Commission Chairwoman Catherine Lhamon said she believes it boils down to a lack of political will on the part of the U.S. government, though not all commissioners agreed.
"I am ashamed that this is the way we as a nation treat any among us," Lhamon told The Associated Press. "I hope that people who live with this every day and for whom this is and has been a set of experiences and expectations will recognize themselves in this, will feel heard and honored and see a path forward consistent with what they are owed."
The independent, bipartisan commission was created under the 1957 Civil Rights Act to inform Congress about civil rights matters.
Among the report's recommendations is for Congress to assemble a spending package that meets tribal needs. The most basic are identified as electricity and running water, but the report doesn't include a price tag. The fiscal year 2019 requests for more than 20 federal agencies and sub agencies that serve tribes and tribal communities was about $20 billion — $2 billion less than what was enacted the previous year, according to the report.
The commission also makes a strong push for Native Hawaiians to receive the same benefits as federally recognized tribes, which reverses a previous stance that Commissioner Karen Narasaki said was erroneous. Native Hawaiians are the last remaining indigenous people in the United States who haven't been allowed to establish their own government.
"I'm pleased the commission has corrected its position, and it's finally standing on the right side of history," Narasaki said.
Stacy Bohlen, chief executive of the National Indian Health Board, ticked off a list of health disparities she said no one in mainstream America would tolerate: Native Americans and Alaska Natives have the highest rates of diabetes, are five times more likely than non-Hispanic whites to have tuberculosis, and Native youth are more likely to commit suicide than any other group.
"We are sicker, die younger and suffer longer than any group in the U.S.," said Bohlen of the Sault Ste. Marie Tribe of Chippewa Indians based in Michigan. "And why? Because of broken promises. It is long past due to invest in the health of Indian Country."
The National Indian Education Association said chronic underfunding can mean broken heaters don't get fixed in classrooms and schools can't hire math teachers. The U.S. Bureau of Indian Education oversees about 180 schools in 23 states serving Native children and has been faulted for safety hazards ranging from exposed electrical wires and broken windows to a natural gas leak.
Congress will have dozens of new members next year, including the first two Native American representatives from New Mexico and Kansas. The association said in a statement it hopes they will heed the report's recommendations.
"We view this as an opportunity to create new champions for Native students and their families," the statement said.
A bipartisan group of 20 congressional members wrote to the commission in 2015 asking if conditions in Indian Country had improved since the 2003 report. One of the signatories, Democratic Rep. Derek Kilmer of Washington, said he has visited tribal libraries with no internet access and heard concerns from the Quinault Indian Nation about losing part of the reservation that's below sea level because of climate change.
"Highlighting this report is going to be important because for those of us who represent a number of Native American tribes, some of this is not surprising," Kilmer said.
Finding data to represent the true need in Indian Country often is difficult, the report said. Native Americans represent about 2 percent of the U.S. population but statistics don't always reflect them, or are incomplete or old. The National Congress of American Indians, the largest tribal advocacy group, has referred to them as "Asterisk Nation."
Peter Kirsanow, the only Republican on the Civil Rights Commission, disagreed that money will solve what he acknowledged are serious problems in Indian Country. He said it's unreasonable and impossible for the federal government to funnel money to tribes to maintain a middle-class lifestyle, and sometimes tribes work against themselves.
The standards of living are different now than in the 19th century when many treaties were signed, he said.
"The best thing Congress can do for Indians and non-Indians is to reform the laws to treat Indians the same as non-Indians, no better and no worse," he wrote in the report.