After a temporary federal hiring freeze, concerns have arisen over filling jobs at long-understaffed Native American health care facilities, although an official exemption for some hiring could be on the way.

"Any freeze in hiring for Indian initiatives, whether temporary or permanent, threatens to make the challenges facing Indian Country worse," Sen. Jon Tester, D-Mont., said in a statement emailed to the Gazette.

Tester was among the seven Democrats on the U.S. Senate Committee on Indian Affairs who sent a letter Tuesday to President Donald Trump advocating against the hiring freeze for services for Native Americans, including Indian Health Service, the Bureau of Indian Affairs and the Bureau of Indian Education. 

"I urge (Trump) to reconsider and reverse the freeze as it applies to Indian Country and to direct affected agency heads to take whatever actions are necessary to fill positions that service Native Americans," Tester said.

The letter did not list the names or signatures of the committee's eight Republican members, including Sen. Steve Daines of Montana and Sen. John Barrasso of Wyoming.

Daines' staff told the Gazette on Wednesday that the administration has given verbal assurances to the IHS that health emergency management personnel essential to public safety — including doctors, nurses and medical technicians — will be exempt from the freeze.

On Jan. 23, Trump ordered a broad hiring "freeze on the hiring of federal civilian employees to be applied across the board" that barred the filling of vacant positions and the creation of new ones. It was presented as a temporary halt until the director of the Office of Management and Budget presents within 90 days, and then implements a plan to reduce the size of the federal workforce.

Indian Health Service facilities have in recent years been down 20 percent or more for physicians, nurses and other clinical providers, which has forced a reduction in access to service while also threatening accreditation statuses.

"Even before the hiring freeze was announced, Federal agencies that provide these services were struggling to recruit and retain a qualified workforce, with personnel vacancies consistently cited by the Government Accountability Office and agency inspectors general as a major factor in the lack of available essential and basic services for Native peoples," the letter said.

Northern Cheyenne President Lawrence "Jace" Killsback echoed that sentiment, saying hiring and retention are especially challenging in rural areas and on reservations.

In Montana, the IHS has service units scattered across the state's seven reservations. According to the agency's website, there are nearly 75 open IHS positions throughout the state, ranging from nurses and physicians to dental officers and pharmacists.

Nationally, the agency employs about 15,000 people, but has had trouble filling open jobs for years.

When reached for comment Tuesday, an IHS spokesman said he didn't have more information to provide and referred all further questions to the White House. Officials there could not be reached for comment Wednesday.

Dorothy Dupree was hired in June 2016 as director of the IHS Billings area, which oversees Montana and Wyoming. The Billings area sees about 70,000 patients annually and operates six service units through three Montana reservation hospitals along with three free-standing ambulatory facilities in Montana and Wyoming.

While Dupree couldn't be reached for comment, she said shortly after her hiring that the challenges faced by the office included a chronic lack of funding, long patient wait times and difficulties meeting health care standards.

"We're working on our priorities, and I wanted to see that we sustained our effort to follow the process for quality care," she told the Gazette in August.

On Jan. 25, shortly after the presidential memorandum ordering the freeze, Daines issued a statement expressing general support for the executive action.

"We don't need more federal employees with less accountability," he said. "The federal government must become more efficient and accountable to taxpayers. Everything should be on the table."

He has also said he supports the effort to temporarily halt hiring while federal officials look at ways to cut a federal budget deficit of nearly $20 trillion.

Tester and other senators noted that the freeze could affect about 100 vacancies within the Bureau of Indian Education and makes it more difficult to address a 50 percent staffing shortage for law enforcement in Native communities.

The order does not include military personnel. A handful of other exemptions and additional guidance documents, including exemptions for certain positions within the U.S. Department of Veterans Affairs that include doctors, nurses and psychologists, have been announced in the days since.

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