“I cannot believe what has transpired here today,” said an incredulous Sen. Jon Tester, D-Montana, speaking to the interim director of the Indian Health Service.
“All I want is some damn answers, that’s it!” he yelled.
Rear Adm. Michael Weahkee, who has served as acting head of IHS since June, had no damn answers. He had no answers at all about his agency’s budget, not even whether the proposed budget was bigger or smaller than previous years.
Weahkee was a deer in the headlights, unable to satisfy the simplest of questions asked by the Appropriations subcommittee, such as whether the proposed budget for IHS would lead to better care or worse care at the agency’s hospitals and clinics.
The video of the exchange between Weahkee and the committee that is chaired by Sen. Lisa Murkowski has by now been widely by thousands of people on social media.
IHS’ performance is notoriously substandard throughout the 36 states in which it operates. The agency is on par in the public’s perception of care given by the Veterans Administration — except in Alaska, where Native care is often superior to what is available to the general public, and has become even more robust under Medicaid expansion, which allows care centers to recover funds from Medicaid in areas where IHS money falls short.
Asked whether the agency has been improved by Obamacare Medicaid expansion, Weahkee was tongue-tied.
“What would you say the number one need in [IHS] is right now?” Sen. Tester asked Weahkee.
“Absolutely, it’s shoring up our long-standing vacancies in some key leadership positions,” Weahkee answered.
“So it’s people?” Tester asked.
“People, yes sir,” Weahkee agreed.
“So what does this budget do to your ability to hire staff?” Tester asked.
“Um. We have a lot of efforts under way,” Weahkee said.
“Is there an increase in dollars for hiring staff or a decrease?” Tester asked.
“We prioritized maintaining direct care services,” Weahkee answered.
“As far as total dollars go, is there an increase in dollars for hiring staff or a decrease?” Tester persisted.
“Our priority has been on ensuring that we can continue –” Weahkee started.
“That’s not my question. You said it’s the number one issue facing. I agree with you, by the way. So does the budget, does it increase the number of dollars for hiring people or is it a decrease?” Tester asked again.
“Well, sir, we had to make a lot of tough decisions,” Weahkee answered.
“OK so it’s a decrease, so that’s what you’re saying?” Tester asked.
“Uhhh. No, sir. I didn’t say that,” Weahkee replied.
“So is it? Come on, man! Just answer the question! I’ll back you ’til your guts cave if the administration comes at you. But is it an increase or a decrease?” – Sen. Jon Tester, D-Montana
“Umm. It’s uh. We really prioritize…”
The grilling continued, and didn’t get any better.
“Have you been told not to answer any questions here by the way?” asked Tester.
“No,” Weahkee replied, stoically.
“Because I think it’s absolutely unbelievable that you can’t separate how much money that Mediciad has helped you with third-party billing. I mean, it’s at the point where I think we should almost demand an audit. Because that is not how things work. You should have those numbers on the tip of your tongue,” Tester lectured.
“I have never had, in 10 years on this committee, had somebody come up here and when I ask them a direct question they don’t answer it. I asked you a direct question on whether this budget is up or down and you refused to answer it and that is totally unacceptable,” Tester said.
MURKOWSKI MORE CIRCUMSPECT
Sen. Lisa Murkowski, who held the hearing yesterday in the Subcommittee on Interior, Environment and Related Agencies, said the Trump budget would cut the agency by 6 percent. Trump is asking for $4.7 billion for IHS. That’s about $2,100 per Native American. The proposed budget for the Department of Health and Human Services as a whole is 18 percent lower than last year under the Trump Administration.
“You have not answered my question on whether we have provided you sufficient resources,” Murkowski explained to Weahkee.
“There is anger, there is frustration and rightly so because as a government, as an agency, we our failing these people,” Murkowski said. “And there is a lot of focus right now on healthcare around the country, and what we do to make it right. Whether it’s the facilities and maintenance backlog that we’re dealing with and the real pressing need, whether it’s the opioid crisis that is hitting our Native people at astonishing rates and we see it all over the country but we’re looking at a cut, 6 percent cut, almost $13 million dollars in the budget for alcohol and substance abuse programs, within the domestic violence initiatives.”
“Again, I think about the headway that we have been making, we must continue to make, and I find difficulty with this budget in terms of how we can advance that. Do you think you can keep that commitment to improving the IHS with the levels that are proposed within this budget here?”
“Well ma’am, we see the budget as an initial proposal,” Weahkee replied. “That we are open to working with you and others to identify and help meet the needs of our American Indian and Alaskan Native people.”
“Well, sir, you have not directly answered the question, whether or not we have provided you with sufficient resources. That’s what this committee does as the appropriations subcommittee for the Interior, for oversight as IHS. We want to help you. We want to know that you’ve got the resources that you need because it’s my assumption that the three that I’m highlighting here—Rose Bud, Pine Ridge, and Winnebago—are just the ones make the Wall Street Journal. That there are other facilities, I know that there are other facilities.
“In Alaska, we are a different model, a different system. And I think that you know, certainly my colleagues here know, that usually I’m laser focused on the situation in Alaska, but I can’t stand down knowing that our system is failing so many of our Native people around the country.”
IHS is responsible for providing federal health services to approximately 2.2 million American Indian and Alaska Native from 567 federally recognized tribes in 36 states.
Conventional wisdom is that it underfunded, and some of its hospitals have been sanctioned for conditions that endanger patients. Its vacancy rate for doctors, dentists and physicians assistants is said to be 30 percent.
IS IT MONEY WELL SPENT?
Sufficient resources are in the eye of the beholder. The compensation for top executives in Alaska’s Native medical care centers is breathtaking.
For example, on the IRS forms for Alaska Native Tribal Health Consortium, Chairman and President Andrew Teuber was shown to be earning $626,104, plus another $32,000 on the organization’s 2014 federal filing. The chief financial officer made $647,000, and the chief executive officer made $500,000.
In that same year, Teuber was the president of Kodiak Area Native Association (KANA), where he brought in another $600,000 in compensation. You read that correctly — over $1.2 million in combined salary.
When President Barack Obama signed the Affordable Care Act — Obamacare — in March 2010, there were a number of provisions that dramatically expanded health coverage for the American Indian and Alaska Native population through Medicaid expansion.
But both the bookkeeping and results accountability of that investment is opaque, and Weahkee had no light to shine for the benefit of the committee.
Obamacare made special enhancements for the health of those in Indian Country. The law permanently authorized IHS and included American Indians and Alaska Natives in Medicaid expansion, which, not coincidentally, greatly benefited the bottom line of Native care centers in Alaska.
Along with expanding Medicaid to more Alaska Natives, Obamacare provided tribal staff members an additional benefit: federal employees’ health benefits.
The current health care bill being considered by the Senate would end Obamacare Medicaid expansion and cap future Medicaid funding.
Gov. Bill Walker of Alaska unilaterally accepted Medicaid expansion in 2015, without the approval of the Legislature, which is the appropriating body of the State. The expansion led to 23,000 more Alaskans being put on Medicaid roles, and health care being the only sector of the Alaska workforce that has seen growth under his administration, while the overall economy in Alaska has shrunk.
That sector’s growth has been based on federal fundin 90 percent level of the expanded Medicaid costs — funding that is unlikely to continue at those levels.
This will leave the State of Alaska with some very difficult decisions, balancing fiscal realities against the expectations of able-bodied adults without children who have been enrolled in Medicaid expansion.
In the meantime, anticipated costs to the state of the Medicaid expansion are running tens of millions of dollars over initial forecasts.