Opposition mounts to Bush IHS initiatives

THURSDAY, APRIL 3, 2003

The Bush administration's plans to consolidate and restructure the Indian Health Service (IHS) met serious opposition at a Senate hearing on Wednesday.

Sen. Ben Nighthorse Campbell (R-Colo.) announced that he was deeply "concerned" about initiatives underway at the Department of Health and Human Services. As chairman of the Senate Indian Affairs Committee, he said the panel would require the agency to provide more details in addition to further consultation with Indian Country.

"I understand that we need to streamline and consolidate and not duplicate efforts and make better, more efficient use of tax money and so on," he said. "But I have seen too many times in the past when Indian programs get folded into bigger programs, money that had been formerly designated for Indian programs somehow gets transferred or moved or something."

"Indian people have never had a really strong voice in the administration, or any administration, or here either, unfortunately, " he concluded.

Tribal leaders made similar remarks about the "One HHS" effort and a separate restructuring of the IHS headquarters. Julia Davis-Wheeler, chair of the National Indian Health Board (NIHB) and secretary for the Nez Perce Tribe of Idaho, said tribes need more time to consider the proposals, which she characterized as "downsizing."

"The time frame for proper consultation was very short -- we had basically seven months," she told the committee. She added: "I know that the Department of Health and Human Services was really putting a lot of pressure on the Indian Health Service to do this. . . It does need some more reviewing."

Don Kashevaroff, chairman of the Alaska Native Tribal Health Consortium and president of the the Seldovia Village in Alaska, criticized HHS for glossing over the needs of Indian Country. Consolidating information technology doesn't make sense for the IHS, he said, because it is the only HHS agency with unique patient services. Yet the Bush administration proposal seeks to cut $9 million from the IT budget, he said.

"If we want one HHS, they should have one HHS," he said. "They should look at the disparities in health for American Indians and Alaska Natives and see that we have the worst statistics across the country. One HHS should come together and say 'We're going to handle the Indian population, we're going to bring them up to the rest of the population.'"

Dr. Charles Grim, who was officially nominated as IHS director last week by President Bush, said no firm decisions have been made about either proposal. "Many of these things are still in the planning phases," he told Campbell.

Grim said the IHS restructuring was the work of nearly a year of tribal consultation. He said the comments that were received were taken into account and weren't earth shattering.

A tribal workgroup has made recommendations about the One HHS initiative, part of which seeks to consolidate information technology and human resource functions, a move the administration predicts will save $31 million. "We don't have specific information yet because it's an '04 budget proposal," Grim said.

The details that have emerged include the elimination of about 36 human resource positions at locations throughout Indian Country. The rest of the HR staff, approximately 180, will be moved to one office in Baltimore, Maryland.

Additionally, the IHS has been granted authority, through homeland security legislation, to offer buy-out and retirement packages to IHS employees. Reports from the field indicate that employees in Oklahoma and New Mexico have been approached. In a recent interview, Navajo Nation President Joe Shirley Jr. said the Navajo IHS was being affected.

"We will make wise and judicious use of buy-out and early-out sorts of authorities, targeted at areas where we may have overages," promised Grim at the Senate hearing. "As a last resort, we would touch the service unit or the health care delivery level, if necessary."

At a separate meeting with with IHS and HHS officials, Navajo Nation Vice President Frank Dayish Jr. voiced the tribe's opposition. "The Navajo Nation is alarmed about the proposed consolidation plan, the department may not honor the Indian Preference act, and it could mean a shortage in health care needs for our Navajo residents," he said.

Congress, in passing the recent 2003 omnibus budget, required legislative approval before HHS moves forward with consolidation.

With about 15,000 employees, IHS is the second largest division within HHS. The agency headquarters are located in Rockville, Maryland.

Relevant Links:
Indian Health Service - http://www.ihs.gov
Department of Health and Human Services - http://www.hhs.gov