The Urban Native Healthcare Gap Congress Could Finally Fix
Why Urban Native Americans Are Fighting for Equality
TL;DR:
70% of Native Americans live in cities, but the Indian Health Service was built for reservations.
Urban clinics get less funding and fewer resources than tribal facilities.
COVID-19 emergency fixes were temporary, and the gaps have returned.
The Urban Indian Parity Act would give urban clinics equal funding, facility upgrades, and emergency support.
The bill has bipartisan backing but needs public pressure to pass.
Here’s a number that might surprise you:
Seventy percent of Native Americans live in cities, not on reservations. Yet the federal healthcare system built to serve them still operates as if that urban majority doesn’t exist.
On July 24, lawmakers reintroduced the Urban Indian Parity Act - a bill that could finally close this decades-old gap in Native healthcare.
How We Got Here
Most Americans don’t realize the U.S. government has a legal obligation to provide healthcare to Native Americans. Those obligations were written into treaties, signed in exchange for hundreds of millions of acres of land.
The Indian Health Service (IHS) was created to fulfill that promise but it was designed for reservation life.
In the 1950s and 60s, federal relocation programs actively encouraged Native families to move to cities for jobs and education. Generations did. Today, Los Angeles County alone has more Native residents than most reservations.
But healthcare didn’t follow them.
A Two-Tier System
Urban Indian health programs exist. There are just 34 clinics nationwide, but they are treated like second-class citizens in the IHS system. They receive less funding per patient, can’t access money for facility upgrades, and are excluded from loan programs that help recruit doctors.
During COVID-19, this inequality became impossible to ignore. Urban clinics struggled to get the same emergency supplies and funding that reservation-based facilities received more readily. States and the federal government eventually stepped in to fill some of those gaps, but the fixes were temporary. Once the crisis passed, the disparities returned.
The result? Your ZIP code determines your healthcare quality, even though treaty obligations are supposed to apply everywhere.
More Than Medical Care
Urban clinics don’t just provide checkups or prescriptions. They are cultural anchors for communities where Native identity can be invisible in daily life.
Many blend traditional healing with Western medicine, and serve as gathering spaces where Native families connect with their heritage.
The health challenges they face are severe:
Diabetes rates three times the national average
Higher rates of heart disease and substance abuse
Devastating suicide rates among Native youth
And they face these challenges on shoestring budgets that make recruiting specialists nearly impossible.
What the Urban Indian Parity Act Would Do
The bill, led by Rep. Sharice Davids (Ho-Chunk Nation) and Rep. Tom Cole (Chickasaw Nation), would:
Remove funding caps for urban Indian programs
Give them the same access to facility maintenance funds and provider recruitment programs as tribal facilities
Ensure emergency funding during health crises
Allow clinics more flexibility to meet community needs
“This isn’t about expanding government,” Davids said. “It’s about honoring existing treaty obligations fairly, regardless of where Native people choose to live.”
Why It Matters For Everyone
This isn’t just a “Native issue.”
When urban Native Americans can’t access preventive care, they end up in emergency rooms, the most expensive, least efficient form of treatment. When clinics can’t retain staff, it strains the entire healthcare system.
Urban Indian programs have also pioneered culturally competent healthcare approaches that could strengthen healthcare nationwide. But these successes have happened despite inadequate funding, not because of it.
The Bigger Picture
At its core, the Urban Indian Parity Act is about one principle: federal treaty promises should apply equally to all Native Americans.
Right now, the system effectively tells urban Native families that their healthcare rights don’t travel with them.
As someone who has lived in both rural and urban Native communities, I can say these aren’t abstract policy debates. They’re about families having to choose between economic opportunity and access to care.
What Happens Next
The bill has rare bipartisan support. But it won’t move without public pressure, especially from non-Native constituents who understand that honoring treaty obligations isn’t a partisan issue.
Native healthcare shouldn’t be a ZIP code lottery. The Urban Indian Parity Act could change that.
The question now is whether Congress will turn decades of promises into practice.