May 6, 2025
Contact: Justin Krakoff/Maggie Sunstrum (Merkley) – 202-224-3753
Contact: Mike Inacay (Schatz) – 202-224-3123
Contact: Hannah Ray (Murkowski) – 907-276-3217
Merkley, Schatz, Murkowski Sound the Alarm Over Staffing Shortages at the Indian Health Service
Washington, D.C. – Senate Interior-Environment Appropriations Subcommittee Ranking Member Jeff Merkley (D-Ore.), Senate Indian Affairs Vice Chairman Brian Schatz (D-Hawai‘i), and Senate Indian Affairs Chairman and Senate Interior-Environment Appropriations Subcommittee Chairman Lisa Murkowski (R-Alaska) demanded urgent action from U.S. Department of Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr. to ensure the Indian Health Service (IHS) has the necessary resources and staffing to fully deliver health care services for American Indians and Alaska Natives, as required by federal law.
In their letter to HHS Secretary Kennedy, the bipartisan group of lawmakers called for the IHS to immediately halt any further actions affecting Tribal health care delivery without first engaging in meaningful Tribal consultation. The lawmakers stressed that the IHS services among the most vulnerable populations, with American Indians and Alaska Natives experiencing disproportionate rates of mortality from many major health issues and having an average life expectancy equal to that of the general U.S. population living in 1944.
“The impacts of the hiring freeze for other positions playing crucial roles administering services at IHS continues to exacerbate existing clinical staffing issues. IHS cannot deliver quality health care without sufficient personnel – not just physicians, nurses, dentists, and mental health professionals, but also laboratory technicians who perform tests and process and collect specimens, and administrative personnel who perform essential tasks, including billing, appointment scheduling, and ensuring IHS facilities maintain their accreditation,” Merkley, Schatz, and Murkowski wrote.
“Additionally, the civilian staff reductions at the U.S. Public Health Service (USPHS) headquarters threatens support functions for approximately 1,200 USPHS officers serving at IHS and Tribal facilities,” they continued. “The loss of administrative infrastructure for payroll, assignments, and special pays will disrupt healthcare delivery in remote Tribal communities. In short, all these positions are imperative to delivery of wrap around health care services to American Indian and Alaska Natives, and staffing cuts, hiring freezes, and staff buyouts are exacerbating the already chronic problem of understaffing at IHS.”
The Senators stressed, “Such cuts also put IHS facility accreditation in danger, as understaffed facilities have little chance of meeting accreditation standards. Losing accreditation would further erode trust in the system and limit access to life-saving care for Native communities…The all too frequent occurrence of incidents that put IHS facility accreditation in jeopardy are precisely why Congress provides $58 million annually for accreditation emergencies: to help IHS make emergency hires to maintain accreditation – and ultimately save lives.”
Full text of the letter can be found by clicking here and follows below:
Dear Secretary Kennedy:
We write to express our deep concerns regarding the Indian Health Service’s (IHS) ability to meet its health care obligation amid recent federal actions that diminish the quality of and access to health care and erode the federal government’s trust responsibility by failing to meaningfully consult with Tribal governments. We urge you to take immediate action to ensure that the IHS programs serving Native communities have the resources and staffing necessary to fulfill their missions and halt any further actions affecting Tribal health care delivery without first engaging in meaningful Tribal consultation.
The IHS provides health care services to approximately 2.8 million American Indians and Alaska Natives, an obligation enshrined in federal law, treaties and through the trust responsibility. As trustee, you must know that the IHS service population is among the most vulnerable in our nation, falling behind in nearly every health metric. American Indians and Alaska Natives experience disproportionate rates of mortality from most major health issues, including chronic liver disease and cirrhosis, diabetes, unintentional injuries, assault and homicide, and suicide, and currently have an average life expectancy equal to that of the general U.S. population living in 1944. Accordingly, the National Indian Health Board recently passed a resolution emphasizing the need for continued and increased staff at IHS, urging the federal government to exempt the IHS and other Indian health programs from any staffing cuts and to instead commit to prioritizing hiring for Tribal health programs, including the IHS. So while we appreciate that you have exempted IHS from probationary employee staffing reductions and exempted a limited number of IHS employees from the hiring freeze to date, it is critical that other Native-serving agencies within your Department be treated similarly.
The impacts of the hiring freeze for other positions playing crucial roles administering services at IHS continues to exacerbate existing clinical staffing issues. IHS cannot deliver quality health care without sufficient personnel – not just physicians, nurses, dentists, and mental health professionals, but also laboratory technicians who perform tests and process and collect specimens, and administrative personnel who perform essential tasks, including billing, appointment scheduling, and ensuring IHS facilities maintain their accreditation. Additionally, the civilian staff reductions at the U.S. Public Health Service (USPHS) headquarters threatens support functions for approximately 1,200 USPHS officers serving at IHS and Tribal facilities. The loss of administrative infrastructure for payroll, assignments, and special pays will disrupt healthcare delivery in remote Tribal communities. In short, all these positions are imperative to delivery of wrap around health care services to American Indian and Alaska Natives, and staffing cuts, hiring freezes, and staff buyouts are exacerbating the already chronic problem of understaffing at IHS.
Such cuts also put IHS facility accreditation in danger, as understaffed facilities have little chance of meeting accreditation standards. Losing accreditation would further erode trust in the system and limit access to life-saving care for Native communities. Additionally, staffing issues can negatively impact the ability of a facility to meet the CMS Medicare Conditions of Participation and Coverage (COPs) or Conditions for Coverage (CFC) requirements. Several high-profile instances where IHS hospitals were found to be in severe condition previously led inspectors from the Centers for Medicare and Medicaid Services (CMS) to threaten the loss of Medicare and Medicaid reimbursement and participation in third-party insurance networks. The all too frequent occurrence of incidents that put IHS facility accreditation in jeopardy are precisely why Congress provides $58 million annually for accreditation emergencies: to help IHS make emergency hires to maintain accreditation — and ultimately save lives.
Finally, we must remind you that meaningful Tribal consultation should be at the forefront of any discussions regarding potential changes at HHS, including the IHS. This foundational tenet of the federal government’s trust relationship empowers Tribes to be a part of policymaking on a government-to-government basis. We are concerned about reports that senior officials from HHS agencies are being reassigned to IHS positions in Alaska, Montana, and Oklahoma without consideration of Tribal needs, Indian Preference requirements, or IHS service priorities. It appears that HHS has failed to meaningfully consult with Tribes on recent actions, which has negatively impacted the federal-Tribal relationship, and we urge you to seek Tribal input and consult on any future federal action impacting their interests.
Native communities deserve reliable access to quality health care, and we urge you to reevaluate all actions that jeopardize delivery of any health care services for American Indians and Alaska Natives. We look forward to your prompt response and request a bipartisan meeting with you and the Senate Appropriations Committee and the Senate Committee on Indian Affairs staff to address our concerns set forth above.
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