Indian Health Service

The Indian Health Service (IHS) is an operating division (OPDIV) within the U.S. Department of Health and Human Services (HHS). IHS is responsible for providing direct medical and public health services to members of federally-recognized Native American Tribes and Alaska Native people. IHS is the principal federal health care provider and health advocate for Indian people, and its mission is to raise their health status to the highest possible level.

IHS provides health care to American Indians and Alaska Natives at 33 hospitals, 59 health centers, and 50 health stations. Thirty-four urban Indian health projects supplement these facilities with a variety of health and referral services. Many tribes also operate their own health systems independent of IHS.

Since its beginnings in 1955, IHS has been severely criticized by those it serves and by public officials^[1][2][3][4]

Formation and mission

IHS was established in 1955 to take over health care of American Indian and Alaska Natives from the Bureau of Indian Affairs (BIA) to the Public Health Service (PHS) in hopes of improving the healthcare of Native Americans living on reservations.

The provision of health services to members of federally recognized tribes grew out of the special government-to-government relationship between the federal government and Indian tribes. This relationship, established in 1787, is based on Article I, Section 8 of the Constitution, and has been given form and substance by numerous treaties, laws, Supreme Court decisions, and Executive Orders.

The IHS currently provides health services to approximately 2.2 million of the 3.3 million American Indians and Alaska Natives who belong to more than 557 federally recognized tribes in 35 states. The agency's annual budget is about $5.1 billion, as of fiscal year 2017.^[5]

Employment

The IHS employs approximately 2,700 nurses, 900 physicians, 400 engineers, 500 pharmacists, and 300 dentists, as well as other health professionals totaling more than 15,000 in all. The Indian Health Service is one of two federal agencies mandated to use Indian Preference in hiring. This law requires the agency to give preference hiring to qualified Indian applicants before considering non-Indian candidates for positions.^[6]

IHS draws a large number of its professional employees from the U.S. Public Health Service Commissioned Corps. This is a non-armed service branch of the uniformed services of the United States. Professional categories of IHS Commissioned corps officers include physicians, physician assistants, nurses, dentists, pharmacists, engineers, environmental health officers, and dietitians.^[6]

Many IHS jobs are in remote areas as well as its headquarters in Rockville, Maryland, and at Phoenix Indian Medical Center. In 2007, most IHS job openings were on the Navajo reservation. 71% of IHS employees are American Indian/Alaska Native.^[6]

Efficiency and Public Law 93-638 (Tribal Self Determination – 1975)

ExpectMore.gov lists four rated areas of IHS: federally administered activities (moderately effective), healthcare-facilities construction (effective), resource- and patient-management systems (effective), and sanitation-facilities construction (moderately effective). All federally recognized Native American and Alaska Natives are entitled to health care. This health care is provided by the Indian Health Service, either through IHS-run hospitals and clinics or tribal contracts to provide healthcare services.^[7]

IHS-run hospitals and clinics serve any registered Indian/Alaska Native, regardless of tribe or income. Tribal-contract health care facilities serve only their tribal members, with other qualified Indians/Alaska Natives being offered care on a space-available basis. This policy makes it difficult for an Indian who leaves their tribal home for education or employment to receive health care services to which they are legally entitled. An IHS fact sheet clarifies that Indians are also eligible to apply for low-income health care coverage provided by state and local governments, such as Medicaid. IHS 2007 third-party collections were $767 million, and estimated to be $780 million in 2008.^[7]

Some of those who are served by the system are not satisfied with the efficiency of IHS. A contributor to Indianz.com, a website for Native American news, feels that Native Americans are "suffering" at the hands of IHS.^[8] She feels IHS is underfunded, and necessary services are unavailable. Others have concerns that the restrictions of the Indian-preference policy do not allow for the hiring of the most highly qualified health professionals and administration staff, so quality of care and efficiency of administration suffer.

IHS also hires Native/non-Native American interns, who are referred to as "externs"; one position available every summer at area offices is the Engineering Externship. Participants are paid according to the GS pay-grade system, which is beneficial for college students. Their GS level is determined according to credit-hours acquired from an accredited college. Engineering Extern participants generally practice field work as needed and office work.

Administration

The Indian Health Service is headed by a director; as of mid-2017 the agency has seen five different directors since the beginning of 2015.

The current Acting-Director is Rear Admiral Michael D. Weahkee, a Zuni^[9]. Rear Admiral Chris Buchanan, a Seminole, served as Acting Director from January-June 2017^[10], and presently serves as Deputy Director.^[11]. Prior to Buchanan, the office was headed by attorney Mary L. Smith (Cherokee)^[12][13]. Dr. Yvette Roubideaux (Rosebud Sioux), was appointed Director of IHS by President Obama in 2009; she was re-nominated for a second four-year term in 2013 but was not re-confirmed by the Senate^[14]. After she stepped down in 2015, she was briefly replaced by Robert McSwain (Mono)^[15]. Roubideaux was also preceded by McSwain^[16], who had served as Director for eight months.

Reporting to the Director are a Chief Medical Officer, Deputy Directors (Operations, Government Affairs, Management, and Quality), and Offices for Tribal Liaison, Urban Health, and Contracting. Twelve Regional Area Offices each coordinate infrastructure and programs in a section of the United States^[17].

Current issues

A 2010 report by Senate Committee on Indian Affairs Chairman Byron Dorgan, D-N.D., found that the Aberdeen Area of the IHS is in a "chronic state of crisis."^[18] "Serious management problems and a lack of oversight of this region have adversely affected the access and quality of health care provided to Native Americans in the Aberdeen Area, which serves 18 tribes in the states of North Dakota, South Dakota, Nebraska and Iowa," according to the report.

In 2013 the Indian Health Service was hit hard by sequestration funding cuts of $800 million, representing a substantial percentage of its budget.^[19][20]

In July 2017, Director Weahkee was severely chastised during the Senate Interior Appropriations Subcommittee budget hearings by Senator Jon Tester [D Montana],^[21]. Weahkee refused to answer repeated direct questions about whether the 2018 IHS budget had been increased or decreased.

IHS Areas

• Alaska Area:^[22] Director, Christopher Mandregan, Jr., M.P.H., (Aleut Community of St. Paul, Alaska)
• Albuquerque Area:^[23] Director, Leonard Thomas, M.D. (Navajo)
• Bemidji Area: Director, Keith Longie, M.P.H., Turtle Band of Chippewa
• Billings Area: Director, Dorothy Dupree, M.B.A., (Assiniboine)
• California Area:^[24] Director, Beverly Miller, C.P.A., (Cherokee)
• Great Plains Area:^[25] Acting Director, James Driving Hawk (Rosebud Sioux). The name of this area was changed in 2014 from the "Aberdeen" area.
• Nashville Area:^[26] Director, Martha A. Ketcher, M.B.A, (Cherokee)^[27]
• Navajo Area:^[28] Acting Director, Capt. Brian Johnson, M.P.H.
• Oklahoma Area:^[29] Director, Rear Adm. Kevin Meeks, M.P.H., (Chickasaw)
• Phoenix Area:^[30] Director, Rear Adm. Charles Ty Reidhead, M.P.H., (Three Affiliated Sioux Tribes)
• Portland Area:^[31] Director, Dean Seyler, B.S., (Confederated Tribes of Warm Springs)
• Tucson Area: Director, Dixie Gaikowski, (Three Affiliated Sioux Tribes)

Budget

The 2017 United States federal budget includes $5.1 billion for the IHS to support and expand the provision of health care services and public health programs for American Indians and Alaska Natives (AI/ANs). The proposed 2018 budget proposes to reduce IHS spending by more than $300 million^[32].

This covers the provision of health benefits to 2.5 million Native Americans and Alaskan Natives for a recent average cost per patient of less than $3,000, far less than the average cost of health care nationally ($7,700), or for the other major federal health programs Medicaid ($6,200) or Medicare ($12,000)^[33].

See also

Wikimedia Commons has media related to Indian Health Service.

• Title 25 of the Code of Federal Regulations
• Health insurance
• Health insurance in the United States
• Luana Reyes

References

External links

• Indian Health Service
• Indian Health Service in the Federal Register
• Biography of Dr. Yvette Roubideaux
• United States Department of Health and Human Services
• ExpectMore.gov
• Emery A. Johnson Papers - National Library of Medicine finding aid

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