North Carolina’s Lumbee Tribe Faces Healthcare Crisis Despite Historic Federal Recognition

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 while a framed re-creation of The Last Supper, Lone Ranger posters, and a 3-foot-wide tobacco harvesting basket adorn her walls. As a collector, the 44-year-old mother has spent years amassing remnants of her region’s past, but behind the house, her backyard garden showcases her goals for the future: collard greens, bell peppers, onions, tomatoes, red and white potatoes, and kale.

Lowery, like many in the small towns of Lumberton and nearby Pembroke, is a citizen of the Lumbee Tribe who has dealt with serious heart conditions. The mother of four struggled with obesity and had to take insulin pills and shots daily. 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, and 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.

She expanded her garden, 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. Her transformation reflects both personal determination and the broader health challenges facing her tribe.

Historic Recognition Brings Hope and Uncertainty

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 healthcare. John Lowery, chairman of the tribe and a state representative, declared that “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.

After fighting for more than a quarter of a century for recognition, the tribe can now secure federal benefits through IHS. The Lumbee are found in a region that for years has held the worst health record in the state. For decades, tribal citizens have lived with chronic health issues like cardiac disease, obesity, and substance use disorder.

Andrea Blackburn, a Lumbee citizen and family physician, has witnessed the deteriorating health conditions firsthand during her 18 years of service.

“I’ve been here 18 years, and our patients are just getting sicker. They’re not getting healthier,” Blackburn said.

Federal Funding Falls Drastically Short

Lumbee researchers and healthcare providers warn that federal money won’t be enough to address the tribe’s mounting health crisis. For decades, IHS has been chronically underfunded, with the agency’s budget workgroup estimating that it’s nearly $55 billion short of what it needs this year. That calculation came before the Trump administration’s cuts to other federal agencies further pinched IHS resources.

Slashes to the Centers for Disease Control and Prevention last year initially included laying off nearly 1,000 IHS employees. Even with access to federal resources, reversing the health trends plaguing the Lumbee community will prove extraordinarily difficult. Blackburn believes the funding gap leaves the tribe with no choice but to explore alternative revenue streams.

“They’re not getting better because we just don’t have the resources or the grant money to help,” Blackburn said.

Gaming Revenue as Healthcare Lifeline

In recent months, the Lumbee Tribe tried to pass a referendum to allow gaming and build a casino. Blackburn, Lowery, and many tribal leaders hoped gaming would pay for better healthcare and change the lives of Lumbee citizens. She thinks it’s the tribe’s responsibility to find funding beyond the federal government to help address the healthcare crisis affecting thousands of tribal members across southeastern North Carolina.

The push for casino development reflects a broader strategy employed by other federally recognized tribes nationwide. Gaming revenues have enabled numerous Native American communities to build comprehensive health systems, fund preventive care programs, and address social determinants of health. For the Lumbee, whose citizens live predominantly in economically challenged rural areas, such revenue could prove transformative for healthcare infrastructure and service delivery.

Personal Transformation Amid Systemic Challenges

Angie Lowery’s journey toward better health illustrates both the power of individual action and the systemic barriers facing Lumbee citizens. During a recent tour of her backyard, Lowery and her 9-year-old son, Daylon, showcased their thriving garden filled with collard greens, various peppers, and 11 baby chickens they affectionately call “biddies.” These days, Lowery, her garden, and her family are thriving, but her transformation required extraordinary personal effort in an environment lacking adequate healthcare support systems.

“Being a grandmother now, you know, make you think you got to make changes because you want to be here to enjoy that time with them and let them know, hey, I got a grandma,” Lowery said.

Two years ago, she was overweight and at high risk for heart disease, taking insulin shots and pills daily. Her biological father’s death from heart complications at 63 – following years of diabetes management and dialysis – served as a stark warning. Her first grandchild’s birth became the catalyst for change, motivating her to pursue the healthy life she envisioned for herself and her family.

Future Remains Uncertain for Tribe’s Health

The Lumbee Tribe now stands at a crossroads between historic federal recognition and the harsh reality of insufficient healthcare funding. While the 575th federally recognized tribe celebrates its sovereignty, the chronic underfunding of Indian Health Service threatens to limit the practical benefits of this milestone. The $55 billion funding shortfall represents a systemic failure to meet treaty obligations and provide adequate healthcare to Native American communities nationwide.

For tribal leaders, the path forward requires creative solutions beyond traditional federal funding streams. The gaming referendum represents one potential avenue, though its outcome remains uncertain. Meanwhile, healthcare providers like Blackburn continue serving patients with limited resources while individual citizens like Lowery take personal health transformation into their own hands, growing gardens and reshaping habits in an environment that has historically failed to support their wellbeing.