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The Indian Health Service (IHS) remains largely misunderstood by those not directly connected to it, and often derided as a bureaucratic and confusing system by those who are. IHS marks its 70th anniversary, providing care to all Native citizens. Of course, the agency’s history is also documented in the hundreds of treaties over almost 200 years in which the U.S. Government explicitly signed on to its responsibility. We’ll trace the history of IHS from the first immunizations to Public Law 638, and chart its future amid a major reassessment of federal government services.
GUESTS
Benjamin Smith (Navajo), acting director of Indian Health Service
Retired Rear Adm. Michael Weahkee (Zuni Pueblo), former director of Indian Health Service
Mary Smith (Cherokee), former CEO of Indian Health Service
Dr. Donald Warne (Oglala Lakota), co-director of the Johns Hopkins Center for Indigenous Health
Dr. John Molina (Pascua Yaqui and Yavapai Apache), director of the Arizona Advisory Council on Indian Health Care
Break 1 Music: Intertribal Song (song) Black Lodge Singers (artist) Enter the Circle – Pow-Wow Songs Recorded Live at Coeur D’Alene (album)
Break 2 Music: Kunax yak’ei gayshagook (song) Khu.éex’ (artist) Siyáadlan (album)
Here’s more from our interview with Dr. John Molina (Pascua Yaqui and Yavapai Apache) discussing how IHS was instrumental in getting him into medical school and Congress’s failure to recognize the importance of the agency:
I have zero confidence in IHS under a second Trump regime. We already saw what happened during his first term. In October 2017, Trump nominated Robert Weaver—a man who lied on his resume and lacked real qualifications—to lead the Indian Health Service. That nomination collapsed after scrutiny revealed financial issues and tax liens. Now, the Trump administration is pushing Medicaid work requirements that will disproportionately harm Native people, despite the federal government’s trust and treaty obligations to provide health care. I’m hearing nothing but neutrality or praise from Acting Director Benjamin Smith–he sounds more like a Trump spokesperson than an advocate for the Indigenous Peoples he’s supposed to represent. On top of that, the Trump regime eliminated advance appropriations for IHS in its latest budget—a move tribal leaders have condemned. We need leadership that defends us, not one that plays nice while our communities are under attack.
However, Sean Spruce did an excellent job asking questions that matter and bringing accountability to this conversation. I’m deeply grateful for his work on this issue.
Yes, the Robert Weaver nomination may have been a misstep—but to suggest that a single failed nomination defines the entirety of IHS policy under the Trump administration is both misleading and reductive. Criticism is fair, but historical accuracy matters too.
The claim that Medicaid work requirements were a targeted attack on Native communities ignores key legal distinctions: tribal nations often negotiated exemptions or waivers based on sovereignty and unique healthcare relationships. More importantly, both Democratic and Republican administrations have fallen short in fully honoring the federal government’s trust responsibility to tribal nations—cherry-picking Trump’s tenure as uniquely harmful oversimplifies a long history of bipartisan neglect.
As for Benjamin Smith, dismissing him as a “Trump spokesperson” because of measured public statements shows more concern with political optics than with the complex realities of leading a chronically underfunded agency in a fractured political climate.
If we want to improve IHS and tribal health outcomes, we need nuanced, strategic advocacy—not ideological litmus tests or partisan finger-pointing. Otherwise, we risk alienating the very people we claim to serve.
You’re right that IHS has been chronically underfunded across administrations, but that does not excuse actively harmful policy or poor leadership decisions under Trump. The nomination of Robert Weaver was not just a “misstep.” It was a glaring example of negligence. Appointing someone who falsified their credentials to run a life-and-death agency for Native people shows how little priority tribal health was given. That was not an isolated incident. It was part of a broader pattern.
Regarding Medicaid work requirements, yes, some tribal nations negotiated exemptions, but only after legal battles and administrative hurdles that many smaller or under-resourced tribes could not manage. CMS under Trump initially denied tribal exemptions altogether, arguing that tribes are racial groups, not sovereign nations. That was a direct threat to tribal sovereignty. It took sustained backlash to get a reversal. That is not neutral policy; it is aggressive and dangerous.
As for Benjamin Smith, I am calling for courage. “Measured” public statements are not helpful when our people are dying from preventable diseases and when the average life expectancy for American Indian and Alaska Native people is about t 10.5 years lower than the U.S. all-races average of 75.7 years. If tribal leaders are loudly criticizing policy decisions that undermine healthcare, and the IHS Director is not publicly standing with them, that is not strategy. It is silence. We cannot afford neutrality in these matters.
You are right that bipartisan neglect is real and historical. But pretending Trump’s actions were not especially hostile ignores real harm. We do not need to be neutral about that. We need to be accurate, and that means naming when policies were not just inadequate but actively regressive.