Tribal leaders tell House subcommittee IHS must modernize 638 contracting but warn against centralizing negotiators

A House Natural Resources Subcommittee on Indian and Insular Affairs field hearing reviewed Indian Health Service (IHS) plans to modernize implementation of Public Law 93-638, the Indian Self-Determination and Education Assistance Act, and to realign certain IHS functions.

Chair opening remarks framed the oversight goal: tribes now manage a majority of IHS-funded programs and the agency must improve contract processing, transparency, and modernize systems so tribal health programs can plan reliably. The chair said delays in amendments, inconsistent area-office performance, and a legacy electronic health record system impede services and tribal self-governance.

Deputy Director Benjamin Smith of IHS told the subcommittee IHS oversees a system with 12 area offices, roughly 2,800,000 American Indian and Alaska Native patients annually, and that tribes now manage about 62% of the IHS budget. Smith said IHS’s priorities include addressing contract support costs and 105(l) lease issues after recent litigation, modernizing the RPMS electronic health record, and addressing workforce shortages. Smith described a proposed realignment as a ‘‘realignment, not a reduction’’ intended to standardize practice and bring enterprise resources to bear while continuing tribal consultation.

Tribal witnesses offered examples of how 638 self-governance changed care. Cherokee Nation Principal Chief Chuck Hoskin Jr. said 638 "has been transformational," describing Cherokee Nation’s system—more than 2,000,000 patient visits last year—and said the tribe will replace a Claremore facility with a $244,000,000 campus. Hoskin urged predictable funding (advanced appropriations at minimum, mandatory appropriations at best) and stronger safeguards to prevent headquarters actions that duplicate or undercut successful area-office decisions.

Greg Abramson, chair of the Spokane Tribal Business Council, described Spokane Tribe’s April 2025 transition to a tribally operated clinic and highlighted operational problems during transitions, especially EHR and information-technology incompatibilities with the Indian Health Service’s RPMS. He urged either full funding for tribal transitions to commercial EHR systems or comprehensive modernization of RPMS so patient care, pharmacy operations and billing are not disrupted.

A witness introduced in the record as Jay Spahn (the transcript also shows a different rendering of his name) representing the Tribal Self-Governance Consortium said modernization is necessary but cautioned that centralizing Title I and Title V negotiations in a single national office could introduce delays, reduce flexibility, and make negotiations more transactional. He recommended preserving local decisionmaking where it works and offering a tribal choice for a headquarters "strike team" only where area offices underperform.

Multiple members of the subcommittee pressed IHS on concrete metrics. Members cited a roughly 30–35% vacancy rate across IHS positions, an average facility age of about 41 years, and bottlenecks such as 1,200 section 105(l) leases managed by only a few staff. IHS said it has posted a GAO action plan on its website and is developing performance metrics and consultation materials; Smith said IHS will follow up with members for specific staffing and timeline data.

On consultation process and timing, witnesses and members repeatedly criticized a brief notice accompanying IHS’s December 5 release of an executive summary about the proposed realignment. Tribes said the short window left insufficient time to prepare meaningful input; witnesses called for geographically diverse, well-documented consultations in which tribes receive full details in advance.

Law and funding questions were prominent. Witnesses urged Congress to make contract support costs (CSC) mandatory or extend advance appropriations so tribal programs are not forced to absorb administrative costs. The hearing record refers to a recent Supreme Court decision identified in testimony as Becerra v. San Carlos Apache (2024) and to GAO findings that have kept IHS on a high-risk list since 2017; those references framed arguments for clearer funding rules and statutory alignment.

The subcommittee held the record open for 10 business days and asked members to submit any additional questions by 5 p.m. on 2025-12-16. The hearing adjourned without formal votes or committee action.

What to watch next: whether IHS revises its realignment proposal after consultation, whether Congress acts to make CSC funding mandatory or extends advanced appropriations, and whether IHS provides the specific staffing, timeline, and performance metrics members requested.

Direct quotes in this article are drawn from witness testimony at the hearing and are attributed to the speakers as identified in the hearing record.