Employees at the Indian Health Service headquarters in Rockville, Maryland. Photo: IHS

Health | National | Politics

Indian Health Service feels the heat as frustration boils over in budget hearing

Wednesday, July 12, 2017

Lawmakers from both parties expressed anger and frustration at the Indian Health Service as they vowed to seek more resources to fulfill the federal government's treaty and trust responsibilities.

Sen. Lisa Murkowski (R-Alaska), a key member of the Senate Committee on Appropriations, set the tone by bringing up The Wall Street Journal's much-read expose on the agency. She said the long-standing problems in the Great Plains Area, a region that includes Nebraska and South Dakota, can be found elsewhere in Indian Country.

“I was horrified, I was sickened, I was mad,” Murkowski said at a hearing on Capitol Hill on Wednesday morning. "There was a whole range of emotions as I read that because this is our IHS. These are our facilities that are supposed to care for our first people."

Yet Murkowski pointed out that President Donald Trump wants to cut the IHS budget by $300 million, or 6 percent below current levels. While she acknowledged funding alone won't fix the agency's shortcomings, she said it's an important start.

"When they say it's not about the funding, it is about the funding," said Murkowski, who chairs the Senate Appropriations Subcommittee on Interior, Environment, and Related Agencies. "We are not doing right by our Native peoples. This must be remedied."

Indianz.Com on SoundCloud: Indian Health Service FY2018 Budget Hearing

But attempts to get the "acting" leader of the IHS to explain whether the new administration's fiscal year 2018 budget request will remedy the situation went nowhere. Michael D. Weahkee, a citizen of the Pueblo of Zuni who noted that he's only held the agency's top leadership post for three weeks, repeatedly deflected questions about funding needs in Indian Country.

"All I want are some damn answers," a visibly upset Sen. Jon Tester (D-Montana) said after a round of questions went unanswered. "And if we cannot get answers from Indian Health, where do we go to get those answers? I don’t expect you to answer that either."

"This is an unbelievable hearing," Tester added.

As the lawmakers in charge of the appropriations bill for the IHS, Murkowski, Tester and their colleagues are in a position to do what they said the Trump team isn't doing, and that's advocate more strongly for the first Americans. But they also expressed concern about another key issue -- a lack of information about Medicaid spending in Indian Country.

Thanks to the Affordable Care Act, an expansion of Medicaid has brought in more revenue to the IHS, helping to overcome shortfalls in the agency's budget. Yet committee members said the Department of Health and Human Services is unable to tell them how proposed changes to the system will impact American Indians and Alaska Natives.

Sen. Jon Tester on YouTube: Tester Grills IHS Director About Proposed Budget

"Now is not the time to lose ground on the progress we have made. We know that tribal communities can thrive when they have adequate access to health care," said Sen. Tom Udall (D-New Mexico), the top Democrat on the subcommittee.

Weahkee and other senior IHS officials who accompanied him to the hearing admitted they don't have the data in question. The one figure they were able to provide was that 47 out of 67 facilities in Indian Country used Medicaid in fiscal year 2016 to address shortfalls in their budgets.

But lurking behind the request for more information is the fact that Republican leaders are drafting the Better Care Reconciliation Act in secret, keeping key details from Murkowski and Democrats in the process.

'I'm asking, I think, a very fair and legitimate question," said Murkowski, whose concerns about the overhaul are dooming chances that her party will be able to pass the so-called "Trumpcare" bill in the Senate.

"If you don't have the numbers and the data .. how can I do a fair assessment as to the impact of these proposals on our Alaska Native people, or our American Indians, our Native people around the country?" she asked.

Weahkee seemed equally in the dark even though President Trump is pushing for passage of the bill, which repeals portions of the Affordable Care Act, in addition to making changes to Medicaid. When asked directly by Udall if he has been contacted by the White House or Republican leaders in Congress to discuss any proposals, he said no one had.

"Not to my knowledge," Weahkee said. "This is my third week on the job and I'm not aware of any requests for information at this point."

Chris Buchanan, a citizen of the Seminole Nation who served as "acting" director from January through June, when the initial versions of bill were being drafted behind closed doors, also said he hadn't been contacted. "Not to my knowledge, either," he told Udall.

The House passed H.R.1628, the American Health Care Act, in May. No Democrats supported the measure.

Senate Republicans expect to unveil a new version of their bill on Thursday. Sen. Mitch McConnell (R-Kentucky), the Republican majority leader in the chamber, is hoping to bring it to the floor as early as next week, without so much as a convening a hearing on the subject.

"Look at how many people are in this hearing room. Ten," Murkowski said as she looked out into the sparse audience toward the end of the proceeding. "Who's paying attention to the failures? Not enough. Apparently, that's why it's allowed to continue."

"Maybe we need to get the President out to Rosebud or Pine Ridge," she concluded, referring to the Rosebud Sioux Reservation and the Pine Ridge Reservation, where The Wall Street Journal's report highlighted numerous problems.

Senate Subcommittee on the Department of the Interior, Environment, and Related Agencies Notice:
Review of the FY2018 Budget Request for the Indian Health Service (July 12, 2017)

Department of Health and Human Services Fiscal Year 2018 Budget Documents:
Budget in Brief | Indian Health Service Justification