There’s a sliver of good news for a stricken federal agency during the first alarming month of President Trump’s administration: relief from Trump’s hiring freeze for the Indian Health Service (IHS).
“This exemption is a step in the right direction,” seven Democratic senators said in a statement Friday. “Indian Health Services facilities face staff vacancy rates of 20 percent or higher, and a hiring freeze would make these challenges even more severe, further impacting access to health care and even patient health.”
Unfortunately, that step won’t necessarily improve the agency, but perhaps it will prevent it from getting even worse. The hardships for IHS and other Native American programs are already so severe that the Government Accountability Office (GAO) added them to its “high-risk list” last week, calling them “ineffectively administered.”
That bureaucratically bland language points to more dramatic, serious complications. The long-troubled medical system serves a population with severe afflictions — including a significantly lower life expectancy rate and drastically higher death, infant mortality and disease rates than for white people. Although IHS has increased funding for contracting out some health-care services, the GAO reported that the program “is unable to pay for all eligible services, and that these gaps in services sometimes delay diagnoses and treatments, which can exacerbate the severity of a patient’s condition and necessitate more intensive treatment.”
After a long history of racist and bloody treatment at the hands of Uncle Sam, he continues to shortchange the nation’s first peoples.
“The chronic underfunding of IHS and a lack of accountability measures are hamstringing the agency and its ability to provide timely, quality care,” said Marnee Banks, a spokesperson for Sen. Jon Tester (D-Mont.), a member of the Senate Indian Affairs Committee. “Folks in Congress are always quick to criticize IHS without first looking in the mirror. IHS receives less than half of what is needed to provide quality, year-round care to folks in Indian Country. Congress invests $3,000 per capita on Indian health care; this is compared to $5,000 per capita on state prison inmates and $12,000 per capita on Medicare beneficiaries.”
IHS flunked its way to a spot on the high-risk list after reports from the GAO and others about poor conditions confronting American Indians and Native Alaskans. In October, we wrote about an inspector general’s report on a variety of maladies, including long patient wait times, outdated equipment, staffing shortages and even sewage in one IHS operating room.
Just last month, the GAO said that “IHS officials cannot ensure that facilities are providing quality health care” because of “limited and inconsistent” oversight, significant leadership turnover and a “lack of agency wide quality of care standards” among other problems.
Trump’s crew makes no promises it will deal with the native population any better than the Obama administration did. “The new administration will evaluate the report carefully and gain a full understanding of the agency and how it can better serve American Indians and Alaska Natives,” an IHS statement said.
Adequate resources along with consistent and effective managers would be a start. The GAO said IHS management “inconsistencies are exacerbated by significant turnover in area leadership.” Four of the nine area offices “reported that they had at least three area directors in the past 5 years, and officials from three area offices reported that they had at least three chief medical officers.”
Personnel shortages and outdated facilities also contribute to IHS’s systemic disorders, according to Brian Cladoosby, president of the National Congress of American Indians. “The problems are complex and didn’t develop overnight,” he said, citing “a continued lack of funding and a growing population …” The many workforce openings “coupled with aging facilities only compounds the challenges. The federal legal and treaty obligation to provide health care has never been adequately fulfilled and these problems have continued over time.”
The GAO demonstrated that with several reports critical of IHS dating back more than five years. Three of the seven reports, including the first and the last during that period, called for improved or increased oversight. Subjects covered long patient wait times, issues with contract health services and expanded enrollment needed in health coverage programs.
Among the problems listed in the high-risk report from previous GAO studies:
- Tribal representatives said “patients reported difficulty scheduling primary care visits because of extended wait times. For example, one facility reported that new patients may wait 6 weeks for an initial exam with a family medicine physician, and new patients in internal medicine may wait 3 to 4 months for an initial exam.” IHS “has not developed agency-wide standards for patient wait times in federally operated facilities.”
- Because of an antiquated funding formula, IHS “cannot equitably allocate funds to meet the health care needs of Indians.”
- “Limited federal workforce planning” led IHS officials to report “an insufficient workforce was the biggest impediment to ensuring patients could access timely primary care.” As of last month, IHS had not implemented a 2013 recommendation to realign resources and personnel.
- “Outdated and deteriorating equipment, technology, and infrastructure,” including “analog mammography machines and telephones with an insufficient number of lines for scheduling patient appointments.”
“If they had long-term leadership in the CEO positions,” Cladoosby said, “I believe that would go a long way to overcome many of the problems we are seeing.”