NIHB Calls on the Federal Government to Honor Treaties, Trust Responsibility in Testimony to Congress on U.S. Civil Rights Commission Broken Promises Report

NIHB recommends investments in Tribal health systems, infrastructure and protection of the Indian Health Care Improvement Act. 


Contact: Shervin Aazami 202-507-4088

NIHB Calls on the Federal Government to Honor Treaties, Trust Responsibility in Testimony to Congress on U.S. Civil Rights Commission Broken Promises Report

NIHB recommends investments in Tribal health systems, infrastructure and protection of the Indian Health Care Improvement Act.

WASHINGTON, DC—November 19, 2019—The National Indian Health Board (NIHB) CEO Stacy A. Bohlen testified today before the House Subcommittee for Indigenous Peoples of the United States (SCIP) on the U.S. Commission on Civil Rights’ report,  Reviewing the Broken Promises Report: Examining the Chronic Federal Funding Shortfalls in Indian Country . The report effectively contextualizes the federal government’s funding and resource shortfalls and ongoing failure to live up to its Treaty and Trust obligations on federal Indian policy, including adequate funding and access to quality health care to American Indians and Alaska Native Peoples. The report offers actionable recommendations to the President, Congress and numerous federal agencies.

“The federal government has constitutional obligations to provide quality and comprehensive health services for all AI/AN Peoples that it has continuously failed to achieve. The Broken Promi ses report summarized and brought national attention to the gravity of those failures and provided recommendations for how to address those failures,” said NIHB CEO Stacy Bohlen. “NIHB embraces most of the recommendations for Native health contained in the U.S. Civil Rights Commission report, though we believe they are too incremental and represent stop-gap measures in what is clearly a crisis. NIHB recommends several systemic, long term policy changes and investments into Indian health care and public health infrastructures and systems.”

For over a century, sovereign Tribal Nations and the United States signed 375 Treaties requiring the federal government to assume specific, enduring and legally enforceable fiduciary obligations to the Tribes. The Treaties and Trust responsibility are the solid ground on which to stand when examining Indian Country’s alarming health disparities, funding shortfalls for health care, and the whole host of issues that together create the crisis in American Indian and Alaska Native health. 

The Commission acknowledges and puts Treaties first – stating in their letter conveying the report to the White House: “The United States expects all Nations to live up to their treaty obligations; it should live up to its own.”

According to the Centers for Disease Control and Prevention (CDC), in 2017, at 800.3 deaths per 100,000 people, AI/ANs had the second highest age-adjusted mortality rate of any population. In addition, AI/ANs have the highest uninsured rates (25.4%); higher rates of infant mortality (1.6 times the rate for Whites); higher rates of diabetes (7.3 times the rate for Whites); and significantly higher rates of suicide deaths (50% higher). American Indians and Alaska Natives also have the highest Hepatitis C mortality rates nationwide, as well as the highest rates of Type 2 Diabetes, chronic liver disease and cirrhosis deaths. Further, while overall cancer rates for Whites declined from 1990 to 2009, they rose significantly for American Indians and Alaska Natives.

Bohlen said all these determinants of health and poor health status could be dramatically improved with adequate federal investment into the health systems, health care, public health systems and infrastructure in Indian Country. Bringing investment into American Indian and Alaska Native health will require cooperation and collaboration between the Administration and Congress to ensure that both budgets and appropriations reflect the Trust responsibility throughout all aspects of AI/AN health and well-being.

“Even while Congress has provided IHS funding increases during the past 10 years, those increases barely keep pace with medical inflation and appropriations for health services in Indian Country continue to fall significantly below need,” added Bohlen. “Tribal representatives are testifying today in unison about future steps on how systems changes will secure and demonstrate the United States’ commitment to long-term, sustained and Tribally-informed investment in several areas to address the astounding health disparities across Indian Country.”

Some of those recommended investments include:
  • Full needs-based funding for the Indian Health Service at the levels identified by the National Tribal Budget Formulation Workgroup
  • Enacting advance appropriations for Indian programs
  • Making long-term and committed investments into Tribal health and public health infrastructure, capacity, and services - including for facilities, sanitation, water, and modernization of health information technology
  • Rebuilding American Indian and Alaska Native communities;
  • Protecting the Indian Health Care Improvement Act and the Indian-specific policies in the Affordable Care Act;
  • Advancing self-determination and self-governance to all AI/AN programs.

Other witnesses were: Honorable Patricia Timmons Goodson , Vice-Chair of the U.S. Commission on Civil Rights; Dr. Anna Maria Ortiz , Director of Natural Resources and Environment in the U.S. Government Accountability Office; Rear Admiral Chris Buchanan , Deputy Director of the Indian Health Service, U.S. Department of Health and Human Services; Jason Freihage , Deputy Assistant Secretary for Management with the Bureau of Indian Affairs, U.S. Department of the Interior; Honorable Fawn Sharp ,
President of the National Congress of American Indians; Honorable Lynn Malerba , Secretary of the USET Sovereignty Protection Fund; Honorable Jonodev Chaudhuri , Ambassador to the Muscogee Creek Nation; and Francys Crevier , Executive Director of the National Council of Urban Indian Health.

“We ask Congress to simply honor the Treaties, the Trust responsibility and the government-to-government relationship with Tribes. We know how to heal our communities best. It’s imperative that lawmakers listen to Tribes, respect our sovereignty and our knowledge and traditions,” said Bohlen. “NIHB stands ready to work with Congress in a bipartisan fashion to achieve the fulfillment of the federal trust responsibility for health.”

To access a copy of NIHB’s written testimony, click here .

For more information about NIHB’s legislative efforts, please contact NIHB Deputy Director of Congressional Relations, Shervin Aazami, at

NIHB CEO Stacy A. Bohlen testifies before the House Subcommittee for Indigenous Peoples on health care priorities in Indian Country
From left to right: NCAI President Fawn Sharp; Chief Marilynn Malerba; Muscogee Creek Nation Ambassador Jonodev Chaudhuri; NIHB CEO Stacy A. Bohlen; NCUIH Executive Director Francys Crevier

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