---
title: "Lumbee Federal Recognition and Healthcare Challenges: IHS Limits, Casino Fallout, and Local Respon"
id: "kff-health-news-0-the-newest-federally-recognized-tribe-wants-better-healthcare-it-may-be-on-its"
canonical_url: "https://medichelpline.com/clinical-feed/kff-health-news-0-the-newest-federally-recognized-tribe-wants-better-healthcare-it-may-be-on-its"
content_type: "clinical_feed_article"
specialty: "General"
source_name: "KFF Health News"
source_url: "https://kffhealthnews.org/rural-health/tribe-native-disparities-indian-health-service-federal-recognition-lumbee-north-carolina/"
published_at: "2026-07-31T09:00:00.000Z"
evidence_level: "Verified Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Lumbee Federal Recognition and Healthcare Challenges: IHS Limits, Casino Fallout, and Local Respon
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/kff-health-news-0-the-newest-federally-recognized-tribe-wants-better-healthcare-it-may-be-on-its
- **Specialty:** [General](https://medichelpline.com/clinical-feed/general.md)
- **Primary Source:** KFF Health News
- **Source URL:** [Original Journal Publication](https://kffhealthnews.org/rural-health/tribe-native-disparities-indian-health-service-federal-recognition-lumbee-north-carolina/)
- **Published At:** 2026-07-31T09:00:00.000Z
- **Evidence Rating:** Verified Feed
## Executive GIST (TL;DR)
- The Lumbee Tribe of North Carolina secured federal recognition in late 2025, becoming the 575th federally recognized tribe, a milestone expected to open access to the **Indian Health Service (IHS)** and federal funding for health services. - Local health burdens in Robeson County are high: elevated rates of **heart disease**, **diabetes**, and substance-use risks, alongside one of the state’s highest percentages of Medicaid enrollment. - IHS is chronically underfunded nationally; workgroup estimates and prior reporting indicate a major funding shortfall for IHS services, and recent federal budget proposals and agency cuts have further strained resources. - The nearest IHS facility is more than a two-hour drive for many of the Lumbee’s ~55,000 citizens, leaving local access to IHS care limited despite recognition. - The Congressional Budget Office previously estimated IHS spending tied to recognition could rise by about $247 million over four years for the tribe, but tribal leaders and health researchers say IHS funds alone will not be sufficient to reverse entrenched disparities. - Tribal leaders pursued gaming as a revenue source to build healthcare infrastructure and other services; a proposed constitutional amendment to enable a Lumbee casino was rejected by more than 60% of Lumbee voters in June 2026, halting that revenue pathway. - Examples from other tribes show gaming revenue has funded hospitals and health systems, though research also notes potential increases in substance use and smoking associated with gaming income. - Local clinicians and researchers, including Lumbee physicians and UNC and Johns Hopkins faculty, argue a dual approach—combining IHS funding with additional tribal revenues—is necessary; the IHS did not provide comments to reporters and tribal leadership did not respond to interview requests. - Personal narratives illustrate the stakes: Angie Lowery, a Lumbee citizen, reversed obesity and insulin dependence through diet and exercise, and community members link potential tribal revenues to improved education, infrastructure, and healthcare. - The reporting indicates momentum and optimism after recognition but leaves unresolved many operational details about how the tribe will build a health system; several specifics about ongoing community research and future plans were not reported in the article.
## Clinical Analysis & Structured Key Points
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It May Be On Its Own. Share This Story * Republish this story * Copy link * Print * Email ![A Native American woman stands outside in the late afternoon sun.](https://kffhealthnews.org/wp-content/uploads/sites/8/2026/07/Lumbee_04.jpg) # The Newest Federally Recognized Tribe Wants Better Healthcare. It May Be On Its Own. Angie Lowery, a citizen of the Lumbee Tribe, stands outside her home in Robeson County, North Carolina. (Andrew Jones/KFF Health News) # The Newest Federally Recognized Tribe Wants Better Healthcare. It May Be On Its Own. By [Andrew Jones](https://kffhealthnews.org/author/andrew-jones/) July 31, 2026 Republish LUMBERTON, N.C. — Soybean fields surround Angie Lowery’s home in Robeson County, on a plot of rural land in southeastern North Carolina. Dozens of antique gas station signs, 20 feet tall, dominate her front yard. A framed re-creation of _The Last Supper_ , Lone Ranger posters, and a 3-foot-wide tobacco harvesting basket adorn the walls of her home. A collector, Lowery over the years has amassed remnants of her region’s past. [ ![Partner logo](https://kffhealthnews.org/wp-content/uploads/sites/8/2022/07/npr-hi-res-logo.png?w=500) ](https://www.npr.org/2026/07/30/nx-s1-5906740/lumbee-tribe-indian-health-service-gambling-north-carolina) This story also ran on [NPR](https://www.npr.org/2026/07/30/nx-s1-5906740/lumbee-tribe-indian-health-service-gambling-north-carolina). It can be [republished for free](https://kffhealthnews.org/republish/rural-health/tribe-native-disparities-indian-health-service-federal-recognition-lumbee-north-carolina/). But behind the house, the 44-year-old’s backyard garden showcases her goals for the future, one that involves a long, healthy life with her kids: collard greens, bell peppers, onions, tomatoes, red and white potatoes, kale. Like Lowery, many in the small towns of Lumberton and nearby Pembroke are citizens of the Lumbee Tribe who have dealt with heart conditions. The mother of four struggled with obesity and had to take insulin pills and shots daily. By when her first grandchild was born, in 2024, Lowery imagined her own life ending the way her biological father’s did: Daily insulin shots for diabetes. Kidney dialysis treatments at home. Dead of a heart attack at 63. She wanted her grandkids to remember her. “If I don’t get this weight off me, if I don’t change my eating habits, it’s going to take me over,” she recalled thinking. So, she expanded her garden. She cut fatty foods and sugary drinks out of her diet, stopped eating fried and fast food, and started moving more. She lost 120 pounds in two years and weaned herself off the daily insulin pills. The Lumbee Tribe of North Carolina late last year became the 575th tribe to secure federal recognition as a sovereign nation, a milestone that leaders and citizens celebrated in tears. The designation provides federal funding for an array of services, including for healthcare. [John Lowery](https://www.ncleg.gov/Members/Biography/h/1001), chairman of the tribe and a state representative, [declared that](https://www.youtube.com/live/CXydqVc8Qpg?si=xx1IlvFnk-V0Me4Z&t=4753) “the biggest benefit” would be access to the Indian Health Service — its clinics and hospitals, as well as funding that it could provide for the tribe to [create its own health system](https://www.ihs.gov/selfgovernance/aboutus/). But Lumbee researchers and healthcare providers say that money won’t be enough. For decades, IHS has been [chronically underfunded](https://www.kff.org/racial-equity-and-health-policy/key-data-on-health-and-health-care-for-american-indian-or-alaska-native-people/#4c121d57-d38d-46b1-ba19-d6a69f032e51), with the agency’s budget workgroup estimating that [it’s nearly $55 billion short](https://legacy.nihb.org/resources/NIHB-FY26-Budget.pdf) of what it needs this year. And that was before the Trump administration’s cuts to other federal agencies further pinched IHS. Slashes to the Centers for Disease Control and Prevention last year initially included laying off nearly [1,000 IHS employees](https://ictnews.org/news/rfk-jr-rescinds-indian-health-service-layoffs/), and President Donald Trump’s proposed 2027 budget cuts more than $150 million for a [program to address diabetes](https://www.nihb.org/nihb-highlights-trump-administration-releases-fy2027-budget-request-to-congress/#:~:text=Includes%20%2449,million,-%2E) in Native American tribes. The nearest IHS facility is more than a two-hour drive to another state for most of the 55,000 Lumbee citizens in Robeson County. The county is one of the [poorest in the U.S.](https://www.census.gov/library/stories/2023/05/persistent-poverty-areas-with-long-term-high-poverty.html) and has some of the [worst health outcomes](https://www.countyhealthrankings.org/health-data/north-carolina/robeson?year=2025). ![A photo taken from the side of the road shows three signs. They read: "Welcome to North Carolina." "Welcome to Robeson County; first U.S. rural health department." "Home of the University of North Carolina at Pembroke."](https://kffhealthnews.org/wp-content/uploads/sites/8/2026/07/Lumbee_01.jpg)Robeson County is mostly rural, agricultural land. Most of the members of the Lumbee Tribe live in the small towns of Lumberton and Pembroke, both about a half-hour drive from the South Carolina border. (Andrew Jones/KFF Health News) The Congressional Budget Office in 2022 estimated that the tribe could increase IHS spending by [$247 million over four years](https://www.cbo.gov/system/files/2022-10/hr2758.pdf). The tribe will have to rely on other revenue sources that are now allowed through recognition, such as a casino, to reverse the health disparities their people have faced for decades, Lumbee researchers said. “None of us can depend on IHS alone, because we just don’t have the resources within that system,” said [Donald Warne](https://publichealth.jhu.edu/faculty/4481/donald-warne), a physician, a researcher at the Johns Hopkins Center for Indigenous Health, and a member of the Oglala Lakota tribe. “But it’s a great starting point.” The IHS did not respond to questions about plans for the tribe’s health system. John Lowery did not respond to requests for an interview or a list of questions, but he said on a June podcast that he expected healthcare to be the [largest portion of the tribe’s budget](https://youtu.be/5aKRcFiOi2A?si=24e3za9DYNDEsbpw&t=1521). ![Angie Lowery holds up a piece of jewelry she made.](https://kffhealthnews.org/wp-content/uploads/sites/8/2026/07/Lumbee_06.jpg) Lowery makes beaded earrings, teaches culture classes, owns a gravestone business, and makes engravings in her Pembroke, North Carolina, shop. (Andrew Jones/KFF Health News) ![A photo of a wall. On the left is a print of a painting of the Last Supper. On the right are prints of vintage advertisements: Merita bread, a red stamp featuring a Native American man wearing a headdress, and 7Up.](https://kffhealthnews.org/wp-content/uploads/sites/8/2026/07/Lumbee_08.jpg) Antiques hang on Lowery’s walls at her home. She and her husband, Grant Hunt, are avid collectors. (Andrew Jones/KFF Health News) **‘Not Just Statistics’** Eighteen years ago, [Andrea Blackburn](https://healinghandsfamily.com/about/), a doctor in Lumberton and a citizen of the tribe, was working at a nearby medical center. There, she said, she was taught that patients with certain last names “are often referred directly to cardiac catheterization,” a procedure to diagnose heart conditions. Blackburn said she realized that common Lumbee surnames carried an expectation of disease. “Nearly two decades later, I can tell you that reality has not changed,” she told assembled tribal leadership and citizens at a public hearing. Robeson County’s rates of heart disease, diabetes, and [risky substance use](https://www.dph.ncdhhs.gov/programs-services/chronic-disease-and-injury/injury-and-violence-prevention-branch/north-carolina-overdose-epidemic-data) continue to rank among the highest in the state, Blackburn noted. In 2025, [more than half of the county’s residents](https://www.ncacc.org/wp-content/uploads/2025/05/2025_05_Medicaid-Enrollment.pdf) were Medicaid enrollees, the highest percentage of all counties in the state. “But these are not just statistics to me,” she said. “These are my patients. These are our families.” ![A photo of a woman standing in her office.](https://kffhealthnews.org/wp-content/uploads/sites/8/2026/07/Lumbee_10.jpg?w=1270)Andrea Blackburn, a citizen of the Lumbee Tribe, is a physician in Robeson County. (Andrew Jones/KFF Health News) For Angie Lowery, breaking free from those statistics meant taking her health into her own hands. She hopes a healthy diet is the answer to breaking her family’s cycle and living long enough to form relationships with her grandkids. And she brought the rest of the family with her. Her teenage daughter lost about 35 pounds. Two of her other children are now “health fanatics,” Lowery said. Her granddaughter will be 2 in November. One Sunday morning in March, Lowery served up macaroni, cauliflower, and chickpeas for her as they spent the day together. Lowery had supported building a casino, believing it would provide better education, infrastructure, and healthcare for her family. “That vote, I’m thinking of my children’s future,” she said. ![Angie Lowery stands next to rows of plants growing in rows in her backyard garden.](https://kffhealthnews.org/wp-content/uploads/sites/8/2026/07/Lumbee_03.jpg?w=1270)Lowery grows squash, onions, potatoes, and other produce in her backyard garden. Later this year, she’ll can some of the harvest for her family. (Andrew Jones/KFF Health News) ![Newsletter Icon](https://kffhealthnews.org/wp-content/plugins/kff-shared/dist//images/newsletter-icon.png) #### Email Sign-Up Subscribe to KFF Health News' free Morning Briefing. Your Email Address Sign Up **Casino Dreams in Limbo** Tribal citizens are deeply divided over how to reverse decades of economic decline that have led to poor living conditions, unaffordable health services, and chronic disease. Four months after Trump signed the Lumbee Fairness Act — [declaring](https://www.youtube.com/watch?v=8dCUuQcHMmA) “I love the Lumbee Tribe” — tribal leaders gathered at a business meeting to take the first steps toward building a casino and establishing gaming as a new revenue source. Hundreds of federally recognized tribes across 29 states have used gaming as a source of revenue, [bringing in $43.9 billion](https://www.nigc.gov/?wpdmdl=12761&ind=1754333463993) in fiscal 2024, according to the latest report from the National Indian Gaming Commission. The approach has been popular among tribal nations looking for more dollars to build up healthcare. The Choctaw Nation of Oklahoma in 1999 [became the first tribe](https://www.choctawnation.com/news/iti-fabvssa/the-talihina-indian-hospital-part-ii/#:~:text=In%201999,hospital%29%2E) to build its own hospital, using roughly $25 million in gaming money, and the Eastern Band of Cherokee Indians in western North Carolina funded its own hospital in 2015 mostly with [$82 million in gaming funds](https://kffhealthnews.org/health-industry/how-the-eastern-cherokee-took-control-of-their-health-care/). But the Lumbee Tribe’s effort to establish a casino collapsed in June. [More than 60% of voters](https://www.axios.com/local/raleigh/2026/06/24/election-results-lumbee-casino-north-carolina) rejected a Lumbee constitutional amendment that would have allowed tribal leaders to create infrastructure needed for a gaming business. John Lowery said [on Facebook](https://www.facebook.com/permalink.php?story_fbid=pfbid02gnKG1awQz8uzSvAijTigCiwPnJRUnKc5TPSSmw7udqJknWJzcNn6NUpVWoi4DJXZl&id=100082023654573) that he doesn’t plan on bringing back the initiative now that it was rejected “by the majority of Lumbee voters.” His term as chairman ends in two years. ![An indoor photo shows a headshot of a John Lowery framed next to a sign that shows a rendering of a casino. Text above it reads, "Visit LumbeesChoose.com to learn more about the June 23rd Amendment vote."](https://kffhealthnews.org/wp-content/uploads/sites/8/2026/07/Lumbee_11.jpg?w=1270)A portrait of Lumbee Tribe Chairman John Lowery hangs beside a rendering of a proposed casino and resort meant to help bring in revenue for the newly federally recognized tribe. Citizens voted against the project. (Andrew Jones/KFF Health News) Other funding sources to provide health services for the tribe could include gas stations or hotels, he said in a call with citizens before the vote. Lumbee and other Native health researchers said they believe a twofold system — using IHS money and additional revenue — is necessary. Funds from gaming could compensate for what IHS can’t support. Casinos’ impact on tribal health has been debated in research for decades. [Studies show](https://pmc.ncbi.nlm.nih.gov/articles/PMC4957391/) that the money from gaming helps tribes build more facilities, hire more doctors, and improve social services, but unhealthy substance use and smoking increase. “There’s going to be negative impacts,” [Brittany Locklear](https://www.uncp.edu/about/directory/brittany-strong-locklear.html), a social work professor at the University of North Carolina and citizen of the Lumbee Tribe, said at a June panel discussion on gaming. [Ronny Bell](https://pharmacy.unc.edu/directory/bellr/), 62, a Lumbee citizen and a researcher studying Native health at UNC, said the community has felt ripple effects from systemic racism, having not been acknowledged as a tribal nation for so long, and the economic downturn following the loss of Robeson County’s manufacturing and tobacco jobs. That history plays a part in the health statistics in Robeson today, Bell said. But with federal recognition, he said, the Lumbee people have achieved a victory they’ve fought for since 1888. “I think about the resilience of the Lumbee people and how they’ve gone through this 100-plus-year fight for federal recognition,” Bell said. “I sort of see that as a continuation of this resilience, and how now we have this opportunity with federal recognition to bring in resources to help address those issues.” ![A photo of a large government building. In front of it are three flagpoles: on the left is the Lumbee Tribe flag; the American flag is in the center; the North Carolina flag is on the right.](https://kffhealthnews.org/wp-content/uploads/sites/8/2026/07/Lumbee_13.jpg?w=1270)The Lumbee Tribe government offices and citizen housing in Pembroke, North Carolina, stand amid long stretches of agricultural countryside. (Andrew Jones/KFF Health News) **Resolution and Uncertainty** Jada Brooks, a Lumbee citizen and UNC researcher who studies Indigenous health and lives in Robeson County, is conducting a study about heart health among Lumbee women. The initiative includes classes in which Lumbee women ages 18 to 50 signed up to discuss their health. That’s where she met Angie Lowery, who talked about her lifestyle changes with the group. “I was just floored by, like, just the extent to whi
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