Healthcare & 638

For a long time, the federal government ran health care on the Navajo Nation through the Indian Health Service (IHS). A law called Public Law 93-638 — everyone just says “638” — lets the Nation take over and run its own programs instead, like its own hospitals and clinics.

The idea is self-government: our people running our health care. Some Navajo hospitals already do this, and a few have weathered federal cuts better than IHS did. But running a health system is hard and expensive, and it only works if the Nation has the money, the trained people, and real watchdogs in place.

New to this? Read the plain lesson: Healthcare 101  ·  638 vs. IHS, explained

Just the few words you need so the rest makes sense. No background needed.

638 — a federal law (Public Law 93-638) that lets the Nation run its own programs, like hospitals, instead of the federal government running them. IHS (Indian Health Service) — the federal agency that has long run health care on the reservation. Oversight — someone whose job is to watch the money and the doctors and step in when something’s wrong. (Think of it like a referee.) Vetting — checking out a doctor or company before letting them treat people, to make sure they’re for real and safe.

Want the full picture? Start with Healthcare 101 →

Before asking what’s broken, it helps to know who’s even supposed to be in charge. Here’s the map for health care under 638: the law, the referee, and the watchers. Why this matters →

What’s the law?Public Law 93-638 — the federal Indian Self-Determination Act — lets the Nation run its own health programs instead of the federal government doing it. Navajo health law governs the rest. 638 vs. IHS · 101 → Who regulates it? (the outside referee)CMS (the federal Medicare/Medicaid agency) surveys facilities, and accreditation and credentialing bodies set and check medical standards. And while accreditation is rarely revoked outright, the warning signs short of losing it — citations, deficiencies, corrective-action plans — are where the real story shows up first.

How credentialing works → — Who oversees it? (the inside watchers)Each facility’s board of directors and the Council’s Health, Education & Human Services Committee (HEHSC). They only work if they actually meet and have the expertise to catch problems.

How boards work → — What’s broken — and what candidates would fixOn this page: weak boards, the recruiting reality, and exposure to fraud — plus how candidates answered, summarized from their interviews.

A starting map — confirm current laws and body names against the Nation’s official resources. General civic information, not legal advice.

When Cal pressed candidates, the same problems came up again and again:

• Weak watchdogs. The boards of directors — the groups that run our hospitals, clinics, and schools — are supposed to keep an eye on the money and the doctors. But they don’t always meet, and the committee that oversees health can lack medical know-how.
• Weak or incomplete background checks. The Nation has to be careful about who it lets treat patients. When background checks are weak or incomplete, it can be an easy target for outside operators — so how providers are screened really matters.
• Hard — and expensive — to recruit. Good doctors are hard to bring in and costly to keep. The Nation can end up a provider’s last choice, so it pays a premium — which makes strong oversight and careful vetting matter even more.
• Hired for “who you know.” People admitted that underqualified staff sometimes get hired through connections instead of qualifications — a huge problem when lives are on the line.
• Services missing or out of reach. A clinic may send you hours away for something as basic as an ultrasound. And many people are poor — no gas money, no ride — so even care that exists can be impossible to reach. Why that matters →
• The “not enough capacity” excuse. Some say the Nation simply isn’t ready to run a big health system yet — which is a real concern, and also the easiest reason to never start.

These are problems candidates and the record describe. We’re naming what’s broken — not accusing any one person.

This isn’t abstract. When systems are weak and jurisdiction is unclear, outside operators move in — and Navajo people pay. In a recent Arizona scheme, fake “sober living” homes billed the state’s Medicaid program for addiction treatment that was never provided, in a fraud estimated around $2.8 billion.

Many of the people pulled in were Native American, recruited from reservations — including Navajo citizens. Some Navajo-speaking elders were taken to the city, got lost, and were found at bus stops unable to get home. More than 100 people have been indicted.

The point isn’t that the Nation failed — it’s that the Nation was preyed upon. The gaps in oversight and jurisdiction left the door open, and predators walked through it. That’s why who watches the system, and who has authority over it, matters so much. How oversight is supposed to stop this →

Sources: Arizona Attorney General indictments and AHCCCS statements, reported 2023–2025. Some victim and death counts are advocates’ estimates.

When a hospital or clinic claims to be safe and good, who actually checks? That’s where accreditation and credentialing come in.

Accreditation is an outside review of whether a facility meets standards — done by accrediting bodies like the Joint Commission. (CMS, the federal Medicare/Medicaid agency, is a separate thing: it certifies and surveys facilities so they can bill those programs — related, but not an accreditation.) Credentialing is the check on each healthcare provider — doctors, nurse practitioners, physician assistants — verifying they’re qualified and safe before they treat anyone. Both are outside referees, and both have teeth: fail them, and a facility can lose funding or the right to operate.

A candidate should know who regulates our hospitals and what happens when standards slip — it’s the difference between a board that looks good on paper and one that actually protects patients. Same idea for schools — see who regulates our schools.

Learn what these mean: Healthcare 101  ·  Credentialing & 638 vs. IHS

“Do you support 638? Does the Nation really have the money, the people, and the oversight to run it — and if it’s not working, why not?”

Candidates were asked whether the Nation should run its own care under 638, whether it’s ready, and what to fix first — their answers, in their own words, are on the record below.

Curtis Yanito spoke about the Utah-area 638 and his concerns about oversight. Cornelia Carm Wagoner, from a long health-care career, pointed to the gap between the government and the community and weak oversight.

LaVonne Tsosie — was honest that she’d need to study the 638 details more, but named real problems — a local clinic missing services, and a health committee without medical expertise.

Shaquille Begay — called for stronger oversight of the boards.

Jamie Henio — backed 638 but said it only works when the watchdogs and capacity are actually in place. Donovan Begay pointed to a reported overbilling investigation near Kayenta or Tuba City and his own wrongful-billing experience, and said the judicial system must be tightened so patients can rely on fair billing.

(Each name links to that candidate’s full interview.)

Dr. Christine J. Benally — Cal asked whether she agrees with 638 and how she’d fix its problems. A retired IHS epidemiologist, she supports the concept but says oversight thins once money passes to boards — “Somebody has to answer to those tax dollars” — backs a medical-board-style oversight body, and would use the Council’s 638-contract approval power to demand budgets. On retention: compound housing isolation, IHS pay-scale gaps, and referral costs weighed against keeping providers local.

What goes wrong in 638 health care isn’t unique to health care. It’s one face of a pattern that runs under every topic: a board or leadership there to hold a seat, not to run and grow what they were trusted with.

In 638 health care: boards there for a seat, not to run the network → mismanagement, weak oversight, exposure to fraud. In the enterprises: the same board failure becomes no growth and a yearly allowance. See it → In government: people running the motions, not finishing the design.

It’s often one problem in seven places. See the root — Accountability & Justice →

Staff who stay, or visiting contractors — where do you land?

Take the workforce survey →

Where the community stands: collecting — tallies and best ideas publish with the weekly findings.

A plan only matters if you can tell whether it’s working. Here are specific things to watch on this topic — so “we fixed it” means the numbers moved, not just that a law passed.

What to measure

• Wait time for an appointment and for a referral (days)
• Share of services available on the Nation vs. sent off-reservation
• How many provider/credentialing problems were caught BEFORE harm
• Patient complaints — volume, type, and whether they get resolved
• Employee complaints — the internal signal patients never see
• Hiring, firing & turnover — who’s leaving, and why
• Office of Navajo Labor Relations (ONLR) charges (Office of Navajo Labor Relations) — how many are filed, their outcomes, and how long each takes to resolve. Worth asking, too, whether cases tend to be adversarial — are workers or the facility routinely bringing attorneys?
• Spending — how much goes to lawyers and outside contractors versus staff and care
• Issues with accreditation — citations, deficiencies, corrective-action plans, conditional status. (Accreditation itself is rarely pulled, so the warning signs matter more than the seal.)

These are a lens for reading any facility’s health — not a scorecard of named hospitals, and this site does not rate any facility.

How to gather the data
Pull from each facility’s board reports, accreditation surveys, and HEHSC oversight records — published on a public dashboard, updated quarterly. What success looks like
Shorter waits, more care delivered on the Nation, zero lapses in accreditation, problems caught early instead of after patients are hurt.

Ask any candidate: how would you measure whether this is working? A real leader can name the number.

• If you support 638, what’s the one thing you’d fix first?
• Who watches the money and the doctors — and how do you know they’re actually doing it?
• Would you publish the Nation’s health statistics openly — public by default — instead of by request?
• How would you bring in and keep good doctors here?
• How would you know, in a year, if it’s working? (What would you measure?)

Everything on the site that connects to 638 — learn more, or hear it straight from the candidates.

• Healthcare 101 — the plain lesson.
• The history: 638 vs. IHS — how we got here and how vetting works.
• Navajo health facilities — which hospitals run on 638.
• Glossary — 638, IHS, HEHSC and more, defined.
• Watch the interviews — Cal’s full talks with candidates.
• Compare candidates — see their 638 takes side by side.

You’ve seen the takes and found yours. Here’s how to go deeper on any candidate — everything sourced to their interviews.

• Candidate profiles — a quick overview of each person.
• Full interview write-ups — what each one said, topic by topic.
• Watch the interviews — Cal’s full videos, if you want to hear it straight from them.
• Interview Q&A — the questions and answers, laid out.

(In the live version, these link straight to the candidates who spoke most on 638.)

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Reading is step one. Here’s a concrete move on this topic: Ask who sits on your facility’s board and whether it actually meets — and attend a public board meeting.

See your full part — the To-Do List for the Nation →

This isn’t the end of it. The election is just the start. You help decide what gets explored next — who Cal interviews, what questions get asked, what topics we dig into. That’s how we do this together.

• Want Cal to interview someone? Tell us who.
• Have a question he should ask? Send it — the best ones get used.
• A topic we haven’t covered? Name it. Childcare, elder care, housing, whatever matters to you.

Send an idea → Join the conversation on Facebook →

Built with the people — and someday, by them. The more voices, the truer it gets.