Voters reject casino, leaving healthcare gap
The Lumbee Tribe of North Carolina received federal recognition in late 2025 when President Donald Trump signed the Lumbee Fairness Act, making the tribe the 575th federally recognized sovereign nation in the United States. Tribal leaders and citizens celebrated the milestone, which unlocks eligibility for Indian Health Service funding and the ability to pursue other revenue sources such as a casino.
However, the tribe’s 55,000 citizens in Robeson County face severe health challenges with limited access to care. The nearest IHS facility is more than a two-hour drive to another state. Robeson County is one of the poorest counties in the country and has among the highest rates in North Carolina of heart disease, diabetes, and substance use disorder. In 2025, more than half of the county’s residents were enrolled in Medicaid, the highest percentage of any county in the state, according to the NPR/KFF Health News report.
“The biggest benefit” of federal recognition would be access to IHS, declared John Lowery, the tribe’s chairman and a state representative, on a June podcast, according to the report. He said he expected healthcare to be the largest portion of the tribe’s budget.
But the Indian Health Service has been chronically underfunded for decades. The agency’s budget workgroup estimated this year that IHS is nearly $55 billion short of what it needs. The Trump administration’s cuts to the CDC last year included initially laying off nearly 1,000 IHS employees, and the president’s proposed 2027 budget cuts more than $150 million from a program addressing diabetes in Native American tribes.
The Congressional Budget Office estimated in 2022 that federal recognition could increase IHS spending for the Lumbee by $247 million over four years. But researchers and healthcare providers said that funding alone would not be enough.
“None of us can depend on IHS alone, because we just don’t have the resources within that system,” Donald Warne, a physician and researcher at the Johns Hopkins Center for Indigenous Health and a member of the Oglala Lakota tribe, told the reporter. “But it’s a great starting point.”
Tribal leaders had pursued a casino as an additional revenue source. Hundreds of federally recognized tribes across 29 states have used gaming, which brought in $43.9 billion in fiscal year 2024, according to the National Indian Gaming Commission. The Choctaw Nation of Oklahoma used about $25 million in gaming money to build its own hospital in 1999, and the Eastern Band of Cherokee Indians in western North Carolina funded its own hospital in 2015 mostly with $82 million in gaming revenue.
However, in June 2026, more than 60% of Lumbee voters rejected a constitutional amendment that would have allowed tribal leaders to create infrastructure for a gaming business. Chairman Lowery said on Facebook that he does not plan to bring back the initiative after it was rejected “by the majority of Lumbee voters.” Other potential revenue sources, Lowery said, could include gas stations or hotels.
The debate over the casino reflected deeper divisions within the tribe about how to reverse decades of economic decline that have led to poor living conditions, unaffordable health services, and chronic disease.
Angie Lowery, a 44-year-old Lumbee citizen and mother of four, supported building a casino, believing it would provide better education, infrastructure, and healthcare for her family. “That vote, I’m thinking of my children’s future,” she told the reporter. Lowery struggled with obesity and took insulin daily but made lifestyle changes after her first grandchild was born in 2024. She expanded her garden, cut fatty foods and sugary drinks, and lost 120 pounds in two years, weaning herself off daily insulin. “If I don’t get this weight off me, if I don’t change my eating habits, it’s going to take me over,” she said.
Jada Brooks, a Lumbee citizen and UNC researcher studying Indigenous health, expressed concern that a casino could encourage smoking and drinking. “Let’s not create more problems for ourselves than we already have,” she said at a public discussion. She voted against the casino. Brittany Locklear, a social work professor at UNC and Lumbee citizen, acknowledged potential negative impacts. “There’s going to be negative impacts,” she said at a June panel.
Ronny Bell, 62, a Lumbee citizen and researcher at UNC, said the community’s health challenges stem from systemic racism, the long denial of federal recognition, and the economic decline after the loss of manufacturing and tobacco jobs. But with recognition, he said, the tribe now has the opportunity to bring in resources. “I think about the resilience of the Lumbee people and how they’ve gone through this 100-plus-year fight for federal recognition,” Bell said. “I sort of see that as a continuation of this resilience, and how now we have this opportunity with federal recognition to bring in resources to help address those issues.”
Dr. Andrea Blackburn, a physician in Lumberton and Lumbee citizen, said that 18 years ago she was taught that patients with certain last names “are often referred directly to cardiac catheterization” — a sign that common Lumbee surnames carried an expectation of disease. “Nearly two decades later, I can tell you that reality has not changed,” she told tribal leaders at a public hearing.
The IHS did not respond to questions about plans for the tribe’s health system, according to the report.
Lowery said she believes in her people’s power to help themselves. “Just because we’re federally recognized don’t mean that the doors are going to open up and money’s going to fall through the door like dirt,” she said.