The Silent Collapse
How Hospital Access Is Failing Native Communities
Across Indian Country, a catastrophe is unfolding.
Between 2019 and 2021, life expectancy for American Indian and Alaska Native (AI/AN) people plummeted by more than six years—from 71.8 to just 65.2. That’s not a dip. That’s a freefall.
To put this in perspective: a life expectancy of 65.2 years is lower than the average in many developing nations. In fact, it is the lowest of any racial or ethnic group in the United States. While the COVID-19 pandemic hit Native communities especially hard, this drop was no accident, no anomaly. It was the result of decades of policy neglect, broken treaties, and systemic underinvestment.
But one culprit stands out for how fundamental it is: hospital access.
Too Far to Care
A recent analysis published on Lexology explores what happens when we use provider network adequacy standards—the rules that define how far a patient should reasonably travel to reach a hospital or provider—to evaluate access for Native communities.
Spoiler: it’s bleak.
While health plans and government agencies might use metrics like “30 minutes to the nearest facility” or “60 miles to a hospital,” these standards don’t match the lived experiences of Native families—especially in rural or reservation settings. Many tribal communities are simply left out of the equation entirely. Others have hospitals that meet the mileage requirements, but lack culturally competent care or the specialties needed to treat chronic, life-threatening conditions like diabetes or cancer.
And for the record: it’s not just distance. It’s weather. It’s transportation. It’s infrastructure. It’s whether you even trust that the hospital near you will treat you fairly.
The Disparities Are Not a Mystery
Let’s be clear: we know why Native communities are struggling.
COVID-19 hit harder in AI/AN populations—1.6× more infections, 3.3× more hospitalizations, and 2.2× more deaths compared to non-Hispanic white people.
Social determinants of health—like extreme poverty, food insecurity, lack of running water, and historical trauma—compound risks.
Health system failures—like provider shortages, limited services at Indian Health Service (IHS) facilities, and high rates of uninsured people—create a perfect storm.
But what this latest analysis shows is that even the basic question of “Can I get to a hospital in time?” is not being answered equitably.
Redefining “Adequate”
If policymakers want to take these disparities seriously, they need to do more than fund short-term fixes or launch another study. They need to redefine what adequacy means.
Adequacy means:
Building hospitals and clinics in partnership with Tribes—not just near them.
Training providers who understand Native communities and can deliver culturally responsive care.
Factoring in the real-world barriers of transportation, seasonal access, and provider turnover.
And above all, listening to Native people about what they need.
It Shouldn’t Be This Hard to Stay Alive
Hospital access isn’t glamorous policy work. It’s not going to go viral on TikTok. But it is a life or death issue for too many Native families. And if we don’t fix this? That life expectancy number will keep falling.
We deserve better. Our communities deserve better. And this country—whose history is built on Native land—owes us better.