Honoring Native American Heritage

By U.S. Sen. Mike Rounds (R-S.D.)
Nov. 9, 2017

The rich and vibrant history of Native Americans is deeply woven into the fabric of America, especially in South Dakota. I believe we should celebrate our diversity. To honor their culture and the countless contributions Native Americans have made to our society, President Trump recently designated November as National Native American Heritage Month.

Native Americans called South Dakota home long before Europeans settled in the West. South Dakota was originally a part of the vast territory of the Dakota, Lakota and Nakota people. A number of other tribal nations include the Dakota Territory in their histories as well.

Today, our state is home to nine sovereign tribal governments, comprising more than 70,000 enrolled members. I have appreciated the opportunity to work closely with tribal government leaders on a number of initiatives both during my time as governor and now as a senator.

One priority of mine has been to improve the quality of care at Indian Health Service (IHS) facilities in South Dakota. It is well-known that IHS has failed to live up to its trust responsibility to provide health care services to Native Americans, particularly in the Great Plains Region which includes our state. Decades of mismanagement and poor leadership at IHS have resulted in a health care crisis created by government bureaucrats.

The IHS facilities within the Great Plains Region have the worst health care outcomes of any of the 12 regions nationwide, including the lowest life expectancy, highest diabetes death rate, highest tuberculosis death rate and the highest overall age-adjusted death rate. This is unacceptable.

I have repeatedly said that the first step to fixing the crisis is to understand where the problems lie within the agency itself. For this reason, I introduced a bill that calls for an outside assessment of IHS. My bill would require an in-depth look at the overall financial structure, organizational structure and quality of care at the agency. The Senate Committee on Indian Affairs recently held a legislative hearing on our bill. The hearing was productive, and the testimony from Sisseton-Wahpeton Oyate Chairman Dave Flute in support of our IHS assessment bill was helpful in educating committee members about the severity of the problems at Great Plains Region IHS facilities.

Our proposal is now moving forward in the Senate. The problems at IHS are at a crisis level, and our bill is a first step toward getting the agency back on track. The federal government must live up to its trust and treaty responsibility to provide quality health care to Native American citizens.

This month, as we honor the culture of our Native American friends and neighbors, I encourage South Dakotans to also acknowledge the hardships they have faced throughout history and those they continue to face today. The health care crisis at IHS is just one example of how the government has failed to follow through on its obligations to tribal members, and I will continue fighting to fix this problem.

Rounds Delivers Opening Statement on his IHS Assessment Bill

November 8, 207

WASHINGTON—U.S. Sen. Mike Rounds (R-S.D.) today spoke in support of his legislation, S. 465, the Independent Outside Audit of the Indian Health Service Act of 2017, during a Senate Committee on Indian Affairs hearing. Since taking office in 2015, Rounds and his staff have analyzed the IHS and its shortcomings, concluding there are three primary areas of concern: there is no funding allocation strategy for the 12 IHS regions, there is no standard of quality measurement and there is high turnover of staff resulting in low accountability amongst management. Rounds’ assessment legislation is the first step toward setting us on a path to address the agency’s longstanding failures.

“For years, tribal members in my home state of South Dakota have dealt with unimaginable horrors in dealing with IHS facilities,” said Rounds in his opening remarks. “Tribal members are suffering and even dying due to inadequate and disgraceful care. IHS will only continue to fail unless we take a close look into the operations, funding, quality of care, and management at IHS. I believe that a comprehensive assessment of IHS is a necessary first step toward making calculated and systematic changes at IHS.”

 Rounds’ remarks as prepared for delivery:

Good afternoon, I first want to start off by thanking Chairman Hoeven, Vice-Chairman Udall and the members of the Senate Committee on Indian Affairs for their dedicated service to the Native American communities.

Today, I am introducing my bill to provide for a comprehensive assessment of the Indian Health Service, S.465.

As you know, the IHS is the agency responsible for providing health care for American Indians and Alaska Natives as required by federal treaty agreement.

For years, tribal members in my home state of South Dakota have dealt with unimaginable horrors in dealing with IHS facilities.

Upon taking office in 2015, my staff and I have spent significant time trying to learn more about these problems.

In our research, we found four primary areas of concern: there is no funding allocation strategy for the 12 IHS regions, there is no standard of quality measurement, there is high turnover of staff resulting in low accountability amongst management and there is no consultation with tribes.

The IHS serves approximately 2.2 million Native Americans, who are members of 567 federally recognized tribes.

For fiscal year 2017, IHS was appropriated just under $5 billion dollars in discretionary funding and $147 million dollars in mandatory funding from the Special Diabetes Program.

This does not include third-party collections of approximately $1.1 billion dollars.

Despite a large user population and an annual appropriation of $5 billion, IHS does NOT have a funding formula.

Regional allocations are not based upon the number of people who received healthcare through IHS, regional user population growth or types of services offered.

While many believe that IHS is underfunded, from my standpoint, investing more taxpayer money into a dysfunctional system will only compound the problem. IHS lacks an efficient system and accountability; this needs to be addressed before we consider funding. Then, I agree it will be time to talk about adequate funding.

Furthermore, there are no consistent qualitative measurements. The most recent qualitative measurements are from 2008 – nearly a decade old – so it’s unclear if IHS management has a sense of which regions are successful or failing.

IHS divides itself into 12 service areas in the United States. IHS’s Great Plains Area, which serves South Dakota tribal members, has the worst health care disparities of all IHS regions, including:

  • Lowest life expectancy,
  • Highest diabetes death rate, 5 times the U.S. average,
  • Highest TB death rate, and
  • Highest overall age adjusted death rate.

To give you an idea of some of the things we are seeing and hearing in our area:

  • The Wall Street Journal reported in June 2017, “At the Indian Health Service hospital in Pine Ridge, South Dakota, a 57-year-old man was sent home with a bronchitis diagnosis—only to die five hours later of heart failure.”
  • When a patient at the federal agency’s Winnebago, Nebraska, facility stopped breathing, nurses responding to the “code blue” found the emergency supply cart was empty, and the man died.
  • In Sisseton, South Dakota, a high school prom queen was coughing up blood. An IHS doctor gave her cough syrup and antianxiety medication; within days she died of a blood clot in her lung.
  • And just this August, IHS officials announced that patients who have recently received care at the podiatry clinic in the Winnebago IHS Hospital may have been exposed to HIV and hepatitis.

Because there are not standard of quality expectations and a methodology to measure quality; these facilities are failing very basic quality performances that our people deserve. In fact, the quality problems have become so pervasive, that the Centers for Medicare and Medicaid Services, or CMS, accreditation of several IHS facilities are in jeopardy.

Throughout the past year-and-a-half, the Rosebud and Pine Ridge Hospitals in the Great Plains Region have been operating under a Systems Improvement Agreement with CMS trying to regain their accreditation status.

Thankfully, the Systems Improvement Agreement at Rosebud was completed on September 1st of this year.

However, our office was made aware of multiple timeline extensions in Pine Ridge because these IHS direct-care facilities continued to fail CMS surveys.

Just last Friday, the Pine Ridge IHS Hospital was deemed not in compliance with CMS’s conditions of participation for emergency services. By issuing a final notification for the Pine Ridge IHS Hospital, the facility is in immediate jeopardy status and hospital’s provider agreement will be terminated at the end of next week.

Termination means that IHS can no longer bill Medicare for services, impacting Medicaid funding as well. Further, future third-party revenue available to IHS to fund services, maintenance projects and other necessary costs will likely be reduced.

Finally, there is high turnover throughout the entire IHS organization.

For example, within my home state’s Great Plains Region, we’ve had 5 different area directors in the last 21 months. That’s an average tenure in this important management position of roughly 4 months. And as you may know, nationally there has not been a permanent director leading IHS since February of 2015.

Tribal members are suffering and even dying due to inadequate and disgraceful care.

IHS will only continue to fail unless we take a close look into the operations, funding, quality of care, and management at IHS. I believe that a comprehensive assessment of IHS is a necessary first step toward making calculated and systematic changes at IHS.

S. 465 would accomplish this goal and set us on a path to address the long standing failures of IHS.

My legislation would require the Inspector General of the Department of Health and Human Services to conduct an assessment of IHS’s health care delivery systems and financial management processes only at direct-care facilities. Let me be clear, this assessment is not proposed for tribes with 638 Agreements in place; only direct IHS facilities.

This assessment I am proposing is a proven model for identifying potential reforms. We all remember the problems in 2014 in Veterans Administration health care. To address this issue Congress passed legislation calling for the Secretary of the VA to conduct an overall and systematic assessment of VA healthcare.

The integrated report was completed within the mandated timeframe of less than a year, and was officially submitted to the Secretary of the VA in September 2015. The assessment provided feedback and recommended changes that could lead to improvement in health outcomes.

The same should be done for the Indian Health Service.

Thank you.

Thune, Rounds Reintroduce Tribal Veterans Health Care Enhancement Act

February 3, 2017

WASHINGTON — U.S. Sens. John Thune (R-S.D.) and Mike Rounds (R-S.D.) today reintroduced the Tribal Veterans Health Care Enhancement Act, legislation that would improve tribal veterans’ access to health care. The bill, which was first introduced in the 114th Congress, would allow the Indian Health Service (IHS) to cover copay costs for tribal veterans who are referred by IHS to the Veterans Health Administration (VA) for services that are unavailable at IHS facilities. These referrals often require a copay that is currently the responsibility of the veteran. The bill would also require IHS and VA, in consultation with Indian tribes, to outline an implementation plan through a memorandum of understanding.

“Since tribal veterans are frequently referred to the Veterans Health Administration by the Indian Health Service for services the agency cannot provide on its own, it only makes sense that these copays would be covered,” said Thune. “Ask any tribal veteran, and they will tell you there is always more work that can be done to streamline the coordination between these two federal agencies. There is no question that passing this legislation would be an incremental step toward achieving that goal.”

“No veteran should have to worry about additional costs when seeking health care services, particularly our Native American veterans,” said Rounds. “The Tribal Veterans Health Care Enhancement Act is a step toward fulfilling our promise to provide care for both our tribal and veteran populations.”

The Tribal Veterans Health Care Enhancement Act would:

·         Allow for IHS to pay for veterans’ copayments for services rendered at a VA facility, pursuant to an IHS referral;

·         Require IHS and VA to enter into a memorandum of understanding to provide for such payment; and

·         Require a report within 90 days of enactment with respect to:

o   The number, by state, of eligible Native American veterans utilizing VA medical facilities;

o   The number of referrals, by state, received annually from IHS to the VA from 2011 to 2016; and

o   Update on efforts at IHS and VA to streamline care for eligible Native American veterans who receive care at both IHS and VA, including changes required under the Indian Health Care Improvement Act and any barriers to achieve efficiencies.

Democrats Respond to the Final Meeting of the South Dakota Health Care Solutions Coalition

January 11, 2017

PIERRE – State Senate Assistant Democratic Leader Troy Heinert of Mission released the following statement in response to the final meeting of the South Dakota Health Care Solutions Coalition and the end of discussions on expanding Medicaid in South Dakota:

State Senate Assistant Democratic Leader Troy Heinert.

“Expanding Medicaid in South Dakota, by Governor Daugaard’s own estimates, would have closed the coverage gap for 55,000 working-class South Dakotans, injected hundreds of millions of dollars of federal money into our state, and would have helped improve the care at Indian Health Services in our state.

“Democrats have worked tirelessly to take this commonsense step to improve healthcare in our state and boost our economy. Unfortunately, due to too many members of the Republican caucus in Pierre caring more about party than the people of South Dakota, it could not get through the Legislature. This is a dark day in the history of our state; South Dakotans deserve much, much better from their leaders. Every Republican legislator who worked against expanding Medicaid owes the people of South Dakota an apology.

“Democrats in Pierre will continue to do everything we can to expand access to affordable, quality health care to every South Dakotan. We hope our Republican colleagues will be ready to join us soon for the sake of the people of South Dakota.”


Indian Health Service Reform Bill Approved By Committee, Heads to Full Senate

Legislation Would Bring Accountability to IHS, Greater Peace of Mind to Tribal Citizens

September 21,2016

WASHINGTON  Today the Senate Committee on Indian Affairs approved the Indian Health Service (IHS) Accountability Act of 2016, introduced earlier this year by U.S. Sens. John Thune (R-S.D.) and John Barrasso (R-Wyo.), chairman of the Indian Affairs Committee. Thune’s bill, which is cosponsored by U.S. Sens. Mike Rounds (R-S.D.), John McCain (R-Ariz.), and Steve Daines (R-Mont.), represents one of the most comprehensive IHS reform bills introduced in the Senate this Congress, and if enacted, would bring some much-needed change and accountability to the federal agency responsible for providing quality health care to tribal citizens in South Dakota and around the United States.

“Creating a culture change at a federal government agency is never an easy task, but that doesn’t mean we should shy away from the hard work that’s required to ensure tribal citizens receive the quality care to which they’re entitled,” said Thune. “In crafting this legislation, we’ve been deliberate in our effort to work with a wide range of stakeholders and take into consideration their feedback and concerns. I’ve said all along that we wouldn’t be able to achieve meaningful reform without this important consultation, and I believe that today more than ever.”

“I thank Chairman Barrasso and Sen. Thune for their work to improve the quality of care at IHS,” said Rounds. “Any time we can make improvements to Native Americans’ access to health care, it’s a good thing, and the Indian Health Service Accountability Act is a step in the right direction as we seek ways to fix the broken IHS system. I’m pleased to see this important bill pass out of committee so we can continue to debate and amend it on the full Senate floor.”

The IHS Accountability Act of 2016 would improve transparency and accountability at the IHS by:

  • Expanding removal and discipline authorities for problem employees at the agency;
  • Providing the HHS secretary with direct hiring and other authorities to avoid long delays in the traditional hiring process;
  • Requiring tribal consultation prior to hiring area directors, hospital CEOs, and other key leadership positions;
  • Commissioning Government Accountability Office reports on staffing and professional housing needs;
  • Streamlining the volunteer credential process and providing federal liability insurance to those providers who volunteer their time at an IHS service unit;
  • Mandating that the HHS secretary provide timely IHS spending reports to Congress; and
  • Requiring IHS to engage in a negotiated rulemaking to develop a rule regarding tribal consultation policy for IHS.

The IHS Accountability Act also addresses staff recruitment and retention shortfalls at IHS by:

  • Addressing gaps in IHS personnel by giving the HHS secretary flexibility to create competitive pay scales and provide temporary housing assistance for medical professionals;
  • Improving patient-provider relationships and continuity of care by providing incentives to employees; and
  • Giving the HHS secretary the ability to reward employees for good performance and finding innovative ways to improve patient care, promote patient safety, and eliminate fraud, waste, and abuse.  

In June, at Thune’s request, the Indian Affairs Committee held an oversight and legislative field hearing in Rapid City, South Dakota, on the IHS Accountability Act. Prior to the field hearing, committee staff led a town hall meeting to hear firsthand from stakeholders about the IHS and receive feedback on the bill.

Canada, Germany, Japan, Kuwait, The Netherlands, and the United States  Pledging 2 Billion Dollars in Support of Iraq

Office of the Spokesperson
U.S. Department of State
Washington, DC
July 21, 2016

Over $2 billion in new money has been pledged for the people of Iraq in response to Da’esh’s campaign of tyranny that has resulted in enormous suffering, deprivation, and devastation for the Iraqi people. To help address the grave conditions faced by those displaced in Iraq, the international community has surged forward to provide desperately needed humanitarian support such as food, water, and shelter for those in need, and to help create the conditions that will allow the safe and voluntary return of displaced families to liberated areas as quickly as possible. The foundations for long-term stability can be achieved if Iraq’s humanitarian crisis is alleviated and its citizens are able to return to their homes safely, with access to basic services, healthcare, and education, and hope for economic prosperity.

As a result of the conference, led by the co-hosts Canada, Germany, Japan, Kuwait, The Netherlands, and the United States, the international community mobilized to meet near-term funding requirements for Iraq in four critical-need areas:

  • humanitarian assistance;
  • demining;
  • UNDP’s Funding Facility for Immediate Stabilization;
  • UNDP’s new Funding Facility for Expanded Stabilization (FFES), endorsed by Prime Minister Abadi to provide pivotal, medium-term stabilization initiatives to foster resiliency and recovery in Da’esh liberated areas.

The humanitarian assistance raised yesterday primarily supports United Nations agencies operating in Iraq, as well as other international organizations and non-governmental organizations. Through these organizations, the international community has provided resources for assistance to every governorate in Iraq, helping people who need it most—ultimately saving lives and alleviating human suffering amid daily threats of violence from Da’esh. The stabilization pledges generated through this initiative will contribute meaningfully to longer-term reconciliation efforts within Iraq, the success of which is vital for the country’s longer-term stability and recovery from Da’esh oppression.

The donors that gathered remain committed to assisting Iraq, and strongly urge all governments, organizations, and individuals to support the lifesaving efforts of the UN and its funds and agencies, in addition to other humanitarian partners. We are particularly gratified by the presence at yesterday’s conference of the Organization of Islamic Cooperation, and welcome its efforts to broaden advocacy efforts on behalf of the Iraqi people.

As donors, we remain cognizant as well that success on the battlefield enacts a disproportionate toll on the civilian population. The United Nations announced July 20 that it will require an additional $284 million in order to plan for the humanitarian impact of Mosul’s liberation, while far more will likely be needed to mitigate this challenge as Da’esh is defeated in Mosul. We therefore hope the results of the initiative allow donors to more speedily align their pledged contributions against elements of the United Nations latest appeal.

While not a comprehensive listing of the pledges tabled during the event, the following highlights signal achievements of the Pledging Conference in Support of Iraq. The list excludes 2017 and 2018 commitments from those donors not able to specify publicly their out-year programming.

Conference Highlights:

Responsive and Robust Humanitarian Assistance Pledges

A total of 26 donors pledged contributions totaling more than $590 million for humanitarian assistance in support of Iraq, through bilateral and multilateral channels. These funds will support the needs identified in the United Nations 2016 Humanitarian Response Plan for Iraq, in addition to other organizations providing aid in Iraq and the region, and lay the groundwork for a more effective international response to the anticipated humanitarian challenges attendant to the Mosul campaign.

Support for Stabilization Programming

Fourteen nations announced new funding for critical stabilization programming in Iraq, pledging more than $350 million. An even larger number of countries made additional pledges totaling $125 million for UNDP’s Funding Facility for Immediate Stabilization, a significant advance towards meeting the $180 million requirement identified by the United Nations for 2017.

Dedicated Funds for Humanitarian Demining Activities

More than ten nations made over $80 million in new pledges for demining efforts in Iraq. This support will provide approximately three-quarters of the total amount of funding the United Nations estimates is required for one year of demining activities in Iraq.

Launching the Funding Facility For Expanded Stabilization

The United States was the first major donor, with $50 million, to pledge funding to the new UNDP Funding Facility for Expanded Stabilization. FFES facilitates recovery and resilience in Da’esh liberated areas, providing project-specific funding to support rehabilitation of facilities to restore critical, public services and create jobs. The UN estimates that teaching colleges, hospitals, and universities eligible for FFES support will be able to employ an estimated 17,000 to 20,000 people in each of the areas previously devastated by Da’esh.

Long-Term Commitment to the People of Iraq

In addition to securing immediate funds for near-term humanitarian needs and critical stabilization programming, the Pledging Conference in Support of Iraq secured more than $200 million in commitments for 2017 and 2018 to address demining, stabilization and humanitarian needs. This funding pipeline provides international organizations and NGOs with the flexibility and programing safety-net required to address unforeseen humanitarian crises or respond rapidly to evolving stabilization challenges.

Democratic U.S. House Candidate Paula Hawks to Host West River Town Halls Next Week

 Sioux Falls, SD July 13, 2016 – U.S. House candidate Paula Hawks will host several West River Town Halls next week to discuss agriculture, Indian healthcare and take questions from those in attendance. The events are free and open to the public.

Spearfish Town Hall – Monday, July 18th

Location: Grace Balloch Memorial Library – 625 N. 5th Street, Spearfish, SD 57783

Time: 6:00 – 7:00 PM MST

Custer Town Hall – Tuesday, July 19th

Location: Re-Treat Room – 21 N. 4th Street, Custer, SD 57730

Time: 6:00 – 7:00 PM MST

Rapid City Town Hall – Wednesday, July 20th

Location: Rapid City Public Library – 610 Quincy Street, Rapid City, SD 57701

Time: 6:00 – 7:00 PM MST