Yesterday, A.C. Locklear (Lumbee), Interim NIHB CEO, testified before the House Natural Resources Subcommittee on Indian and Insular Affairs in support of H.R. 741, the ‘Stronger Engagement for Indian Health Needs Act of 2025.’ This crucial legislation would elevate the Indian Health Service (IHS) Director to an Assistant Secretary for Indian Health, ensuring direct Tribal representation at the highest levels of government.
The IHS Director leads the agency with the primary responsibility for meeting the trust and treaty responsibility for health care. Elevating this role to an Assistant Secretary would strengthen advocacy, prioritize funding, and improve accountability for American Indian and Alaska Native (AI/AN) health policies.
AI/AN communities face severe health disparities due to chronic underfunding of the Indian healthcare system. In 2023, IHS spending per patient was only $4,078, compared to the national average of $13,493. This underinvestment contributes to unacceptably high rates of chronic disease and premature death in Tribal communities.
The U.S. government has a legal and moral responsibility to uphold its trust obligations. “Tribes signed treaties and negotiated agreements in which they ceded vast amounts of land in exchange for certain solemn promises, including the federal obligation to provide health care,” said Locklear. “Elevating the IHS Director to an Assistant Secretary is more than just a bureaucratic change – it’s a necessary step to bring parity, visibility, and real accountability to Tribal health. It’s time for Congress to act and uphold its trust responsibility to our people.”
During his confirmation hearing, HHS Secretary nominee Robert F. Kennedy stated, “I’m going to bring in a Native at the Assistant Secretary level.” H.R. 741 aligns with this commitment, ensuring that Tribal health receives the attention, leadership, and investment it rightfully deserves. NIHB urges Congress to pass H.R. 741 and take meaningful steps to address the severe underfunding of IHS that has devastated Tribal health for generations. We will continue to advocate for fully funded, culturally competent, and accessible healthcare for all American Indians and Alaska Natives.
