Indian Health Service IHS

Federal health care for tribes grew out of treaties in which tribes ceded land in exchange for promised services, and the Snyder Act of 1921 authorized spending on Indian health. For decades that care was run by the Bureau of Indian Affairs, until a 1954 law moved it to the Public Health Service, and the Indian Health Service began operating on July 1, 1955. The Indian Health Care Improvement Act of 1976, made permanent in 2010, is its main governing law. It is led by a Director.

IHS serves roughly 2.8 million American Indians and Alaska Natives from federally recognized tribes through hospitals, clinics, and health stations organized into twelve regional areas. More than half of its budget now flows to tribes that run their own health programs under self-determination contracts and compacts, and it also funds urban Indian health organizations. It is not insurance: it delivers care directly and buys outside care when services are not available, often relying on Medicaid and Medicare billing to stretch funds.

Spending per patient has long been far below that of other federal health programs, and American Indians and Alaska Natives have among the lowest life expectancies of any group in the country. In a long-sought change, Congress began providing advance appropriations for most IHS accounts starting in fiscal 2024, cushioning it from shutdowns. In 2025, after objections from tribal leaders, HHS exempted IHS from most of its department-wide staff reductions. Tribal leaders continue to press for full, mandatory funding as a treaty obligation, while appropriators cite competing budget pressures.