Top leaders with the U.S. Department of Health and Human Services (HHS) have pressed pause on the complicated tenure of Dr. Yvette Roubideaux, who has served as director of the Indian Health Service (IHS) since 2009. They cite legal reasons, but there is more to her demotion, department and Senate officials say.
In a press release issued by HHS leadership on February 10, a department spokesman announced that Robert McSwain, currently the deputy director of IHS, will begin serving as the acting director of the agency.
Roubideaux, the spokesman said, will be indefinitely demoted, tapped to serve as a senior advisor to the HHS secretary for American Indians and Alaska Natives.
The spokesman added, however, that the administration will continue to strongly support Roubideaux to be re-confirmed as the director of IHS.
“Dr. Yvette Roubideaux has led the Indian Health Service since 2009 through a significant period of budget growth and work to continue to improve the health and well-being of tribal communities,” the spokesman said in an e-mailed statement.
The HHS official also noted that President Barack Obama re-nominated Roubideaux, a Rosebud Sioux citizen, to the position in 2013 after her first four years in service.
But she has been forced to serve in an acting capacity since that time because the Democratic Senate of 2013-4 and the current Republican Senate both have refused to re-confirm her, citing concerns of tribal leaders focused on Roubideaux’ leadership decisions.
Tribal leaders have widely complained that Roubideaux has made unilateral decisions without appropriate consultation during her tenure, specifically involving contract support costs, tribal health settlements, and other trust obligations.
Disgruntled employees who have served under Roubideaux at IHS have fanned the flames, sending gossipy missives about her work decisions to news outlets, including ICTMN. She has also been slow to explain her decisions, ignoring several interview requests, while past leaders at IHS – including McSwain even while under fire from the Senate – have been eager to detail their work with tribes.
Now Roubideaux is forced to step down altogether from the job, the spokesman said, because “a provision in a 2009 appropriations act that is permanent law limits the amount of time that a nominee can serve in an acting position for which they have been nominated.”
Defenders of Roubideaux note that under her leadership money allocated to tribes for health purposes has dramatically risen, and she has steadily worked to increase consultation and settlements with tribes.
A separate HHS official, who asked to remain anonymous due to the sensitive nature of this situation, said that the current HHS Director Sylvia Mathews Burwell, who came into her position overseeing Roubideaux in 2014, is “quite familiar” with tribal concerns about Roubideaux’ leadership. This familiarity dates back to Burwell’s previous time leading the Office of Management and Budget, during which she and Roubideaux took alternating blame for trying to cap payments to tribes for contract support costs.
“I think Director Burwell knows full well about the tribal complaints,” the official said, speculating that Roubideaux perhaps has less of a protector in Burwell than she did in Kathleen Sebelius, the previous HHS director who stepped down after her botched role in the unveiling of the Affordable Care Act.
Senate Indian Affairs staffers on both sides of the aisle also believe it is unlikely that Roubideaux can be re-confirmed to her job under the Republican Senate when friendly Democratic allies could not get that job done last year when Democrats controlled the chamber.
McSwain, a citizen of the North Fork Rancheria of Mono Indians, now takes the hot seat – again – having previously served as IHS director starting in 2008 during the Bush administration. Democratic senators, citing questions about his commitment to tribal self-determination and vast money mismanagement issues highlighted by the Government Accountability Office, rebuked him several times before his leadership came to an end in 2009.
Former Senate Committee on Indian Affairs Chairman Byron Dorgan (D-N.D.) warned Roubideaux at the beginning of her tenure to avoid McSwain’s mistakes and to hone her managerial skills. Whether she has heeded his advice seems up to interpretation.