Photo: Alex Wong (Getty Images)

The federal government’s refusal to adequately fund the Indian Health Service is slowly killing two South Dakota tribes.

The Argus Leader published a massive series on Wednesday outlining the failures of the federally-funded Indian Health Service in South Dakota and the toll it’s taken on two tribes, the Rosebud Sioux and Oglala Sioux, also known as the Oglala Lakota. The Leader’s blockbuster report provides everything from first-hand horror stories of Natives losing limbs and loved ones to damning statistics that show the breadth of the systematic failure to provide decent healthcare to the tribes—citing a state report, the newspaper found that the median life expectancy for Native Americans living in South Dakota is a staggering 21 years shorter than the state average. I highly encourage you to go read the series.

The tribal reservations, located next to each other in the southeast corner of the state, sit on largely undeveloped, remote land in some of the poorest counties in the state and the nation, making it a difficult to recruit doctors to IHS hospitals. It’s this isolation, combined with the United States government’s inability to provide healthcare services as set forth in the Fort Laramie Treaty of 1866, that’s led to a full-on crisis in the Badlands.

The gist of the situation is that when colonizers came through the region in the 1800s, the federal government promised to fund healthcare services for the tribes in exchange for land they would give up, either peacefully or by being violently uprooted from by the U.S. Army. Some 80 years after this trade, the government decided in 1955 to move the responsibility over to the newly-created Indian Health Service, housed in the Department of Health and Human Services, or HHS. Since then, Congress has done all it can to squeeze and bleed IHS’s budget to the point that it can’t function as it was meant to originally. To bypass the bureaucracy, some tribes have decided to avoid IHS entirely by signing contracts with the federal government, meaning that instead of IHS running the local tribal hospitals, the Native nations themselves handle operations.

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But this has been the exception, not the norm, and Rosebud and Oglala hospitals are still under IHS control. As the Leader makes plain, this has not gone well, with dozens of Natives dying for no other reason than inadequate care:

Earlier this year, Rosebud IHS hospital was put on “immediate jeopardy” status. A federal inspection released in August detailed the shortcomings that put patients at risk. A 12-year-old girl tried to hang herself while left unsupervised, and the next day, a 35-year-old man died of a heart attack after hospital guards pepper-sprayed him and restrained him.

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While Congress controls the funding of IHS, they have paid little attention to calls from South Dakota legislators to fix the mess caused by their underfunding of IHS; all of the recent bills introduced have died in committee, per the Leader. Given the potential government shutdown that might come as a result of the impending budget battle, it’s unclear whether the House version of the budget, which carves out $5.9 billion in IHS funding, or the Senate version, which carves out $5.77 billion, will win out.

What is clear is that even with the historical trend of underfunding Native healthcare, the state government of South Dakota has done little to extend a hand to the tribes or other low-income residents. Both the state’s outgoing governor and Gov.-elect Kristi Noem have declined to champion Medicaid expansion. Per the Leader, of the nearly 50,000 adults that would qualify if the state went for expansion, 30 percent are Native.

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“I believe that’s a much more appropriate way to do it,” Noem told the Leader. “[We’ll] make sure that we’re providing services to those who need it in Medicaid but making sure that IHS is actually paying the bill for Native American folks instead of having Medicaid constantly pick up that bill.”

For the Rosebud and the Oglala, an expansion might not even have the chance to make a difference thanks to IHS—within the past 12 months, the Rosebud IHS hospital and the Pine Ridge IHS hospital have both racked up enough violations to be stripped of their ability to bill Medicaid.

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The best path forward isn’t clear, at least not now. The Leader reports that IHS has brought in a new leadership team for the hospitals, and state representatives have vowed to continue fighting for change-via-legislation in Washington. Until then, the Rosebud and the Oglala will have to hope that someone with more power than a state newspaper will finally listen.