Lawmakers once again seek fixes to 'broken' Indian Health Service

Thursday, May 25, 2017

Republican members of Congress are once again seeking ways to improve the Indian Health Service.

The Restoring Accountability in the Indian Health Service Act targets long-standing management, staffing and transparency issues at the agency. Key provisions address hiring and discipline, patient wait times at clinics and facilities and recruitment of more professionals.

“For years, the Indian Health Service as fallen short in providing high quality medical care throughout Indian Country. The long history of failures at IHS are unacceptable and will not be tolerated,” said Sen. John Barrasso (R-Wyoming), the primary sponsor of the bill, said in a press release.

What the bill does not do is authorize more funding for the severely underfunded IHS, which barely meets half of the needs of its patients. Indian Country leaders last week called on Congress to appropriate at least $7 billion in fiscal year 2018, an amount that more than likely will be whittled down to about $3.5 billion.

"We would like to reconcile the discrepancy between $8,517 average spent per capita for health care per American citizen versus the $3,136 spend on American Indians / Alaska Natives in the IHS system of care," Esther Lucero, the executive director of the Seattle Indian Health Board said in writtten testimony to the lawmakers that write the funding bill for the agency.

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Still, tribal leaders have been supportive of efforts to reform the IHS. Many point to the Great Plains Area, a region that includes Nebraska and South Dakota, as one place where the provisions in the bill might bring about change.

In 2015 and 2016, an unprecedented three facilities in the Great Plains lost federal certifications due to unresolved problems. Nearly two years later, the hospital that serves the Omaha Tribe and the Winnebago Tribe is still unable to collect revenues that help supplement the IHS budget.

"I just come here yet again with no good news -- we're not certified, we're pushing it back further," Victoria Kitcheyan, the treasurer for the Winnebago Tribe, told key members of the House Appropriations Committee, last week. "Frankly, I'm tired of telling you the same thing over and over again."

On Wednesday, the same committee dug deeper and learned more about the way the IHS deals with crises. The agency simply shuffles officials and executives who failed to make improvement to other regions and brings in other leaders who end up being transferred somewhere else.

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"When there's a problem in one area, they move people around to go to that area, to fix the problem, to fix the crisis, but it results in a big churn among the area offices," Kathleen King, the director of the Health Care Team at the Government Accountability Office told the House Appropriations Subcommittee on Interior, Environment, and Related Agencies at the hearing on "high risk" programs, a designation that applies to the IHS.

The pattern repeated itself with Chris Buchanan, who happens to be serving as the "acting" head of the IHS. He was called to the Great Plains last year to address certification and other problems but the assignment was not a permanent one.

Before Buchanan showed up to serve as "acting" director for the Great Plains, the region saw four different directors between 2011 and 2015, Rep. Betty McCollum (D-Minnesota), the top Democrat on the subcommittee, said. One hospital in South Dakota that lost certification had 7 different chief executive officers during that time period. The Omaha-Winnebago hospital in Nebraska had 10, she noted.

"There's a high turnover," Buchanan acknowledged. He said the IHS is focusing on recruitment, accountability and transparency in the Great Plains, the same areas targeted in the reform bill.

“It would be a significant understatement to say tribal members deserve better health care than what they’re accustomed to receiving from IHS," said Sen. John Thune (R-South Dakota), a co-sponsor of the bill.

S.1250 is the Senate version of the bill. A companion, H.R.2662, has been introduced in the House.

Government Accountability Office Report:
HIGH RISK: Actions Needed to Address Serious Weaknesses in Federal Management of Programs Serving Indian Tribes (May 24, 2017)