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Indian Health Service

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Overview:

The 2000 census indicated that more than 4 million Americans were of American Indian and Alaska Native heritage. American Indians and Alaska Natives die at higher rates than other Americans from tuberculosis (750% higher), alcoholism (550% higher), diabetes (190% higher), unintentional injuries (150% higher), homicide (100% higher) and suicide (70% higher). (Rates adjusted for misreporting of Indian race on state death certificates; 2002-2004 rates.) As a branch of the U.S. Department of Health and Human Services, the purpose of the IHS is to offset this disparity by providing health programs for Native Americans. The IHS has 12 Area Offices located throughout the continental United States and in Alaska.

 
more
History:

 

 

 

 

 

 

 

 

The provision of health services to members of federally-recognized tribes grew out of the relationship between the federal government and Indian tribes that were established in 1787 from Article I, Section 8 of the Constitution. This has been given form and substance by numerous treaties, laws, Supreme Court decisions, and Executive Orders. In 1921, the Snyder Act (42 Stat.208) (PDF), was passed by Congress to provide continuing authority for Federal Indian programs. The Snyder Act is the basic authorization for Federal health services to U.S. Indian Tribes. It identified the “relief of distress and conservation of health of Indians” as one of the Federal functions. In 1954, all functions of the Secretary of the Interior relating to the conservation of the health of Indians were transferred to the Surgeon General of the United States Public Health Service. On July 1, 1955, about 2,500 health program personnel of the Bureau of Indian Affairs, along with 48 hospitals, 18 health centers, 62 stations, 13 school infirmaries, and other locations, came under the jurisdiction of the newly created Indian Health Service. One of the initial orders of business for the first Director of the IHS was to describe the health status of American Indians and Alaska Natives. A report entitled “Health Services for American Indians” was prepared by the Surgeon General of the USPHS and submitted to Congress on February 11, 1957. This report became known as the “1957 IHS Gold Book.” The Gold Book is recognized as a founding historical marker outlining the challenges that faced the newly formed IHS.

 

more
What it Does:

 

 

 

 

 

 

 

 

The IHS is meant to provide preventive, curative, and community health care to approximately 1.9 million of the nation’s 3.3 million American Indians and Alaska Natives. The IHS currently provides health services to approximately 1.5 million of these American Indians and Alaska Natives who belong to more than 557 federally recognized tribes in 35 states. IHS services are administered through a system of 12 Area offices and 163 IHS and tribally managed service units.

 
Three major pieces of legislation are at the core of the Federal government's responsibility for meeting the health needs of American Indians/Alaska Natives: the Snyder Act (PDF) of 1921, P.L. 67- 85, the Indian Health Care Improvement Act (IHCIA), P.L. 94-437, as amended, and the Indian Self Determination and Education Assistance Act (ISDEAA) (PDF), P.L. 93-638, as amended. The Snyder Act authorized regular appropriations for "the relief of distress and conservation of health" of American Indians/Alaska Natives. The IHCIA was enacted "to implement the Federal responsibility for the care and education of the Indian people by improving the services and facilities of Federal Indian health programs and encouraging maximum participation of Indians in such programs." Tribes will control an estimated $1.8 billion, or approximately 54 percent, of the total IHS budget in FY2008. Like the Snyder Act, the IHCIA provided the authority for Federal government programs that deliver health services to Native Americans. The ISDEAA promotes Tribal administration of Federal Indian programs, including health care. According to ISH data from 2000 to 2007, the agency handled 58,281 inpatient admissions, 10,173,528 outpatient visits, and 3,203,117 dental visits.
 
Programs
 
The IHS budget includes $150 million for diabetes prevention and treatment grants. Through the Special Diabetes Program for Indians, the IHS has awarded $850 million in grants over the past 6 years to more than 300 Tribes and Indian organizations to support diabetes prevention and disease management at the local level. This program has substantially increased the availability of services, such as basic clinical exams, newer treatment medications and therapies, laboratory tests to assess diabetes control and complications, screening for diabetes and pre-diabetes, nutrition education, and physical fitness activities.
 
Section 3 of P.L. 94-437, the Indian Health Care Improvement Act, declares that "it is the policy of the Nation, in fulfillment of its special responsibilities and legal obligations to the American Indian people, to ensure the highest possible health status for Indians and urban Indians." The FY 2008 budget includes $34.5 million in funding for the Urban Indian Health Program. The IHS supports 34 urban programs, which provide services ranging from community health to comprehensive primary health care services.
 
Compared to the general U.S. population, American Indian and Alaska Native   patients experience more oral disease, including both tooth decay and periodontal disease. Studies have shown that almost 32 percent of adults have advanced periodontal disease, compared to only 12 percent of adults in the general U.S. population, and that over two-thirds of Indian adolescents have untreated tooth decay, compared to 24 percent of similar aged children in the general U.S. population. This program aims to narrow the gap in dental health by promoting preventative and clinical care for Native Americans.
 
The FY 2008 budget included $237 million for the Mental Health and Alcohol/Substance Abuse budgets. The suicide death rate for the American Indian and Alaska Native population is currently 60 percent greater than the national average, and data on methamphetamine use reveals a 30 percent increase between 2004 and 2005 alone in IHS patients.

Nationwide Programs and Initiatives

 

more
Where Does the Money Go:

 

 

 

 

 

 

 

 

The enacted budget authority for the Indian Health Service (IHS), for fiscal year (FY) 2008 was $3.35 billion. This is a $166 million, or approximately 5.2 percent, increase over the FY 2007 enacted budget level.

 
Adding in funds from health insurance collections estimated at $780 million, designated diabetes appropriations of $150 million, and $6 million for staff quarters rental collections, increases the enacted budget for the IHS to $4.3 billion in program level spending.
 
IHS receives in excess of $150 million annually in revenue from Centers for Medicare and Medicaid Services for services provided to Medicaid, Medicare, and the State Children’s Health Insurance Program eligible patients.
 

Partnership with the Centers for Medicare and Medicaid Services

 

more
Controversies:

 

 

 

 

 

 

 

 

Abortion funding Ban on American Indian Clinics

In March 2008 the U.S. Senate voted 83-10 to provide $35 million in funding to improve programs and build new clinics through IHS. With the bill however, came 80 amendments, including one to permanently prohibit the use of federal funds to pay for abortions at clinics that serve indigenous women, except in rare cases. Women’s health advocates are asking why Native American women should be subject to restrictions not applicable to other ethnic groups.
 
Environmental Health Risks
Because the annual per capita income of the Navajo nation is $7,100, one third less than the rest of the U.S., uranium and coal mining companies have little trouble setting up shop in their territory, even if it means polluting air, earth and water resources. This occurs in many Indian Nations, as they struggle to make a living on a reservation, they lose out on their environmental and personal health. 
 
Who Is Native American Enough to Receive Services?
One of the most difficult questions to resolve is what percentage of Indian blood an individual must possess to qualify for Indian services. Also, the U.S. Native American population is divided into two major tribal categories: federally recognized and non-federally recognized. Federally recognized refers to a tribe that at some point in the past has had a formal relationship with the U.S. government, agreement or other administrative rule. The primary consequence of federal recognition is that services, assistance and funds are available only to recognized groups.
 
Ineffective Programs and Failure to Help Urban Native Americans
The IHS has been criticized for its ineffectiveness. Death and disease rates among Native Americans continue to exceed double the rate of white Americans. Despite its mission statement and $4 billion budget, more than a third of Native Americans did not have suitable health coverage in 2004. Also, only 15.5 percent of native adults received medical treatment of any kind in that same year, says Hannah Graff, a research associate of the Health Policy Program at the New America Foundation. According to Yvette Roubideaux, the majority of Native Americans live in urban areas, but only approximately 1 percent of the IHS budget is distinguished for urban Indian program.
 
Medical Prejudice
Between 1972 and 1976, the IHS directed a policy to sterilize Indian women across the nation. In the month of July 1974 alone, 48 sterilizations were performed and several hundreds of women were sterilized between 1972 and 1974. As one of the people who initiated investigation into IHS sterilization policy, Dr. Connie Uri, a Choctaw Indian physician in Oklahoma IHS facilities, observed that the women she interviewed had received the operation a day or two after childbirth. The sterilization story surfaced in a 1974 Akwesasne News article. Dr. Connie Uri wrote that women at the Claremore, Oklahoma IHS facility were sterilized, apparently without informed consent, an action Uri defined as "genocide of the Indian people."

Genocide of Family Planning (by Beth A. Spencer, Inside Chico State)

 

 

more
Former Directors:

 

 

 

 

 

 

 

 

Charles W. Grim

The former director of IHS, Charles W. Grim, a member of the Cherokee Nation, graduated from the University of Oklahoma College of Dentistry in 1983. He was appointed Director of the Division of Oral Health for the Albuquerque Area of the IHS in 1992 and he eventually became the Interim Director in August 2002, appointed by President George W. Bush, and received confirmation as Acting Director in July 2003. After his four years of commitment at IHS, he withdrew from nomination for a second term in September 2007. Grim, told Indian Country Today that it was too difficult to commute between Oklahoma, where his family resides, and IHS headquarters in Washington, D.C. 

 

 

more

Comments

michael longman 9 years ago
member of a federal reconized gov. tribe. been off work for year and a half. my tribe is doing great on medical part. But is there any other help I can get. im married and they say I make to much cause of her job. I don't how this works cause they will not help my wife with in program help cause she is white. im seeking for me cause im native American and my tribe is self-gov. and federal recon. and members of these tribe get certain help for us. gov and the bia of indian affairs I thought. als im service connected disable from the us army,thought I got certain help on that end as well. things are getting really bad now.cant seem to get help any where state or local. I hate to lose home every thing we work for.

Leave a comment

Founded: 1955
Annual Budget: $3.35 billion (2008)
Employees: 15,378 (71% are Native American)
Official Website: http://www.ihs.gov/
Indian Health Service
Smith, Mary L.
Previous Acting Director

Mary L. Smith, an attorney and enrolled member of the Cherokee Nation, took over the Indian Health Service in March 2016.

 

Smith was born in Chicago and attended Loyola University there, earning a B.S. in mathematics and computer science in 1984. She initially worked with computers, as a systems programmer for drug chain Walgreens and as a senior systems engineer at Northern Trust Bank, both in Chicago.

 

In 1988, she returned to Loyola to attend law school. After her first year, she transferred to the University of Chicago law school, where she earned her J.D. in 1991. Smith then clerked for Judge R. Lanier Anderson III of the Eleventh Circuit Court of Appeals.

 

After finishing her clerkship, Smith took a job at the Chicago law firm of Ross & Hardies. In 1994, she joined the Justice Department as a trial attorney in the civil division. She took time off in 1996 to work in President Bill Clinton’s re-election campaign. In the spring of 1997, she was named associate counsel to the president, and associate director of policy planning for the administration’s Domestic Policy Council.

 

When Clinton left office in 2001, Smith took a job at the firm of Skadden, Arps, Slate, Meagher & Flom. In 2005, she joined Tyco International and managed that company’s response to a huge suit filed by shareholders after its former CEO, L. Dennis Kozlowski, and other company officials were charged with looting the company. Tyco eventually settled the suit for $3 billion. At the time, it was the largest recorded settlement of a class-action suit against a single company.

 

Smith left Tyco in 2007 to work on Hillary Clinton’s presidential campaign. When Clinton dropped out of the race, Smith briefly went to work for the firm of Schoeman, Updike & Kaufman. After Barack Obama won the presidency, Smith was named to the Department of Justice transition team. In 2009, Obama nominated her to be Assistant Attorney General in charge of tax issues. However, Senate Republicans blocked her appointment, saying she was unqualified. Smith worked as a counselor in the Justice Department’s civil division until 2011, when her nomination was turned down.

 

Smith left the administration and became general counsel for the Illinois Department of Insurance, where she worked on tax aspects of implementing the Affordable Care Act in that state.

 

Smith returned to the Obama administration in 2015, this time to the Indian Health Service, and took over the agency the following year upon the departure of Yvette Roubideaux.

-Steve Straehley

 

To Learn More:

Nomination Annoucement

Official Biography (pdf)

more
Roubideaux, Yvette
Former Director

A physician and professor who has dedicated her career to combating diabetes, Yvette Roudideaux is the first Native American woman to head the Indian Health Service since it was founded in 1955. She was sworn in May 12, 2009.

 
Born in 1963, Roubideaux is a member of her father’s tribe, the Rosebud Sioux. Her mother’s tribe is the Standing Rock Sioux.  Roubideaux grew up in Rapid City, South Dakota, and experienced first-hand the limited health care services available to Native Americans. “I often waited four to six hours to see a doctor,” she once wrote, “As a teenager, I realized that I had never seen an American Indian physician.” Driven to study medicine, she was accepted into Harvard, where she received her Bachelor of Arts degree, and then received her M.D. in 1989. She completed the Primary Care Internal Medicine Residency Program at Brigham & Women’s Hospital, Harvard Medical School’s teaching affiliate, in 1992, and was board certified in internal medicine. Roubideaux earned her M.P.H. at Harvard’s School of Public Health in 1997.
 
After finishing her studies at Harvard, she worked for the Indian Health Service in Arizona, first as a medical officer at the Hu Hu Kam Memorial Hospital on the Gila River Indian reservation for one year, followed by three years as a clinical director and medical officer at the San Carlos Indian Hospital on the San Carlos Apache Indian reservation
 
 
She joined the faculty at the University of Arizona, first as an assistant professor in both the College of Public Health and College of Medicine, and later in the Department of Family and Community Medicine. She also served as the director of the University of Arizona/Inter Tribal Council of Arizona Indians into Medicine (INMED) Program and director of the training program of the Inter Tribal Council of Arizona/University of Arizona American Indian Research Center for Health.
 
Roubideaux has also worked as a consultant and medical epidemiologist for the Division of Diabetes Translation at the Centers for Disease Control and Prevention (CDC), and for the Indian Health Service National Diabetes Program. She was also a consultant to the Henry J. Kaiser Native American Health Policy Fellowship Program and is a faculty mentor and former participant in the University of Colorado Native Elder Resource Center Native Investigator Program.
 
In 2001 Roubideaux co-edited a book on Indian health policy entitled Promises to Keep: Public Health Policy for American Indians and Alaska Natives in the 21st Century.
 
Roubideaux has worked on a number of national committees related to diabetes, including the National Diabetes Education Program Steering Committee, and American Indian Campaign, and the Awakening the Spirit Project Team for the American Diabetes Association. She has also helped tribal leaders on a number of initiatives, including the Tribal Leader Diabetes Committee Technical Workgroup and the Blue Ribbon Panel for Navajo Health Care. In 1999-2000 she was president of the Association of American Indian Physicians, and was a member of the Department of Health and Human Services Secretary’s Advisory Committee on Minority Health from 2000-2002. She also helped found the Native Research Network, Inc.
 
Roubideaux testified before the Senate Committee on Indian Affairs regarding the Indian Health Care Improvement Act reauthorization, and in 2000 advised the CDC on health funding priorities for its first meeting of American Indian Governments and Organizations Budget Planning and Priorities. She was a consultant to the National Indian Health Board and in 1998 she was one of the authors of the national survey of tribes, “Tribal Perspectives on Indian Self-Determination and Self-Governance in Health Care Management.”
 
She also served on President Barack Obama’s transition team.
 
Promises to Keep (by Janice O’Lear, Harvard Medical Alumni Bulletin)
more

Table of Contents
Bookmark and Share
Overview:

The 2000 census indicated that more than 4 million Americans were of American Indian and Alaska Native heritage. American Indians and Alaska Natives die at higher rates than other Americans from tuberculosis (750% higher), alcoholism (550% higher), diabetes (190% higher), unintentional injuries (150% higher), homicide (100% higher) and suicide (70% higher). (Rates adjusted for misreporting of Indian race on state death certificates; 2002-2004 rates.) As a branch of the U.S. Department of Health and Human Services, the purpose of the IHS is to offset this disparity by providing health programs for Native Americans. The IHS has 12 Area Offices located throughout the continental United States and in Alaska.

 
more
History:

 

 

 

 

 

 

 

 

The provision of health services to members of federally-recognized tribes grew out of the relationship between the federal government and Indian tribes that were established in 1787 from Article I, Section 8 of the Constitution. This has been given form and substance by numerous treaties, laws, Supreme Court decisions, and Executive Orders. In 1921, the Snyder Act (42 Stat.208) (PDF), was passed by Congress to provide continuing authority for Federal Indian programs. The Snyder Act is the basic authorization for Federal health services to U.S. Indian Tribes. It identified the “relief of distress and conservation of health of Indians” as one of the Federal functions. In 1954, all functions of the Secretary of the Interior relating to the conservation of the health of Indians were transferred to the Surgeon General of the United States Public Health Service. On July 1, 1955, about 2,500 health program personnel of the Bureau of Indian Affairs, along with 48 hospitals, 18 health centers, 62 stations, 13 school infirmaries, and other locations, came under the jurisdiction of the newly created Indian Health Service. One of the initial orders of business for the first Director of the IHS was to describe the health status of American Indians and Alaska Natives. A report entitled “Health Services for American Indians” was prepared by the Surgeon General of the USPHS and submitted to Congress on February 11, 1957. This report became known as the “1957 IHS Gold Book.” The Gold Book is recognized as a founding historical marker outlining the challenges that faced the newly formed IHS.

 

more
What it Does:

 

 

 

 

 

 

 

 

The IHS is meant to provide preventive, curative, and community health care to approximately 1.9 million of the nation’s 3.3 million American Indians and Alaska Natives. The IHS currently provides health services to approximately 1.5 million of these American Indians and Alaska Natives who belong to more than 557 federally recognized tribes in 35 states. IHS services are administered through a system of 12 Area offices and 163 IHS and tribally managed service units.

 
Three major pieces of legislation are at the core of the Federal government's responsibility for meeting the health needs of American Indians/Alaska Natives: the Snyder Act (PDF) of 1921, P.L. 67- 85, the Indian Health Care Improvement Act (IHCIA), P.L. 94-437, as amended, and the Indian Self Determination and Education Assistance Act (ISDEAA) (PDF), P.L. 93-638, as amended. The Snyder Act authorized regular appropriations for "the relief of distress and conservation of health" of American Indians/Alaska Natives. The IHCIA was enacted "to implement the Federal responsibility for the care and education of the Indian people by improving the services and facilities of Federal Indian health programs and encouraging maximum participation of Indians in such programs." Tribes will control an estimated $1.8 billion, or approximately 54 percent, of the total IHS budget in FY2008. Like the Snyder Act, the IHCIA provided the authority for Federal government programs that deliver health services to Native Americans. The ISDEAA promotes Tribal administration of Federal Indian programs, including health care. According to ISH data from 2000 to 2007, the agency handled 58,281 inpatient admissions, 10,173,528 outpatient visits, and 3,203,117 dental visits.
 
Programs
 
The IHS budget includes $150 million for diabetes prevention and treatment grants. Through the Special Diabetes Program for Indians, the IHS has awarded $850 million in grants over the past 6 years to more than 300 Tribes and Indian organizations to support diabetes prevention and disease management at the local level. This program has substantially increased the availability of services, such as basic clinical exams, newer treatment medications and therapies, laboratory tests to assess diabetes control and complications, screening for diabetes and pre-diabetes, nutrition education, and physical fitness activities.
 
Section 3 of P.L. 94-437, the Indian Health Care Improvement Act, declares that "it is the policy of the Nation, in fulfillment of its special responsibilities and legal obligations to the American Indian people, to ensure the highest possible health status for Indians and urban Indians." The FY 2008 budget includes $34.5 million in funding for the Urban Indian Health Program. The IHS supports 34 urban programs, which provide services ranging from community health to comprehensive primary health care services.
 
Compared to the general U.S. population, American Indian and Alaska Native   patients experience more oral disease, including both tooth decay and periodontal disease. Studies have shown that almost 32 percent of adults have advanced periodontal disease, compared to only 12 percent of adults in the general U.S. population, and that over two-thirds of Indian adolescents have untreated tooth decay, compared to 24 percent of similar aged children in the general U.S. population. This program aims to narrow the gap in dental health by promoting preventative and clinical care for Native Americans.
 
The FY 2008 budget included $237 million for the Mental Health and Alcohol/Substance Abuse budgets. The suicide death rate for the American Indian and Alaska Native population is currently 60 percent greater than the national average, and data on methamphetamine use reveals a 30 percent increase between 2004 and 2005 alone in IHS patients.

Nationwide Programs and Initiatives

 

more
Where Does the Money Go:

 

 

 

 

 

 

 

 

The enacted budget authority for the Indian Health Service (IHS), for fiscal year (FY) 2008 was $3.35 billion. This is a $166 million, or approximately 5.2 percent, increase over the FY 2007 enacted budget level.

 
Adding in funds from health insurance collections estimated at $780 million, designated diabetes appropriations of $150 million, and $6 million for staff quarters rental collections, increases the enacted budget for the IHS to $4.3 billion in program level spending.
 
IHS receives in excess of $150 million annually in revenue from Centers for Medicare and Medicaid Services for services provided to Medicaid, Medicare, and the State Children’s Health Insurance Program eligible patients.
 

Partnership with the Centers for Medicare and Medicaid Services

 

more
Controversies:

 

 

 

 

 

 

 

 

Abortion funding Ban on American Indian Clinics

In March 2008 the U.S. Senate voted 83-10 to provide $35 million in funding to improve programs and build new clinics through IHS. With the bill however, came 80 amendments, including one to permanently prohibit the use of federal funds to pay for abortions at clinics that serve indigenous women, except in rare cases. Women’s health advocates are asking why Native American women should be subject to restrictions not applicable to other ethnic groups.
 
Environmental Health Risks
Because the annual per capita income of the Navajo nation is $7,100, one third less than the rest of the U.S., uranium and coal mining companies have little trouble setting up shop in their territory, even if it means polluting air, earth and water resources. This occurs in many Indian Nations, as they struggle to make a living on a reservation, they lose out on their environmental and personal health. 
 
Who Is Native American Enough to Receive Services?
One of the most difficult questions to resolve is what percentage of Indian blood an individual must possess to qualify for Indian services. Also, the U.S. Native American population is divided into two major tribal categories: federally recognized and non-federally recognized. Federally recognized refers to a tribe that at some point in the past has had a formal relationship with the U.S. government, agreement or other administrative rule. The primary consequence of federal recognition is that services, assistance and funds are available only to recognized groups.
 
Ineffective Programs and Failure to Help Urban Native Americans
The IHS has been criticized for its ineffectiveness. Death and disease rates among Native Americans continue to exceed double the rate of white Americans. Despite its mission statement and $4 billion budget, more than a third of Native Americans did not have suitable health coverage in 2004. Also, only 15.5 percent of native adults received medical treatment of any kind in that same year, says Hannah Graff, a research associate of the Health Policy Program at the New America Foundation. According to Yvette Roubideaux, the majority of Native Americans live in urban areas, but only approximately 1 percent of the IHS budget is distinguished for urban Indian program.
 
Medical Prejudice
Between 1972 and 1976, the IHS directed a policy to sterilize Indian women across the nation. In the month of July 1974 alone, 48 sterilizations were performed and several hundreds of women were sterilized between 1972 and 1974. As one of the people who initiated investigation into IHS sterilization policy, Dr. Connie Uri, a Choctaw Indian physician in Oklahoma IHS facilities, observed that the women she interviewed had received the operation a day or two after childbirth. The sterilization story surfaced in a 1974 Akwesasne News article. Dr. Connie Uri wrote that women at the Claremore, Oklahoma IHS facility were sterilized, apparently without informed consent, an action Uri defined as "genocide of the Indian people."

Genocide of Family Planning (by Beth A. Spencer, Inside Chico State)

 

 

more
Former Directors:

 

 

 

 

 

 

 

 

Charles W. Grim

The former director of IHS, Charles W. Grim, a member of the Cherokee Nation, graduated from the University of Oklahoma College of Dentistry in 1983. He was appointed Director of the Division of Oral Health for the Albuquerque Area of the IHS in 1992 and he eventually became the Interim Director in August 2002, appointed by President George W. Bush, and received confirmation as Acting Director in July 2003. After his four years of commitment at IHS, he withdrew from nomination for a second term in September 2007. Grim, told Indian Country Today that it was too difficult to commute between Oklahoma, where his family resides, and IHS headquarters in Washington, D.C. 

 

 

more

Comments

michael longman 9 years ago
member of a federal reconized gov. tribe. been off work for year and a half. my tribe is doing great on medical part. But is there any other help I can get. im married and they say I make to much cause of her job. I don't how this works cause they will not help my wife with in program help cause she is white. im seeking for me cause im native American and my tribe is self-gov. and federal recon. and members of these tribe get certain help for us. gov and the bia of indian affairs I thought. als im service connected disable from the us army,thought I got certain help on that end as well. things are getting really bad now.cant seem to get help any where state or local. I hate to lose home every thing we work for.

Leave a comment

Founded: 1955
Annual Budget: $3.35 billion (2008)
Employees: 15,378 (71% are Native American)
Official Website: http://www.ihs.gov/
Indian Health Service
Smith, Mary L.
Previous Acting Director

Mary L. Smith, an attorney and enrolled member of the Cherokee Nation, took over the Indian Health Service in March 2016.

 

Smith was born in Chicago and attended Loyola University there, earning a B.S. in mathematics and computer science in 1984. She initially worked with computers, as a systems programmer for drug chain Walgreens and as a senior systems engineer at Northern Trust Bank, both in Chicago.

 

In 1988, she returned to Loyola to attend law school. After her first year, she transferred to the University of Chicago law school, where she earned her J.D. in 1991. Smith then clerked for Judge R. Lanier Anderson III of the Eleventh Circuit Court of Appeals.

 

After finishing her clerkship, Smith took a job at the Chicago law firm of Ross & Hardies. In 1994, she joined the Justice Department as a trial attorney in the civil division. She took time off in 1996 to work in President Bill Clinton’s re-election campaign. In the spring of 1997, she was named associate counsel to the president, and associate director of policy planning for the administration’s Domestic Policy Council.

 

When Clinton left office in 2001, Smith took a job at the firm of Skadden, Arps, Slate, Meagher & Flom. In 2005, she joined Tyco International and managed that company’s response to a huge suit filed by shareholders after its former CEO, L. Dennis Kozlowski, and other company officials were charged with looting the company. Tyco eventually settled the suit for $3 billion. At the time, it was the largest recorded settlement of a class-action suit against a single company.

 

Smith left Tyco in 2007 to work on Hillary Clinton’s presidential campaign. When Clinton dropped out of the race, Smith briefly went to work for the firm of Schoeman, Updike & Kaufman. After Barack Obama won the presidency, Smith was named to the Department of Justice transition team. In 2009, Obama nominated her to be Assistant Attorney General in charge of tax issues. However, Senate Republicans blocked her appointment, saying she was unqualified. Smith worked as a counselor in the Justice Department’s civil division until 2011, when her nomination was turned down.

 

Smith left the administration and became general counsel for the Illinois Department of Insurance, where she worked on tax aspects of implementing the Affordable Care Act in that state.

 

Smith returned to the Obama administration in 2015, this time to the Indian Health Service, and took over the agency the following year upon the departure of Yvette Roubideaux.

-Steve Straehley

 

To Learn More:

Nomination Annoucement

Official Biography (pdf)

more
Roubideaux, Yvette
Former Director

A physician and professor who has dedicated her career to combating diabetes, Yvette Roudideaux is the first Native American woman to head the Indian Health Service since it was founded in 1955. She was sworn in May 12, 2009.

 
Born in 1963, Roubideaux is a member of her father’s tribe, the Rosebud Sioux. Her mother’s tribe is the Standing Rock Sioux.  Roubideaux grew up in Rapid City, South Dakota, and experienced first-hand the limited health care services available to Native Americans. “I often waited four to six hours to see a doctor,” she once wrote, “As a teenager, I realized that I had never seen an American Indian physician.” Driven to study medicine, she was accepted into Harvard, where she received her Bachelor of Arts degree, and then received her M.D. in 1989. She completed the Primary Care Internal Medicine Residency Program at Brigham & Women’s Hospital, Harvard Medical School’s teaching affiliate, in 1992, and was board certified in internal medicine. Roubideaux earned her M.P.H. at Harvard’s School of Public Health in 1997.
 
After finishing her studies at Harvard, she worked for the Indian Health Service in Arizona, first as a medical officer at the Hu Hu Kam Memorial Hospital on the Gila River Indian reservation for one year, followed by three years as a clinical director and medical officer at the San Carlos Indian Hospital on the San Carlos Apache Indian reservation
 
 
She joined the faculty at the University of Arizona, first as an assistant professor in both the College of Public Health and College of Medicine, and later in the Department of Family and Community Medicine. She also served as the director of the University of Arizona/Inter Tribal Council of Arizona Indians into Medicine (INMED) Program and director of the training program of the Inter Tribal Council of Arizona/University of Arizona American Indian Research Center for Health.
 
Roubideaux has also worked as a consultant and medical epidemiologist for the Division of Diabetes Translation at the Centers for Disease Control and Prevention (CDC), and for the Indian Health Service National Diabetes Program. She was also a consultant to the Henry J. Kaiser Native American Health Policy Fellowship Program and is a faculty mentor and former participant in the University of Colorado Native Elder Resource Center Native Investigator Program.
 
In 2001 Roubideaux co-edited a book on Indian health policy entitled Promises to Keep: Public Health Policy for American Indians and Alaska Natives in the 21st Century.
 
Roubideaux has worked on a number of national committees related to diabetes, including the National Diabetes Education Program Steering Committee, and American Indian Campaign, and the Awakening the Spirit Project Team for the American Diabetes Association. She has also helped tribal leaders on a number of initiatives, including the Tribal Leader Diabetes Committee Technical Workgroup and the Blue Ribbon Panel for Navajo Health Care. In 1999-2000 she was president of the Association of American Indian Physicians, and was a member of the Department of Health and Human Services Secretary’s Advisory Committee on Minority Health from 2000-2002. She also helped found the Native Research Network, Inc.
 
Roubideaux testified before the Senate Committee on Indian Affairs regarding the Indian Health Care Improvement Act reauthorization, and in 2000 advised the CDC on health funding priorities for its first meeting of American Indian Governments and Organizations Budget Planning and Priorities. She was a consultant to the National Indian Health Board and in 1998 she was one of the authors of the national survey of tribes, “Tribal Perspectives on Indian Self-Determination and Self-Governance in Health Care Management.”
 
She also served on President Barack Obama’s transition team.
 
Promises to Keep (by Janice O’Lear, Harvard Medical Alumni Bulletin)
more

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