President Donald Trump meets with Obamacare "victims" at the White House in Washington, D.C., on July 24, 2017. Photo: Department of Health and Human Services

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President Trump taps Bush-era official as Health and Human Services Secretary

Monday, November 13, 2017

President Donald Trump has picked a new leader for the Department of Health and Human Services, the parent agency of the Indian Health Service.

Alex Azar, a pharmaceutical executive, may be familiar to some in Indian Country, having served in top leadership posts at the department in the George W. Bush administration. During that era, HHS, the White House and their Republican allies in Congress mounted stiff resistance as tribes sought to reauthorize the Indian Health Care Improvement Act.

"I am committed to working with you to find solutions to the health problems of Alaska Natives and American Indians," Azar said during a visit to the Cook Inlet Tribal Council in Alaska in August 2006, according to a transcript of his remarks. The trip was his fifth to Indian Country, he said.

At the time, Azar was serving as deputy secretary of HHS, the second-highest ranking post at the department. Just two months later, tribal leaders blasted the Bush administration for a "last-minute ambush" that derailed passage of a reauthorization bill.

The IHCIA finally became law in 2010, only after Barack Obama took office and after Democrats gained control of Congress. It was also made permanent, sparing tribes the need to return to Washington, D.C., to seek its authorization every few years.

Prior to serving as deputy secretary, Azar held the top legal job at HHS. During his tenure, the department refused to fully fund self-determination contracts with tribes despite promising to do so.

Happy to announce, I am nominating Alex Azar to be the next HHS Secretary. He will be a star for better healthcare and lower drug prices!
— Donald J. Trump (@realDonaldTrump) November 13, 2017

As general counsel, Azar participated in a landmark case that went all the way to the U.S. Supreme Court. By a unanimous vote, the justices ruled HHS must pay contract support costs to tribes, rejecting a position advanced by Azar and other government attorneys.

"The question before us is whether the government’s promises are legally binding. We conclude that they are," Justice Stephen Breyer wrote in the Cherokee Nation v. Leavitt decision in March 2005.

Despite the ruling, HHS failed to carry out its obligations until the Supreme Court ruled on the matter a second time in Salazar v. Ramah Navajo Chapter in 2012. The IHS has since developed a contract support costs policy and has consistently asked Congress for the money to fully fund the self-determination contracts.

Azar, if confirmed by the Senate, would succeed Tom Price, a physician and former Congressman who resigned on September 29 amid scrutiny over his repeated use of private planes, which he used to visit Indian Country and other places.

"He will be a star for better healthcare and lower drug prices!" President Trump said of Azar in a post on Twitter on Monday morning.

Indianz.Com on SoundCloud: Senate Committee on Indian Affairs November 8, 2017

The timing of the announcement poses some scheduling issues, as the Senate has yet to consider the nomination of Robert Weaver, a citizen of the Quapaw Tribe, to serve as the director of the IHS. Lawmakers typically act on higher-ranking nominees, such as a Secretary, before moving on to other picks.

The IHS has gone without a permanent leader for more than two years. Since September 25, the agency has seen four "acting" directors, including two since Trump took office on January 20.

Since 2015, two hospitals in the Great Plains Area, a region that includes Nebraska and South Dakota, have lost the ability to bill Medicare and Medicaid for services after reviews found that they were placing patients at risk of imminent injury, serious harm, death or impairment.

“Tribal members are suffering and even dying due to inadequate and disgraceful care,” Sen. Mike Rounds (R-South Dakota) said last week at a hearing to consider S.465, the Independent Outside Audit of the Indian Health Service Act.

The bill, which Rounds introduced in February, requires an independent audit of the IHS to determine where improvements can be made in budget, staffing and management. The Trump administration did not offer a strong position on the bill, for or against, having sent a lower-level official to the Senate Committee on Indian Affairs hearing on November 8.

“We are working every day to overcome the longstanding systemic challenges that impede our efforts to meet our mission and provide the quality health care to American Indians and Alaska Natives that they expect," Elizabeth Fowler, the deputy director at the IHS, told the committee.

Fowler, a citizen of the Comanche Nation, is a career employee at the IHS, not a political appointee, and at one point was unable to comment on specific provisions of the bill. She merely conveyed the new administration's desire to offer "technical assistance" on S.465.

"We're just not getting the answers," said Dave Flute, the chairman of the Sisseton Wahpeton Oyate. "Consultation is not there."