Secretary of Health and Human Services Alex Azar speaks at the “Prescribed to Death” opioids memorial in Washington, D.C, on April 11, 2018. Photo: HHS
Top Trump officials skipped out on tribal consultation session amid big changes
The Trump administration is overseeing dramatic changes in the way Medicaid works in Indian Country but the highest-ranking officials at the Department of Health and Human Services didn't show up to a recent consultation to tell tribes about it.

Secretary Alex Azar was supposed to attend the annual tribal budget consultation session, which took place February 28-March 1 at HHS headquarters in Washington, D.C. But he canceled at the last minute, POLITICO reported, for reasons unknown.

Deputy Secretary Eric Hargan, who served as "acting" secretary prior to Azar's arrival, was supposed to attend in his boss's place. But he got sick so he wasn't able to participate, POLITICO reported.

"That aggravated tribal leaders who were already concerned about the Trump administration’s policies," reporter Dan Diamond wrote in a story published on the same day POLITICO exposed the administration's unusual treatment of tribes in a closely-watched gaming matter.

Had Azar or Hagan showed up, tribes could have asked them why the Trump administration won't exempt American Indians and Alaska Natives from Medicaid work requirements slowly being imposed in states across the nation. A Dear Tribal Leader Letter sent on January 17, 2018, claims exemptions could be illegal.

"Unfortunately, we are constrained by statute and are concerned that requiring states to exempt AI/ANs from work and community engagement requirements could raise civil rights issues," the letter reads.

So just what are these "civil rights issues" cited, but not explained, in the letter? According to POLITICO, the Trump administration is treating Native Americans as a "race," instead of as a political group, as the U.S. Supreme Court has ruled, and as the treaty and trust relationship dictates.

“The United States has a legal responsibility to provide health care to Native Americans,” Mary Smith, a citizen of the Cherokee Nation who led the Indian Health Service during the final years of the Obama administration, told POLITICO. “It’s the largest prepaid health system in the world — they’ve paid through land and massacres — and now you’re going to take away health care and add a work requirement?”

But the "race" card isn't new to the Trump administration. Last May, the president himself incorrectly described a tribal housing program as illegal, a contention contradicted by one of his own nominees, who noted that Congress retains the power to legislate in Indian affairs.

The same idea previously surfaced under another Republican president. During the George W. Bush administration, top officials held up passage of the Indian Health Care Improvement Act, questioned the legality of urban Indian health programs and removed mentions of the trust relationship from Congressional testimony, all based on a belief that treating the first Americans differently somehow violates the U.S. Constitution.

By refusing to take a stand on Medicaid work requirements, the current Republican administration is resuming that "race" tradition. And it's endangering the already underfunded IHS, according to a key tribal leader.

“Without supplemental Medicaid resources, the Indian health system will not survive,” Chairman Ron Allen of the Jamestown S'Klallam Tribe wrote in a letter posted by POLITICO.


Allen leads the Tribal Technical Advisory Group, which was established to "provide advice and input" to the federal government on Medicaid. But that advice and input appears to be being ignored when it comes to the work requirements that have been implemented so far in Arkansas, Kentucky and Indiana. At 10 other states are considering applications, POLITICO reported.

"#Indiana’s vision, and ours, is for #Medicaid to become a pathway out of poverty, paving the way for better long-term health and independence. #TransformingMedicaid," Azar wrote in a post on Twitter on February 2. Azar, who lives in Indiana, also has touted the state's Medicaid efforts and "innovations" in other posts.

Though Azar is new to the Trump administration he is no stranger to Indian health. He served in top leadership posts at HHS when the Bush administration was holding up the IHCIA and refusing to fully fund self-determination contracts.

Azar was confirmed to his post on January 24, so he missed the previously scheduled meeting of the Secretary's Tribal Advisory Committee just a few days prior. Hagan spoke instead.

"Our government-to-government relationship is a two-way street, and we are eager to hear what in particular we can be doing better in partnership with you," Hagan told tribal leaders in Washington, D.C., on January 18.

Azar had a chance to make up for lost time at the 20th annual tribal budget consultation session several weeks later. POLITICO did not report why he missed the meeting and HHS does not appear to have offered an explanation for his absence.

But the newly-minted secretary was definitely around, only he was paying attention to a more high-profile matter. He attended an opioid summit at the White House on March 1, the same day the tribal meeting was wrapping up.

More recently, Azar has been dealing with health issues, having been hospitalized not just once but twice in recent days due to diverticulitis, a bowel condition that can be painful, The Associated Press reported. His first trip was a "one-night stay" around April 16, a day before Hargan met with the IHS budget formulation team in D.C.

Azar's predecessor was Tom Price, a former member of Congress and a physician. He attended both the Secretary's Tribal Advisory Committee and the 19th annual tribal budget consultation session during his short stint as Secretary last year. He was ousted in the fall due to concerns about his spending on travel.

Read More on the Story:
Trump challenges Native Americans’ historical standing (POLITICO April 22, 2018)