• ROSELYN TSO WRITTEN STATEMENT: PDF

WASHINGTON, D.C — The Biden administration’s nominee to lead the Indian Health Service faced few questions at a long-awaited nomination hearing on Capitol Hill.

But Roselyn Tso, a citizen of the Navajo Nation told the Senate Committee on Indian Affairs on Wednesday that she was ready to meet the challenges in delivering services to more than 2.5 million American Indians and Alaska Natives across the country. Chronic disparities in health care and health status have only been exacerbated by the ongoing COVID-19 pandemic, the longtime IHS employee said.

“When I travel across the region to different IHS facilities, I am reminded of the many health disparities facing American Indians and Alaskan Natives — health disparities that in many cases were made worse by COVID-19,” Tso said in her opening statement at her nomination hearing before the committee.

“For example, sadly, today, too many Navajo families still do not have access to running water in their homes,” Tso continued. “Access to clean, safe drinking water is essential to the health and well-being of our people.”

Tso, who has been working for the IHS since 1984, currently leads the Navajo Area of the IHS. The region, which serves more than 240,000 people on the largest reservation in the United States, has suffered from some of the highest COVID-19 rates over the last two years.

“Throughout my career at IHS, I have worked to improve the agency to better meet the needs of the people we serve,” Tso said. “This was most evident throughout the pandemic, where I saw and was part of a true partnership with the Navajo Nation, San Juan Paiute Tribe, and federal, state, local and private partners to collectively combat COVID-19.”

President Jonathan Nez of the Navajo Nation testified first-hand about his tribe’s partnership with the IHS. Thanks to those efforts, he said the reservation has some of the highest COVID-19 vaccination rates in the U.S. — and even the world.

“Currently our elderly population 65 years and over are 90 percent fully vaccinated,” Nez told the committee in a strong statement of support for Tso’s nomination to lead the IHS. “Most of the general Navajo population is vaccinated. At a time when mainstream America had barely reached a 50 percent rate, the Navajo Nation was at 75 percent.”

“Through her leadership, the Navajo Nation achieved one of the highest vaccination rates in the world,” Nez said of his tribe’s work with Tso.

Four members of the Senate Committee on Indian Affairs — — three Democrats and one Republican — participated in Tso’s hearing, which lasted about 40 minutes. Their questions largely focused on improving operations at the IHS, especially when it comes to ensuring the federal government lives up to its trust and treaty obligations to provide services and funding to Indian Country.

Sen. Brian Schatz (D-Hawaii), the chair of the committee, noted that Tso’s written statement did not contain any explicit references to tribal sovereignty or the nation-to-nation relationship between tribes and the U.S. He sought assurances that the Biden administration

“Without a doubt, there is a trust responsibility to Native Americans and Alaska Natives — specifically to healthcare — that have been documented through statute, as well as the Supreme Court decisions,” Tso responded.

Sen. Maria Cantwell (D-Washington), a past chair of the committee, also sought assurances about the IHS meeting its obligations through self-determination and self-governance agreements with tribes. She said the agency, historically, has not always made payments in a “timely fashion.”

“Looking at the business component of the Indian Health Service, we can strengthen that part too, to ensure that proper payments are made in a timely manner with regards to actual payments of funding when we do get funding at the area level,” Tso told Cantwell.

“Within the Navajo Area, our goal — and my expectation — was to ensure that payments were made within 24 hours to every tribe, particularly when the CARES money and infrastructure monies were coming down,” Tso said in reference to COVID-19 and infrastructure bills enacted by Congress in the last two years.

“That was critical,” she added. “We were able to do it, and we should be able to do that throughout Indian Health Service.”

President Nez speaks on Capitol Hill in support of the confirmation of Roselyn Tso to serve as the new Director of IHS pic.twitter.com/CmERUp83uk

— Navajo Nation President Jonathan Nez (@NNPrezNez) May 25, 2022

Sen. John Hoeven (R-North Dakota), another past chair of the committee, was the only Republican who participated in the hearing. Sen. Lisa Murkowski (R-Alaska), the current vice chair of the panel, was absent due to personal reasons, her GOP colleague said.

Hoeven expressed concerns about ensuring IHS and tribal facilities receive medical equipment in a timely manner. He cited a May 5 story in The Wall Street Journal that reported on delays faced in the Great Plains Area, where services have routinely been deemed “substandard.”

“In some instances, facilities have waited for over a year for the equipment,” Hoeven said. “And obviously these delays caused hospitals to search for alternative sometimes even more costly ways to proceed while waiting for the equipment.”

If confirmed as director of the IHS, Tso promised that she would prioritize business operations at the agency in order to improve delivery of services, including medical equipment. “This can be done,” she said.

Sen. Ben Ray Lujan (D-New Mexico) also focused on operations — or the lack of them — in his home state of New Mexico. He questioned why the IHS has dramatically reduced care at a hospital servicing Pueblo and Navajo communities near Albuquerque, the largest city in the state.

“Recently, Acoma-Canoncito-Laguna Hospital in New Mexico was closed and converted into a Monday to Friday, 9 to 5 clinic,” Lujan said of changes at the facility that have taken place over the last two years.

“I was troubled by the data underpinning this closure, which took place during a pandemic and how the change was communicated to the Pueblos and to the community,” Lujan added.

Tso noted that the changes were primarily due to the Pueblo of Laguna entering into a self-determination contract with the IHS in order to open its own health facility. The agreement for the Laguna Community Health Center required the agency to redirect funds away from the larger hospital, known locally as ACL.

According to Tso, the IHS should “honor the positions and the decisions of tribal leaders when they determined to assume their own health care systems under self-governance or self-determination and that was part of this particular situation.”

While Tso promised to improve the way in which IHS communicates these kinds of service level changes to tribes and patients, she did not respond to Lujan’s question about whether she will take steps to ensure the agency “stems the tide of hospital closures.” Similar reductions in care have been seen in the Great Plains Area, where one hospital lost its accreditation under the watch of the federal government.

“It is a fine balance here in terms of making sure that … we do maximize the health care systems and access to care for all of our patients,” Tso told Lujan.

President Joe Biden announced Tso as his nominee to lead the IHS on March 9. He had asked the prior director to step down when he took office back in January 2021.

Michael Weahkee, a citizen of the Pueblo of Zuni, had only been on the job for nine months before he left the position. He was the last IHS director to have been confirmed by the U.S. Senate amid a leadership drought at the agency.

For six of the last seven years, in fact, the IHS has gone without a permanent director. The leadership crisis started toward the end of the Barack Obama’s Democratic administration and continued through most of the single term of Republican former president Donald Trump.

As chair of the Senate Committee on Indian Affairs, Schatz said he would work with Murkowski, the vice chair, to “move this nomination expeditiously” through the panel. The next step in the process would be a business meeting to approve Tso. Assuming she is approved, she could then be considered by the full Senate.

“The hearing record will be open for two weeks,” Schatz said as he welcomed a special guest to the dais in the committee room. The daughter of Jennifer Romero, the committee’s staff director and chief counsel, closed out the hearing with a bang of the gavel.

“This hearing is adjourned,” the young guest said.

Nomination Hearing to consider Roselyn Tso to be Director of the Indian Health Service, Department of Health and Human Services (May 25, 2022)