By Michelle Tirado
July 20, 2009

Yvette D. Roubideaux (Rosebud Sioux), M.D., M.P.H., was confirmed as the director of the Indian Health Service by the U.S. Senate in May. Since then, she has been very busy. Sure, she has been putting a lot of time into administering a $4.3 billion national health care delivery system, but she has also been fielding loads of inquiries from the media. Roubideaux is, after all, the first woman to head the IHS in its 54-year history.

AIR caught up with Roubideaux this summer. We posed some questions on why she was picked to lead the IHS, what she hopes to accomplish, about the big boost the agency got from the Recovery Act and could get in the federal government’s FY 2010 budget and health care reform. Here is what she had to say:

AIR: Is this a position that you aspired to have or did it kind of just land in your lap?

Roubideaux: Well, I think it would be most accurate to say that it landed in my lap. I have always had a goal of trying to help improve the quality of health care for American Indians and Alaska Natives, ever since I decided to become a doctor when I was a teenager. I first thought my role would be as a physician and working in the IHS, then I transitioned to working on health policy as an educator and a researcher.

Through the work that I have done, I was initially asked to be on the transition team [for the Obama administration]. … When I was asked to be the IHS director, it was a surprise to me, but a pleasant surprise because I really see this new administration and this time as a wonderful opportunity to see what we can do to improve Indian health.

AIR: What do you hope your impact will be at the IHS?

Roubideaux: I hope that my impact will be that we can see what we can do to further the mission of the IHS and also ensuring that American Indians and Alaska Natives get the high-quality health care that they deserve.

I have identified four priorities for what I would like to do in the IHS as the director. The first priority is to renew and strengthen our partnership with tribes. I feel that in order for the IHS to improve the health of the communities it serves, we need to work in partnership with them. So, I am looking forward to talking with tribes about how we can improve that partnership.

The second priority is in the context of national health reform. I would like to bring reform to the IHS. By this I mean looking at what we do well and trying to do more of it, but also very honestly looking at what we are not doing well and coming up with strategies and solutions to change and improve.

The third priority is to improve the quality of access to care that we provide. This will likely also be part of the reform discussion. …

My final and fourth priority is to make all our work transparent and accountable and also fair and inclusive so that any changes that we make benefit all of our patients, whether they are coming through IHS directly, tribally managed programs or Urban Indian Health programs.

AIR: Just before you came on board, the announcement came that President Obama's proposed FY 2010 budget has an almost 13 percent increase for IHS. Is that more than the agency expected? Is it not enough?

Roubideaux: I am very grateful to the president for proposing that nearly 13 percent increase in the budget. It is the largest annual increase in the IHS budget in over 20 years. It is consistent with his work as a senator, where he supported increased IHS funding, and it certainly, to me, represents a significant step in the right direction. It is clear that in the past the IHS has been under-funded, and we definitely need a significant amount of additional resources to meet the growing needs of the population we serve.

AIR: After you were sworn in, the agency received $500 million in Recovery Act funds. Any bumps or snags in the funding process — getting the money to the projects or meeting requirements under the act?

Roubideaux: Actually, as I have watched the process, I think it has been very well organized. And I think the focus has been [on] getting the money out quickly so that it can have the intended impact, which is to stimulate the economy and provide jobs. I was, again, grateful to the president and to Congress for having passed this funding. They are very significantly needed funds for the Indian Health system. It is addressing needed services, needed facilities and maintenance and sanitation needs. …

AIR: Obama is charging ahead with his health care reform initiative. What role do you see tribal governments playing in this reform? How will health care reform benefit them? And what do you plan to do to ensure that they are not overlooked or that they do not come out on the short end of this?

Roubideaux: It is clear that any changes to the national health care system will impact American Indian and Alaska Native people, tribes and Indian health system facilities.

Tribes and tribal organizations have been holding listening sessions and roundtable discussions on the impact of health reform and have developed position papers. In general, they hope to benefit from any new insurance options or new programs and also want to make sure that any new changes do not adversely affect them in terms of penalties or adverse impacts on reimbursement for services they provide.

The Department of Health and Human Services, in partnership with IHS and their Office of Health Reform, held a tribal consultation session on July 7, 2009, in Denver to hear input from tribes on national health reform. HHS will consider this input as they are asked to provide comments and review pending legislation on health reform.