EXECUTIVE SUMMARY

The federal government’s trust responsibility, honored by decades of treaties and doctrines, is based on need. Funds to the Indian Health Service are prepaid obligations between the United States and indigenous Tribes and cannot be means-tested. American Indians and Alaska Natives have long experienced health disparities when compared with other Americans. Shorter life expectancy and the disproportionate disease burden exist because of inadequate education, disproportionate poverty, discrimination in the delivery of health services, and cultural differences. These are broad quality of life issues rooted in economic adversity, poor social conditions, and decades of historical trauma.