The reservation of the Kashia Pomo Tribe, based in Sonoma County, Calif., is nearly two hours away from the nearest hospital or center providing critical medical services.

Reno Keoni Franklin, chairman emeritus of the Kashia Pomo Tribe, says the long commute is just one of several inconveniences impacting American Indians, whose medical care is funded by federal dollars. Funding for Indian Health Service (IHS), the agency that provides Native Americans with medical care, is under threat by slashes to national spending imposed by the Department of Government Efficiency (DOGE), which tribal leaders say could worsen their situation.

“These cuts are jeopardizing a system that's working. The notion by DOGE is that it's of no real value… They don't know what these workers do to provide essential services,” says Ron Allen, chairman of the Jamestown S'Klallam Tribe. “They’re an essential pipeline to help the community. We do what we can to make a difference. And we're still struggling.”

Tribal reliance on federal funds for medical care is part of the existing legal trust obligation to provide certain services, including health care, to Native Americans because the government took over Indigenous land.

But looming DOGE cuts could upend the already-underfunded IHS. For fiscal year 2025, IHS received a budget of some $8 billion, far below its estimated need. The IHS National Tribal Budget Formulation Workgroup recommended the agency receive $73 billion—nine times the amount allotted to the agency. Administrators for tribal public health boards are able to supplement lack of funding by applying for federal grants—which are also being gutted by DOGE—and other third-party revenue reimbursements from Medicare and Medicaid. While President Trump has said that Medicaid and Medicare will not be cut, Congressional Republicans have pledged to make massive cuts to their budget, and constituents fear the two programs will be affected.