Tribal leaders say 2020 should be about 'life or death' issues, not Warren's DNA "When you have people dying, that -- that's trivial," one leader said.

Tribal leaders say it's a grave disappointment that the political focus on Native Americans these days can seem limited to their reaction to Sen. Elizabeth Warren's DNA test results or President Donald Trump calling her "Pocahontas" to disparage her fraught history of claiming Native American ancestry.

Attention, instead, should be paid to issues such as health care and suicide that for years have plagued Native Americans living both on and off reservations, tribal leaders and Native Americans from around the country told ABC News in a series of interviews.

"When you have people dying, that -- that's trivial," OJ Semans, a member of the Rosebud Sioux Tribe, said about Warren and Trump. "I mean, we deal with life and death."

Semans was a lead organizer of a recent presidential forum, called the Frank LaMere Native American Presidential Forum, named after an activist who died earlier this year.

Held in Sioux City, Iowa, and attended by eight presidential candidates, it was the largest Native American presidential forum in history and tribal leaders hoped it marked a turning point.

"We come here today as citizens and leaders of proud tribal nations whose 6.8 million population has been largely ignored in the federal election and federal decision making process. We hope this event signals a change in that treatment and we will continue to advocate until it does," said Chairman Frank White of the Winnebago tribe in Nebraska as the forum got underway.

Semans, who told ABC News he had fielded "about 20" questions from the news media about Warren and how Native Americans felt about her claims of having tribal ancestry, said he had talked to panelists and was prepared to avoid the issue, "keeping an eye toward our issues," he said.

"I mean, it doesn't do any good to, you know, have a U.S. senator or future president get up there and talk for 45 minutes about DNA. How does that help us with with our high suicide rate? How does that help us with the Keystone XL pipeline? How does that help us with our missing and murdered Indigenous women and children? It makes no sense to me," Semans said.

Ultimately, although Warren chose to open her remarks at the forum with an apology for her "mistakes" and "any harm" she caused by claiming Native American ancestry over the years and taking a DNA test in 2018 -- an action criticized by tribes who pointed out the difference between DNA and tribal citizenship -- it wasn't something she was asked about by any of the panelists on stage.

The issue, however, is sure to dog Warren throughout the race -- and there are Native American activists who say they're not satisfied with Warren's apology.

Joseph Pierce, an associate professor at Stony Brook University in New York and a citizen of the Cherokee Nation, is an outspoken critic of how Warren has handled the political maelstrom of her ancestry. He has argued that Warren's apology does not do enough to address the broader problem of people claiming to be Native American, or do enough to demonstrate that she understands the harm he said she caused in claiming ancestry without being a member of the tribe. Pierce advocated for a new apology from Warren that goes further.

He argued that Warren's claims of Cherokee ancestry are not separate from the daily challenges affecting tribes, but instead connected.

"Warren is not an isolated incident. She's not an isolated case. She's symptomatic of a broader misunderstanding," he said, referencing the history of Native American people losing land to settlers and how that contributes to issues tribes face today in keeping their own identities alive. "As Native communities, we're constantly dismissed as living people, and constantly relegated to existing only in the historical memory of the United States as something of the past."

"I think that the bigger political picture there is that it takes a particular type of privilege to be able to operate in the world as a white person, while also claiming indigeneity -- that's the privilege of colonialism for white people," he said.

As for Cherokee Nation leadership, which was highly critical of Warren's DNA test months ago, reaction to Warren's latest apology struck a different tone.

Asked by ABC News for a comment on Warren's apology and what issues the tribe's Principal Chief Chuck Hoskin Jr. hopes to focus on going forward, spokesperson for Cherokee Nation Julie Hubbard said Hoskin agrees with "other tribal leaders, that there are other important issues to focus on."

"It's important that all presidential candidates understand the history of our Tribal Nations and the treaty and trust responsibilities of the U.S. government to our people," Hoskin said in a statement to ABC News ahead of the presidential forum, also highlighting the need for "more resources, economic development, housing, education and health care" in Indian country.

Robin LeBeau, a former council representative of the Cheyenne River Sioux Tribe, said she had her own criticism about Warren's decision to take a DNA test.

"Elizabeth Warren, do you feel you're an Indian? Do you feel you're Native American? Do you feel you're indigenous? Then you hold that in your heart and you rock on. You keep moving. Because I know what makes me," LeBeau said.

But her concerns over Warren's decisions in the past were dwarfed compared to threats from the Trump administration, she said, and hopes about what the potential next president could do for tribes.

"Now look at -- we're focused here. She's running a presidential campaign here. And everybody is focused on: 'Are you going to let that count in your vote?'" she said, referring to Warren's DNA test.

"No," she said. "I want to know, Elizabeth Warren, are you going to give Native Americans a seat at the table?"

With Trump continuing to hurl the "Pocahontas" insult, and Warren steadily gaining traction in the polls throughout the summer, her supporters point to LeBeau's questioning the wisdom of the candidate re-telling DNA saga.

"I mean, I think it's just a matter of her moving forward," said Rep. Deb Haaland, one of the first Native American women in Congress and one of the first to endorse Warren.

One way of showing that, Haaland said, is through recently-introduced legislation she worked on with Warren to address Native American issues, which they announced ahead of the forum and which was well-received by the audience.

"I don't know what the president plans -- ratcheting up his attacks or whatever," Haaland said. "But what is his plan [for Native Americans]?"

Semans, who is also co-executive director of Four Directions, a voting rights activist group, has yet to decide who he's voting for -- and most tribal members reached by ABC News said the same.

Democrat or Republican, the votes are ripe for candidates who show they understand the issues affecting tribes, he and others said.

But this upcoming election in particular will prove significant because of the increased attention from Democrats on populations of people who felt left behind in 2016 -- and Native American turnout in particular could make a difference in swing states that were key in the last presidential election.

"I'll tell you what, we have enough votes to tip the scale in seven battleground states," said Semans. "They really need to start thinking about this a little bit harder. That's 77 electoral votes out there. And all of it has a heavy population of Native American Indians in those states."

Aaron Payment, the vice president of the National Congress of American Indians and chairperson of his Michigan tribe, the Sault Ste. Marie Tribe of Chippewa Indians, said he saw up close the difference lost votes made in 2016. Payment recalled sitting in a meeting with 2016 Democratic vice presidential candidate Tim Kaine and laying out the impact Indian country could have in states like Michigan, Wisconsin and Arizona.

"There was no platform" for Native American issues, he said of the Clinton-Kaine campaign in 2016. "So, we don't want to make that same mistake. And I'm trying to not to be partisan, but I just want candidates to take notice that there are a number of American Indians in those respective states that could make the difference," Payment said.

Payment estimated that his tribe of about 32,000 Michigan residents has roughly 19,000 members of voting age.

"And Michigan went Republican in the last presidential election by less than about 11,000 votes," Payment said, a gap that could be swung by his tribe alone. "So we can make a difference."

"And of course, tribes are not monolithic, and they don't vote straight party line. That's why it's really important for a candidate to have specifics about what they have to offer to American Indians and tribes," Payment added.

Payment, Semans and other tribal leaders listed a similar rundown of key issues, including honoring the treaty obligations of the government to tribes and calling attention to the increasing number of women being murdered or going missing on tribal lands.

Throughout the history of the United States, despite the hundreds of treaties that were signed, not a single federal treaty with Native American tribes has been adequately funded. Some of those treaties include guaranteed U.S. protection, federally provided health care, education or hunting and fishing rights.

"The way the treaties were written, the United States government was supposed to treat us equally as they treat the state," Semans said. "And what has happened over and over is that instead of the federal government treating us equally, they have sided with the state and allowed the state to create laws that actually hurt us socially and economically on the reservation."

"Do you know, federal inmates get five more dollars a person for health care than we do? And it's things like that that are common sense, that I think people would understand."

Another issue key facing tribes is the alarming number of murdered and missing women whose cases have gone unsolved, in part because of laws that only allow tribal nations to make an arrest or prosecute a suspect if they determine that person is a citizen of the federally recognized tribe.

The process often means that when a woman or a girl goes missing, family members or friends undertake the search to rescue her instead of law enforcement, as Mary Kathryn Nagle, a lawyer and activist from the Cherokee Nation of Oklahoma, testified before Congress earlier this year.

Those struggles were but a snapshot of what tribal leaders listed as their top concerns in interviews with ABC News -- and at times, the bar was low.

"Just basic recognition as human beings, I think is number one," Harold Frazier, chairman of the Cheyenne River Sioux Tribe.

"I mean, you know, our rights as humans just to live in peace and prosperity. I think that's one of the main things because everything else will fall under it," he added.

In that respect, Frazier, like many other tribal leaders, is open to any candidate that shows attention to issues Indian country has seen fall by the wayside for years.

"They never address or even consider us, and it's very upsetting and disheartening to know that that's what America thinks of us Indians, they don't think of us as anything. I mean, I could go on and on and talk about this," Frazier said.

Stopping the progress of the Keystone XL pipeline through South Dakota, home to the Cheyenne River Sioux Tribe, is one of those issues Frazier said was infringing on basic rights of his tribe.

"That's going to affect our fresh water -- so that's another big issue and I'm kind of hopeful and optimistic that we're gonna get a change in president and hopefully get that stopped like, it was stopped when Obama was president," he said. The Keystone XL project is supported by Trump, though it's currently tied up in litigation.

Frazier sat in the front row at the Frank LaMere presidential forum as each candidate took the stage. Asked if he considered himself a Democrat or Republican, he said, "I consider myself an Indian."

As for Warren's controversial claims on Native American heritage, Frazier said "we have more important issues to deal with back home."

Shannon Holsey, president of the Stockbridge-Munsee band of Mohican Nation, was one of the panelists on stage with Warren. Holsey, who has voted for Democrats and Republicans in the past, hasn't yet endorsed anyone for 2020.

Before even taking the stage, Holsey decided that she didn't want to hear about the "minutiae of that issue" involving Warren's DNA over "so many other important questions that need to be answered."

Holsey's tribe, which is in Wisconsin, is in one of the handful of swing states across the country that Native American voting rights activists see as key territory for flipping the country in 2020.

"If you're suggesting that it's a deciding factor for me one way or the other, whether or not she's suitable to serve the citizens of the United States in that capacity, no, it's not. It's definitely not. There are so many other issues," Holsey said.

This story has been updated with additional responses from citizens and leaders of the Cherokee Nation