The Trump administration is starving the Lumbee Tribe’s healthcare after a hundred and thirty-seven years of broken promises.
Angie Lowery is forty-four years old. She is a citizen of the Lumbee Tribe, and she lives in Lumberton, North Carolina, in Robeson County. She has a vegetable garden out behind her house — collard greens, bell peppers, onions, red and white potatoes, kale. She lost a hundred and twenty pounds in two years. She weaned herself off the daily insulin pills her father took before he died of a heart attack at sixty-three. She has a granddaughter who will turn two in November. She wants to live long enough to form a relationship with that girl.
I live nine hundred miles west of Lowery, in Adams County, Wisconsin, on a forty my grandfather left me. The nearest hospital to my shop is Adams County Memorial — the one George and Mary Polivka paid for in 1959. The IHS nearest Lowery’s house is more than a two-hour drive to another state, and her county is one of the poorest in the country with some of the worst health outcomes. The agency’s own budget workgroup, per KFF Health News, estimates the IHS is nearly fifty-five billion dollars short of what it needs this fiscal year. Last year the administration’s cuts to the Centers for Disease Control and Prevention initially included laying off nearly a thousand IHS employees — the layoffs were later rescinded, but the threat told the agency what the administration thinks of it. The administration’s proposed 2027 budget cuts more than a hundred and fifty million dollars for a program to address diabetes in Native American tribes. Diabetes is the disease that killed Angie Lowery’s father at sixty-three. “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.
Lowery and her family are doing the work the federal government should have been doing for her people since before she was born. The Lumbee Tribe of North Carolina became the five hundred and seventy-fifth federally recognized tribe late last year, after a fight that began in 1888. The tribal chairman, John Lowery, is a sitting state representative. He said on a podcast that the biggest benefit would be access to the Indian Health Service — its clinics and hospitals, and the funding to build their own health system. The Lumbee are the people who have been told by Washington for a hundred and thirty-seven years that the federal government’s word to them was a piece of paper. Now the paper has come. The paper is not medicine. The paper is not a clinic. The paper is the lie that recognition alone was the deliverable.
I want to be clear about what the Lumbee Fairness Act actually delivered, because the gap between the press release and the lived experience in Robeson County is the whole story.
It delivered sovereignty. That is real. The Lumbee have fought for federal acknowledgment since 1888 — 137 years of petitions and bills and state-level recognitions and the particular cruelty of being “Indian enough” for North Carolina to claim and not “Indian enough” for Washington to fund. Since recognition, the Lumbee can access IHS at all, apply for federal health grants by tribe, be counted in the census as Lumbee rather than folded into a generic category, and enter self-governance compacts that would let them run their own healthcare system if they can ever get the money to build one. That is not a small thing. The chairman was right when he called access to IHS the biggest benefit of recognition. He was wrong only if anyone believed that benefit was going to arrive at the scale the health outcomes in his county demand.
I want to be clear about what recognition did not deliver, because Angie Lowery’s life depends on the distinction.
It did not deliver a clinic in Lumberton. The nearest Indian Health Service facility is more than a two-hour drive into another state. It did not deliver enough money to change the trajectory of the chronic disease statistics that define Robeson County. The Congressional Budget Office estimated in 2022 that the Lumbee could increase IHS spending by two hundred and forty-seven million dollars over four years — a real number, and a small one against a county where more than half of all residents are Medicaid enrollees and where heart disease, diabetes, and substance use disorder rank among the highest rates in North Carolina. It did not deliver the data infrastructure the Lumbee need to understand their own health. As Ryan Dial, a Lumbee public health researcher at UNC, said, “There’s challenges in even understanding the nuances of these complex health disparities, because a lot of data isn’t out there.” Census data on Lumbee citizens didn’t exist as a category until federal recognition made it possible. You cannot fix what you cannot measure, and the federal government just spent 137 years refusing to give the Lumbee the measuring stick.
The Lumbee Tribal Council and Chairman Lowery tried to build a casino to fund the gap. The Eastern Band of Cherokee Indians in western North Carolina — two hundred miles west of Robeson County, in the same state — funded their own hospital in 2015 mostly with eighty-two million dollars in gaming funds. The Choctaw Nation of Oklahoma built its own hospital in 1999 with roughly twenty-five million in gaming money. Hundreds of federally recognized tribes across twenty-nine states have used gaming as a revenue source — forty-three point nine billion dollars in fiscal year 2024, according to the National Indian Gaming Commission. In June, more than sixty percent of Lumbee voters rejected a constitutional amendment that would have allowed tribal leaders to create the infrastructure for gaming. The chairman has said he will not bring the measure back. His term ends in two years. The tribe will have to find some other revenue source — gas stations, hotels, anything taxable — to supplement what IHS cannot provide.
I want to say something about that vote, because the easy read is wrong. The easy read is that the Lumbee rejected prosperity. The accurate read is that the Lumbee did the math. They have watched other tribes take gaming money and trade it for substance use disorder and smoking rates that compound the very health disparities they were trying to address. Brittany Locklear, a Lumbee social work professor at UNC, said at a June panel: “There’s going to be negative impacts.” That is what the voters read. Jada Brooks, a Lumbee researcher studying heart health in Lumbee women, voted against the casino. “Let’s not create more problems for ourselves than we already have.” The tribe made a sovereign decision to refuse a revenue stream that would have made their health system real, because they understood what the Choctaw and the Cherokee and every other gaming tribe already know — that casino money solves the budget problem and creates a parallel public-health problem, and the two problems do not cancel out.
Donald Warne, an Oglala Lakota physician and Johns Hopkins researcher, said it plain. “None of us can depend on IHS alone, because we just don’t have the resources within that system. But it’s a great starting point.”
That sentence is the most important one in this column, and I want to read it back.
“None of us can depend on IHS alone. But it’s a great starting point.”
That is what a starting point looks like when the finish line is a county where the median life expectancy gap is measured in years, the diabetes rate is generational, and the nearest federal health facility is in another state. That is what a starting point looks like when the same administration that signed the recognition paper is filing a budget that cuts the diabetes program for Native Americans. That is what a starting point looks like when the alternative revenue source the tribe pinned its hopes on — a casino, the same mechanism the Choctaw used in 1999 to build their own hospital, the same mechanism the Eastern Cherokee used with eighty-two million in gaming funds to build theirs in 2015 — was voted down by Lumbee citizens who feared the public-health costs of a gambling economy more than they feared the absence of healthcare dollars.
Andrea Blackburn, a doctor in Lumberton and a citizen of the tribe, said that eighteen years ago she was taught that patients with certain last names “are often referred directly to cardiac catheterization,” a procedure to diagnose or treat heart conditions. Blackburn said she realized that common Lumbee surnames carried an expectation of disease. “Nearly two decades later, I can tell you that reality has not changed,” she said at a public hearing. Brooks is running a heart-health study among Lumbee women. She met Lowery in one of the study’s classes. “I was just floored by, like, just the extent to which she went,” Brooks said. That is what the work recognition is supposed to fund.
I have worked on small engines in this county for a long time. I see what rural healthcare consolidation has done to Adams County. I see the same pattern in Robeson County, where the Lumbee’s vegetable gardens sit in the middle of soybean fields owned by three corporations whose names I would recognize if I read them in the paper. The pattern is the pattern. The dollars that used to circulate in the county leave the county overnight on an electronic-transfer schedule.
The federal government has been telling rural America since the New Deal that electricity wasn’t worth running wire for. Then REA ran the wire anyway, and the wire is still in my shop. The federal government has been telling the tribes for a hundred and thirty-seven years that the IHS isn’t worth the funding. The Lumbee have been waiting. The administration’s answer is to cut the program. The same administration gutted federal climate data and forced ex-NOAA employees to launch Climate.us to rebuild what the government used to provide for free. The pattern is the pattern. The administration cuts the program, the affected people rebuild it themselves, and the administration calls it reform.
Aldo Leopold meant it when he said a land ethic changes the role of Homo sapiens from conqueror to citizen. The Lumbee have been citizens of Robeson County since before there was a Robeson County. The federal government’s job is to be a citizen back. The Trump administration is failing the job.
Recognition was the door. IHS is the room behind it. The room was empty before the Lumbee walked in, and the administration’s proposed budget would take more of the furniture out. The Lumbee did not ask for a starting point. They asked, for 137 years, to be counted. The federal government counted them. The federal government also gave them a health system that cannot afford to treat them, a budget that proposes to cut the very diabetes program Robeson County needs most, and a tribal government now tasked with finding a revenue source that does not compound the crisis it is meant to solve.
Angie Lowery grew a vegetable garden. She lost a hundred and twenty pounds. She weaned herself off the insulin. She did the work the federal government should have been doing for her people since before she was born. The least the federal government owes her is the clinic and the doctor and the diabetes program the Trump administration is cutting. The least.