Northern Arapaho Business Councilman Lee Spoonhunter testified in a hearing about the Indian Health Service (IHS) Act in Washington, D.C. at the end of July and shared his perspectives on barriers to care for those on the Wind River Reservation.
The U.S. House Natural Resources Subcommittee on Indian and Insular Affairsdiscussed the draft of a bill titled “Restoring Accountability in the Indian Health Service Act of 2023” that would amend the current Indian Health Care Improvement Act.
The amendments aim to improve hiring practices and improve incentives for recruitment and retention of health-care employees in the IHS. The IHS is a division within the U.S. Department of Health and Human Services that is responsible for providing direct medical and public health services to members and descendants of federally recognized Native American Tribes and Alaska Native people.
Councilman Spoonhunter is a member of the National Indian Health Board and advocated for increased funding for IHS.
“There is no amount of red tape that can patch an underfunded system – imagine having one day's worth of food for a week for generations. The funding at IHS at one-seventh of the estimate of the Tribal Budget Formulation Workgroup sets us up for failure,” he said.
The Tribal Budget Formulation Workgroup makes annual recommendations to the Indian Health Service on Tribal budget priorities.
IHS has long struggled with issues of substandard medical care, high staff vacancy rates, aging facilities and equipment, and lack of accountability – these challenges first received widespread national attention as a result of a 2010 investigation conducted by the Senate Committee on Indian Affairs.
A 2018 study published by the U.S. Government Accountability Office found that the overall vacancy rate for health providers like physicians, nurses, nurse practitioners, certified registered nurse anesthetists, certified nurse midwives, physician assistants, dentists, and pharmacists— was 25 percent, ranging from 13 to 31 percent across areas.
Spoonhunter said that earlier this year, IHS Director Roselyn Tso testified before the subcommittee and said that the agency currently has a 28 percent provider vacancy rate and a 40 percent mental health professional vacancy rate.
“The lack of providers forces IHS and Tribal facilities to rely on contracted services, which can be more costly and less effective,” Spoonhunter said.
According to IHS, American Indian and Alaska Native people born today have a life expectancy that is 5.5 years less than all races in the United States and die at higher rates than other Americans from preventable causes.
Spoonhunter testified that the National Indian Health Board is supportive of the attempt of the bill to address policy concerns at IHS, but said the government needs to work collaboratively with tribes across the country to achieve the best possible results.
“We are concerned that this bill has been developed so far without national tribal consensus, and could harm tribes and their past work. I know that if we work together as sovereigns, we can do so much more,” he said.
Spoonhunter said that for years, there was a National Steering Committee charged with identifying needed objectives and policy changes for the Indian Health Care Improvement Act. The committee consisted of Tribal representatives from across the country.
“The National Steering Committee worked diligently to reach consensus on many issues, some of which were contentious and controversial. We call upon Congress to support a National Steering Committee process again – we hear from tribal leaders that there is a lack of transparency around activities and decision-making at IHS,” Spoonhunter testified.
Spoonhunter was one of three tribal representatives invited to speak at the hearing. Jerilyn Church, Executive Director of the Great Plains Tribal Leaders’ Health Board, and Cindy Marchand, Tribal Council Secretary for theConfederated Tribes of the Colville Reservation, also shared testimony on health care issues facing their communities.
Alabama Congressman Jerry Carl, who sits on the subcommittee, proposed that the group travel to the Native communities to get a better idea of the health care challenges they are facing.
“I would love to do a CODEL [congressional delegation] and go out and look at some of these places that these tribal members actually pick for us to look at, not for IHS to choose for us – I'd like to go out there and look at it,” he said.
Subcommittee chair Harriet Hagemen (R-Wyo.) said she would work with staff to see if such a trip would be possible. She also said the group plans to seek further insight from those who testified as they continue to draft the bill to amend the current Indian Health Care Improvement Act.
