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Republicans Talk Accountability at IHS Field Hearing, Dodge Own Accountability for Throttling IHS Budget

Senator John Thune speaks to tribal leaders before IHS field hearing in Rapid City, 2016.06.17. Photo by OJ Semans, Twitter, 2016.06.18.
Senator John Thune reads his lines to tribal leaders before IHS field hearing in Rapid City while Senator Mike Rounds, Senator John Barrasso, and Rep. Kristi Noem do what they do best. Photo by OJ Semans, posted to Twitter, 2016.06.18.

The GOP spin machine is acting like Senator John Thune, Senator Mike Rounds, and Representative Kristi Noem achieved some great breakthrough by standing around in Rapid City talking about how bad the Indian Health Service is. But not one word of the Thune press release or the excerpted media coverage or the bill Thune and Rounds are pushing (S. 2953) mentions the basic and obvious problem that keeps IHS from delivering on the health care we promised to our Lakota neighbors: Thune, Rounds, and Noem‘s failure to fully fund our treaty obligations.

The Rapid City Journal doesn’t fall for the misdirection. leads its summary of the IHS field hearing by putting blame on Congress:

Federal representatives seeking suggestions for improving the Indian Health Service heard repeatedly Thursday the problems start with their bosses in Congress.

“Money talks,” said Cheyenne River Sioux Chairman Harold Frazier, who complained all the legislation is meaningless without funding the promises for better healthcare [Mike Anderson, “Tribal Members: IHS Overhaul Starts with Congress,” Rapid City Journal, 2016.06.17].

SDPB lets Thune air his gripes, then turns to a tribal health care official who says Congress has given IHS less than half the money it needs to provide quality health care:

Wehnona Stabler is a tribal health director for the Omaha Tribe of Nebraska. She says she’s operated three IHS hospitals in the past and says the issue is about funding…

“If Congress would fund our need, the way they fund other programs… And I see a lot of money going overseas to cultures that we have had wars against. They go in and they rebuild their communities, they spend beaucoup bucks. And here we are, the first American’s and we can’t get any help. We’re only funded at maybe 40 percent at our hospitals,” Stabler says [Lee Strubinger, “Tribal Officials Point to Funding, Thune Points to Accountability over IHS Woes,” SDPB Radio, 2016.06.16].

South Dakota Democratic Party exec Suzanne Jones Pranger reminds us that accountability is for Congress as much as for IHS:

While IHS leaders must be held accountable for their agency’s failures, Republicans in Congress who supported the Budget Control Act of 2011 (also known as “the sequester”) and then steadfastly refused to address IHS funding until now – including Senator Thune – should be held accountable as well. This lack of action has denied much-needed resources to tribal communities, and helped bring about the current crisis [Suzanne Jones Pranger, press release,, 2016.06.17].

Senator Mike Rounds explicitly rejects increasing IHS funding:

The IHS needs major reform but more taxpayer money won’t solve the dysfunction, because what IHS lacks is an efficient system and accountability. I appreciate Health and Human Services Acting Deputy Secretary Mary Wakefield’s support for an independent audit and look forward to working with her to get the answers necessary to turn the agency around. From my standpoint, investing more taxpayer money in a dysfunctional system will only compound the problem [Senator Mike Rounds, press release, Black Hills Pioneer, 2016.06.17].

…but I’m not sure how IHS fills 1,550 vacancies with qualified health care personnel or updates its aging infrastructure and equipment without more taxpayer money:

Facility staff that we interviewed told us that they have been unable to fill some ongoing vacancies due either to salaries and benefits that are not competitive with tribal health centers, other federally funded health programs, or the private sector; or to IHS’s lengthy hiring process and the remote locations of some facilities. For example, staff at a Billings area facility told us that an optometrist position that was recently filled had been vacant for 5 years because four previous offers were declined due to inadequate pay. In addition, staff at this facility said that the facility is losing its family physicians because the IHS starting salary is about a third of what the competition can offer.

…According to IHS’s 2011 Facilities Report to Congress, the average age of federally operated IHS facilities is 31 years, and fourteen of the 35 IHS hospitals and 22 of the 61 IHS health centers are older than 40 years. In contrast, the average age of private-sector hospitals is 9 to 10 years. IHS officials and facility staff told us that several IHS facilities lack sufficient physical space to increase the number of available appointments, and stated that, even if they could recruit sufficient providers, there would be insufficient physical space or equipment with which the additional staff could work. For example, staff at a Billings area facility who hired an optometrist after a 5-year vacancy told us that they were unable to request equipment for this provider until the start of the new fiscal year when additional funds would be available. In addition, staff at a Bemidji area facility told us that, even though they had an insufficient number of providers, they were unable to hire any additional providers until they completed construction on a new facility because of a lack of space in the current facility….

…According to IHS, medical and laboratory equipment, which has an average useful life of 6 years, generally is used at least twice that long in Indian health care facilities. Documents provided by a facility in the Great Plains area stated that its mammography equipment is outdated but, in order to upgrade to digital mammography equipment, the facility would need to remodel its radiology room. In addition, staff at a Billings area facility told us that they have not used their radiology equipment since 2000 because it needs to be upgraded to digital technology. Documentation from a governing board meeting in 2014 showed that another Great Plains area facility was unable to upgrade any of its technology until the building was completely rewired. In addition, IHS facility staff reported challenges in providing timely primary care because of aging or outdated telecommunication systems. For example, staff at multiple facilities reported having a limited number of telephone lines, making it difficult for patients to make appointments and for staff to make reminder calls or provide services through telemedicine. Staff at a Billings area facility stated that the facility had only three telephone lines, so if a doctor and a pharmacist were on separate calls, there would only be one line left available for patients to call for appointments. As a result, some staff reported receiving complaints from patients unable to schedule appointments. The scheduling staff at this facility told us that they used their personal cellphones to call or text patients to remind them of their appointments so they did not occupy a phone line. In addition, the CEO of this facility told us that their telephone system was so outdated that they could no longer purchase new replacement phones or parts. As a result, she said that she spends time searching the internet for replacement parts to fix their phones [U.S. Government Accountability Office, “Indian Health Service: Actions Needed to Improve Oversight of Patient Wait Times,” Report to the Committee on Indian Affairs, U.S. Senate, March 2016].

Our Republican Congressional delegation likes to portray IHS as another corrupt government program that they are whipping into shape. But you don’t hire doctors and rewire hospitals with audits. It’s hard to hold doctors, nurses, and IHS administrators accountable for using resources if Congress isn’t providing them the resources they need to provide adequate care.


  1. Richard Schriever 2016-06-19 08:59

    Rounds lack of effective ability as an administrator (governor, or private business person) is made obvious in his statement about needing more efficiency, accountability – and an independent audit. Each of those programs/approaches/processes requires an expenditure – I.E., FUNDING. But then he likely is aware that his appeal to voters is mostly toward those as unable to connect that dot as he is.

  2. Dana P 2016-06-19 09:17

    This has been one to watch, hasn’t it Cory? The hypocrisy on this hold no bounds. And IHS is/was a problem to address……during an election season? What a coincidence!

    I hope that Paula Hawks and Jay Williams are taking notes (I have the confidence that they are!) and will address this vigorously with the respective candidates in ads and during debates.

  3. BIll DIthmer 2016-06-19 09:30

    I hate to admit this, but Rounds is right.

    The Blindman

  4. Mark Winegar 2016-06-19 10:03

    Its time to rotate the crops in Congress. The failure of our representatives including John Thune, Mike Rounds, and Kristi Noem to fully fund IHS in accordance with the Fed’s treaty obligations affects all South Dakotans.

  5. Douglas Wiken 2016-06-19 10:33

    Do away with IHS and expand medicare to cover everybody as a single-payer system. Do the same for Veterans. The huge bureaucratic system of these services sucks the meat out of the funding for veterans, Native Americans, and the unrich.

    Republicans talk about responsible spending, controls, oversight, etc and it is all about expensive, ineffective systems that could be replaced with a much simpler expanded system.

  6. mose11 2016-06-19 10:56

    Photo op probably thinks vets have health care priority 8 veterans should not have any mean tests at all according to their income Rounds and Facebook John are out of touch with South Dakota veterans.

  7. BIll DIthmer 2016-06-19 11:01

    I hope that Paula Hawks and Jay Williams are taking notes (I have the confidence that they are!) and will address this vigorously with the respective candidates in ads and during debates.”

    Dana if Hawks and Williams do address this in adds and debates, the only votes they will gain are, none. Thats right, they already have the native vote and that would be about 15 percent of the total native population in this state. The natives are about eight percent of the states population.

    This might be feel good stuff people but if these two are serious about this election, that dog will never get off the porch in South Dakota.

    The Blindman

  8. mike from iowa 2016-06-19 11:04

    Is there some mental block in South Dakota that prevents wingnuts from even whispering about accountability in office? Audit…..I think Rounds meant Aw @#it!

  9. grudznick 2016-06-19 11:18

    If only 15% of the 9% of South Dakotans who are Indians vote and we French Math it out that Indians comprise the same proportion of the registered voters as they do the population as a whole then that’s like the equivalent population of the whole city of Rapid. A voting block who moves in unison indeed.

  10. Jason Sebern 2016-06-19 12:17

    Douglas is right. Medicare for all would solve a lot of health care issues for consumers of health care. It would eliminate the need for all these duplicate agencies (IHS, VA, etc.) and streamline the process of receiving care. But that is not what the neoliberals want. They want to underfund existing public programs to the point that they fail. Then they arrive on the scene to propose privatization as a cure-all.

  11. John Kennedy Claussen, Sr. 2016-06-19 13:12

    What is equally disturbing about this story other than just the fact that our South Dakota congressional delegation helped to create this problem with their sequestration tactics a few years ago, is the fact that, with the exception of the Rapid City Journal piece mentioned above, the media in this state constantly reports this crisis as if Senator Thune and Congresswoman Noem are not to blame but are instead a part of the hopeful answer.

    The media’s unwillingness or inability to report the facts of this crisis in the context of the past Republican congressional politics of sequestration demonstrates how the media in this state is failing the public as much as the past votes from Senator Thune and Congresswoman Noem are now failing the Lakota people through a lack of IHS funding.

    I am reminded of something that Michael Moore said on the Larry King Show about ten years ago, when King asked Moore to respond to the then successes of the “Surge.” Moore claimed the Bush administration’s bragging about the “Surge’s” successes is like the guy who brags about cleaning up the spilled milk even though he is the same guy who spilled the milk to begin with….

  12. Rich 2016-06-19 13:33

    That picture tells the tale story of our Washington delegation: Kristi with a blank look on her face, phone in hand and worried more about the state of her hair; Mike Rounds with two hands on a cup of coffee with a useless look on his face; Thune talking the crowd to sleep. And Senator Barrasso with a sassy, hand on one hip stance. So, to sum up the conference: Thune and Kristi are up for re-election. So they’re pretending to care.

  13. Steve Sibson 2016-06-19 13:43

    By reading this post is seems like there has never been any Democrats in Congress or the White House. Look at all the money wasted on Gear up. Perhaps it is time for us to take care of ourselves, instead of coveting money from others.

  14. David Newquist 2016-06-19 14:08


    The following is a press release from Sen. Tom Daschle (D-South Dakota).
    Senator Tom Daschle today criticized President Bush’s Fiscal Year 2005 budget proposal for drastically underfunding the Indian Health Service (IHS).

    Bush’s budget proposal includes only $2.1 billion for the IHS clinical services account that funds individual health care services, far below the $5.54 billion Daschle requested in a December letter to President Bush. In the letter, Daschle noted that recent IHS funding increases have failed to keep pace with medical inflation or population growth, and called the state of Indian health care a “a national disgrace that simply must end.”
    “Once again, President Bush and his Republican allies have abandoned Native Americans,” said Senator Daschle. “The President likes to call himself a ‘compassionate conservative.’ But there is nothing compassionate about a budget that leaves thousands of Indians without access to even the most basic medical care.”

    A recent study of federal health care spending per capita found that the United States spends $3,803 per year per federal prisoner, while spending about half that amount per year, per Native American: $1,914. Per capital health care spending for the U.S. general population is $5,065 per year. Daschle pledged to continue his efforts to improve Indian health care and ensure adequate funding for IHS.

    “It is simply unacceptable for our nation to spend more money on health care for prisoners than we do on health care for Native Americans,” Daschle added. “Our government has made a commitment to provide high-quality health care to Native Americans, and I will continue to make every effort to ensure that it does. The first step is to give the Indian Health Service the resources it needs to provide that care.”
    Republicans have continually opposed efforts to increase funding for the Indian Health Service, blocking Daschle legislation that would have increased IHS funding by $2.9 billion in March 2003 and a second measure offered in September of last year that would have provided one tenth of that amount — an additional $292 million — for the IHS.

    Ultimately Indian health negligence is the choice of the people of South Dakota. The puppets in office are their choice. They hold accountable anyone who wants to enforce the treaty obligations, as they did in 2004.

  15. caheidelberger Post author | 2016-06-19 14:11

    Dana, Paula Hawks said Wednesday, “Real reform begins with fully funding IHS….”

    Steve, yeah, sure, and Democrats supported slavery back in the 1850s, too. No history changes the fact that our Congressional delegation could push its majority party in both chambers to pass a budget that fully funds IHS. Such funding would surely win the signature of President Obama, whose sympathies for Indian issues are clear.

    Notice that when Republicans are clearly screwing up, Republicans try to distract us with “blame on both sides!” chatter. Stace is doing the same thing on my Twitter, and it’s malarkey. We elect Congresspeople to solve problems. Thune, Rounds, and Noem aren’t solving problems.

  16. mike from iowa 2016-06-19 14:58

    JKC- Moore claimed the Bush administration’s bragging about the “Surge’s” successes is like the guy who brags about cleaning up the spilled milk even though he is the same guy who spilled the milk to begin with….

    and the natural wingnut response to Moore is-“You Democrats lie. Bush never spilled any milk.”

  17. Roger Elgersma 2016-06-19 15:41

    Until now it puzzled me how Daugaard could get so much money out of Indian health as to fund Obamacare. But since Indian health is so underfunded, if they got enough money for the Indians and then just gave it to the white guys, we would have health care for the whites. But OPPS, how are they then going to fund health care for the Indians, oh they probably were not going to do that anyways. Some one has to wake up and realize that a treaty is a treaty and our word should be our word. We should first fund Indian health and then our own. They were here first.

  18. Steve Sibson 2016-06-19 16:47

    “No history changes the fact that our Congressional delegation could push its majority party in both chambers to pass a budget that fully funds IHS”

    When was the last time the Democrats controlled both chambers and the White House?

  19. Steve Sibson 2016-06-19 16:49

    “They were here first.”

    So how did they fund their medicine man back then?

  20. mike from iowa 2016-06-19 16:57

    Dems had it all for about 4 months in 2009, amid having to wait for Franken to get seated and Kennedy missing so much time due to illness. (Kennedy cast very few votes that year)

    Sibby Drumpf-is there a single group of humans you don’t go out of your way to insult, demean, disparage etc?

  21. Darin Larson 2016-06-19 16:58

    “So how did they fund their medicine man back then?”

    When was the last time Sibson had something relevant to say about a given topic? “Oh look, a squirrel.”

  22. bearcreekbat 2016-06-19 17:54

    Roger E, I agree with your statement that “Some one has to wake up and realize that a treaty is a treaty and our word should be our word.” Here is another interesting point that even Sibby might support:

    “This Constitution, and the Laws of the United States which shall be made in Pursuance thereof; and all Treaties made, or which shall be made, under the Authority of the United States, shall be the supreme Law of the Land; and the Judges in every State shall be bound thereby, any Thing [sic] in the Constitution or Laws of any State to the Contrary notwithstanding.”

    United States Constitution (Article VI, Clause 2).

    Wow, treaties are part of the “supreme Law of the Land!” Who can argue with that but the lawless.

  23. mike from iowa 2016-06-19 18:01

    Yeah,but,bcb-those treaties are so yeasterday and we should give the voters a say after the elections,unless HRC and Dems win.

  24. Steve Sibson 2016-06-19 18:53

    BCB, now do you begin to believe me when I point out that the original Constitution has been put to rest?

    And Darin must not want to address the point that the Indians want white man’s medicine, but don’t want to pay for it, nor respect the white man’s capitalist culture. Instead he resorts to social justice bullying.

    BCB, was white man’s medicine included in any of the treaties?

  25. Richard Schriever 2016-06-19 19:08

    Sibby – By treaty (supreme law of the land) yes, the tribes are entitled to healthcare – not due to their “wanting” it – but due to it being the supreme law of the land.

  26. Steve Sibson 2016-06-19 21:10

    Richard, I thought the Indians were sovereign. And second, they should take better care of themselves if they really appreciated white man’s medicine and how hard we work providing it.

  27. Rich 2016-06-19 21:15

    You still working hard for the Japanese at Toshiba, Sibby?

  28. grudznick 2016-06-19 21:21

    Mr. Sibby, some Indians are sovereign as some of us, but I think you are confusing the government units called Tribes or Nations with individual humans who might live in places like Mitchell or Huron or anywhere else. Those fellows are as sovereign as you and I. But they live in South Dakota a state of the U S of A. You have a poster.

  29. Spike 2016-06-19 22:56

    Sibson, I’m a native. Kiss my @ss….

  30. Roger Cornelius 2016-06-19 23:13

    Unsuccessful and failure blogger, Sibson, never fails to show his ignorance, he has outdone himself on this post.
    I don’t even know where to start correcting his stupidity, that is how overwhelmed I am.
    I agree with Spike, pucker up Sibson and kiss my ass.

  31. leslie 2016-06-20 06:41

    Capitalism only works for entrepreneurs who take free resources from undefended opportunities. They killed off 60 million buffalo. By 1870 they violated the 1868 treaty, took the land and the gold and got rich, President Grant and Gen. Harney lived happily ever after and today you have T, N&R distracting the argument (like useless sibby here) spending public money on the wrong priorities. Fund public health fully and plan for infrastructure maintenance (e.g. digitization, phones, equipment). Quit buying guns. See Boston Globe anti-gun Editorial re: spending.

  32. leslie 2016-06-20 06:59

    2005-bush funds IHS $2B while SD dem senator demands $5B. 2016 $19B spent on guns ammo while Boston Public Schools budget is $975M. Stand up and lead GOP or elect Jay and Paula who will.

  33. leslie 2016-06-20 07:14

    2003 bush started Iraq war spending $1.7T now owing Vets $490B which will grow to $6T plus over nxt 40 yrs. And GOP is denying health care funding as a result. Spend on caring for people, not weapons. Reuters

  34. Rorschach 2016-06-20 08:45

    Looks like this audience found out about the borehole. Was Mr. McTaggart there?

  35. Robert McTaggart 2016-06-20 08:53

    No. I was physically separated by any such meeting by several hundred miles, but maybe they have been reading this blog.

  36. Lanny V Stricherz 2016-06-20 15:28

    Douglas Wiken and mose11 are both right. Only with medicare for all can this be solved. And why would we deny VA services to a veteran who even though he sacrificed, became successful after his military service. We need to take care of our treaty obligations to the Native Americans and to our moral obligations to veterans by giving them the healthcare that they need. 23 suicides a day by veterans and also many by Native Americans is unacceptable. Especially when you consider that our federal government and our churches find assisted suicide objectionable.

  37. caheidelberger Post author | 2016-06-20 16:25

    David, that’s an enormously important reminder from Daschle 2004. The feds spend more on health care per prisoner than per Indian.

    That ratio held in 2005:

    Ron His Horse is Thunder, chairman of the Standing Rock Sioux Tribe, tells the U.S. Senate Indian Affairs Committee that the U.S. spends nearly twice as much on health care for prisoners as it does for Americans Indians. Federal appropriations for the Indian Health Service amount to $2,130 per person in 2005, while, per person, it spends $7,600 for Medicaid; $5,200 for the Veterans Administration; $5,000 for Medicare; and $4,000 for the Bureau of Prisons [source here].

    That ratio holds in this decade:

    Donna Keeler is executive director at South Dakota Urban Indian Health, which has been providing health services to the American Indian population since 1977. Keeler said her clinics in Sioux Falls and Pierre receive federal grants, but unfortunately, a federal prisoner has a larger health care budget allocated to him than an urban American Indian does.

    In 2013, Indian Health Service spending for patient health services was $2,849 per person, compared to $7,717 for health care spending nationally, according to a report from the National Congress of American Indians [CNN, 2016.04.15].

    It’s pretty clear underfunding is problem #1. Yet Thune, Rounds, and Noem refuse to acknowledge that need, because they think a population with more health care needs can get by on less health care spending.

  38. Roger Cornelius 2016-06-20 17:44

    Even with Medicare for all, that does not solve the problems of Indian healthcare on the reservations. It would be a start, but not the full solution.
    The government still has the obligation for healthcare and tribes have to agree with it. Hospitals and clinics will have to be updated, modern equipment added and recruiting and hiring of professional staff and support staff.
    These changes will have to be administered by the same old IHS.
    If you look at hospitals and clinics in your own community, you’ll find that they are governed by local boards and often by various committees to support the board.
    Your hospitals and clinics are staffed by competent administrators and support staff. When the hospital or clinic director needs to make a major decision, he goes to the board.
    Under the current IHS system, hospital administrators need to get approval for their decisions from bureaucrats and bureaucracies at the Aberdeen area IHS office.
    If Aberdeen isn’t allowed to make that decision, they must go to Washington, D.C for an answer where they are again met with multiple levels of bureaucrats and bureaucracies before a decision is rendered. This all takes time and you’d be surprised at the paperwork that gets lost.
    Can you imagine how well your hospital or health center would operate under these conditions. It is amazing that more Indians aren’t dead from a system that operates in this manner.
    Note that during this hearing process that Thune, Noem and Rounds didn’t specifically address the delivery of healthcare.
    More money is needed and there has to be accountability, I don’t trust Rounds to do that. The only way the changes needed for IHS to function properly is by local control.
    When patients have concerns or complaints, they can take them directly to their local board comprised of their peers.
    I was on the board of directors of Community Health Center of the Black Hills for nearly ten years and also served on various committees for Regional Health and we did have standard problems in staffing and other problems common in this environment .
    But, having local control beats having to go to Aberdeen and Washington for a decision.

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