Chris Buchanan, the acting director of the Indian Health Service, addresses the winter session of the National Congress of American Indians in Washington, D.C., on February 15, 2017. Photo by Indianz.Com (CC BY-NC-SA 4.0)

Health | National

Bill seeks comprehensive audit of Indian Health Service amid debate on Obamacare

Wednesday, March 1, 2017

As the nation's politicians spar over the fate of Obamacare, tribes are still waiting on the federal government to fulfill its trust responsibilities.

Numerous treaties and laws require the United States to provide health care to tribes and their citizens. But inadequate funding, limited staff and mismanagement at the Indian Health Service have long hindered those efforts, leaving American Indians and Alaska Natives at the bottom of the rung in terms of life expectancy and chronic conditions.

In simple terms, the IHS "cannot ensure that patients receive quality care" due to its shortcomings, the Government Accountability Office said in flagging the agency's programs as "high-risk" for the administration of new President Donald Trump.

Trump has yet to propose a budget for the agency, which saw record gains during the Obama era. Lawmakers don't expect to see one until May and observers are already preparing for cuts in domestic programs, like Indian health, in order to pay for increases in defense spending.

Amid the uncertainty, Sen. Mike Rounds (R-South Dakota) is hoping to keep the IHS on the radar in Washington, D.C. During the last session of Congress, he was highly critical of the way tribal citizens in the Great Plains, a region that includes South Dakota, have been mistreated by the agency.

Obamacare is collapsing – and we must act decisively to protect all Americans. Action is not a choice, it is a necessity. #JointAddress
— President Trump (@POTUS) March 1, 2017

“The inadequate care being delivered at IHS facilities across the country has reached crisis level,” Rounds said in a press release on Tuesday. “It is a serious issue that requires tangible solutions."

To address the issue, Rounds introduced S.465. The bill requires an independent and comprehensive audit of the IHS to determine where improvements can be made in budget, staffing and management.

"An outside audit of the failing agency – which has never been done before despite its ongoing problems – will help us better understand where the problems lie so that the federal government, working in close collaboration with the tribes, can take steps forward to fix them," Rounds said of the Independent Outside Audit of the Indian Health Service Act. "Only after identifying specific areas of concerns through the audit can we make the necessary changes to fulfill the federal government’s trust responsibility of delivering timely, adequate health care to tribal members.”

During hearings on health care in the Great Plains last year, officials from the IHS and its parent agency, the Department of Health and Human Services welcomed an audit. But the GAO and the Office of the Inspector General at HHS lack the resources to undertake the type of review needed, according to Rounds.

The Great Plains Tribal Chairman’s Association, which represents 16 tribes in South Dakota, North Dakota, and Nebraska, has long been calling for a comprehensive audit. A resolution passed in April 2016 cited a "myriad of failures, incompetence [and] non-compliance" at IHS facilities in the region.

"The inadequate quality of health care in the Great Plains Region has resulted in actual genocide of our tribal members, who suffer from the highest diabetes death rates, the highest tuberculosis death rates, higher incidences of other diseases than mainstream America, and the lowest life expectancy among all IHS regions in the United States and mainstream America," the resolution stated.

Rep. Markwayne Mullin (R-Oklahoma) addresses the winter session of the National Congress of American Indians in Washington, D.C., on February 15, 2017. Photo by Indianz.Com (CC BY-NC-SA 4.0)

The IHS is currently under the leadership of acting director Chris Buchanan, a citizen of the Seminole Nation. President Trump has not yet nominated a permanent leader for the agency.

As the transition remains in flux, Buchanan told the winter session of the National Congress of American Indians last month that he is looking to "ensure that our operations continue to work smoothly."

In one of his first major actions as president, Trump imposed a freeze on hiring new employees at all federal agencies, including the IHS. But Buchanan said certain positions, including the Commissioned Corps officers that serve in facilities throughout Indian Country, are exempt from the directive.

Democrats on the Senate Committee on Indian Affairs have since confirmed that additional positions, including clinical staff at IHS facilities, are exempt from the freeze. A letter also went out to tribal leaders last month.

"While we welcome the decision with regard to clinical positions at the Indian Health Service, we remind the president that the U.S. government has a solemn obligation to fulfill its treaty and trust responsibilities for Native peoples," Sen. Tom Udall (D-New Mexico), the vice chairman of the committee, and fellow Democrats said on February 17.

Besides the budget, the biggest unknown is the Indian Health Care Improvement Act. The law, which updates numerous programs at the IHS, was made permanent by the Affordable Care Act but Republicans are vowing to repeal the ACA.

"Action is not a choice, it is a necessity," Trump said on Tuesday night in his first address to Congress. "So I am calling on all Democrats and Republicans in Congress to work with us to save Americans from this imploding Obamacare disaster."

During last month's NCAI meeting in D.C., Republican lawmakers repeatedly vowed to protect the IHCIA and the IHS from their repeal efforts. Yet they offered little specifics on how they plan to do that.

“It is vitally important to Indian Country," Rep. Markwayne Mullin (R-Oklahoma), a citizen of the Cherokee Nation, said of the IHCIA. "We are not wanting to see a lot of changes."

Tribal leaders welcomed the message but several noted they have not seen any draft legislation that would fulfill the promises they are hearing. And Democrats continue to accuse Republicans of not having any plans.

"We have nothing from the administration ... not even on the Affordable Care Act," Sen. Chuck Schumer (D-New York), who is the new Democratic leader in the Senate, said on Wednesday morning.