Secretary of the Department of Health and Human Services (HHS) Sylvia Mathews Burwell wants American Indians, Congress, her employees and the press to know that she fully supports the re-nomination of Dr. Yvette Roubideaux to be director of the Indian Health Service (IHS).
Roubideaux, a citizen of the Rosebud Sioux Tribe, was recently forced out of her position leading IHS, which she has held for almost six years, due to an appropriations law enacted in 2009 that limits the amount of time a presidential nominee can serve in an acting position for a job for which they have been nominated.
President Barack Obama re-nominated Roubideaux to the position in 2013, but she has been in acting status since then because the Democratic Senate of 2013-4 did not re-confirm her; in fact, Democrats voiced several concerns based on negative tribal assessments of her performance. Her re-nomination was never able to clear the Democratic Senate Committee on Indian Affairs (SCIA) where she faced intense questioning from leaders of the committee, including Sens. Maria Cantwell (D-Wash.) and Jon Tester (D-Montana). Former Sen. Mark Begich and Sen. Lisa Murkowski, both from Alaska but from opposing sides of the aisle, also played major roles in blocking her re-nomination.
Roubideaux' role has now shifted to senior advisor to Burwell for American Indians and Alaska Natives—a new position not listed in the HHS organizational hierarchy chart that has been created for her based on the circumstance she faces, according to department officials.
Robert McSwain, former head of IHS during the latter part of the George W. Bush administration, has been tapped by Burwell to take over the job until the now Republican Senate decides whether to move forward on Roubideaux' re-nomination.
After an HHS spokesman who requested anonymity to share details of the change spread word to the press on February 10 and the shift became news, feelings in both Roubideaux' office and Burwell's were rankled.
Adding to the consternation, another HHS official who requested anonymity told ICTMN that Burwell is perhaps less a protector of Roubideaux than former HHS Secretary Kathleen Sebelius.
Roubideaux, according to a person close to her, was worried that these unnamed HHS officials were going out of their way to convey a lack of support for her by Burwell. (Roubideaux has not spoken to ICTMN about this situation, and she has ignored requests for comment about her leadership and on Indian health matters over a number of years.)
At the secretary's headquarters in Washington, Burwell, too, was concerned about the optics. A named spokesman for HHS, Mark Weber, soon contacted ICTMN to share an e-mail of support for Roubideaux that Burwell had recently sent employees of the department.
"Dr. Yvette Roubideaux has ably led the Indian Health Service (IHS) since 2009 and been an important member of the HHS leadership team," Burwell's letter read in part. "In her new role, Yvette will bring her experience, commitment and expertise to a number of important projects."
The full letter, according to some IHS employees, was not widely seen as a ringing endorsement, but more of a perfunctory statement explaining the change in leadership.
Weber, meanwhile, said the letter clearly demonstrated Burwell's "continued support" for Roubideaux. "The perception that there is any daylight between the secretary and Yvette—that's just not true," he said. "She has the full support of the secretary."
Weber also insisted that Roubideaux was not experiencing a demotion.
"[I]t is not a demotion at all," he said. "In fact, it provides Dr. Roubideaux a broader portfolio of initiatives and policies that impact Indian country."
He elaborated: "It's going to be a matter of perception. If you're not enmeshed in how the government bureaucracy works and positions of power—a position close to the secretary, such as an advisor, is an incredible position of power."
The position sounds pretty attractive the way Weber describes it, so why shouldn't Roubideaux want to just keep it rather than dealing with all the complicated bureaucracy of leading IHS? "I have not discussed that issue specifically with Dr. Roubideaux," Weber said. "Right now, this is the best way she can serve."
If Roubideaux has such power, should McSwain, now acting as the head of IHS, feel undermined? "We're all colleagues here that work together," Weber said. "By legal authority, Mr. McSwain has the signature authority; however, before we make any big decisions around here, we all consult with each other and make sure our policies are aligned and our work is moving the department forward in the best interest of the American public and in this case the American Indian population."
Weber further shared a Youtube video of Roubideaux testifying before the House Interior Subcommittee on February 11 as the official face of HHS. In the video, Rep. Tom Cole (R-Oklahoma), one of two Native Americans in Congress, speaks highly of Roubideaux—a fact Weber pointed to in a later phone conversation during which he noted bi-partisan House support for the former director.
But Weber also said that all the House support in the world does not matter if the Republican Senate does not get on board to re-confirm Roubideaux.
"We can encourage and hope the Senate acts, and we certainly can't control that, but we can keep pushing for Yvette and her confirmation," Weber said. "Look at her budget testimony [of February 11]—when you look at the increases that IHS is seeing, where we are with the contract support costs issues—it's night and day from where she started."
Support from Senate Republicans is an unlikely – but still possible – scenario given past concerns expressed by tribal leaders and health experts about Roubideaux' lacking consultation on contract support costs, tribal health settlements, and her miscalculations regarding the federal sequester's impact on Indian health programs.
"I would absolutely say that Secretary Burwell is aware of tribal concerns," Weber said. "And I will say that if you look at the budget proposal this year, we heard those tribal concerns, and we are acting on them."
Weber added that Roubideaux' situation is not unlike those of many of the president's nominees who were not confirmed last year and who now awaiting re-confirmation However, many of those nominees were able to pass their respective Democratic committees, which is a difference in Roubideaux' nomination compared to several other stalled ones.
"The Senate process is the Senate process," Weber said on that matter. "Whether they choose to pick up somebody or not, we can't control [that] here at HHS."
Roubideaux' stumbles combined with Republican distaste for controversial changes made by Senate Democrats to the confirmation process in 2013 that allowed Obama's nominees to more easily pass the chamber may ultimately prevent her confirmation, Senate staffers on both sides of the aisle say. Republicans, these staffers say, could choose to use past tribal and Democratic concerns about Roubideaux against her. And Republicans would have cover from charges of obstructionism because the Democratic Senate itself did not move on her re-nomination when it had the chance to do so.
The record of Democratic opposition is long. Several Democratic senators penned a letter in 2013 to the White House expressing concern over Roubideaux' mishandling of tribal contract support costs and related issues, and former SCIA Chairman Tester wrote a letter to Burwell last July highlighting vacant positions at area IHS agencies that he believed she had been slow in filling. Some also did interviews decrying her leadership.
"I think there are some communication issues that need to be worked out, and I've told [Roubideaux] exactly that," Tester told ICTMN in an interview last year. "There needs to be a lot better communication between tribes and her."
He added that there are "a lot of Native folks out there who don't like [Roubideaux], saying further, "[T]here needs to be the leadership there that pushes the envelope and listens to the people on the ground...."
Weber believes Roubideaux now meets that standard. "Absolutely, folks like Dr. Roubideaux, other leaders here in the department, have their detractors," he said. "But if you aren't stirring up things, you're just taking up space."