Alex Azar is the new Secretary of Health and Human Services. Photo: Senate Committee on Health, Education, Labor and Pensions
Indian Health Service enters another year without permanent leader
New leadership is coming to the Department of Health and Human Services but it's not for one of the most important positions in Indian Country.

The Senate confirmed Alex Azar as the new Secretary of Health and Human Services on Wednesday. The roll call was 55 to 43, with six Democrats and one Independent joining Republicans in supporting the nomination.

"He will be responsible for overseeing $1.13 trillion in department spending, supervising critical research, and administering and reforming programs that touch millions of American lives, such as Medicare and Medicaid," Sen. Mitch McConnell (R-Kentucky), the Republican majority leader in the chamber, said of Azar, a former pharmaceutical executive.

In his new Cabinet position, Azar will be touching the lives of more than 2 million American Indians and Alaska Natives. He is overseeing the Indian Health Service, an agency that has faced criticism for its substandard quality of care.

But Azar won't be directly running the IHS, which remains without a permanent leader more than one year into the Trump administration.

Robert Weaver, a citizen of the Quapaw Tribe, was nominated to serve as director of the Indian Health Service but never secured a confirmation hearing in the Senate. Courtesy photo

Last October, President Donald Trump nominated Robert Weaver, a citizen of the Quapaw Tribe, to serve as director of the IHS. But Weaver never received a confirmation hearing in the Senate amid questions about his qualifications.

Some tribal leaders have supported the idea of naming an outsider to run the IHS. They point to a lack of progress in addressing long-standing issues, particularly those affecting the Great Plains Area, where a slew of hospitals have been sanctioned for repeatedly placing the lives of patients in danger, resulting in a number of deaths.

But Weaver's resume shows he lacks some of the "desired qualifications" outlined by the Association of American Indian Physicians. While he has helped tribes develop health insurance plans, he does not hold a medical degree, or a degree in a health-related field, for that matter.

The organization also supports a director with at least five years of clinical experience, meaning the delivery of care to patients. Though Weaver listed nine years of work in "various hospital administration positions" on his resume, none of them were in clinical care.

Yet even that part of Weaver's resume has been called into question. The Wall Street Journal contacted people who worked at the St. John’s Regional Medical Center in Missouri and none could confirm he was involved in hospital management or administration there.

"The critical decisions upon which the health and, indeed, lives of American Indian / Alaska Native people depend cannot be left to political appointees who do not possess a comprehensive, experiential understanding of American Indian / Alaska Native health," the leadership of the Association of American Indian Physicians said in their November 8, 2017, statement.

The organization otherwise said it "looks forward" to working with Weaver should he be confirmed as director of the IHS. Trump, however, has yet to re-submit his nomination, which expired at the end of December.

Deputy Secretary Eric D. Hargan of the Department of Health and Human Services, left, with Michael Weahkee of the Indian Health Service. Photo: IHS

The IHS in the meantime remains in the hands of an "acting" director. Michael D. Weahkee, a citizen of the Pueblo of Zuni who has worked in Indian and public health for more than 20 years, has a master's degree in health and another master's in business, according to his biography.

"Leading this agency is more than a job, it’s personal," Weahkee wrote in a blog post earlier this month. "I was born in an IHS hospital in Shiprock, New Mexico, and grew up as a patient in the IHS health care system. Many of my friends and family use IHS for their health care needs."

The last permanent, Senate-confirmed director of the IHS was Yvette Roubideaux, a citizen of the Rosebud Sioux Tribe with a medical degree. She stepped down from the role in February 2015.

Since then, the IHS has gone through four "acting" directors, including two since Trump took office in January 2017. The three years without a permanent leader appears to be the longest streak since the first director was named back in 1955.

In addition to the challenges in places like the Great Plains, the IHS is dealing with the opioid epidemic, which tribes say has devastated their communities, and the status of the Special Diabetes Program for Indians, a critical program that's due to run out of funds in March.

Tribes count on $150 million in annual grants to help them prevent and treat diabetes, which affects American Indians and Alaska Natives at the highest rates in the nation. The Ponca Tribe, which operates two clinics in Nebraska, is among those worried about the future of the program.

“I know they’re nervous about whether or not they’ll have jobs,” Larry Voegele, the CEO of the tribe's health department, told Indianz.Com, referring to the two employees who are funded with a Special Diabetes Program grant.

Though Azar is new to the Trump administration, he held top positions at HHS during the George W. Bush administration. He served as deputy secretary during the Congressional battle over the Indian Health Care Improvement Act.

At the time, the Bush administration and their Republican allies in Congress were setting up roadblocks to reauthorization of the key law. It was finally made permanent in 2010, only after Barack Obama took office and after Democrats gained control of Congress.

Azar also held the top legal job at HHS. During his tenure as general counsel, the department refused to fully fund self-determination contracts with tribes despite promising to do so.

In 2005, the U.S. Supreme Court ruled that the IHS must pay the contracts. But it took another seven more years, and another court case, before the agency developed a contract support costs policy and began asking Congress for sufficient funds to carry out its mandate.

Despite his knowledge of Indian health issues, Azar did not mention the IHS during his prepared statements during his first Senate confirmation last November, or during a second hearing earlier this month.

Azar succeeds Tom Price, a former member of Congress, as Secretary of Health and Human Services. Price resigned last September amid scrutiny of his use of government and chartered air craft. He had been reaching out to Indian Country prior to his departure.

Eric D. Hargan, the deputy secretary at HHS, has been running HHS since Price's resignation.

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Mark Trahant: What does it take to manage the Indian health care system? (January 8, 2018)
Ponca Tribe prepares for brighter future with plans for $26 million health center (December 6, 2017)
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