Indian Health Service (ihs) Rural Health

A growing concern is the decreasing access to health care services for Americans living in rural, less populated areas. Many find themselves in regions that were not previously as rural as industries move away, taking with them economic prosperity and often medical providers. Others are in essential professions such as farming that by nature necessitate living in regions with fewer city accommodations and economic opportunities. Seeking space for one’s family and cultivating the land are valued goals that are deeply rooted in America’s fabric.

Both Congress and an Administration must continually keep in mind how health care policies uniquely affect these regions because their market trends and populations are different from those of more populous regions. Often, rural patients face an hour’s drive to the nearest medical provider or facility or have

The Indian Health Service serves our American Indian and Alaska Native popu- lations. Reforms are needed to improve America’s ability to deliver on its promises to these important populations and must take account of cultural preferences and lifestyles, limitations due to geography (such as challenging terrain), and limited Internet access. For example, contacting individuals within some of these com- munities and tribes during the COVID-19 pandemic proved to be difficult because many had transient addresses and unreliable cell service.

During the transition to the Biden Administration, IHS abandoned tribes as their sources of COVID-19 tests and vaccine supplies disappeared. It is important to guard against such situations in order to preserve these tribes’ access to health resources during public health emergencies (PHEs). Even before the pandemic, services available to these populations through federal resources and personnel (such as vision care) were often scarce or nonexistent.

Patients in these populations should be empowered to rely on alternatives to IHS through better access to private health care providers. Exploring positive reforms contained in the VA MISSION Act74 could reveal similar opportunities for increased options and access for American Indians and Alaska Natives. limited or no Internet access, which restricts their access to telehealth services (especially video visits).

To improve its health care policies that affect rural regions, HHS should:

Reduce the regulatory burden and unleash private innovation that can discover solutions to unique, local needs. Implement or encourage policies that increase the supply of health care providers, such as increased telehealth access and interstate licensure (a historically state matter), including for volunteers wishing to provide temporary, charitable services across state lines. Encourage flexibility in modes of health care delivery, including less expensive alternatives to hospitals and telehealth independent of expensive air ambulances.

OFFICE OF THE SECRETARY

The Secretary of Health and Human Services and the Office of the Secretary necessarily set the tone for the entire department. The Secretary is the most accountable individual within HHS and, along with his or her immediate staff, should therefore be responsible for setting the policies that govern the depart- ment’s operations instead of allowing the operational divisions to assume the leading role in policymaking, thereby diffusing responsibility. Practical reforms to enhance the Secretary’s accountability should include the following:

Restrict HHS’s ability to declare indefinite public health emergencies (PHEs). Currently, HHS is merely required to notify Congress of such a declaration within 48 hours. Congress should establish a set time frame for any PHE, placing on the Secretary the burden of proof as to why an extension of the PHE is necessary.

Reinstate the HHS SUNSET (Securing Updated and Necessary Statutory Evaluations Timely) rule.75 Congress should codify the now- reversed Trump Administration rule that required all HHS agencies to review regulations retrospectively and publish results; without such a review, regulations expire. Investigate, expose, and remediate any instances in which HHS violated people’s rights by:

1. Colluding with Big Tech to censor dissenting opinions during COVID.
2. Colluding with abortion advocates and LGBT advocates to violate conscience-protection laws and the Hyde Amendment.

OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH (OASH) / OFFICE OF THE SURGEON GENERAL (OSG)

The Assistant Secretary for Health (ASH) is the four-star admiral for the United States Public Health Service Commissioned Corps (USPHS), and the Surgeon Gen- eral (SG) is the three-star admiral.

The ASH is tasked with overseeing not only the USPHS, but also 10 regional health offices, multiple presidential and secretarial advisory committees, and other offices such as the Offices of Minority Health, Women’s Health, and Population Affairs. The Secretary can further expand the ASH’s responsibilities (for example, by

The Life Agenda. The Office of the Secretary should eliminate the HHS Repro- ductive Healthcare Access Task Force and install a pro-life task force to ensure that all of the department’s divisions seek to use their authority to promote the life and health of women and their unborn children. Additionally, HHS should return to being known as the Department of Life by explicitly rejecting the notion that abortion is health care and by restoring its mission statement under the Strategic Plan and elsewhere to include furthering the health and well-being of all Americans “from conception to natural death.”

The next Administration should create a dedicated Special Representative for Domestic Women’s Health. In the Trump Administration, there was a Special Representative for Global Women’s Health that focused on international issues, but this position lacked authority to be the lead on international policies because of overlapping issues with the U.S. Department of State and USAID (and at times a lack of clarity as to the lead point of contact and policy decisions at the White House). The new Special Representative would serve as the lead on all matters of federal domestic policy development related to life and family with support from the DPC for implementation and coordination among agencies. In the post-Dobbs era, advancing support for mothers will include coordination among agencies out- side of HHS, and the Special Representative would provide a clear focal point for all issues related to protecting life and serving families.

The Family Agenda. The Secretary’s antidiscrimination policy statements should never conflate sex with gender identity or sexual orientation. Rather, the Secretary should proudly state that men and women are biological realities that are crucial to the advancement of life sciences and medical care and that married men and women are the ideal, natural family structure because all children have a right to be raised by the men and women who conceived them.

designating the ASH as liaison to the CDC). The SG officially oversees the daily oper- ations of the USPHS, although those are actually under the control of the Director of the USPHS Commissioned Corps Headquarters. The SG also issues information to the public (Surgeon General’s advisories, Calls to Action, and Reports), serving in effect as a key public health spokesperson for the federal government.

USPHS officers are assigned to various agencies such as the CDC, NIH, and Bureau of Prisons. Their organizational structure is similar in some respects to the National Guard’s, and their salaries are paid primarily by the agencies to which they are assigned (which serves to limit USPHS appropriations). USPHS officers can be deployed on missions to respond to domestic or international crises (for example, a hurricane in Florida or an Ebola outbreak in Africa) at any time.

The USPHS should be restructured to make it more like its sister uniformed services with a more streamlined chain of command and corresponding appropriations to ensure efficiency and clarity of mission. Its core mission should be refocused to emphasize prompt, responsive deployments that meet specific criteria and are less dependent on the various agencies to which the officers are assigned. Fulfillment of specific tasks should not be duplicated by non-uniformed civil ser- vants and USPHS officers, and any roles that can be filled by civilians should be filled by them.

The ASH and SG positions should be combined into one four-star position with the rank, responsibilities, and authority of the ASH retained but with the title of Surgeon General and some of the SG’s communications responsibilities, which would include disseminating other HHS messages and sharing general medical advice without legal weight. The holder of this consolidated position, which should be filled by a health care provider, would be better positioned to ensure that the USPHS is properly focused and deployed.

With such reforms, the supporting office (previously the OASH and OSG) would be better equipped than other HHS offices or agencies to reduce silos and con- solidate or eliminate duplicative functions. Congress should consider legislation that would require this office to take such actions or at least make such recom- mendations to the Secretary. Such legislation would require a thorough analysis of the various legal authorities impacting the department’s current organiza- tional structure.

The position previously known as the Principal Deputy Assistant Secretary for Health should be combined with and have the title of Deputy Surgeon General and become a three-star position with operational control including financial and deployment decisions. The Director of the Headquarters should be responsible for implementing the decisions of the Deputy Surgeon General. Promoting Life and Family. In dealing with sexually transmitted diseases and unwanted pregnancies, the OASH should focus on root-cause analysis with a focus on strengthening marriage and sexual risk avoidance. Strong leadership is needed