VIDEO: https://www.youtube.com/watch?v=tDio6QU8sTE&feature=youtu.be
 
WASHINGTON – Today, U.S. Senator Tom Udall, the lead Democrat on the Senate Appropriations Subcommittee that oversees funding for the Indian Health Service (IHS) and vice chairman of the Senate Committee on Indian Affairs, questioned IHS Acting Director Rear Admiral Michael Weahkee and other top IHS officials on the FY2019 budget for the Indian Health Service. Udall pressed the panel on how it can sufficiently improve health outcomes in Indian Country with the proposed cuts to the IHS budget, and how IHS plans to make much-needed improvements to IHS facilities in New Mexico and address the opioid epidemic and addiction in tribal communities with insufficient funding.

"The budget before us is still wholly insufficient to meet this nation's trust and treaty responsibilities and provide quality health care to American Indians and Alaska Natives. All told, the budget decreases funding for IHS by 2 percent…. Despite the fact that this subcommittee has fought to increase the Indian Health Service budget, we're still not where we need to be," Udall said in his opening statement. "This is a matter of setting priorities. And my view is that this administration needs to work with Congress and make funding for tribal health programs a greater priority."
 
After voicing strong objections to the administration's proposed cut of more than 40 percent to IHS facilities construction, Udall secured a confirmation that the additional funding he fought to secure in the FY2018 omnibus will allow IHS to move forward with construction projects on the IHS outpatient priority list. This list includes four facilities in New Mexico: Alamo, Pueblo Pintado and two facilities in the Albuquerque Health Care System. All four will move forward in various phases of planning and construction due to the increased funding secured in the latest spending bill.
 
Citing concerns he has heard from a number of Tribal Leaders in New Mexico, Udall pressed IHS officials on the proposed 48 percent cut to preventative health funding – which would include zeroing out funding for IHS health education and community health representatives. He went on to highlight the importance of these programs as part of a comprehensive plan to combat the opioid and substance abuse epidemic in Indian Country.
 
Udall then questioned Weahkee about efforts to improve quality of care at the Gallup Indian Medical Center (GIMC), which is under review after the Joint Commission and Centers for Medicare and Medicaid Services (CMS) found several deficiencies that put the facility's accreditation at risk. Weahkee agreed to work with Udall on the issue to ensure GIMC has adequate funding to make the needed improvements, including any new deficiencies identified in the most recent full hospital survey by CMS for which results are pending. Failure to resolve serious issues identified by CMS could result in the loss of CMS accreditation, preventing the facility from receiving Medicare or Medicaid payments – which made up over ninety percent of GIMC's collections in 2017. This loss would strain the IHS facility's ability to continue serving an estimated 5,800 inpatient admissions and 250,000 outpatient encounters annually.
 
"I can't emphasize enough how important it is to see these issues at the Gallup Indian Medical Center addressed promptly and completely. I'd like your commitment that you and your staff will continue to follow up with the subcommittee, that you provide the reports we requested on time, and that you will work with me to make sure that this facility has the resources it needs to address these challenges going forward," Udall said.
 
Udall also received a positive update on progress being made by Na'Nizhoozhi Center Inc. (NCI) in Gallup, the only social detox facility serving the rural community adjacent to the Navajo Nation and Pueblo of Zuni. Udall recently helped secure $1.5 million to help the facility expand treatment services for substance use and provide shelter in the area.
 
Udall's opening remarks as prepared are available below:
 
I'm happy to welcome the acting director of Indian Health Service, Rear Admiral Michael Weahkee, before the subcommittee this morning.
 
Welcome back, Admiral Weakhee. And I'm very pleased to remind my subcommittee colleagues of your New Mexico roots.
 
I'd like to acknowledge the other officials who have joined Admiral Weahkee, including Rear Admiral Michael Toedt, who serves as chief medical officer; Rear Admiral Gary Hartz, who serves as director of Environmental Health and Engineering; and Ms. Ann Church, who is the acting director of Finance and Accounting for the Service. Thank you for being here.
 
I'd also like to recognize the important work that my chair, Senator Murkowski, has done in support of the IHS budget.
 
Since I joined this subcommittee in 2015, I'm proud that we have increased funding for the IHS by 19 percent. We've done some good work, but we have much more to do.
 
And speaking of that, let's turn to the budget.
 
I appreciate that the administration's proposal for the IHS is relatively generous by comparison to the rest of the president's budget request.
 
But the budget before us is still wholly insufficient to meet this nation's trust and treaty responsibilities and provide quality health care to American Indians and Alaska Natives.
 
All told, the budget decreases funding for IHS by 2 percent.
 
Within that amount, the budget does increase funding for contract support costs, which is important.
 
It also recognizes the need to pay for staffing for new health care facilities. And the need to continue investments to address urgent accreditation issues at IHS facilities in the Great Plains and, as of late last year, the Gallup Indian Medical Center in New Mexico.
 
But to fund these priorities, the executive takes an axe to other critical programs.
 
Facilities programs are cut by 42 percent. Line item construction—funding that's needed to build hospitals and health centers for tribal communities in New Mexico and other states that have been waiting for decades—is cut by two-thirds.
 
Funding for Indian Health Professions programs—dollars that go directly toward filling vacancies and improving access to quality health care—are cut by 12 percent.
 
Urban Indian Programs, purchased and referred care, and self-governance programs are all reduced.
 
Preventive programs are cut in half—even though Native Americans face some of the biggest challenges when it comes to access to health care.
 
And, much to the dismay of many tribes in New Mexico that I've heard from, the budget even proposes discontinuing federal funding for community health representatives. These are tribal members who provide essential health care services when health clinics are closed or too far away.
 
These tradeoffs are unacceptable—especially when we think about the work that remains to improve health outcomes in Indian Country.
 
Despite the fact that this subcommittee has fought to increase the Indian Health Service budget, we're still not where we need to be.
 
We are still not providing all the resources on the ground we need to address preventive care. Or to tackle the epidemic-level mental health and addiction issues that Native communities are fighting to overcome.
 
We still have an unacceptable number of facilities dealing with accreditation problems – a problem that seems to be growing instead of shrinking.
 
We're still seeing double-digit vacancy rates for doctors, nurses, and other clinical personnel.
 
And—despite some important increases just gained in the omnibus—we're not making the progress we need to replace the Service's aging health care facilities.
 
This is a matter of setting priorities. And my view is that this administration needs to work with Congress and make funding for tribal health programs a greater priority.
 
While we're talking about priorities, I also want to stress a subject that's important to all of us on this dais.
 
That's respect for the government-to-government relationship that the United States government has with tribal nations.
 
I have been deeply concerned by certain administration policies reflecting this relationship. This includes rejecting requests from tribal leaders who asked to be exempted from state Medicaid proposals that would take health care coverage away from tribal members who do not meet new work requirements.
 
That's why I joined a number of members in January of this year to write the Department. We questioned the department rejecting the requests based in part on the rationale that granting such requests could quote "raise civil rights issues".
 
I recognize decisions relating to Medicaid are made by the Centers for Medicare and Medicaid Services, not IHS. But the question of how the administration views government-to-government relationships with tribes is much bigger and more significant than any one program or bureau.
 
I want assurances -- and Tribal leaders deserve assurances -- that this administration views its relationship with Native Americans as trust-based, not "race-based."
 
Taking the latter position would reverse two centuries of law and Supreme Court decisions that have, very firmly, underscored the political nature of this unique relationship.
 
That would be a non-starter. I know that I'm not alone in this position. And I expect this administration will face stiff bipartisan opposition if it tries.
 
It also bears emphasis that any changes that discourage tribal participation in Medicaid would also impact the service's bottom line. Thanks to Medicaid expansion under the Affordable Care Act, IHS has expanded access to health care for tribal members and greatly increased its third party reimbursements.
 
So I would also have serious concerns – both legal and fiscal – about any efforts to limit the ability to use Medicaid funds to supplement IHS dollars.
 
I look forward to talking more about this issue, and many others, when it's time for questions. Thank you Madame Chair.