WASHINGTON, D.C. — It’s been a year since Joe Biden took office as president of the United States and he has yet to name a permanent leader of the Indian Health Service, even amid a pandemic that increasingly affects the lives of the first Americans.

But change is coming to the federal agency charged with providing health care to more than 2 million American Indians and Alaska Natives, according to tribal leaders and policy experts. Speculation has grown in recent days, in Indian Country and in the nation’s capital, about a potential announcement for the vacant position at the IHS.

According to several tribal advocates who closely monitor Indian policy developments in Washington, D.C., the White House has singled out a candidate for the job of IHS director.

“We understand there is a person undergoing vetting,” said one Indian health advocate, speaking on the condition of anonymity because of the uncertain nature of the situation.

Cases of #COVID19 continue to surge across Indian Country, according to Indian Health Service​.

Since January 1, 2022, the 7-day positivity rate @IHSgov has increased by 97 percent.

And in some areas, nearly every other person is testing positive.https://t.co/8JBPs0vEZV

— indianz.com (@indianz) January 25, 2022

The timing of an announcement for the IHS position, though, is up for significant debate. One tribal health leader expected the White House to make an announcement as soon as this week, a year after President Biden asked the prior director to step down.

But another Indian policy expert with connections to the Biden administration believes word from Washington might not come until next week, as members of the U.S. Senate return to work. The IHS director must be confirmed by the chamber, which is led by Democrats.

The identity of the potential IHS nominee is also a huge unknown. Although seven people independently confirmed increased chatter about the position in the last week, all said the White House was being extremely tight-lipped about the next steps in the process.

For Dr. Aaron Payment, the chairperson of the Sault Ste. Marie Tribe of Chippewa Indians, an announcement couldn’t come at a more critical time. Pointing to the disproportionate impacts of COVID-19 in Indian Country, he said the Biden administration must demonstrate its commitment to the trust and treaty responsibility.

“We’re in the middle of a pandemic,” Payment said in an interview with Indianz.Com. “Some of the impacts on Indian Country are worse than in other racial and ethnic populations.”

According to the data from the Centers for Disease Control and Prevention, American Indians and Alaska Natives are more likely to contract the coronavirus, to be hospitalized for the disease and to die of COVID-19 when compared to other racial and ethnic groups.

And while COVID-19 vaccination rates are high among the first Americans, Payment said inadequate data hinders the ability of the U.S. government to truly provide health care to all Native people, especially those who aren’t close to the IHS service areas designated for their respective tribal nations. He believes permanent leadership at the agency can help address the situation.

“Right now we’re, we’ve got a lot of critical questions during the pandemic that really warrant a solid commitment in terms of making the nomination known,” Payment said of the IHS position, which he was once under consideration for during the early days of the Biden presidency.

“And so we’re a year into this administration,” he added. “We’re not at the levels of Donald Trump, you know, where he went three years before nominating Admiral Michael Weahkee.”

Still, Payment added: “It’s really time for us to see a nominee.”

Michael Weahkee, a citizen of the Pueblo of Zuni, was confirmed by the Senate on April 21, 2020, as the 10th director of the IHS. He had been nominated to the position by Republican former president Donald Trump.

But Weahkee, who has decades of experience in providing health care, only came to the job after Trump suffered a major embarrassment. The White House unceremoniously dumped the former president’s first pick — Robert Weaver, a citizen of the Quapaw Nation — after serious doubts were raised about his professional and educational background.

Republicans were in charge of the Senate at the time so the withdrawal underscored the lack of confidence within the chamber to confirm someone who had been suggested to the White House by members of their own party. The doubts were so strong that the Senate Committee on Indian Affairs never even held a nomination hearing for Weaver.

The debacle left the IHS without a permanent director for three of the four years of the Trump era. Weahkee finally rose to the top position a month after the arrival of COVID-19 in Indian Country, where infection rates have soared to the highest they’ve ever been throughout the pandemic.

But the leadership crisis extends even further. There hadn’t been a Senate-confirmed director of the IHS since early 2015, back in the days of Democratic former president Barack Obama.

Despite the uncertainty, tribes and their advocates are seeing signs of progress in D.C. Through the efforts of the Biden administration and the U.S. Congress, historic levels of funding have been provided to the IHS, which has suffered from a consistent lack of resources. The infrastructure bill that was signed into law last November, for example, includes $3.5 billion for sanitation facilities construction.

“We are pushing,” Secretary Xavier Becerra, the leader of the Department of Health and Human Services, said on the first day of the White House Tribal Nations Summit on November 15. “By the way, this is the first time I think you’ve seen a president not only dramatically increase funding for IHS, but at the same time, call for Congress to provide direct appropriations, mandatory appropriations.”

“Those are things that could have been done many years ago,” said Becerra, a former member of Congress and former attorney general of California. “They weren’t. This president has undertaken that effort and we’re on the verge of successes on some of those things.”

“So we’re building, and there’s no doubt that we have a ways to go to make up for the lagging efforts that had we’ve seen in the past,” the secretary concluded.

A month later, Indian Country cheered another development affecting the IHS. The Biden administration dropped an appeal in a closely-watched case that requires the federal government to provide “competent physician-led healthcare” to the tribes of the Sioux Nation.

Though the precedent in Rosebud Sioux Tribe v. United States is based on the language in one treaty, the victory from the 8th Circuit Court of Appeals is being embraced as another way to hold the U.S. accountable for the legal promises made to Native people.

“This is a 21st century vindication and historic affirmation of American Indian and Alaska Native (AI/AN) health care in perpetuity,” said Stacy Bohlen, a citizen of the Sault Tribe who serves as Chief Executive Officer of the National Indian Health Board.

“The National Indian Health Board advocated for upholding the decision of the Eighth Circuit Court of Appeals and is pleased that the administration will not challenge this decision,” Bohlen added. “We look forward to working with the administration in advancing and improving health care services to tribal nations and their members.

“This matter of federal trust responsibility for AI/AN health is now settled,” she noted. “Let’s move forward toward equity and investment so this promise has meaning.”

IHS Acting Deputy Director Elizabeth Fowler visited the Northern Valley Indian Health Clinic and the Native American Health Center in California this week to encourage vaccinations & booster shots, and to highlight the President’s new actions to protect against #COVID19 variants. pic.twitter.com/Mu7GoQ0mWj

— IndianHealthService (@IHSgov) December 9, 2021

The Indian Health Service referred a question about a potential nominee to the Department of Health and Human Services. An email inquiry placed with HHS in the early afternoon on Wednesday had not yet been answered at the time of this posting.

The IHS is currently led by Elizabeth Fowler, a citizen of the Comanche Nation. In her role as “acting” director over the past year, she has made COVID-19 a top priority.

“As you’re well aware, COVID-19 hit our Native communities hard,” Fowler said during a visit to the the Native American Health Center in Oakland, California, on December 7. “At the height of the pandemic American Indians and Alaska Natives had infection rates over 3.5 times higher than non-Hispanic whites, were over four times more likely to be hospitalized as a result of COVID-19, and had higher rates of mortality at younger ages than non-Hispanic whites.

“The pandemic highlighted the need for comprehensive, culturally appropriate personal and public health services that are available and accessible to all American Indian and Alaska Native people,” Fowler said.

Fowler began her career at the IHS in 1990 and has played a major role in formulating the agency’s budgets. Dr. Payment said her experience makes her a great choice to be nominated as the permanent director.

“I think she’s well qualified. I’ve seen firsthand her skill,” Payment said, citing her knowledge of the appropriations process as key to helping Congress understand the need for providing funding to the IHS ahead of time.

“Right now, advanced appropriations is looking positive in that it might get enacted, and I have to believe that from an administrative perspective, she was critical in being able to project expenses” at the IHS, he said.

During recent meetings of the Secretary’s Tribal Advisory Committee, which advises HHS on policy decisions affecting Indian health, Payment said he urged the Biden administration to nominate Fowler. He’s hoping to hear news soon about the position.

“We’re in a pandemic. So if there’s ever a reason for us to cut through whatever red tape and get to an appointment, now is the time,” Payment told Indianz.Com.

Indian Health Service finalizes rule for Buy Indian Act (January 13, 2022)
Indian Country starts off new year with surge in COVID-19 cases (January 6, 2022)
Rosebud Sioux Tribe thanks Biden administration for honoring victory in treaty rights case (December 20, 2021)
Great Plains Tribes: Indian health care is a treaty right (December 20, 2021)
‘No one else needs to die’: Biden administration faces another test of commitment to Indian Country (December 17, 2021)
Cronkite News: Navajo Nation continues fight against COVID-19 pandemic (December 14, 2021)
Harold Frazier: Indian Country demands action, not words, from White House (November 18, 2021)
‘A long journey’: Indian Country continues to suffer from COVID-19 (November 9, 2021)
Indian Health Service COVID-19 Media Event (November 9, 2021)