RAPID CITY, S.D. — South Dakota is one of 14 states that has not expanded Medicaid under the Affordable Care Act, a move that would improve healthcare services for the state's large American Indian population, according to one expert.

Nurse Margaret Moss has spent 30 years researching and educating the public about the health of indigenous people. South Dakota has the fourth-largest percentage of Native Americans in the U.S., with rates of death from heart disease, diabetes, pneumonia and other causes that are significantly higher than non-Hispanic whites. And Moss said the numbers have been static for three decades.

"People think American Indians are the past, they're not around anymore,” Moss said. “And if you don't have a very good understanding or view of the history or politics, or culture of American Indians in a state, then you're not going to vote for things."

Gov. Dennis Daugaard appointed a coalition four years ago with the goal of improving healthcare for American Indians. But opposition from fellow GOP lawmakers led him to decide against applying for Medicaid expansion, and the coalition was disbanded last month.

In South Dakota, 36 percent of the 50,000 state residents who would qualify for expanded Medicaid are Native Americans. The state's Argus Leader newspaper recently reported the median life expectancy for Native Americans in South Dakota is 21 years shorter than the state average.

Moss said a huge obstacle for improving healthcare is patient misidentification, which is higher for American Indians than any other group.

"So, if the numbers are all wrong, we don't even really know what are the true death rates, what are the true cancer rates, or admission rates, access rates,” she said. “We don't know a whole lot because nobody asks, or they guess."

In the 1800s, the U.S. government promised to provide health services for tribes in exchange for their land. But Moss said the federal Indian Health Service is chronically underfunded. She noted there are now 573 federally recognized U.S. tribes. But when addressing policymakers, she's found few are familiar with their own state's demographics.

"'Do you know the tribes that are there, and what are they, and whatever?' And no one ever knows!” Moss said. “I said, if you don't know that, how can I even get to the intricacies of their specific problems."

The Indian Health Service is one of several agencies affected by the current government shutdown.


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A Nevada grassroots organization has launched its inaugural endorsement process for the 2024 elections in an effort to champion indigenous voices in the Silver State.

Taylor Patterson, executive director of the Native Voters Alliance Nevada, said the state is getting better about tribal and indigenous representation but contended there is still a long way to go. Nevada is home to 21 federally recognized tribes and 28 reservations, but only one Native legislator.

Patterson explained they saw the need to be more engaged with issues from the top to the bottom of the ticket.

"I think very easily we can forget that Native people are everyday people," Patterson observed. "I think it has been painted in a very specific way of 'still is very much a person of the past,' but there are people who are in all different spaces that are engaging with the government in a multitude of ways that need to be represented."

Patterson acknowledged the state does have elected officials who understand the needs of the Native community but hopes the new initiative will give those who are not familiar with the Native space an opportunity to learn more.

Last summer, Republican Gov. Joe Lombardo expanded Nevada's Effective Absentee System for Elections program program, which requires election clerks to meet with all tribes located in their respective jurisdictions to coordinate voting locations prior to elections.

Patterson noted they have had a good response from candidates and she is pleased to know officials are starting to realize the meaning and value of an endorsement from Native Voters Alliance Nevada. She said her organization can help provide politicians with access to Indigenous communities.

"In recent years there has been so much made of sort of this 'BIPOC' label," Patterson emphasized. "I very often have to remind all sorts of people, whether those are federal agencies or elected officials, you're not truly working with the BIPOC vote share or BIPOC people if you're not working with the 'I.'"

Patterson added the endorsement process will be instrumental to shaping policy and governance in the Silver State.

Next week, Native American leaders from the Midwest will go before a United Nations panel with their concerns over a controversial oil pipeline they say is trespassing on tribal lands.

Enbridge's Line 5 operation in the Great Lakes region is expected to be a topic when the Permanent Forum on Indigenous Issues convenes Monday in New York.

In the Midwest, the law firm Earthjustice represents some Tribes contesting the rerouting of Line 5 in Wisconsin. There, managing attorney Debbie Chizewer said climate change is affecting the region and tribal nations' ability to exercise their treaty rights.

"The perpetuation of this fossil-fuel infrastructure will only worsen that," she said, "and will affect their special tribal resources, like sugar maple and loons, and whitefish and other species that are an integral part of Bay Mills and other tribal nations."

The pipeline runs through Wisconsin and Michigan, traversing the treaty-reserved territory of tribal nations, including the Bay Mills Indian Community and Bad River Band of Lake Superior Chippewa. Enbridge rejects those claims and has said it isn't trespassing on tribal lands.

Similar cases have been filed in other parts of the Midwest. In Michigan, opponents have said they're worried about Enbridge's plan to construct an oil tunnel beneath the Great Lakes. The company has claimed it would be safer than the existing pipeline, but Native American Rights Fund senior staff attorney Wes Furlong said he sees it as a disaster waiting to happen.

"There is a likelihood that if a leak happened within that tunnel, it would cause a catastrophic failure," he said. "Essentially, the tunnel could explode underneath the Straits of Mackinac, pumping crude oil into the strait and into the Great Lakes."

Furlong said pushing back against Line 5 aligns with calls to reduce the use of fossil fuels, citing its connection to climate change and the impact on treaty-reserved resources in the Midwest, on which Tribes rely.

"There's pending litigation over the State of Michigan's order to shut down the pipeline, and ordering Enbridge to vacate the state-owned bottomlands of the Strait of Mackinac," he added. "So, that would spell, I think, the end of Line 5 as we know it."

The Nebraska Winnebago Tribe's Ho-Chunk Community Development Corporation, or HCCDC, has been awarded $2 million through MacKenzie Scott's Yield Giving company.

Some 6,300 nonprofits applied to Yield Giving's open call for grants. The HCCDC was among 279 to receive a top tier rating. In the next-highest tier, 82 organizations each received $1 million.

Kristine Earth, executive director of the corporation, said the Tribe has a lot to be proud of but a lot of work left to do.

"We're so excited and are so thankful for this generous gift for our community," Earth stated. "We do have a lot of issues; we have a lot of health disparities. And so, a donation like this really is going to make an impact for our entire Tribe as a whole."

HCCDC marks its 20th anniversary this year, working to improve economic, educational and social opportunities for tribal members. Earth pointed out they have five key initiatives: housing development, commercial development, financial services, quality of life and food sovereignty.

The Winnebago Tribe has experienced huge growth in its middle class in the past few decades but roughly 30% of its members still live in poverty. HCCDC created a farmer's market, which Earth says is helping them address both health disparities and food sovereignty.

"Through our farmers market, now we're able to touch on not only agriculture and tribal farming, but also our health care system," Earth outlined. "Offering the fresh fruits and vegetables and the Indian corn; things that will restore the health of our people."

Earth added Winnebago is in a "food desert," making food security a major focus for the Tribe.

"It's hard for people to access fresh fruits and vegetables, and we have such a growing community," Earth stressed. "We are all coming together to grow our own food and to feed ourselves, so we can be sustainable in the future."

On the website, MacKenzie Scott called all the open call grant winners "vital agents of change." Scott's Yield Giving organization has donated more than $17 billion to 2,300 nonprofit organizations since 2019.