Less than four months after the Department of Health and Human Services (HHS) created a special, top-tier position for Dr. Yvette Roubideaux to advise HHS Secretary Sylvia Burwell on Indian health and other Native-focused matters, Roubideaux has announced that she is stepping away from the department altogether.
“I am so grateful to have served in the Obama Administration with you and to have witnessed history – at IHS, we have experienced strong and historic support for our work from the President, the Administration, the Office of Management and Budget (OMB), former HHS Secretary Kathleen Sebelius and our current HHS Secretary Silvia [sic] Burwell, other HHS leadership, and bipartisan support from Congress,” Roubideaux wrote in a June 1 e-mail to Indian Health Service (IHS) staff. “This historic support has enabled us to increase our budget by over a third, and accomplish much to improve healthcare for the patients we serve.”
Roubideaux encouraged IHS employees “to continue to change and improve” the agency, the Rosebud Sioux citizen wrote. “And while the answers and solutions are not simple, and cannot all be done at once, the progress we have made in the last six years has been substantial; even so, we all know that there is much more to do.”
Roubideaux also touched on a difficult situation when she was pushed out of being the IHS Director in February due to 2009 appropriation act language that required her to move on because she had not been re-confirmed to her position by Congress. Senators from across the aisle, especially Sens. Lisa Murkowski (R-Alaska), Jon Tester (D-Montana), Maria Cantwell (D-Wash.), and former Alaska Sen. Mark Begich (D) had made it quite clear to Roubideaux both privately and in some cases during public hearings that many tribal leaders were concerned about her ability to be a strong advocate on pressing tribal concerns.
“I am grateful to Mr. Robert McSwain who has been serving as the Acting Director of IHS since February 10, 2015,” Roubideaux wrote on the matter. “That’s when the 2009 appropriation act language required that I and some others in the administration across the federal government move from their Acting positions. This was certainly a surprise for all of us, but I am proud of everyone, especially the senior leadership, for adapting to this situation and doing a great job keeping forward momentum and progress.”
What Roubideaux did not mention is that when the change occurred, HHS leaders created a new position for her that they framed at the time as actually being more important, or at least of equal importance, than her previous IHS Director role. The new position made her senior advisor to Burwell for American Indians and Alaska Natives.
“[I]t is not a demotion at all,” Mark Weber, a spokesman for HHS, told ICTMN in February. “In fact, it provides Dr. Roubideaux a broader portfolio of initiatives and policies that impact Indian country.”
Weber also said that he and other HHS leaders did not sense tension between Burwell, who came into her position in June 2014, and Roubideaux, who had long been seen by tribal leaders and IHS employees as having had a protector in former HHS Secretary Kathleen Sebelius.
When asked again about this supposed conflict on June 3 and why Roubideaux was choosing to move on, Weber shared by e-mail a recent note from Burwell to colleagues highlighting Roubideaux’ service.
“She has been key in the President’s efforts to increase resources at IHS, not just for the hospitals and clinics but also for purchased and referred care and the contract support costs that support tribal self-governance,” Burwell wrote. “During her tenure as Director, we also saw the permanent reauthorization of the Indian Health Care Improvement Act and Dr. Roubideaux made major contributions to implement provisions of the Affordable Care Act that impact American Indians and Alaska Natives.”
Weber added: “It was a personal decision for Dr. Roubideaux [to leave]. She does not have ?an announcement to make at this time about the opportunity ahead of her.”
Weber would not address why the new, heralded position did not work out for Roubideaux, but the advisory role apparently was not as attractive to her in the end as her former IHS Director position, and over the last few months she heard in no uncertain terms from Republican Congress members that they would never support her in getting that job back—just as Democrats had not supported her when they had the opportunity to do so in the last Congress. (Roubideaux has not said publicly where she will work next, and Weber did not respond to a question on that.)
Murkowski was particularly direct at a February Senate budget hearing, in which she told Roubideaux to her face that she was disappointed with the director’s poor leadership involving the administration’s reluctance in 2012-3 to pay tribes back for contract supports costs, as required by multiple Supreme Court rulings. The senator also highlighted a continuing lack of support from the administration for the idea of advanced funding for IHS; Alaska-specific Indian health issues that she said had perennially gone unaddressed by the administration; the lack of an administrative fix to the definition of “Indian” in the Affordable Care Act; and staffing package problems.
“Tribes have been frustrated,” said Murkowski, who chairs the Senate Committee on Energy and Natural Resources. “Should the White House be considering whether to send your name forward for (re)-nomination, I’m going to push back. I’m going to suggest that they consider new leadership because we just haven’t seen the results and the partnership that we have been looking for.”
Democrats, too, have continued to be frustrated by Roubideaux. Begich, who was voted out of office last year, told ICTMN upon learning of Roubideaux’ decision to leave IHS that it has been “no secret that Director Roubideaux and I did not always agree.”
“I made it clear that I did not think the administration’s overall understanding of key tribal issues was adequate—that is why I ultimately held up her nomination,” Begich said. He did note, however, that progress was made on several issues he had with Roubideaux involving Alaska Native tribes after he dug in his heels on her nomination.
“After 20 years of keeping tribes in limbo, we were able to finally push the administration to honor their obligations on contract support cost payments meaning nearly $1 billion coming back to tribes to date (via overdue contract support cost payments),” Begich said, concluding that he thanks Roubideaux “for her service, wish[es] her luck on future endeavors, and hope[s] the administration continues the progress we have made on this critical issue.”
Some Indian affairs experts, meanwhile, appeared puzzled by Roubideaux’ decision to move on.
“I was surprised by the announcement,” said Geoffrey Strommer, a lawyer with Hobbs Straus, who focuses on Indian affairs and health issues. “I thought that she was settling in to her new role as special advisor to the secretary, and I was hopeful that from that new position she could become an advocate for Indian health programs throughout the HHS.”
Others had the opposite reaction.
“I am not surprised,” said Lloyd Miller, an Indian affairs lawyer with Sonosky Chambers, who has led successful legal battles against the administration to have contract support cost paid back to tribes.
“Dr. Roubideaux never enjoyed the confidence of key members of Congress,” Miller said. “She tended to dodge committee questions and not to readily accept responsibility for problems within her agency. She imposed unprecedented restrictions on agency communications with Indian country and tribes, as well as with Congress, and agency morale suffered as a result. She was slow to engage meaningfully about how to tackle the thousands of contract support cost claims she faced after the 2012 Supreme Court decision in Salazar v. Ramah, and she resisted for years any meaningful consultation with tribal leaders and technical staff to reform the agency’s contract support cost practices. The agency’s resistance under her leadership to working openly and collaboratively with tribes led to the entirely avoidable 2014 reprogramming of over $20 million to meet the agency’s contractual commitments to the tribes.”
But Miller added that despite Roubideaux’ difficulties with Congress, he saw her as “an excellent advocate for Indian health within the administration, and she led the agency during a period of unmatched appropriations increases. Those increases are her greatest legacy, including her success in working with the administration to finally embrace fully funding all tribal health-care contracts, something which finally came about with the president’s 2015 budget.”