Reform the Indian Health Service to deliver quality healthcare

It’s important that Indian Country, like everywhere else, has quality, affordable healthcare. Unfortunately, the Indian Health Service is struggling to achieve that goal.

Federal healthcare for Indians is not part of the nation’s social welfare program, nor is it insurance. Rather, it is a program founded upon the federal promise to provide healthcare services to Native Americans, a federal promise made in treaties and statutes and authorized by the Constitution.

Congress created the Indian Health Service in 1955 to provide direct patient care to Native Americans. Today, IHS is a network of over 679 hospitals, clinics and health stations located on or near reservations. They serve approximately 2.2 million out of the 3.7 million American Indians and Alaska Natives in the 567 federally recognized tribes.

Although Congress has generally increased appropriations since 2011, the IHS has been chronically underfunded and the patients are the ones who suffer from the lack of funding. IHS is the only healthcare-providing federal agency that does not receive mandatory or advanced appropriations, causing funding for this critical agency to hang in the balance during government shutdowns.

A little over half of the IHS budget goes directly to tribal communities that operate their own health systems under contracts and compacts authorized by the Indian Self-Determination and Education Assistance Act. While programs operated directly by tribes consistently demonstrate positive results, those administered by the IHS continue to be plagued by evidence of inadequate patient care, unsafe environments and lack of medical staff.

For years, federal reports have documented shocking cases of mismanagement and poorly delivered care at IHS facilities. Reports released by the CMS indicate that some IHS-operated facilities are so unsafe that the CMS had to pull some hospitals’ accreditation, and others have closed emergency services entirely. Chronic funding shortages and agency mismanagement are significant contributors to this crisis.

In order to provide full services to their people, tribal communities rely on outside funding from the federal and state governments, in the form of grants, supplemental commercial revenue (if available), and third-party collections. This patchwork method of funding means that tribal health programs are often varied and face habitual funding challenges just to ensure that basic needs are met.

The IHS also struggles with accountability and maintaining a workforce. Services and level of care can vary from office to office. While every office has its own standards that it tries to adhere to, there are no best practices in place or oversight of the day-to-day operations of each office. Staff shortages and a constantly changing workforce also contribute to the struggles offices face. Patients end up experiencing long wait times or can’t get the services they need because of this organizational dysfunction.

There has been a lot of talk about how government-run healthcare could be the answer to ensuring every American has access to affordable, quality healthcare. But unfortunately, the IHS is a prime example of what can go wrong when the government takes over our healthcare system.

As one of four Native Americans in Congress and a member of the Energy and Commerce Committee’s Health Subcommittee, I was asked to lead the IHS Task Force in the last Congress. The task force worked toward reforming the healthcare system and making it work for the people it serves. Last Congress, I sponsored a bill that would fundamentally change how the system operates and I will introduce that bill again.

The IHS must continue to uphold its foundational promise “to uphold the federal government’s obligation to promote healthy American Indian and Alaska Native people, communities and cultures and to honor and protect the inherent sovereign rights of tribes.” By reforming the IHS, we can keep that promise.

More commentaries from members of the 116th Congress on the state of healthcare

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