Tribal leaders are meeting in the Washington, D.C., area this week to discuss their concerns and priorities for the Indian Health Service (IHS) budget.

Representatives of all 12 areas of the IHS are using the session to get a better handle on the way the agency's budget is formulated. On Wednesday, they heard from top officials at the Department of Health and Human Services (HHS) and from the Office of Management and Budget (OMB) within the White House.

Government officials described the talks, which have been held for several years, as productive. They said they have tried to incorporate suggestions made by tribal leaders into the budget.

"I find the consultation very helpful in that regard," said Kerry Weems, the acting assistant secretary for budget, technology and finance at HHS.

But tribal leaders expressed frustration that their needs aren't being addressed despite an abundance of evidence showing that American Indians and Alaska Natives experience the worst health conditions in the nation. They repeatedly cited an apparent "disconnect" between HHS and OMB, where the budget request originates.

"Every year we come here, IHS says 4 percent [increase]. Last year we got 1 percent," said Don Kashevaroff, president of the Alaska Native Tribal Health Consortium. "Somewhere between the 4 and the 1, the president didn't request it."

Tribes also were concerned that the rising costs of health care aren't included in the budget. In fiscal year 2005, the IHS is growing by just 1.6 percent in the face of double-digit increases in health service expenditures.

"We're going backwards," observed one tribal leader.

"We're aware that inflation occurs," Charles Montgomery, the OMB examiner who handles the public health budget, later said. "The honest answer is we don't always meet it. We have finite resources." Montgomery also described the budget as "austere."

But Dr. Charles Grim, the director of the IHS, said his agency has fared well in an era of restrained spending. He tied increases in recent years to the ratings IHS programs have received under the Performance and Results Act (GPRA) and under the Program Assessment Rating Tool (PART), a new initiative that President Bush brought to OMB.

"We have actually made some strong showings," Grim told tribal leaders. "We have had some of the best scores."

At the same time, Weems and Montgomery sought to downplay the effect a PART score has on funding. "It's another point in our decision making," said Weems. "It's not the only thing that helps determine the federal budget."

Tribal leaders are worried that the GPRA and PART systems are being handled inconsistently. They say negative scores are used to justify cuts in the budget while positive scores don't lead to increases.

"Even with the limited resources we receive, we are doing a substantially good job," Rachel Joseph, chair of the Lone Pine Paiute-Shoshone Tribe of California, said.

The session concludes today as tribal leaders finalize their priorities and recommendations for the IHS budget. They will also prepare for another round of talks with HHS officials. On May 12-13, the department will host its sixth annual budget consultation in Washington, D.C.

Budget Documents:
HHS Budget in Brief | HHS Performance Plan | Secretary Thompson's Remarks

Relevant Links:
National Indian Health Board - http://www.nihb.org
Northwest Portland Area Indian Health Board - http://www.npaihb.org
Indian Health Service - http://www.ihs.gov
Department of Health and Human Services - http://www.hhs.gov