A cascade of actions from the Trump administration represents a “grave threat” to health care, social, educational and other critical services in Indian Country, including for Native American communities in the Northwest, tribal leaders say.
In the past two weeks, the Trump administration has announced the cancellation of leases for at least 12 Indian Health Service facilities and 25 Bureau of Indian Affairs offices, representing nearly 30% of all agency locations, including one each in Toppenish, Washington, and Lapwai, Idaho, as part of an effort to decrease federal office space.
Additionally, IHS employees were included in the latest buyout offer from the Trump administration, alarming tribal officials and Indigenous community leaders who fear that any employees leaving the understaffed, underfunded agency will force the shutdown of critical health services.
A steady stream of executive orders from the president and cuts made by Elon Musk’s Department of Government Efficiency — combined with frequent changes of course — have had a destabilizing effect on agencies that serve tribes, including those in the Northwest. Hundreds of employees at the Bureau of Indian Affairs have been fired. Access to important payment systems has been blocked. Congressionally approved grants have been unilaterally terminated.
The chaos intensifies concerns about whether critical health care services for roughly 3 million Native American and Alaska Native tribal citizens can be preserved.
“Significant underfunding cannot be categorized as wasteful,” said Greg Abrahamson, vice-chair of the Northwest Portland Area Indian Health Board and the chairman of the Spokane Tribe of Indians, who, along with other Northwest tribal leaders, testified before the U.S. House Interior Appropriations Committee on Feb. 27.
“IHS federally operated facilities and tribal clinics are already stretching their dollars to provide health care services to members, with most clinics already struggling to meet rising needs, especially around the mental health and opioid crisis,” Abrahamson said.
U.S. Sen. Patty Murray, D-Washington, told InvestigateWest she’s already heard from tribes in Washington who are seeing consequences from Trump’s “careless” firings and funding freezes.
“Trump and Elon Musk are taking a wrecking ball to government with zero idea of what they are doing and zero concern for who gets hurt — and their reckless and illegal moves are already harming Tribes in Washington state and throughout the Pacific Northwest,” she said in a written statement.
U.S. Sen. Jeff Merkley, D-Oregon, said it’s imperative that funds Congress approves are spent.
“We have to do everything we can to boost the strength of the health care core team at Indian Health Service, not do anything that would diminish it,” Merkley said in an interview with InvestigateWest. “When I heard the administration talking about significant firings at Indian Health Service, I thought, ‘Oh, my goodness, no, absolutely not. That would be horrific.’”
Tribal officials express concern that policy decisions affecting their communities — like unilateral lease terminations, blocked funds used for fighting wildfires, and disabled payment systems for Native American health organizations — are being made without legally mandated, official government-to-government consultation between the U.S. and tribes.
“Ignoring this duty isn’t just disrespectful, it’s a violation of federal law,” testified Quintin Swanson, chairman of the Shoalwater Bay Indian Tribe.
Cuts strain critical care access
Concerns about services being swept up in anti-DEI — diversity, equity and inclusion — efforts at the federal level drove 120 tribal leaders to testify on Capitol Hill in February, advocating for funding and stability for the programs and agencies that fill the U.S. government’s trust and treaty obligations.
Although many tribes control the administration of federal dollars earmarked for IHS, five tribes in the Northwest’s Portland Service Area, including the Spokane Tribe of Indians, receive health care directly through the IHS, making them particularly vulnerable to cuts or closures.
“Spokane Service Unit providers have already been destabilized by these directives even when they get rescinded because of chronic provider shortages at our service unit. At a minimum, we request tribal consultation for any decisions that would affect funding, staffing, and services for the Indian Health Service, tribes, or tribal organizations,” Abrahamson told the Interior Appropriations Committee.
The Bureau of Indian Affairs, Bureau of Indian Education and Indian Health Service make up less than 0.25% of the federal budget and the funds are already appropriated by Congress. Tribal leaders told Congress that because these agencies need more funding, not less. Billions in other funding sources that tribes rely on, like federal grants from the EPA, are frozen.
For fiscal 2024, the Indian Health Service received $8.2 billion in funding despite asking for nearly $60 billion. The Bureau of Indian Affairs, which provides funding for law enforcement services to hundreds of tribes, meets just 12% of law enforcement funding needs in Indian Country, according to Mark Macarro, chair of both the National Congress of American Indians and the Pechanga Band of Indians.
The Confederated Tribes of Colville Reservation in rural north-central Washington also receive health care directly through the IHS. The lone clinic on its 1.4 million acre reservation, the largest in the Northwest, has long faced serious understaffing.
Jarred-Michael Erickson, chairman of the Colville Business Council, the governing body of the tribe, told the committee that he’s concerned about the Trump administration’s recent actions.
“With more than 200 deferred resignations at BIA and more than 400 on the IHS side, now is the worst possible time to be a direct service tribe,” Erickson said.
The tribe is slated to open a second health clinic in Omak, Wash., this November.
“Health provider positions were already notoriously difficult to fill in rural areas,” he said. “The recent administration’s actions will make filling these new positions much more difficult if not impossible because of the perceived instability of federal employment.”
The tribe is rushing to take over the administration of its health care system from the IHS so the tribe can advertise the Omak jobs as tribal, not federal, in the hopes it will incentivize candidates.
Funding freezes have had “significant detrimental effects” on the Snoqualmie Tribe, according to the tribe’s vice chair, Steve de los Angeles, who said the tribe cannot access millions in allocated funds it needs for managing its forestland to prevent wildfires and sell forest products.
The Confederated Tribes and Bands of the Yakama Nation received notice via email that the U.S. General Services Administration would be terminating its lease on the Yakama Nation Bureau of Indian Affairs office in Toppenish later this year on Sept. 25, more than two years before its original end date of Oct. 31, 2027. The office provides “essential services and functions” in various federal and tribal offices, including natural resources and human services, according to a March 6 press release from the tribe.
The office supports 85 federal jobs at the building located on Yakama tribal land, and the annual lease costs $533,985 for 17,107 square feet of office space. Even before the possible closure, Stephen Selam, executive secretary of the tribe, said the BIA was failing to meet the tribe’s needs, particularly in its forestry department, with key positions vacant.
Washington’s Sen. Murray said she’s “demanding answers” about the planned closure of the BIA office in Toppenish.
Broadly, the U.S. government and agencies responsible for dealing with sovereign tribal governments must engage in official government-to-government consultation with tribal officials for decisions that would affect their communities. The Yakama tribe says it has received no official communication around the reasoning or intent behind the cancellation of the lease.
“The federal government has a trust and fiduciary obligation to the Yakama Nation, one that must not be eroded by budget cuts and freezes,” Selam said.
The lease cancellations don’t guarantee a closure, as some agencies may renegotiate the lease or downsize, but the lack of communication alarms tribal officials.
Some federally funded Indian health organizations have also had their funding frozen.
The Seattle Indian Health Board is an Urban Indian health organization that operates three facilities in Seattle providing medical, dental, mental health care, substance abuse treatment and traditional medicine practices.
On Jan. 28, the board was locked out of its payment management systems, according to Esther Lucero, the organization’s president and CEO, who is Navajo. The board, which receives 54.8% of its funding from the federal government, works on a reimbursement structure.
“So if you can imagine 54.8% of your paycheck going away because you’ve already put out the money to provide those services and you work on a reimbursement basis — that’s what we’re working with,” Lucero said.
Lucero said she is concerned that $5 million in congressionally approved funding to open the Thunderbird Treatment Center, a state-of-the-art residential treatment facility for opioid users, won’t carry forward until they receive a permit.
The center, a $35 million project, would hold 92 beds and increase the total treatment bed capacity in King County by 67%.
“I’m sitting here worried that we may not be able to open those doors,” Lucero said.
Citing a 2021 CDC report showing the opioid crisis in the U.S. cost more than $1.2 trillion, Lucero said cutting funding to treatment programs is poor financial management.
“Here we are in King County trying to provide a service that will help overcome that opioid crisis, right?” Lucero said. “A smart business person looks at cost-benefit and takes calculated risks. So why in the world would you cut the services that are going to reduce that cost for you in the long run? I don’t understand that.”
Merkley, the ranking Democrat on the Senate Interior Appropriations Committee, says Trump’s efforts to take control of congressionally approved funds goes to the heart of the separation of powers.
“What Trump is doing by saying ‘I’m cutting out funding to this and that’ is patently not just illegal, but unconstitutional,” Merkley told InvestigateWest.
“The Constitution gives the power of the purse to Congress — to Congress, not to the president — but now we have an ‘authoritarian-ly’ inclined president who doesn’t like the idea that Congress makes the policy and decides what programs get which,” Merkley said.
U.S. Rep. Mike Simpson, R-Idaho, chair of the House Interior Appropriations Committee, listened to nearly 12 hours of testimony from tribal leaders. The lease for the BIA office in Lapwai, Idaho, in his district, is slated to be closed. Simpson did not respond to a request for comment.
Confusion reigns
For tribal leaders, it has been difficult to keep up with the inconsistent directives and actions.
A Feb. 6 memo from the Department of Health and Human Services supposedly exempted programs serving Indian Country from federal anti-DEI efforts and funding freezes, but a Feb. 14 memo in the Education Department that said “discrimination on the basis of race, color, or national origin is illegal and morally reprehensible” caused more confusion.
Tribal leaders say there were still interruptions to services, even after assurances were made that the programs would be exempted from freezes.
On March 9, all employees under the Department of Health and Human Services, including the Indian Health Service, were offered buyouts of as much as $25,000. The Trump administration and the president’s Department of Government Efficiency, spearheaded by Elon Musk, have made clear their intention to slash federal programs and fire federal employees as part of an effort to eliminate “waste, fraud and abuse.”
It was not the first time the Indian Health Service has been affected by Musk’s “chainsaw” approach.
On Feb. 12, the Office of Personnel Management first announced plans to fire 2,200 of roughly 15,000 total IHS employees, including frontline workers like doctors and nurses, only to reverse the majority of those days later after backlash from tribal leaders and Democrats.
Now, DOGE has announced the termination of leases for at least 12 Indian Health Service facilities across the country. Tribal officials say closures could worsen health disparities for Native Americans and lead to the loss of critical services.
Twenty-five Bureau of Indian Affairs offices are also slated for closure, which tribal leaders say will leave tribal citizens and some rural communities without access to social services and land management, while weakening law enforcement.
So far, thousands of employees at the Indian Health Service have been fired only to be given a reprieve, though hundreds remain listed as deferred resignations. Congressional representatives on both sides of the aisle have petitioned Musk and the Trump administration for reversals of lease terminations and cuts in their respective districts — though Republicans appear to be having more success than Democrats. House Appropriations Chair and Oklahoma Rep. Tom Cole secured reversals of lease terminations in Oklahoma, including the Indian Health Services Office in Oklahoma City, calling it “common sense.”
U.S. Rep. Jared Huffman, D-California, said in a written statement Feb. 28 regarding a spate of planned lease cancellations that the Trump administration was “devastating local economies and abandoning tribes.”
The lease cancellations include two IHS-funded facilities in Huffman’s district.
“The federal government exists to serve the people — not abandon them,” Huffman said. “But Trump and Musk are taking a wrecking ball to our country. … Shuttering these physical locations goes hand in glove with DOGE’s ‘destroy the government’ approach, and it will make their illegal cuts even more challenging to reverse.”
Cuts strain critical care access
The closure of area IHS clinics also places increased pressure on the agency’s beleaguered Purchase and Referred Care Program.
Most IHS clinics are unable to provide comprehensive health care services. Many tribes have small clinics that lack sufficient doctors and nurses, and the IHS has a 30% staffing vacancy rate.
The Purchased and Referred Care Program allows IHS patients to receive care from non-IHS providers when the agency cannot provide the service itself — but the program is plagued with problems. It is a small portion of the agency’s budget that is guaranteed to run out each year, forcing the agency to at times ration the procedures it approves funding for.
As InvestigateWest has reported, the referred care program has persistent issues with the payment process — the agency often fails to reimburse external providers for the care it provides, leaving patients to be held liable for the unpaid bills and often sent to collections, resulting in disproportionate medical debt for Native Americans.
Pressure on the program is especially strong in the Northwest Portland service area, which serves the 43 federally recognized tribes in Washington, Idaho and Oregon, and in the California service area. Since both lack any IHS-operated hospitals, all emergency and hospital-level care must be administered through the referred care program. Any closure of any area IHS clinic means patients may need to travel long distances or go through the referred care program for basic medical treatment.
Even without additional pressure from potential cuts, the referred care program isn’t operating sustainably in the Northwest due to rising costs and inflation, according to Ambrahamson with the Northwest Portland Indian Health Board.
“Many of our people are already on waitlists,” Abrahamson said.
InvestigateWest (investigatewest.org) is an independent news nonprofit dedicated to investigative journalism in the Pacific Northwest. Reporter Melanie Henshaw covers Indigenous affairs and communities in the region. Reach her directly at melanie@investigatewest.org or at (971) 258-0891.
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