The Trump Administration Might Not Be Terrible for Indian Health Services

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Analysis Law and Policy

The Trump Administration Might Not Be Terrible for Indian Health Services

Mary Annette Pember

“This administration is so unstable; I’m reluctant to believe anything Trump proposes until I see it written down in concrete,” Native women’s advocate Charon Asetoyer said.

President Donald Trump’s administration is now supporting an increase of $173.8 million in funding for the Indian Health Service (IHS) over current levels in a newly released “Make America Secure and Prosperous Appropriations Act” (H.R. 3354).

If the math calculated by is correct, the Indian Health Service budget would increase by 4.7 percent if the Senate passes the new appropriations bill and Trump signs it.

The announcement of H.R. 3354 was followed by remarks from U.S. Health and Human Services HHS Secretary Tom Price to participants in a September 12 White House Tribal Health meeting.

According to a news release provided by HHS, Price said, “So let me be very clear: Under this administration, we will have no patience for substandard care for American Indians and Alaska Natives at IHS facilities. We are very optimistic about the opportunity to move forward and take positive steps in improving IHS.”

Price also admitted that the government has not always performed as effectively as it should in supporting IHS.

That’s an understatement.

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IHS has never received enough money from the federal government to fully fund health care for tribesmandated by treaty agreements dating back to 1787.

According to the National Congress of American Indians (NCAI), IHS provides health care for 2.2 million Native people at an average cost of more than $3,000 per person, according to 2013 numbers, which is far below the average cost of health care provided via Medicaid at an average cost of $6,200 per person.

As Mark Trahant of the Shoshone-Bannock tribe noted regarding government funding to IHS, “They expect IHS to defy gravity at a cost no other health system can meet.”

Longtime journalist and expert on Indian health-care policy, Trahant is also a journalism professor at the University of North Dakota.

The move seems to be a turnaround regarding funding for IHS, as President Trump initially sought a $300 million, or approximately 6 percent, decrease in his proposed 2018 budget.

Native women’s advocate Charon Asetoyer is suspicious of the administration’s motives. Given the president’s efforts to repeal the Affordable Care Act and cut Medicaid funding, Asetoyer is unwilling to believe any plan Trump or his advisers support.

“This administration is so unstable; I’m reluctant to believe anything Trump proposes until I see it written down in concrete,” she said.

Asetoyer of the Comanche Nation is director of the Native American Women’s Health Education Resource Center in South Dakota (NAWHERC).

In her advocacy work, Asetoyer often researches how well IHS meets its federal requirement to provide reproductive health services such as the emergency contraceptive Plan B to Native women.

Despite assurances by IHS leaders that reproductive services will be equally available to all Native women and girls, she has seen many examples in which policy changes aren’t communicated throughout the system.

In a recent survey conducted by NAWHERC, researchers found that 10 percent of IHS facilities do not comply with national IHS policies requiring them to provide patients with Plan B as an over-the-counter medication.

According to Asetoyer, some of the non-compliant facilities are tribally run and may be under the impression that as sovereign nations they don’t have to comply with IHS requirements. Since they receive federal funding, however, they are required to honor this directive.

Such shortfalls in service are typical in an agency that is chronically understaffed and underfunded.

Pam Kingfisher of the Cherokee Nation of Oklahoma knows the challenges Native women face in getting health services from IHS both in her personal and professional experiences. Kingfisher is a consultant on Native women’s health policies and sustainable food systems.

“Native women like myself depend greatly on IHS contract services or Purchased/Referred Care [PRC] for cancer prevention, mammograms, vaccinations, and other services,” she said.

Under Trump’s proposed federal budget, PRC funding would receive only a modest increase.

Each year, IHS receives a pot of money to be used for clients needing PRC that falls outside of services available at IHS facilities. Recipients of PRC are served according to greatest medical need; this can mean long wait times for some services.

Long patient wait times for PRC and overall services is only one of the many complaints lodged recently against IHS.

There have been several recent damning media reports and public clashes among lawmakers over shortcomings in the agency. In a series of articles, the Wall Street Journal reported in July about aging substandard facilities and dangerously insufficient care for patients in the IHS Great Plains Area, which includes North and South Dakota, Nebraska, and Iowa. In 2016, the Rosebud Sioux Tribe in South Dakota sued the federal government over its closing of the Rosebud Hospital’s emergency room in December 2015 over a failed agreement with HHS. Although it reopened seven months later, at least nine people died in the interim while riding in ambulances to hospitals sometimes located more than 50 miles away, according to the Argus Leader.

In a February 2017 U.S. Government Accountability Report (GAO), committee members added IHS to its high-risk list of government agencies. According to the report, GAO found that IHS “provides inadequate oversight” of its federally operated health care facilities.

On the heels of the Wall Street Journal reports, Sen. Jon Tester raked IHS Acting Director Rear Admiral Michael Weahkee over the coals during a subcommittee meeting of the Senate Appropriations Committee as Weahkee struggled to avoid answering direct questions about the impact of Trump’s proposed budget cuts.

As unusual as it seems, however, Weahkee is not the first IHS director to dodge these questions from lawmakers, according to Trahant.

Such exchanges tell a story of incompetence, poor management, too few doctors, and not enough money. According to Trahant, it’s a very old story.

“The federal government, from time to time, recognizes that the system is underfunded and it cannot improve without adequate revenue, professional staff, and facilities,” Trahant said.

Indeed, the 2017 GAO report is the latest in a long line of government reports calling attention to the failings of the agency and recommending more funding.

Could Trump be the unlikely ally who helps IHS close this long-standing funding gap? Only time will tell.