Recently, the United Indian Health Services (UIHS) Board of Directors & Executive Leadership traveled to Washington, D.C. with the California Rural Indian Health Board (CRIHB) in their annual March on Washington advocacy trip.  Our purpose was clear: to ensure that the voices of our rural Tribal communities are heard where federal healthcare decisions are made.

For many people, healthcare policy can feel distant and abstract. But for our communities, federal funding decisions are personal. They determine whether an elder can see a specialist, whether a clinic can keep vaccines refrigerated during a wildfire-related power outage, and whether a young family can access lifesaving care close to home.

One of our primary discussions focused on Purchased and Referred Care (PRC) funding.  California is unique among Indian Health Service (IHS) regions because we do not have IHS hospitals.  That means our clinics must rely heavily on outside specialists for services such as oncology, cardiology, dialysis, and other critical treatments.  When PRC funds run out, patients are left facing delayed care, medical debt, or going without treatment altogether.  We advocated for increased funding to address this ongoing shortfall and to bring greater equity to the California region.

We also addressed the severe workforce shortages impacting rural Tribal health programs.  While California is often perceived as a place providers are eager to work, the reality in our most rural areas is very different.  Many clinicians come for short-term loan repayment commitments and leave after a few years.  This forces us to hire locum tenens (temporary providers) who work at UIHS for 3-6 months on average.  This creates instability, disrupts continuity of care, and places emotional strain on patients who must repeatedly retell their medical history to new providers.  Long-term workforce development and support for Native students entering healthcare fields remain critical priorities.

Another important topic was disaster preparedness. With wildfires and planned power shutoffs becoming more frequent, many Tribal health clinics remain vulnerable without adequate backup generators. Power outages threaten vaccines, medications, and essential medical equipment.  Clinics often serve as community hubs during emergencies, providing clean air, refrigeration for medications, and charging stations for medical devices.  Investing in infrastructure like emergency generators is not just a healthcare issue – it is a public safety investment.

We also called attention to longstanding funding disparities in the California Indian Health Service region. Historical court decisions have acknowledged underfunding, yet meaningful correction has not followed.  We urged support for further federal review and analysis to ensure equitable distribution of healthcare resources across regions.

In addition, we advocated for long-term stability of the Special Diabetes Program for Indians (SDPI), a highly successful program that has significantly reduced diabetes-related kidney failure in Native communities.  In recent years, the program has shifted from multi-year to single-year funding extensions, creating uncertainty for providers and patients alike.  Restoring longer authorization cycles would provide the stability needed to continue progress in combating chronic disease.

Beyond policy, what stood out most during our time in Washington was the importance of relationships.  Effective advocacy requires preparation, clarity, and persistence.  It requires pairing data with real stories from our communities.  It requires understanding that staff members play a critical role in shaping legislative decisions.  This requires returning year after year to continue the conversation.

We also shared strength and resilience within our communities – our work in food sovereignty, traditional healing practices, and culturally grounded health education.  These initiatives demonstrate that while we advocate for fair federal support, we are also actively building solutions at home.  

The journey to Washington reaffirmed that federal decisions directly impact the health and well-being of our Tribal community.  Advocacy is not a one-time event; it is an ongoing commitment to protecting access to care for elders, families, and future generations. Our rural voices matter and we will continue bringing them to the national table.