The next chapter in the story about the troubles of the Indian Health Service. Will Congress begin to see the results of long-term underfunding and understaffing? Two comprehensive bills begin to grapple with the major structural challenges, and the House reaches out to hear from tribal leaders.
The Senate Committee on Indian Affairs (SCIA) and the House Sub-committee on Indian, Insular and Alaska Native Affairs (IIANA) have been looking closely at the long-term, systemic problems of the Indian Health Service that have emerged recently in crisis situations. Most recently, concern has focused on the Great Plains Region, where one hospital lost its Medicare/Medicaid certification and two others were close to revocation. The Health and Human Services agency pointed to understaffing, closures, lack of proper equipment, and unsafe conditions, among other continuing problems.
While the Indian Health Service moved quickly to respond to the immediate problems – finding new ways to restaff the hospitals and clinics, and setting and enforcing quality standards – some members of Congress have begun to address the long-term problems. These challenges seem to include underfunding, remote locations, bureaucratic hurdles that get in the way of change and flexibility, and lack of effective oversight.
On July 12, the IIANA held a hearing on a bill introduced by Rep. Kristy Noem (ND1), the “Helping Ensure Accountability, Leadership, and Trust in Tribal Health Care (HEALTTH) Act” (H.R. 5406). This bill proposes expanded hiring and contracting authority for the Indian Health Service, supports for recruitment and development of the workforce, and structural reforms in the Purchased/Referred Care Program. The sub-committee heard from leaders from the affected tribes in the Great Plains region, along with Stacy Bohlen of the National Indian Health Board and Mary Smith, newly appointed Principal Deputy Director of the Indian Health Service.
The tribes expressed appreciation for the intent of Rep. Noem’s legislation, but asked for more tribal consultation in its development. Witnesses offered tangible solutions and recommendations and emphasized the need for more resources for the Indian Health Service. Stacy Bohlen recommendedstructural and administrative reforms in service units and area offices, standardization and implementation of quality assurance measures, improved recruitment and retention of well-qualified personnel, and increased health literacy training for all American Indians and Alaska Natives. Commenting on the need for more investments in Indian health care, Bohlen emphasized Native youth.
In June, the Senate Committee held a field hearing in Rapid City, South Dakota, on the health care situation in the Great Plains region, and a legislative hearing on the Indian Health Service Accountability Act, (S.2953) introduced by the committee chair, Sen. Barrasso. The bill was based primarily on information gathered by the committee during a listening session and oversight hearing on the same issue in February 2016. The bill emphasizes both personnel and structural oversights, while permitting more flexibility in the IHS budget so that the agency can offer competitive compensation.