Stronger Engagement for Indian Health Needs Act of 2025
Click any stage to learn more about the legislative process.
Would elevate the head of the Indian Health Service from a Director-level position to an Assistant Secretary within the Department of Health and Human Services, raising both the title and the executive pay grade of the official responsible for federal health programs serving American Indians and Alaska Natives.
The change would give the Indian Health Service's top official a higher rank within HHS's leadership structure and direct reporting access to the Secretary, potentially strengthening the agency's voice in department-level decisions.
What this bill would do
What it would do
The bill would rename the position of Director of the Indian Health Service (IHS) to "Assistant Secretary for Indian Health" within the Department of Health and Human Services. The Assistant Secretary would report directly to the HHS Secretary. The person currently serving as Director at the time of enactment would automatically continue in the new, elevated role. The bill would also authorize the Assistant Secretary to appoint a Deputy Assistant Secretary and hire necessary staff and attorneys with the Secretary's approval.
The bill would simultaneously move the position from the Level V federal executive pay schedule to the higher Level IV schedule — the same tier occupied by other HHS Assistant Secretaries. It would also update all existing federal laws, executive orders, rules, regulations, and official documents to substitute "Assistant Secretary" wherever they reference the "Director of the Indian Health Service."
Key provisions
- 1Would rename the Director of the Indian Health Service to "Assistant Secretary for Indian Health" and require that official to report directly to the HHS Secretary.
- 2Would authorize the Assistant Secretary, with the HHS Secretary's approval, to appoint a Deputy Assistant Secretary and hire necessary staff and attorneys.
- 3Would deem all existing references to the Director of the Indian Health Service in any federal law, executive order, rule, or regulation to refer to the new Assistant Secretary.
- 4Would move the position's pay rate from the Level V federal executive schedule to the higher Level IV schedule, consistent with other HHS Assistant Secretaries.
Who would be affected
The sitting Director of the Indian Health Service, who would assume the new title and higher pay grade upon enactment. American Indian and Alaska Native communities served by IHS would be indirectly affected through a leadership structure that carries more institutional weight within HHS. Other HHS officials would gain a peer-level counterpart for Indian health matters.
Why it matters
Elevating the IHS head to Assistant Secretary rank would place Indian health policy on equal footing with other major HHS priorities at the department's leadership table. A higher pay grade could also help attract and retain qualified candidates for the role. The change has no immediate effect on IHS programs, funding, or service delivery, but could increase the position's influence in budget and policy deliberations.
What would change
Changes to existing law
Amends Indian Health Care Improvement Act (25 U.S.C. § 1661) (Sec. 2(a)–(d))
Replaces 'Director' with 'Assistant Secretary for Indian Health,' adds direct-reporting requirement to HHS Secretary, and authorizes appointment of a Deputy Assistant Secretary.
Amends 5 U.S.C. § 5315 (Level IV pay positions) (Sec. 2(e))
Increases the number of HHS Assistant Secretary positions at Level IV from six to seven to accommodate the new Assistant Secretary for Indian Health.
Amends 5 U.S.C. § 5316 (Level V pay positions) (Sec. 2(e))
Removes the Director of the Indian Health Service from the Level V pay schedule, as the position is elevated to Level IV.
Agencies directed to act
How implementation would work
Upon enactment, the current IHS Director would automatically become the Assistant Secretary for Indian Health with no separate confirmation required, under the bill's transition provision. The bill's reference-updating subsection deems all existing federal laws, orders, and documents to substitute the new title automatically, avoiding the need for separate conforming amendments across the U.S. Code. The pay-scale change takes effect by striking the Director's Level V slot in 5 U.S.C. § 5316 and adding a seventh Assistant Secretary slot at Level IV in 5 U.S.C. § 5315.
Legislative status & sources
Latest action
Ordered to be Reported in the Nature of a Substitute (Amended) by Unanimous Consent.
Official CRS summary
Show the CRS summaryHide the CRS summary
Stronger Engagement for Indian Health Needs Act of 2025
This bill elevates the current position of the Director of the Indian Health Service within the Department of Health and Human Services (HHS) to Assistant Secretary for Indian Health within HHS.
Legislative subjects
Administrative remedies; Department of Health and Human Services; Executive agency funding and structure; Federal officials; Government employee pay, benefits, personnel management; Native Americans