•Outdated, underfunded, and understaffed facilities cannot provide care beyond non-emergency hospitalization, let alone culturally competent or specialty care.

•Community divestment of surrounding reservations and IHS centers is correlated with low provider retention, diminishing the quality of care and patient-provider relationships.

•Many tribes do not have direct control over community health programs and services due to the need for federal approval, limiting their autonomy.

•Members of federally recognized tribes are not automatically insured outside of IHS providers. Lack of insurance exacerbates disparities due to prohibitive referral costs, inaccessibility of resources outside federal provisions, and low adherence to care.