NDAA Expands Socialized Medicine 

The National Defense Authorization Act (NDAA) is typically filled with wacky and wasteful spending items. As the Taxpayers Protection Alliance has noted in the past, lawmakers have used this legislation to fund their pet projects. The fiscal year 2026 NDAA, which costs taxpayers $900 billion, does not disappoint. The 3,086-page bill shells out taxpayer dollars for everything from controlling the spread of the greater banded hornet in Guam (pg. 295) to removing limits on funding for world’s fairs (pg. 2,092) to greenlighting the Young Balkan Leaders Initiative (pg. 2,817). Even more troubling, the NDAA does not give total dollar amounts for these programs.

Perhaps the strangest of all these provisions is a backdoor expansion of government healthcare to the Lumbee Tribe of North Carolina through the Indian Health Service (IHS). This is part of granting federal recognition to the tribe (pg. 3,075 of the NDAA). This isn’t necessarily a bad idea—provided it isn’t done through an unrelated Defense bill.

Despite the clear benefits of land protection and autonomy that come through tribal recognition, the IHS expansion is at best a mixed bag for the tribe members, who currently have a mix of private and government (e.g., Medicare, Medicaid, VA) healthcare. The government-run IHS healthcare system has long led to the abysmal treatment of patients at high costs to taxpayers. Lawmakers should leave healthcare out of the NDAA and commit separately to giving Native Americans—including the Lumbee tribe—greater choice and affordability in healthcare.

More than two million American Indians have the misfortune of receiving care through the IHS, an agency within the Department of Health and Human Services. This small agency costs taxpayers an astounding $7 billion per year. While the government is well intentioned in attempting to directly provide care to Native Americans, the abysmal results speak to the fundamental failure of federal management of healthcare. 

Across 330 Indian land territories in the U.S., IHS directly foots the bill for hospitals and physicians and dictates the level and quality of care. According to its patients, this much talked about “right” to healthcare amounts to very little in reality. According to Victoria Kitcheyan of the Winnebago Tribe of Nebraska, Native Americans expecting decent and comprehensive quality of care will instead encounter, “emergency room nurses who do not know how to administer such basic drugs as dopamine; employees who did not know how to call a Code Blue; an emergency room where defibrillators could not be found or utilized when a human life was at stake…”

Fortunately, federal oversight bodies are starting to take notice. In 2019, HHS’s inspector general (IG) released a report excoriating the service for poor management, coordination, and standards of care. After interviewing many personnel, the IG noted, “Officials reported that the lack of structure could lead to frequent changes in policy as leadership changed. In some cases, policies lacked detail and were not specific or prescriptive in mandating particular actions.” Communications between IHS area offices and hospitals are next to non-existent, resulting in festering problems that are never addressed. In one case, an IHS-employed doctor abused children for years but retained employment with the agency despite multiple complaints and reports.

Fortunately, there are far better ways to provide healthcare to the struggling Native American population. One option is to provide a means-tested, refundable tax credit for individuals to go out and purchase the private healthcare plan of their choice. This would not only allow tribal members to pick a plan tailored to their needs but also lead to far better healthcare outcomes. According to a 2021 analysis by the Medicaid and CHIP Payment and Access Commission, more than 96 percent of physicians accept privately-insured patients. Compare that to the IHS’ well-documented struggles to recruit and retain qualified doctors, and it’s easy to see the upside of market-provided medicine.

Even absent these significant changes, lawmakers could aim to improve accountability from the IHS. Introduced most recently by Rep. Dusty Johnson (R-S.D.), the Restoring Accountability in the Indian Health Service Act aims to bolster Native American care by implementing standards for timeliness of care, enforcing whistleblower protections, and introducing greater fiscal monitoring and accountability. 

One thing is clear. The status-quo significantly disadvantages tribes across the U.S. at a $7 billion annual cost to taxpayers. Lawmakers should leave these non-defense issues out of the NDAA and pass healthcare legislation that would bolster patient choice and access.