget proposal that became public in April included some $900 million in cuts to the Indian Health Service.
William "Chief Bill" Smith of Valdez Native Tribe said last month that the proposal would lead to the closure of clinics, losses of essential staff and an increase in preventable deaths in Native communities.
"When we talk about the budget cuts to the Indian Health Service, these are not just budget numbers, you know," Smith said. "These are our lives."
Smith said that the federal government has treaty and trust obligations to ensure Native people have access to healthcare.
"We paid with our land, we paid with our health, we paid with our culture," Smith said.
Jacoline Bergstrom is the executive director of health services at Tanana Chiefs Conference and the vice chair for the Association of Alaska Tribal Health Directors. She said the Indian Health Service is already severely underfunded.
Bergstrom also expressed her concern about the idea to implement work requirements for people on Medicaid, which is another program within HHS. She said it would create a challenge for residents in rural Alaska where there's not enough jobs to begin with, and many of them are seasonal.
"All those divisions have federal funding streams that tribal entities, tribal healthcare entities, rely on to provide a broader array of core services," Bergstrom said. "Any cuts to any of the divisions under HHS will have an impact. We just don't know the extent of it at this point in time."
