Executive Calendar
Floor Speech
BREAK IN TRANSCRIPT
Ms. WARREN. Mr. President, I rise today to call on President Trump to nominate a Director for the Indian Health Service.
There are many critical issues facing Indian Country--economic development, infrastructure, protection of Native lands, respect for Tribal governments--and after years and years of broken promises, discrimination, and neglect, Washington owes Tribes a fighting chance to build stronger communities and a brighter future.
The Federal Indian trust responsibility means that Washington has a basic legal obligation to the Tribes. Washington also has a fundamental moral obligation, and that starts with basic healthcare.
American Indians have treaty rights to healthcare from the Federal Government, but the U.S. Government cannot fulfill our treaty obligations if key posts, such as the Director of IHS, lay vacant for years.
The IHS is a big deal. It is the primary Federal healthcare provider for American Indians and Alaska Natives. It serves 2.2 million people spread across 36 States. It has a budget of nearly $5 billion annually. The IHS provides care through more than 660 clinics, hospitals, and health stations on or near reservations, many of them in remote and rural locations located hours away from other health facilities. It serves more than 13 million outpatient visitors a year.
The doctors, nurses, and other healthcare providers at IHS hospitals and clinics do everything from delivering babies, to providing dental services, to fighting the opioid crisis.
Right now, more than a year into President Trump's term, there is still no permanent leader at the Indian Health Service. Two weeks ago, the nomination for IHS Director was withdrawn, and there hasn't been a Senate-confirmed Director for years. This leadership vacuum creates a serious problem. The IHS cannot engage in long-term planning without a permanent Director at the helm. It cannot officially fix problems at hospitals that failed inspections and where Medicare and Medicaid funding is in jeopardy. It cannot move as decisively to ensure that IHS facilities stay open. It cannot implement agency-wide standards for quality of care, as the Government Accountability Office has recommended. The IHS cannot prioritize competing issues, solve serious and longstanding problems, or work through how to meet multiple goals more effectively.
Its relationship with other Federal agencies is weakened without a stable leader--critical relationships with the Centers for Medicare and Medicaid Services, the Office of Management and Budget, the Substance Abuse and Mental Health Services Administration, and the rest of the Department of Health and Human Services. It cannot ensure that programs like the Special Diabetes Program for Indians, which has created real, positive outcomes, is implemented as well as possible. The IHS cannot work out a direction for the Service and hold a single stable leader accountable for doing a good job.
The IHS faces serious challenges that require the attention of a permanent, dedicated Director. The agency is underfunded and has been underfunded for a long time. As a result, its facilities often lack medical equipment that many Americans take for granted when they visit a clinic or a hospital, like an MRI machine or a functioning operating room. A 2016 report by the inspector general of the U.S. Department of Health and Human Services found that IHS hospital administrators have had difficulty recruiting and retaining critical staff. Aging hospital buildings and outdated equipment also raise concerns about patient safety. The inspector general cites concerns about corroded pipes leaking sewage into the OR and not being able to find replacement parts to fix old equipment the hospitals are relying on. Doctors and nurses should be able to focus on helping their patients get well, not on whether the building is habitable and basic facilities are available.
There are also serious staffing shortages. At its Great Plains facilities, for example, IHS vacancy rates have reached 37 percent. Compare that to my home State of Massachusetts, where only 6 percent of nursing jobs were vacant in 2015.
Tribal leaders are understandably concerned about the direction of an agency that plays such a vital role in their communities. Here is what I heard from Chairwoman Cheryl Andrews-Maltais, of the Wampanoag Tribe of Gay Head--the Aquinnah--in Massachusetts: ``This vacancy has created significant instability and negatively affects the already burdened IHS system.'' She added: ``Not only is it a failure on the part of the Federal Government to not adequately fund healthcare for Indians; the failure to appoint someone to lead this critical service area is considered by many Tribes as gross negligence.'' The chairwoman says that the United States is failing to keep its word and failing to fulfill its ``solemn responsibility'' to the Tribes. I agree with the chairwoman.
Healthcare is a basic human right, and everyone in this country deserves access to quality, affordable healthcare. But the stakes are particularly high for Native people.
An American Indian or Alaska Native baby born today has a life expectancy that is almost 4\1/2\ years shorter than the U.S. average. These little babies are also more likely to die before they ever reach their first birthday. Native infant mortality is about 25 percent higher than for the U.S. as a whole.
Chronic diseases like diabetes and heart disease hit Native Americans harder too. For instance, American Indians and Alaska Natives die from diabetes at a rate that is three times higher than that of the entire American population.
Mental health and addiction issues are also a very big concern. The opioid epidemic has devastated communities all over our country, but it is a particularly virulent problem for Native Americans, who have the highest per capita rates of opioid overdoses in the country.
Similarly, the alcohol-related death rate for Native Americans is about 500 percent higher than for the rest of the population.
Suicide rates are about 70 percent higher.
Everyone struggling with addiction deserves access to high-quality treatment, no matter who they are or where they live. That is the only way we are going to make progress in tackling this crisis. But right now, in a place where the need is great, the Federal Government is failing to provide adequate care.
With so much need, investing in improving the IHS should be a top priority for Washington. I am glad that the Trump administration's latest budget for the IHS includes a funding increase. Still, this government needs to do more--much more. A Senate-confirmed Director can serve as the advocate the IHS needs in order to get the resources it deserves. In fact, Federal law explicitly says that advocating good Indian health policy is one of the Director's job responsibilities. We should be doing that job.
We need a good person in this job, which means the nominee must be thoroughly vetted. But that is not an excuse for more delay or for the White House to drag its feet. It needs to work with the Tribes to find the right person for the job and then submit the nomination quickly.
The person who heads up the IHS should be knowledgeable and should have a vision for how to deliver better healthcare to Native Americans. The person should have the determination and commitment to push Congress to meet its treaty obligations in providing healthcare to Native communities.
The Trump administration doesn't have a stellar record when it comes to nominating the right people for important jobs. I often strongly disagree with the President's picks. But leaving hundreds of critical posts across our government vacant, including the IHS Director, has a devastating effect all its own.
It wasn't until just 2 weeks ago that President Trump finally named a nominee to be Commissioner of the Administration for Native Americans.
Several offices in the Federal bureaucracy have an important role in running important programs for Tribes, and the President hasn't nominated heads for some of those offices--for instance, the Director of the Department of Justice's Office on Violence Against Women, which administers key grant programs for Tribal programs to combat domestic violence and sexual assault, and the Assistant Secretary of the Employment and Training Administration in the Department of Labor, which provides workforce innovation and opportunity grants to Tribes and Tribal organizations. These vacancies hit Native communities hard, and they represent one more broken promise to Native people.
There is no excuse for delay. I urge President Trump to move quickly to consult with Tribes and to submit a nomination for IHS Director. The Native community should not have to wait any longer.
BREAK IN TRANSCRIPT
Source