The Lumbee Tribe of North Carolina achieved federal recognition as the 575th federally recognized tribe, a milestone tribal leaders expected would substantially improve healthcare access through the Indian Health Service. However, healthcare researchers and providers within the tribe have raised concerns that IHS funding alone will be insufficient to address longstanding health disparities in the region.
Robeson County, where approximately 55,000 Lumbee citizens reside, ranks among the poorest counties in the United States and experiences some of the worst health outcomes nationally. Residents face significantly elevated rates of heart disease, diabetes, and substance use disorders. The nearest IHS facility is located more than two hours away in another state, presenting a major access barrier. The IHS operates under chronic underfunding, with the agency’s budget workgroup estimating a shortfall of nearly $55 billion this fiscal year. Recent federal budget cuts have exacerbated the situation, with the Trump administration’s proposed 2027 budget reducing diabetes prevention funding by more than $150 million.
Tribal leaders have pursued alternative revenue sources to supplement inadequate federal healthcare funding. A casino proposal emerged as a potential path forward, with hundreds of federally recognized tribes across 29 states generating $43.9 billion in gaming revenue during fiscal year 2024. The Choctaw Nation of Oklahoma and the Eastern Band of Cherokee Indians in western North Carolina have successfully used gaming revenue to establish their own hospitals. However, the Lumbee Tribe’s casino proposal failed when more than 60 percent of voters rejected a constitutional amendment in June that would have enabled such a business venture.
Healthcare disparities in Robeson County reflect broader patterns of systemic racism, delayed federal recognition, and economic decline following losses in manufacturing and tobacco industries. Researchers emphasize that addressing these complex health issues will require both IHS resources and supplementary funding mechanisms. The defeat of the casino proposal has left the tribe uncertain about its next steps for financing expanded healthcare infrastructure and services, even as newly recognized tribal status provides opportunities for improved epidemiological data and healthcare planning specific to Lumbee citizens.
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