American Indian and Alaska Native communities experience the most severe health disparities in the United States, with the highest overdose death rates among all racial and ethnic groups. In 2022, roughly 1,543 non-Hispanic American Indians and Alaska Natives died of overdose, according to the CDC.
These stark statistics gained renewed attention when a California Native American tribe filed a federal lawsuit against the Indian Health Service in December after the agency rejected its proposal to build a tribal opioid treatment facility. Native Americans continue to die from drug overdoses at higher rates than any other racial or ethnic group despite facing limited access to culturally relevant addiction care.
Beyond overdoses, American Indian and Alaska Native people have shorter life expectancy than other Americans, with significantly higher rates of diabetes, heart disease, mental health conditions, and suicide. The Indian Health Service, the federal agency responsible for providing health care to roughly 2.8 million American Indians and Alaska Natives, operates with per-patient spending significantly lower than Medicare, Medicaid, or even the Bureau of Prisons health systems, despite serving populations with higher disease burdens.
Staffing shortages plague the system, with vacancy rates around 30 percent, meaning many clinics struggle to offer regular, comprehensive care. The Purchased and Referred Care program, meant to cover care outside IHS clinics, routinely runs out of money mid-year, leaving patients on the hook for bills.
Proposed federal Medicaid cuts exceeding 900 billion dollars over the next decade threaten to worsen these disparities. Many tribal clinics depend on Medicaid reimbursements for 30 to 60 percent of their revenue, making potential cuts catastrophic for communities already facing the deepest health inequities in the nation.
See: “Why Native health care should be on your radar” (February 9, 2026)
