Note: This article is part of the project: "Indigenous Impacts: How Native American communities are responding to COVID-19." We invite you to view the entire project here.

SIOUX FALLS, S.D. — Federal pandemic relief legislation has poured billions of dollars into Indian Country this year, as tribes fight to keep COVID-19 away from their families, support already limited health systems and reduce the virus' damage to their economies.

But has it been enough?

The short answer is no, even though the bursts of funding did much to help support pandemic testing and health care costs, and buoy local economies. But the longer answer, tribal health experts say, is that the pandemic has been a gut punch for many tribes, whose budgets and health systems were already stretched thin by a virus that disproportionately affects them.

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More help, including big structural assistance, is desperately needed, said Stacy Bohlen, CEO of the National Indian Health Board, in June testimony to a congressional subcommittee examining how the Indian Health Service has responded to COVID-19.

The chronically underfunded IHS is a central piece of the pandemic response as a federal agency that is charged with providing health care for the 2.6 million Native Americans who belong to 574 federally recognized tribes in 37 states.

"These existing capacity and resource shortages meant that the Indian health system was woefully unprepared to prepare, prevent, and respond to the COVID-19 pandemic," Bohlen said in her written testimony, adding the pandemic's strain is also financial, for both tribes and tribal members.

"Tribal economies have been shuttered by social distancing guidelines that have also severely strained tribal healthcare budgets," she testified. "Meanwhile, tribal business closures have compounded the devastation of the COVID pandemic in Indian Country."

Pandemic assistance to Indian Country

The federal pandemic assistance to Indian County came out of several major pieces of legislation that Congress quickly approved with overwhelmingly bipartisan support in March and April as testing showed the surging spread of the virus across the nation and the U.S. economy virtually shut down in response.

The legislation details below, provided by the National Indian Health Board and National Congress of American indians, are those aimed specifically at aiding tribes, although other aspects of federal legislation, such as Paycheck Protection Program loans, were available to tribal members as well.

  • The $8.3 billion Coronavirus Preparedness and Response Supplemental Appropriations Act became law in early March. According to the National Indian Health Board, $40 million was set aside in grants for tribes who handle health programs formerly administered by the Indian Health Service; $30 million was designated for nine regional tribal organizations and tribes with populations over 40,000; $8 million for the National Council of Urban Indian Health to distribute to 41 urban Indian organizations; and $2 million for the National Indian Health Board.
  • The $3.5 billion Family First Coronavirus Response Act, which became law in mid-March, included a number of significant provisions for tribes, the NIHB said, including $134 million for the Indian Health Service for things such as testing, personal protection equipment and treatment and requires the federal government pay for, without cost-sharing, the COVID-19 testing for Native Americans.
  • The largest piece of pandemic-related legislation so far was the $2.2 trillion Coronavirus Aid, Relief, and Economic Security (CARES) Act, which became law in late March. The legislation included $8 billion for tribal governments, $1.03 billion for the Indian Health Service, and over $500 million for other pandemic-related essential services and education-related needs.
  • Approved in April, the Paycheck Protection Program and Health Care Enhancement Act provided $750 million for COVID-19 testing and testing-related services through the IHS.
  • Another large piece of coronavirus response legislation, the $3 trillion Health and Economic Recovery Omnibus Emergency Solutions Act (HEROES) Act, has been approved by the House on nearly a party line vote, aid is now languishing in legislative purgatory as Democrat leaders of the House and Republican leaders of the Senate fight over the scope and size of the legislation. As written, the legislation contains $20 billion in fiscal relief for tribal governments, $2.1 billion for the IHS, $900 million for the Bureau of Indian Affairs, as well as other tribal-related provisions.