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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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.

Billings-based Western Native Voice is holding its annual membership conference in Great Falls starting tomorrow, and members are discussing democratic participation but also cultural issues affecting tribes.

The conference is called No Vote Left Behind and will focus on helping Indigenous people register to vote and know where and when to cast ballots.

Just as importantly, workshops will discuss cultural identity and what it means to be Native.

Western Native Voice communication's director Tracie Garfield is a member of the Assiniboine tribe, and said more than 50% of Indigenous people in Montana live off reservations - which leaves many wondering where and how they fit it with their culture.

"Participants and members of the workshop will be able to talk to each other - talk about what it means to be Native, how they grew up," said Garfield. "Some grew up on a reservation. We'll have people who grew up in urban areas. We'll also have people who grew up in rural Montana - off the reservations."

Cultural identity was the number one topic requested by members for this conference. Western Native Voice has over 13,000 members from Montana and across the U.S.

The conference starts tomorrow morning in Great Falls.

Garfield said Western Native Voice will hold its Expanding Horizons: Beyond Survival youth conference next Monday and Tuesday in Bozeman - where they will be learning about native history, traditional knowledge and cultural identity.

The conference will bring together students from both urban and reservation high schools. She said true native history and cultural identity weren't always taught when she was young.

"When we were growing up, we weren't really taught the true history of our tribes," said Garfield. "Say I'm Assiniboine. I didn't know my own tribal history. Even though I felt Native I didn't really know what it meant to be Native."

Garfield said cultural identity is a complex issue with so many people living in urban areas, and Western Native Voice wants to create a space for people to talk about it by training youth early on so they understand what it means to be Native in today's world.