SIOUX CITY, Iowa — Eleven 2020 presidential candidates took on tough issues like Indian Health Service reform, voter access, the Keystone XL pipeline and more in a first-in-history presidential candidate forum focused entirely on Native American issues.

The Frank LaMere Presidential Candidate Forum in Sioux City, Iowa, saw 10 Democrats and one Independent looking to take on President Donald Trump speak directly to Indian Country on Monday, Aug. 19, and Tuesday, Aug. 20.

Hosted by Native voting rights advocacy group Four Directions, the forum was named in in honor of Frank LaMere, a Native American rights activist from the Sioux City area who died in June.

Here are some of the major issues discussed over the course of two days:

Indian Health Service

With stories of dysfunction and lack of quality care rampant among Native communities, Indian Health Service reform was a hot topic, with several candidates promising for reform.

U.S. Sen. Bernie Sanders, D-Vermont, noted that federally-funded healthcare for Native Americans is guaranteed by treaties between tribes and the United States, but said “that treaty has certainly been abdicated” and “the IHS is not doing anywhere near what it should be doing.”

Voting access

With tribal members often having to travel great distances to polling locations, and North Dakota’s recently upheld controversial voter ID law, U.S. Sen. Elizabeth Warren, D-Mass., called for federal standards to be set to protect voter access in Indian Country.

“Voter suppression is democracy suppression, and it must stop,” she said.

Particularly, Warren said she supported satellite voting to increase access to those who live in rural tribal lands.

Immersion education

With a dark history of Indian schools throughout the country — off-reservation boarding schools which sought to strip Native students of their culture and language — Native communities have stressed the importance of preserving their languages through immersion school programs.

U.S. Sen. Kamala Harris, D-Calif., said that the U.S. Department of Education should invest resources into these programs because “to lose (Native languages) is to lose part of our history and our culture.”

Sanders echoed Harris’s statements, saying that it is important for Americans to know “where we came from if we’re going to know where we’re going forward.”

He said schools need to preserve the history and culture of the United States, including Native languages, “to make sure our kids — Native American kids and kids all over this country — understand the history of their county, the real history, and the languages those who came before them spoke.”

Keystone XL

With President Donald Trump's administration moving forward to permit TC Energy (formally known as TransCanada) to build its Keystone XL crude oil pipeline near federally recognized tribal land and through the historic Great Sioux Nation.

U.S. Sen. Elizabeth Warren, D-Mass., said that as president, she would revoke the permits for the pipeline because "tribal governments are the ones who should control what happens on tribal lands." But she said that in addition to revoking the permits, there must be "structural change" in how the federal government communicates with tribal governments over land matters.

"The pipeline permit should not have been issued in the first place," she said. "We can revoke that and straighten it out, but much better not to make the mistake to begin with."

She said in future land and natural resource use cases, tribes should be "decision makers before the federal government goes forward with action."

Medals of Honor for the massacre at Wounded Knee

Each of the candidates who were asked said they supported rescinding the medals of honor issued to 20 American soldiers for the massacre at Wounded Knee, where hundreds of Lakota people were killed in 1890 in South Dakota. But Mark Charles, an independent candidate from the Navajo nation, said that the country needs to go deeper to "understand why this nation celebrates massacres like these."

"These medals are not only a stain," he said, referencing Congress's unpassed Remove the Stain Act, "they are blood dripping from the clothes of this nation. We don't just need to rescind them. We need to wash the clothes."

Native representation in White House and justice system

Pressed by panel members as to whether they would appoint Native White House staffers, cabinet officials and federal judges, several candidates committed to doing so, and to mending relationships between the federal and tribal governments.

Former Housing and Urban Development Secretary Julian Castro said he believes “an effective administration needs to look like America.” He added that federal courts are litigating issues that directly impact Native Americans — like the Indian Child Welfare Act, which was upheld earlier this month in the 5th Circuit after a lower court ruled it unconstitutional.

The Indian Child Welfare Act in 1978 was Congress’s attempt at keeping Native families together during a time when many Native children were placed into the welfare system and rehomed in non-Native homes. The practice, Native people have argued, took children away from their families and communities, washing them of their indigenous culture.

U.S. Sen. Kamala Harris, D-Calif., said that “ICWA at its core . . . is frankly about how the Native people have been treated,” and that it is important to appoint federal judges “who understand the impact on families, on communities, and overall on the tribes.”

Infrastructure

Borrowing a line from Michigan's governor, U.S. Sen. Amy Klobuchar, D-Minn., said Monday that it's time for the federal government to "fix the damn roads."

Klobuchar isn't the only candidate to push for an overhaul of roads and bridges, and on Monday, she said that "you have to make sure that the tribal communities are included" in an infrastructure plan.

"You are not going to be able to conduct commerce or create economic opportunities . . . if you don't have roads," she said.

The question of funding for roads on reservations comes after historic springtime floods devastated tribal communities in the Midwest. As recently as July 22, Cheyenne River Sioux Tribe Chairman Harold Frazier said in a news release that the tribe remains under a state of emergency, with Bureau of Indian Affairs-managed roads closed and left without repair months after the floods.

Former-U.S. Rep. John Delaney, D-Md., said that infrastructure reform also needs to include development of rural broadband, including on Native reservations.

"If you’re a young person in 2019 and you don't have access to high-speed communications, you don't have a job," Delaney said. "We have to make sure all communities — in particular rural communities and Native American communities — that young people have access to high-speed communications, full stop."

Missing and murdered Indigenous women

Two years after the disappearance of Fargo-area Savanna Greywind, for which the still-not-passed Savanna's Act is named, the epidemic of missing and murdered Indigenous women took center-stage throughout the two days.

Candidates emphasized the need for laws like Savanna's Act to be passed in order to study and raise awareness for the issue, and help coordinate federal and tribal efforts to solve it.

Speaking to the press after her time on stage on Monday, Klobuchar emphasized the magnitude of the epidemic, saying that "there are thousands of women right now, Native women, who are just missing.

"They've just vanished off this Earth," she said. "Well, you know that's not true. And you know if they were white women, we'd probably know what happened to them."

According to the Indian Law Resource Center, Native women in some areas are murdered 10 times more often than the national average, and more than four in five Native women have experienced violence. More than half have experienced sexual violence.