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Hearing on high-risk tribal programs highlights void in Trump leadership team

Filed Under: Health | National | Politics
More on: 115th, ahca, bia, chris buchanan, consultation, doi, donald trump, fy2018, gao, hhs, ihs, medicaid, michael black, ryan zinke, scia, senate, tom price

Secretary of the Interior Ryan Zinke remains the only official at the Department of the Interior who has been confirmed by the U.S. Senate. Photo: U.S. DOI

More than 100 days into the Trump administration, Indian Country still doesn't know who will be advocating for their interests in the nation's capital.

By this time in their first terms, both Barack Obama and George W. Bush had named their picks to lead the Bureau of Indian Affairs. Obama also acted quickly to fill the top post at the Indian Health Service and the Bush team was sorting through potential hires for the agency at the same stage.

But President Donald Trump is taking things a lot slower. He has yet to nominate anyone for the top Indian policy jobs in Washington, D.C., amid massive change at both the BIA and the IHS.

A hearing before the Senate Committee on Indian Affairs on Wednesday highlights the void. The Trump administration is sending two key representatives to talk about "high-risk" tribal programs, but both are career employees who are merely serving in "acting" -- or temporary -- capacities at their respective agencies.

That doesn't give tribes and key lawmakers much to go on. Without leaders to set the agenda, develop priorities, respond to crises or simply reach out, both agencies are essentially stuck in a holding pattern until Trump takes action.

Yet the BIA stands to be greatly affected by a massive reorganization at the Department of the Interior that's being called "bold" despite a lack of information about it. And over at the Department of Health and Human Services, legislative changes to the Medicaid program are contributing to fears about negative impacts at the severely-underfunded IHS.

Then there's the budget. For the fiscal year starting in October, Trump is seeking a 12 percent cut at Interior and a 17.9 percent cut at HHS -- recommendations that go against the advice of tribal leader councils whose members are still waiting, along with lawmakers, on details that should have already been released by now.

For now, Michael Black, a citizen of the Oglala Sioux Tribe, is serving as the "acting" Assistant Secretary for Indian Affairs. He is an able emissary between tribes and the new administration but even he admitted he was brought out of semi-retirement in faraway Montana to take on the job.

"Just when I thought I got out, they sucked me back in," Black told tribal leaders jokingly in February. He had just left the D.C. office in November after more than six years there.

Chris Buchanan is in a similar situation as the "acting" director of the IHS. He's a citizen of the Seminole Nation and up until recently was working in a region whose problems are the type that prompted Government Accountability Office to label Indian health as a "high-risk" program.

He's also been bluntly delivering bad news to tribes about reforms that have been included in the American Health Care Act. He previously told tribes that stopping the expansion of Medicaid -- a key concession Trump made in exchange for more Republican votes on the controversial bill -- would have a "significant impact" on the IHS.

"Between 2014 and 2015, when Medicaid expansion took effect, IHS saw a considerable increase in the user population that presented Medicaid coverage when receiving care," Buchanan said at the winter session of the National Congress of American Indians in D.C. in February. That means Medicaid -- not the IHS -- is paying for more bills at the agency.

It's anyone's guess as to when Trump will pick new leaders of the BIA or the IHS. Potential nominees, representing tribes from Alaska to Oklahoma, are jockeying for the jobs but few are ready to talk openly about their prospects or even the process playing out at the White House.

At Interior, Zinke remains only the official who has been nominated at confirmed by the U.S. Senate. Trump, on his 99th day in office, announced David Bernhardt as his pick for deputy secretary. A confirmation hearing takes place on Thursday.

Secretary Tom Price is likewise largely going it alone at HHS except for some aides. The department's leadership page lists a whopping 12 "acting" officials, including Buchanan.

Wednesday's hearing on "high-risk" tribal programs takes place immediately following a business meeting in Room 628 of the Senate Dirksen Office Building. The full witness list follows:

Ms. Melissa Emery-Arras
Director, Education, Workforce, and Income Security Issues, U.S. Government Accountability Office, Washington, DC

Mr. Michael S. Black
Acting Assistant Secretary – Indian Affairs, U.S. Department of the Interior, Washington, DC

Rear Admiral Chris Buchanan
Acting Director, Indian Health Service, U.S. Department of Health and Human Services, Rockville, MD

Mr. Tony Dearman
Director, Bureau of Indian Education, U.S. Department of the Interior, Washington, DC

Senate Committee on Indian Affairs Notices:
Business Meeting to Consider S. 458, S. 691, & S.1116 (May 17, 2017)
Oversight Hearing on "High Risk, No Reward: GAO's High Risk list for Indian Programs." (May 17, 2017)

Government Accountability Office Report:
Improving Federal Management of Programs that Serve Tribes and Their Members (February 15, 2017)

Related Stories:
Indian lawmakers support Republican repeal of Affordable Care Act (May 5, 2017)
Senate Indian Affairs Committee looks at 'high risk' Indian programs (May 3, 2017)
Bill seeks comprehensive audit of Indian Health Service amid debate on Obamacare (March 1, 2017)
Mark Trahant: Indian programs gain 'high risk' label at worst time (February 20, 2017)

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