The Indian Health Service (IHS), an agency within the U.S. Department of Health and Human Services, provides federal health services to American Indians and Alaskan Natives (AI/AN). The AI/AN comprise 560 federally recognized tribes; tribal nations range from fewer than 100 enrolled members to more than 100,000. The majority of AI/AN live in metropolitan areas, with more than half living in six states: Oklahoma, California, Arizona, New Mexico, Alaska, and Washington. The IHS currently provides health services to approximately 1.8 million of the 3.3 million AI/AN, with an annual appropriation of $3 billion.

The first regular appropriations of funds for the relief of distress and conservation of health among AI/AN was due to the Snyder Act of 1921. In 1954, the U.S. government transferred the responsibility ...