[Congressional Record Volume 164, Number 35 (Tuesday, February 27, 2018)]
[Senate]
[Pages S1236-S1237]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                         Indian Health Service

  Ms. WARREN. Mr. President, I rise today to call on President Trump to 
nominate a Director for the Indian Health Service.
  There are many critical issues facing Indian Country--economic 
development, infrastructure, protection of Native lands, respect for 
Tribal governments--and after years and years of broken promises, 
discrimination, and neglect, Washington owes Tribes a fighting chance 
to build stronger communities and a brighter future.
  The Federal Indian trust responsibility means that Washington has a 
basic legal obligation to the Tribes. Washington also has a fundamental 
moral obligation, and that starts with basic healthcare.
  American Indians have treaty rights to healthcare from the Federal 
Government, but the U.S. Government cannot fulfill our treaty 
obligations if key posts, such as the Director of IHS, lay vacant for 
years.
  The IHS is a big deal. It is the primary Federal healthcare provider 
for American Indians and Alaska Natives. It serves 2.2 million people 
spread across 36 States. It has a budget of nearly $5 billion annually. 
The IHS provides care through more than 660 clinics, hospitals, and 
health stations on or near reservations, many of them in remote and 
rural locations located hours away from other health facilities. It 
serves more than 13 million outpatient visitors a year.
  The doctors, nurses, and other healthcare providers at IHS hospitals 
and clinics do everything from delivering babies, to providing dental 
services, to fighting the opioid crisis.
  Right now, more than a year into President Trump's term, there is 
still no permanent leader at the Indian Health Service. Two weeks ago, 
the nomination for IHS Director was withdrawn, and there hasn't been a 
Senate-confirmed Director for years. This leadership vacuum creates a 
serious problem. The IHS cannot engage in long-term planning without a 
permanent Director at the helm. It cannot officially fix problems at 
hospitals that failed inspections and where Medicare and Medicaid 
funding is in jeopardy. It cannot move as decisively to ensure that IHS 
facilities stay open. It cannot implement agency-wide standards for 
quality of care, as the Government Accountability Office has 
recommended. The IHS cannot prioritize competing issues, solve serious 
and longstanding problems, or work through how to meet multiple goals 
more effectively.
  Its relationship with other Federal agencies is weakened without a 
stable leader--critical relationships with the Centers for Medicare and 
Medicaid Services, the Office of Management and Budget, the Substance 
Abuse and Mental Health Services Administration, and the rest of the 
Department of Health and Human Services. It cannot ensure that programs 
like the Special Diabetes Program for Indians, which has created real, 
positive outcomes, is implemented as well as possible. The IHS cannot 
work out a direction for the Service and hold a single stable leader 
accountable for doing a good job.

  The IHS faces serious challenges that require the attention of a 
permanent, dedicated Director. The agency is underfunded and has been 
underfunded for a long time. As a result, its facilities often lack 
medical equipment that many Americans take for granted when they visit 
a clinic or a hospital, like an MRI machine or a functioning operating 
room. A 2016 report by the inspector general of the U.S. Department of 
Health and Human Services found that IHS hospital administrators have 
had difficulty recruiting and retaining critical staff. Aging hospital 
buildings and outdated equipment also raise concerns about patient 
safety. The inspector general cites concerns about corroded pipes 
leaking sewage into the OR and not being able to find replacement parts 
to fix old equipment the hospitals are relying on. Doctors and nurses 
should be able to focus on helping their patients get well, not on 
whether the building is habitable and basic facilities are available.
  There are also serious staffing shortages. At its Great Plains 
facilities, for example, IHS vacancy rates have reached 37 percent. 
Compare that to my home State of Massachusetts, where only 6 percent of 
nursing jobs were vacant in 2015.
  Tribal leaders are understandably concerned about the direction of an

[[Page S1237]]

agency that plays such a vital role in their communities. Here is what 
I heard from Chairwoman Cheryl Andrews-Maltais, of the Wampanoag Tribe 
of Gay Head--the Aquinnah--in Massachusetts: ``This vacancy has created 
significant instability and negatively affects the already burdened IHS 
system.'' She added: ``Not only is it a failure on the part of the 
Federal Government to not adequately fund healthcare for Indians; the 
failure to appoint someone to lead this critical service area is 
considered by many Tribes as gross negligence.'' The chairwoman says 
that the United States is failing to keep its word and failing to 
fulfill its ``solemn responsibility'' to the Tribes. I agree with the 
chairwoman.
  Healthcare is a basic human right, and everyone in this country 
deserves access to quality, affordable healthcare. But the stakes are 
particularly high for Native people.
  An American Indian or Alaska Native baby born today has a life 
expectancy that is almost 4\1/2\ years shorter than the U.S. average. 
These little babies are also more likely to die before they ever reach 
their first birthday. Native infant mortality is about 25 percent 
higher than for the U.S. as a whole.
  Chronic diseases like diabetes and heart disease hit Native Americans 
harder too. For instance, American Indians and Alaska Natives die from 
diabetes at a rate that is three times higher than that of the entire 
American population.
  Mental health and addiction issues are also a very big concern. The 
opioid epidemic has devastated communities all over our country, but it 
is a particularly virulent problem for Native Americans, who have the 
highest per capita rates of opioid overdoses in the country.
  Similarly, the alcohol-related death rate for Native Americans is 
about 500 percent higher than for the rest of the population.
  Suicide rates are about 70 percent higher.
  Everyone struggling with addiction deserves access to high-quality 
treatment, no matter who they are or where they live. That is the only 
way we are going to make progress in tackling this crisis. But right 
now, in a place where the need is great, the Federal Government is 
failing to provide adequate care.
  With so much need, investing in improving the IHS should be a top 
priority for Washington. I am glad that the Trump administration's 
latest budget for the IHS includes a funding increase. Still, this 
government needs to do more--much more. A Senate-confirmed Director can 
serve as the advocate the IHS needs in order to get the resources it 
deserves. In fact, Federal law explicitly says that advocating good 
Indian health policy is one of the Director's job responsibilities. We 
should be doing that job.
  We need a good person in this job, which means the nominee must be 
thoroughly vetted. But that is not an excuse for more delay or for the 
White House to drag its feet. It needs to work with the Tribes to find 
the right person for the job and then submit the nomination quickly.
  The person who heads up the IHS should be knowledgeable and should 
have a vision for how to deliver better healthcare to Native Americans. 
The person should have the determination and commitment to push 
Congress to meet its treaty obligations in providing healthcare to 
Native communities.
  The Trump administration doesn't have a stellar record when it comes 
to nominating the right people for important jobs. I often strongly 
disagree with the President's picks. But leaving hundreds of critical 
posts across our government vacant, including the IHS Director, has a 
devastating effect all its own.
  It wasn't until just 2 weeks ago that President Trump finally named a 
nominee to be Commissioner of the Administration for Native Americans.
  Several offices in the Federal bureaucracy have an important role in 
running important programs for Tribes, and the President hasn't 
nominated heads for some of those offices--for instance, the Director 
of the Department of Justice's Office on Violence Against Women, which 
administers key grant programs for Tribal programs to combat domestic 
violence and sexual assault, and the Assistant Secretary of the 
Employment and Training Administration in the Department of Labor, 
which provides workforce innovation and opportunity grants to Tribes 
and Tribal organizations. These vacancies hit Native communities hard, 
and they represent one more broken promise to Native people.
  There is no excuse for delay. I urge President Trump to move quickly 
to consult with Tribes and to submit a nomination for IHS Director. The 
Native community should not have to wait any longer.
  I yield the floor.

                          ____________________