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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Montana has joined a coalition of Indigenous groups working to address Canadian coal mining pollution in the state's Kootenai River.

The International Joint Commission, formed in 1909, works to settle boundary waters differences between the U.S. and Canada. It has formed a governance body to take on the issue.

Tom McDonald, vice chair of the Salish and Kootenai Tribal Council, based on western Montana's Flathead reservation, said Canadian coal mines have been polluting the Kootenai for more than a century.

"To the point where the fisheries in Montana, as the watershed drains into Montana from Canada, it's caused fish to be deformed," McDonald explained. "Our native fish, like bull trout."

McDonald pointed out after years of stalled talks with Canada, the binational governance body will establish a cleanup plan for the 18,000-square-mile watershed over the next two years. One of the group's members is from Montana.

McDonald noted the runoff has affected the Kootenai River for nearly 400 miles into Montana and Idaho, and added the tribes finally resorted to involving the International Joint Commission to help. He emphasized selenium levels from the Canadian mines have reached the point where tribal members, who subsist on the fish in the river, cannot eat it.

"We don't know how far it's going into the food web," McDonald stressed. "We've been asking for Canada to fix the problem, enforce their regulatory laws against the coal mines, and they just haven't been able to do that. It's just elevated every year, and they keep expanding and getting bigger."

The Canadian company NWP Coal is proposing a new mine in the same watershed as the existing coal mines. The company claims its project will not increase selenium contamination but does not address the current pollution issue.


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A great way to observe National Native American Heritage Month is to support Native artists but some in Wyoming said there are barriers to their exposure and success.

Some new programs and exhibits support Native art in the region, including a Native Arts Fellowship from the Wyoming Arts Council and a permanent space in Boulder, Colorado's Dairy Arts Center dedicated to Native arts, called the Creative Nations Sacred Space.

Bruce Cook, a Native American artist based on the Wind River Reservation, is a fellow this year and was awarded a startup challenge grant from the Wyoming Innovation Partnership to help emerging Native artists become established creative professionals.

"We just closed the Homeland Show for the welcoming back of the Arapaho and the Cheyenne to their homelands," Cook noted. "We're going to continue on that theme with bringing emerging artists from the reservation down there to get them a show and professional development."

Cook is a celebrated wood carving artist in the Haida tradition and has been expanding his ledger-painting work in the Arapaho tradition. His work will be on display at Scarlow's Art and Coffee in Casper through the end of the month.

Cook pointed out there is not a lot of opportunity for Native artists in the area. Business was easier in Seattle, he said, where he was represented by a gallery. In Wyoming, the road for Native art to be accepted, recognized and funded has been more difficult.

"There's a lot of sales of beadwork within the reservation," Cook acknowledged. "But it's not really being seen outside the reservation. As far as the arts scene in Wyoming, it's pretty nonexistent."

With fellow artist Robert Martinez, Cook cofounded the Northern Arapaho Artists Society and this was the second year they ran a Native arts market in Jackson. He reminded supporters of arts in the West that Native artists are "alive and well, creating art."


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President Joe Biden's recent apology on behalf of the federal government for harms done to generations of Native American children and their families in boarding schools was long overdue, according to Cheryl Crazy Bull, president and CEO of the Denver-based American Indian College Fund.

And she said the apology is also a good start toward reconciliation.

"I feel like when you acknowledge something, you take a step toward healing that," said Crazy Bull. "You can't really have reconciliation unless people acknowledge that harm was done."

The U.S. Government removed Native children from their homes and families by force, and placed them in boarding schools where connections to their culture and language were severed.

Children were routinely beaten for not speaking English, and many were killed.

Until now, the program which operated between 1819 until 1969, was justified by U.S. officials as a necessary evil in order to achieve Manifest Destiny.

Crazy Bull said Native people believe that destiny is laid out by the Creator, not people.

She noted the Tribal College movement is in part an effort to take back control of education, and allow members to learn through a Native lens.

"If Manifest Destiny says that somebody else gets to dictate the path that you take," said Crazy Bull, "Tribally Controlled means that you get to dictate that path as a tribal person."

A bill making its way through the U.S. House would create a truth and healing commission, similar to efforts in South Africa in the aftermath of Apartheid.

Crazy Bull said native communities are still struggling - not only with inter-generational trauma - but also a lack of adequate housing, jobs, health care, and education opportunities.

"I feel like there needs to be a significant investment for the reparative work that needs to be done," said Crazy Bull, "in order for Native people to be healed of the harms."



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