Although Health and Human Services Secretary Robert F. Kennedy Jr. has said he cares deeply about Native American communities, the health of those communities is under severe threat because of massive cuts Kennedy is making to federal health services, U.S. senators and tribal leaders said at a hearing held Wednesday.
Tribal leaders said that they appreciated that Kennedy had spared the Indian Health Service from layoffs that have rocked other parts of HHS but that cuts to other federal programs — including those that help prevent addiction, partner violence, and maternal mortality — were harming the health of Native Americans, who already face the nation’s lowest life expectancy, high rates of suicide, and many chronic diseases.
“I think it’s so ironic because during his confirmation process, he talked a lot about being a champion of Native people,” said Tina Smith, (D-Minn.). “In his role so far, the reality has been very different.”
The witnesses, tribal and native leaders from across the country, including Alaska and Hawaii, said there had been no consultation with tribes about the cuts, despite such consultations being a legal requirement at HHS if policy changes have tribal implications. The hearing, conducted by the Senate Indian Affairs Committee, took place immediately after Kennedy wrapped up hearings before another committee.
Sen. Lisa Murkowski (R-Alaska) said she was working with Kennedy’s office to ensure that he was aware of how HHS cuts would impact tribal communities, but acknowledged the frustration of tribal leaders.
“There is still much going on in this reorganization that we are still learning about,” she said, adding that Kennedy needed time to put full teams in place at HHS to consult with tribes.
Cuts of high concern for the leaders include staff reductions to the Substance Abuse and Mental Health Services Administration, which helps tribes grapple with high rates of addiction; termination of the CDC’s Healthy Tribes program, which focuses on preventing chronic disease; and closures of regional offices of the Administration for Children and Families, which helps tribal leaders apply for funding for programs such as Head Start, family violence prevention efforts, and grants to pay for heating and air conditioning for low income families. Others expressed concern about cuts to Medicaid — which provides 30-60% of funding to IHS — and to federally qualified health centers.
“Everybody’s gone and this was all done without consultation and with very little warning … and no ability to make plans,” said Loni Greninger, vice chair of the Jamestown S’Klallam Tribal Council in Sequim, Wash., who said HHS employees that were the conduit between more than 250 tribes in Alaska and the northwestern U.S. to the federal government were abruptly fired when their offices were consolidated. The tribes have now been assigned to an office in Denver.
“Do they know us? They don’t know who we are or our lands,” she said. Such partnerships with HHS employees are critical for working with the federal government and applying for grants. “They help translate our language into your language,” she said.
Many tribal leaders said they were concerned about the impact of federal cuts on maternal mortality — Native American mothers are two times more likely to die of pregnancy-related causes than white women. The Center for Disease Control and Prevention’s Pregnancy Risk Assessment Monitoring System, whose staff was placed on leave last month, is one of the few tools that track Native American infant and maternal mortality risk, said Janet Alkire, chairwoman of the Standing Rock Sioux Tribe in North Dakota.
She said cuts to a program to prevent sexually transmitted infections were harming efforts to bring a syphilis epidemic in the Great Plains under control.
Alkire said she was all for more government efficiency, including reducing the burdens of grant reporting and allowing direct payment of more federal funds to tribes, but added, “we must avoid new barriers such as DOGE ‘End the Spend’ which increases burdens and withholds funding from tribal citizens.”
Alkire said tribal leaders were frustrated they were not consulted by HHS or leaders and were not receiving answers to letters requesting more information. “We haven’t heard anything yet. That’s the issue all of America is dealing with.”
Sen. Ben Ray Luján (D-N.M.) is among those not getting responses. He could not contain his frustration that Kennedy had not responded to letters from U.S. senators, despite taking an oath he would do so. “Respond to the letter. Keep your word,” Lujan said.
“Nobody’s talking to anybody,” said committee vice chair Brian Schatz (D-Hawaiʻi) In emailed comments to STAT, Schatz said: “If Secretary Kennedy engaged in meaningful consultation with Tribes and the Native Hawaiian Community, he would learn about efforts HHS could take to actually support them — including full funding and advance appropriations for IHS and more funding for programs that serve Native communities.”
IHS has been chronically underfunded; some positions have vacancy rates of up to 25%. “Because they’re fundamentally underserved, [HHS cuts] will dramatically impact those communities disproportionately,” Georges Benjamin, executive director of the American Public Health Association, said at a press conference related to Kennedy’s Senate appearance Wednesday. “Even though Kennedy has said he’s trying to keep them at least at baseline, they’re pulling the rug from under them.”
An HHS spokesperson said in an emailed statement that “Secretary Kennedy remains committed to prioritizing tribal health and the IHS, as reflected in his statements at the recent STAC (Secretary’s Tribal Advisory Council) meeting. Importantly, IHS was not impacted by the recent workforce reductions, and there are no plans to consolidate any of its offices.”
Senators were also frustrated by the offer made to some of the thousands of HHS employees whose jobs were eliminated last month to remain employed if they transferred to IHS locations. Few of these offers appear to have been accepted, several IHS employees told STAT.
HHS did not answer questions about how many employees have accepted such positions but said, “To address staffing needs and support the IHS in fulfilling its mission, HHS has invited certain individuals to consider positions within the IHS. These invitations are voluntary, and individuals have the option to accept or decline.”
Smith called the offer “offensive” and said it did nothing to help IHS facilities. “Sending a research scientist who specializes in tobacco cessation research to an IHS facility when what’s needed is not research but clinical care doesn’t really help, does it?” Smith asked.
Even if IHS was spared at the last minute from the widespread layoffs of probationary employees across HHS, stress, uncertainty, restrictions on hiring and contracts, and the many requests from the U.S. DOGE Service have taken a toll, said a physician and leader at one Indian Health Service facility who spoke to STAT Wednesday and likened the atmosphere at their hospital to the early days of Covid.
“People are coming to work with that same sense of dread and anxiety,” said the physician, who asked that their name not be used because of fears they could lose their job. “We don’t know if our agency is going to survive. We don’t know if we’re going to have jobs.” The atmosphere has made retaining and recruiting staff harder than it had been.
The physician said that patient care was being impacted because clinicians and staffers were spending hours responding to time-consuming “data calls” from DOGE asking for information about staffing levels and contracts, and responding to directives from HHS, such as one that came recently to remove the word Covid from any signs in IHS facilities.
“It imposes on us the need to spend days and days, hours and hours, to meet these requests,” the physician said. “And it pulls people away from what they’d normally be doing, which is patient care.”
The physician said their facility’s staff had spent days reviewing every contract, from the hiring of pharmacists to the purchasing of wrist bands, which meant work on new contracts had ground to a halt, and that off-and-on hiring freezes and a restriction that allows them to only post a handful of job vacancies at a time meant they could not quickly fill vacancies, and instead had to hire contract physicians and nurses, which was much more expensive.
“That’s a market inefficiency contrary to how it’s being described in public,” the physician said. “I’d love to see improved federal efficiency, but the tools they are using are doing the exact opposite.”
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