Indian Health Service - Budget Insurance Tucson

The Indian Health Service (IHS) is an operating division (OPDIV) within the U.S. Department of Health and Human Services (HHS). IHS is responsible for providing medical and public health services to members of federally recognized Tribes and Alaska Natives. IHS is the principal federal health care provider and health advocate for Indian people, and its goal is to raise their health status to the highest possible level.

IHS provides health care to American Indians and Alaska Natives at 33 hospitals, 59 health centers, and 50 health stations. Thirty-four urban Indian health projects supplement these facilities with a variety of health and referral services.

Formation and mission

IHS was established in 1956 to take over health care of American Indian and Alaska Natives from the Bureau of Indian Affairs (BIA) to the Public Health Service (PHS) in hopes of improving the healthcare of Native Americans living on Reservations. The provision of health services to members of federally recognized tribes grew out of the special government-to-government relationship between the federal government and Indian tribes. This relationship, established in 1787, is based on Article I, Section 8 of the Constitution, and has been given form and substance by numerous treaties, laws, Supreme Court decisions, and Executive Orders. The IHS currently provides health services to approximately 1.8 million of the 3.3 million American Indians and Alaska Natives who belong to more than 557 federally recognized tribes in 35 states. The agency's annual budget is about $4.3 billion (as of December 2011).

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Employment

The IHS employs approximately 2,700 nurses, 900 physicians, 400 engineers, 500 pharmacists, and 300 dentists, as well as other health professionals totaling more than 15,000 in all. The Indian Health Service is one of two federal agencies mandated to use Indian Preference in hiring. This law requires the agency to give preference hiring to qualified Indian applicants before considering non-Indian candidates for positions.

IHS draws a large number of its professional employees from the U.S. Public Health Service Commissioned Corps. This is a non-armed service branch of the uniformed services of the United States. Professional categories of IHS Commissioned corps officers include physicians, physician assistants, nurses, dentists, pharmacists, engineers, environmental health officers, and dietitians.

Many IHS jobs are in remote areas as well as its headquarters in Rockville, Maryland, and at Phoenix Indian Medical Center. In 2007, most IHS job openings were on the Navajo reservation. 71% of IHS employees are American Indian/Alaska Native.

Efficiency and Public Law 93-638 (Tribal Self Determination - 1975)

ExpectMore.gov lists four rated areas of IHS: federally administered activities (moderately effective), healthcare-facilities construction (effective), resource- and patient-management systems (effective), and sanitation-facilities construction (moderately effective). All federally recognized Native American and Alaska Natives are entitled to health care. This health care is provided by the Indian Health Service, either through IHS-run hospitals and clinics or tribal contracts to provide healthcare services.

IHS-run hospitals and clinics serve any registered Indian/Alaska Native, regardless of tribe or income. Tribal-contract health care facilities serve only their tribal members, with other qualified Indians/Alaska Natives being offered care on a space-available basis. This policy makes it difficult for an Indian who leaves their tribal home for education or employment to receive health care services to which they are legally entitled. An IHS fact sheet clarifies that Indians are also eligible to apply for low-income health care coverage provided by state and local governments, such as Medicaid. IHS 2007 third-party collections were $767 million, and estimated to be $780 million in 2008.

Some of those who are served by the system are not satisfied with the efficiency of IHS. A contributor to Indianz.com, a website for Native American news, feels that Native Americans are "suffering" at the hands of IHS. She feels IHS is underfunded, and necessary services are unavailable. Others have concerns that the restrictions of the Indian-preference policy do not allow for the hiring of the most highly qualified health professionals and administration staff, so quality of care and efficiency of administration suffer.

IHS also hires Native/non-Native American interns, who are referred to as "externs"; one position available every summer at area offices is the Engineering Externship. Participants are paid according to the GS pay-grade system, which is beneficial for college students. Their GS level is determined according to credit-hours acquired from an accredited college. Engineering Extern participants generally practice field work as needed and office work.

Administration

The Indian Health Service is headed by Dr. Yvette Roubideaux, M.D., M.P.H., a member of the Rosebud Sioux in South Dakota. Dr. Roubideaux was confirmed by the U.S. Senate as IHS Director on May 6, 2009 and she was sworn in on May 12, 2009, replacing director Robert McSwain. McSwain served as Acting Director when Rear Admiral Charles W. Grim declined an additional term of service in September 2007; he was nominated by President George W. Bush, confirmed and appointed in May 2008.

Current issues

A 2010 report by Senate Committee on Indian Affairs Chairman Byron Dorgan, D-N.D., found that the Aberdeen Area of the Indian Health Service(IHS) is in a "chronic state of crisis." "Serious management problems and a lack of oversight of this region have adversely affected the access and quality of health care provided to Native Americans in the Aberdeen Area, which serves 18 tribes in the states of North Dakota, South Dakota, Nebraska and Iowa," according to the report.

In 2013 the Indian Health Service was hit hard by sequestration funding cuts of $800 million, representing a substantial percentage of its budget.

IHS Areas

• Aberdeen Area: Acting Director, Ron Cornelius, B.S., Oneida Tribe of Indians of Wisconsin. The name of this area was changed in 2014 to the "Great Plains" area.
• Alaska Area: Director, Christopher Mandregan, Jr., M.P.H., Aleut Community of St. Paul, Alaska
• Albuquerque Area: Director, RADM Richie K. Grinnell, R.S., M.P.H., Sac and Fox Nation of Missouri
• Bemidji Area: Acting Director, Jenny Jenkins, White Earth Band of Chippewa Indians
• Billings Area: Director, Pete Conway, M.Ed., Blackfeet Tribe
• California Area: Director, Margo D. Kerrigan, M.P.H., White Earth (Mississippi) Band of the Minnesota Chippewa Tribe
• Nashville Area: Director, Martha A. Ketcher, M.B.A, Cherokee Nation
• Navajo Area: Director, John Hubbard, Jr., M.P.H., The Navajo Nation
• Oklahoma Area: Director, RADM Kevin Meeks, Chickasaw Nation
• Phoenix Area: Director, Dorothy A. Dupree, B. Ed., M.B.A., Assiniboine and Sioux Tribes
• Portland Area: Director, Dean Seyler, B.S., Confederated Tribes of Warm Springs Reservation of Oregon
• Tucson Area: Acting Director, George W. Bearpaw, B.S., Cherokee Nation of Oklahoma

Budget

The 2010 United States federal budget includes over $4 billion for the IHS to support and expand the provision of health care services and public health programs for American Indians and Alaska Natives (AI/ANs). Investments in the Indian health system will focus on improving the health outcomes of AI/ANs and promoting healthy Indian communities. The Budget builds upon resources provided in the recovery Act for IHS. This covers 2.5 million Native Americans and Alaskan Natives for an average cost per person of $1,600, far less than the average cost of health care for other United States Citizens.