The urgency to confirm a qualified, competent American Indian or Alaska Native Director of the Indian Health Service (IHS) is overdue. Created by Congress in 1955, the IHS is the embodiment of the federal government’s sacred promise to provide health care for this country’s 573 federally-recognized Indian tribes. This promise was made long ago to the First Peoples of this land in exchange for land and peace.
Yet, the federal government has not done a good job of living up to its side of the bargain. IHS has not had a permanent director since 2015. The agency is chronically underfunded, and has been since its inception. In fact, per capita expenditures at IHS are only about one third that of other federal expenditures for medical care.
The agency also faces great challenges when it comes to quality delivery of health care and accountability, and the next director must be ready, willing and able to take on these issues in a thoughtful, productive way in collaboration with the tribes.
Though about 60 percent of the IHS budget goes directly to tribes who implement their own health programs with remarkable success, many IHS-operated facilities continue to be plagued by reports of mismanagement, negligence, abuse, and substandard care.
In fact, one tribal leader at a Senate hearing in 2016 reported that some in her community believe that the “IHS Hospital is the only place you can still legally kill an Indian.” Despite numerous reports by the Centers for Medicare and Medicaid Services and the Department of Health and Human Services Office of Inspector General, IHS-operated facilities continue to suffer years later. We need a leader that will finally bring change to this dangerous culture at IHS, and save the lives of our people.
IHS’ next leader must be a collaborator and a leader; a listener and a visionary.
The IHS is the place where culturally appropriate care is expected, Tribal sovereignty should be respected and innovative approaches should be implemented. Therefore, we urge the administration to work closely with tribes to find the next IHS director. The next director must be ready and willing to fight for us and for our treaty rights.
This means being an advocate within the administration, with Congress, and with others outside of government. Too often, the greatest disease we suffer from in Indian Country is invisibility. The ideal director must commit to constantly educating others about, and delivering on, the preeminent nature of the federal trust responsibility for health and Tribal sovereignty.
They must be highly educated and qualified to serve as the director of a health care delivery system challenged by limited resources, ready and able to address and assure culturally competent and complex care. But, this also means listening to the tribes.
Tribal governments’ special political status is not that of a racial or ethnic group, nor are we associations, affiliations or interest groups. We are equal, sovereign nations.
The federal government is required to consult with the tribes on any policies impacting their nations. This principle is rooted in Tribal sovereignty, treaty rights, the government-to-government relationship, and the Trust responsibility and has been confirmed in countless federal policies.
The director must be committed to dialogue, to seek and implement solutions to the challenges of health-care access, service competency, safe and modern facilities, an adequate provider population and culturally diverse competencies.
They must understand their role as the trustee of the United States in fulfilling its treaty promises; promises that mean as much today, as when they were first negotiated. Promises that reduce the impact of chronic disease, raise the health status of American Indian/Alaska Native people, close the gap on health disparities and save lives.
Therefore, as national American Indian and Alaska Native health-care leaders from throughout Indian Country, the National Indian Health Board calls upon President Trump to nominate an experienced, culturally competent, capable advocate to serve as the next IHS director and we call upon the Senate to confirm the nominee swiftly.
This nominee should be vetted and supported by Indian Country. Our people have waited for decades to realize the sacred promises the United States made to our ancestors. Give Indian Country the IHS director we want and need.