Since the federal government shutdown began, tribal clinics and hospitals have been running into roadblocks billing Medicare for their patients’ telehealth visits. Liz Malerba, director of policy and legislative affairs for United South and Eastern Tribes, has been fielding calls about that. 

“Telehealth is very important for our elders and especially for ultra-rural tribal communities,” Malerba said. 

Some of the tribal nations she works with have the resources to float the cost of those services and hope for reimbursement when the government re-opens; others with less developed economies are suspending services. 

“The ability to step into the federal government’s shoes and actually pay for the services that we are owed varies considerably,” Malerba said. “The longer the shutdown goes on, the more that ability is jeopardized.” 

Federal programs and funding play an important role in Indian Country because of the government’s trust responsibility to provide or fund services to tribal nations in exchange for ceded land that now makes up the United States. That relationship also means that government shutdowns hit tribes especially hard. 

“The United States agreed to take tribal nations under its protection,” said Matthew Fletcher, a professor of law and American culture at the University of Michigan. “Health care, environmental protection, public safety, housing, education — all of these things are part of that duty of protection.” 

During government shutdowns, when many funding streams under the Bureau of Indian Affairs are frozen, Fletcher said the United States is “massively failing” to fulfill its Constitutionally-mandated responsibilities to tribal nations. 

Since 2022, the federal Indian Health Service has received advance appropriations that provide a funding bridge during government shutdowns. Other agencies that serve tribal nations should be similarly insulated from budget impasses, Fletcher argued, which have become so commonplace that tribes have standing contingency plans for managing them. 

“It would be nice not to have to worry all the time,” said Mary Greene Trottier, director of the Spirit Lake Nation’s food distribution program. 

During the 35-day government shutdown that began in late 2018, Greene Trottier said shipments to tribally-run food distribution programs were canceled and delayed, leading to shortages for their clients. Right now, she’s unsure if orders are being placed to the national warehouses that serve that network of programs. 

“The federal FDPIR workers are furloughed,” Greene Trottier said, adding that she’s been unable to reach the national office. “Nobody’s pressing send at the national level.” 

If the shutdown lingers, she worries that supplies of non-shelf-stable foods like fresh produce and meat could run out and that families could have to go without. 

“We have enough carryover to get us through for a while, but the fear is there,” Greene Trottier said.