Leaders of the Indian Health Service struggled Wednesday at a Senate hearing to defend the Trump administration’s plans to slash funding to the agency, which is reeling from quality of care problems at several of its hospitals, a doctor shortage and facilities showing their age.
The lack of answers infuriated both Democrats and Republicans on the Appropriations subcommittee.
“I cannot believe what has transpired today. All I want is some damn answers, that’s it,” said Sen. Jon Tester, D-Mont., as he admonished Rear Adm. Michael Weahkee, the Indian Health Service’s acting director since June.
When Weahkee refused to say how staffing levels would be affected under the Trump administration’s proposed 2018 budget, Tester became visibly shaken and yelled back: “I did not come in here with my hair on fire but I am leaving here with it. … It’s no wonder [the agency is] in crisis.”
The administration officials could not answer some basic questions from senators, including how much money the agency has gained from the health law’s Medicaid expansion and whether President Donald Trump’s budget proposal would help the agency to hire more staff.
The Indian Health Service, which oversees care to 2.2 million American Indians and Alaska Natives, has been chronically underfunded, and several of its hospitals have lost accreditation or been put under special watch by Medicare because of conditions that harmed patients. It has a 30 percent vacancy rate for doctors, dentists and physician assistants.
In 2013, Indian Health Service spending for patient health services was $2,849 a person, compared with $7,717 for per capita health care spending nationally, according to a report from the National Congress of American Indians. Despite less funding, Native Americans typically have higher incidences of serious health problems than the general public, including higher rates of diabetes, liver disease and unintentional injuries.
Trump’s budget includes $4.7 billion for the agency. Sen. Lisa Murkowski, the Alaska Republican who chairs the Subcommittee on Interior, Environment and Related Agencies that held Wednesday's hearing, said the proposed budget would amount to a 6 percent cut from the current funds. She noted the trim was well below other Department of Health and Human Services agencies, where proposed funding is reduced by an average of 18 percent.
Yet she said she was stunned to hear IHS officials at the hearing say the Trump budget has enough money to improve care.
“You have not answered my question on whether we have provided you sufficient resources,” Murkowski told Weahkee. “I can’t stand down knowing our system is failing so many Native Americans around the country.”
Weahkee, a member of the Zuni tribe, was previously CEO of the IHS’ largest hospital in Phoenix. He said the proposed budget prioritizes funding on patient care, while it cuts funding to modernize and build facilities. He said the agency’s appropriations are augmented by payments from Medicare and Medicaid.
Medicaid provided $880 million in funding in 2016 — more than any other third-party funding source, according to a report released Wednesday by Center on Budget and Policy Priorities.
Murkowski said she is worried about the effects on the Indian health care system if Congress were to accept a Republican health plan to replace the Affordable Care Act. The current version being advanced by Senate leaders would end the ACA’s Medicaid expansion and cap future Medicaid funding to states.
Alaska was one of 31 states to expand Medicaid under the Affordable Care Act, and Murkowski has said she has serious qualms about the current plan.
Senate GOP leadership delayed the bill when it failed to get enough support before the July Fourth recess. A new version of the legislation is expected to be released Thursday.
Operating in some of the nation’s poorest places, the Indian Health Service has failed to meet minimum federal standards for medical facilities, turned away gravely ill patients and caused unnecessary deaths, The Wall Street Journal reported last week, citing federal regulators, agency documents and interviews.
Murkowski said she was dismayed by the agency’s recent track record, particularly after she helped steer an extra $29 million in this year’s budget to address quality of care problems at three of its hospitals in the Midwest.
“I believe the agency is sincere in its desire to fix these problems,” she said, “but a year later these problems remain and appear to more serious than ever.”