1. Update
  2. Native Americans

Reforming the Indian Health Service

July 6, 2017


The Senate Committee and the House Subcommittee have followed through on their multiple oversight hearings on the Indian Health Service by introducing bills that they hope will fix the problems.

New bills in the Senate Committee on Indian Affairs and the House Subcommittee on Indian, Insular and Alaska Native Affairs are proposed to increase accountability and restructure management, and improve staff recruitment and retention in the Indian Health Service (IHS).

On June 13, the Senate Committee held a substantive hearing on S. 1250, the Restoring Accountability in the Indian Health Service Act of 2017, introduced by Sen. Barrasso (WY), former chair of the committee, along with Senators Thune (SD) and Hoeven (ND). Among other provisions, the bill would offer incentives to health care professionals to serve in the IHS; establish standards to measure the time patients wait for care; ease the processing of medical credentials so that volunteers could serve at IHS hospitals or service units; and establish a new tribal consultation policy for IHS.

Senator Udall and one of the tribal witnesses, Winnebago Tribal Councilor Kitcheyan, urged consultation with the tribes on the specifics of the bill. Senators Udall (NM), Tester(MT), and others emphasized the chronic underfunding that had brought about the problems within IHS, and the important role of Medicaid expansion in supporting the continued health of the IHS.

Rear Admiral Buchanan, the acting director of IHS, reported that IHS has made "substantial progress" in improving organizational capacity since last November under the Quality Framework and Implementation Plan and the Department of Health and Human Service Executive Council on Quality of Care. 

One week later, the House Subcommittee held a similar hearing on a companion bill, H.R. 2662, offered by Rep. Noem (SD). A clear difference in the framing of the problem emerged in the opening remarks. Rep. Torres (CA), ranking member, emphasized the underfunding of both IHS facilities and services as a cause of the current problems within IHS. The chair, Rep. LaMalfa (CA) noted that IHS had received substantial funding increases since 2010 when the "Dorgan Report" pointed out the serious problem in the quality of care delivered through IHS facilities in the Great Plains region; in his view, proper management is the problem.

Rep. Gonzalez Colon (PR) requested additional language in the section requiring IHS consultation with tribes, to describe what constitutes appropriate consultation. Rep. Torres and Councilor Kitcheyan (who appeared again as a witness) strongly urged specific consultation with the tribes, with an amendment process to follow to incorporate tribal recommendations. (Note: Rep. Grijalva’s bill, H.R. 2689 – the “RESPECT” Act – provides these definitions.) Rep. Torres indicated a reluctance to move “expeditiously” on the bill until such consultation takes place.