The Indian Health Service

 Shameless Ask: As the Shutdown drags on, the pinch we feel gets harder and harder, I love writing and sharing these posts, but they take time for me to research, write, and publish. If you feel you benefit from them, and you have a little extra would you consider making a small donation  to help us keep them going. 

Editorial Note: The word “Indian” is used in this article only in context of quoting the Government or Agency names and the agency’s statement of its mission, I have used the word “Native” to describe this group of people outside of that specifc instance. If my word choice is inaccurate, outdated, or offensive and you would be willing to educate me on how to properly write on this topic, please let me know and I will gladly learn, edit accoringly, and update this note to educate my readers. Thank you. 


What is The IHS?

I write you from Day 24 of the Partial Shutdown, still no progress, still no solutions. McDonald’s is being served to the Clemson Tigers in the White House as I type. But, we have more important things to discuss tonight, this one is hard, I’m leaving most of my jokes behind, and working hard to reign in my snark. Strap in.

Let’s talk about a little agency that rolls up under the currently unfunded Department of the Interior, The Indian Health Service (IHS). The IHS provides federal health services to Native people throughout the US. The provision of health services to members of “federally-recognized tribes” grew out of the special government-to-government relationship between the US Federal Government and the sovereign Governments of each native tribe. This relationship, dating back to 1787 is based directly in our Constitution (Article 1, Section 8) and has been given substance through many treaties, laws, SCOTUS decisions, and Executive Orders throughout our nation’s history. This is a history and relationship fraught with hardship, wrong-doing, oppression, and mistrust.

What Does IHS Do?


The IHS states their mission succinctly: “To ensure the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level. It’s a good mission, a noble one even.
Although the IHS has had five different directors since the beginning of 2015 (!!!), they have a full compliment of staff to carry out their mission. The IHS currently employs 2,650 nurses, 700 physicians, 700 pharmacists, 100 physicians assistants, and 300 dentists; who are complimented by a variety of other health professionals, administrative staff, IT, and all the other positions an agency needs to operate (that’s a post on it’s own, if you really want to see it, remind me).

Where Do They Work?

Headquartered in Washington, DC, the IHS is divided into twelve physical areas (Alaska, Albuquerque, Bemidji, Billings, California, Great Plains, Nashville, Navajo, Oklahoma, Phoenix, and Tucson).   Their FY2017 Budget was $5.1 Billion, and the FY2018 budget proposal reduces that by more than $300 Million.

This budget covers the provision of health benefits for 2.5 million native peoples, for a recent cost per patient of less than $3,000 (no that’s not missing any zeros, yes it is less than it costs me to insure and provide healthcare for my family of three for two months).

Budget PROBLEMS Aren’t New to IHS

As a small and hollow comfort if you are shocked and appalled by that number, the current IHS director was in a bit of hot water with Congress and was chastised during Appropriations Subcommittee hearings by Senator Jon Tester (D-MT) for refusing to answer repeated direct questions about whether the 2018 budget proposal was adequate to fulfill the mission. 

Before we move on, you should know: It’s hard to blame Director Weahkee for not answering though, because when talking about the IHS budget you absolutely MUST remember that in 2013 the IHS experienced a funding cut that took around $800 Million from their budget (Thank you, Sequestration) they’ve not returned to their previous funding levels.  The Director has a big hill to climb and very little help doing it. 

What’s Happening Now?

As you can see above, the budgetary stress is not new to the IHS, operating for 24 days without funding at all, however, is unprecedented. The image on the left is a screen grab of the “Tribal Notification on Status of Federal Funding” posted to the IHS site on or around 12/21/2018 (the post is undated).  The second paragraph of this letter reads:
Your current Indian Self-Determiniation and Education Assistance Act (ISDEAA) agreement is funded by appropriations that will be affected by the government shutdown should one occur. However HHS has determined Tribally-managed programs operating under ISDEAA agreements are “excepted programs” in which functions must  continue under the following criteria defined by OMB: addresses emergency circumstances, such that the suspension of the function would imminently threaten the safety of human life or the protection of property.”  This designation means that the IHS may incur the obligation to enter into the agreement, but the agency cannot pay Tribes or Tribal organizations contracting under the ISDEAA until appropriations are enacted.  Therefore, there will be no funding available from the IHS until such time as appropriations are enacted and available for such purpose.  We acknowledge that this circumstance may result in insufficient funds to carry out the terms of the agreement and that the program may cease to operate.” 

Here’s what that says for those who don’t speak fluent Government (a class I offer, by the way): We have determined that the services you, as a tribe, provide under this agreement with the Federal Government to be imperative to the public health and saftey, so those services must continue through the shutdown. HOWEVER (emphasis mine), we will not be making any payments until we are funded again. So, please keep doing the work, we will pay you when we figure this out.

Essentially, it means yes, we know this is of vital importance, no we don’t have a better answer than this.

To Be Continued…




About The Author

Elizabeth DeBiase, CF APMP, has spent her life immersed in the GovCon community. She has helped government contractors – from entrepreneurs to Fortune 100 companies – navigate the arcane and complex regulations that govern the process of winning and managing government contracts. Today, Liz is the majority owner of TWRG, and dedicates her time to making sure the truly ethical

companies win government contracts so that citizens get the best services for their tax dollars. Being inside GovCon is to watch the sausage getting made. The vast majority of procurement actions are tied to taxpayer needs and are public knowledge, but very few people can take the time to follow the hundreds of thousands that are released each year. Liz’s career has given her the ability to quickly recite the historical and most recent major contract actions, describing who won them, why they did, and the effect they have on American communities. She can tell you how the Federal government works and why it works that way so that you can be more informed.