These two essays trace how the Indian Health Care Improvement Act reauthorization was built between 1999 and 2010, and who built it. They are companions to Paper I-B — The Reauthorization of the Indian Health Care Improvement Act: The Critical Year 1999–2000 and to Graphic 14, Reauthorization of the Indian Health Care Improvement Act.
Who Built the Indian Health Care Improvement Act? A Multi-Level History of Tribal Leadership, Regional Organizations, Technical Staff, Legislative Counsel, Congress, and the Administration
Edward J. Fox, PhD — September 2026
Discussion draft — posted for comment before final publication. This paper argues that the IHCIA reauthorization (1999–2010) was not the product of any single committee or Congress, but of a decade-long, multi-level process running from individual Tribal governments through regional and national Tribal organizations, technical advisers, legislative counsel, and Congress — with influence moving in both directions rather than down a simple chain. Tracing two threads (Title IV’s consolidation and the Entitlement Commission’s removal) across three legislative stages, it argues that what looks from a distance like uniform attrition of the original 1999 Tribal proposal actually took three distinct forms: consolidation that preserved the underlying policy, a contested and documented deletion, and gradual erosion ending in disappearance without any single clean removal point. Comments welcome at edfoxphd@icloud.com.
A working roster of participants
The reconstruction above draws on a working, documented roster of the people and institutions involved in the IHCIA reauthorization effort. It is not a complete participant list — the most significant known gap is the May 28–30, 2002 national meeting in Portland, which brought together more than 200 Tribal representatives, federal personnel, and congressional staff whose full attendance list has not yet been located. Each entry below carries a documentation standard: A — directly documented role; B — documented substantive participation, precise function requiring some reconstruction; C — credible connection requiring additional verification; D — institutional participant, individuals not yet fully identified. Sections are collapsed by default — expand any section to see who is documented there.
National Steering Committee Leadership
Rachel A. Joseph (California Area) — a principal leader of the National Steering Committee; later co-chaired the renewed national effort with Julia Davis-Wheeler beginning in late 2002. Documentation: A
Buford Rolin (Poarch Creek / National Indian Health Board) — National Indian Health Board representative, National Steering Committee co-chair, and chair of the Health Financing Workgroup; still identified as an NSC co-chair in 2007 Senate records. Documentation: A
Julia Davis-Wheeler (Portland Area) — Portland Area representative on the original national roster; selected with Rachel Joseph in December 2002 as co-chair for the next phase of the NSC’s work, and later testified before the Senate Committee on Indian Affairs. Documentation: A
1999/2000 National Steering Committee — Area Representatives
| Area | Representative | Alternate |
|---|---|---|
| Aberdeen (now Great Plains Area) | Tex Hall | Jim Cournoyer |
| Alaska | H. Sally Smith | Larry Ivanoff |
| Albuquerque | Rick Vigil | Robert Nakai |
| Bemidji | Eli Hunt | Sandra Ninham |
| Billings | Alvin Windy Boy | Pearl Hopkins |
| California | Rachel A. Joseph | Jack Musick |
| Nashville | Eddie Tullis | (role designation pending verification) |
| Navajo | Dr. Taylor McKenzie | Jerry Freddy |
| Oklahoma | Merle Boyd | Mamie Rupnicki |
| Phoenix | Arlan Melendez | Merna Lewis |
| Portland | Julia Davis | Pearl Capoeman-Baller |
| Tucson | Edward Manuel | Benito Valencia |
| Urban Indian Representation | Barbara Namias | Kay Culbertson |
| Self-Governance Representation | Merle Boyd | Dennis Smith |
| National Indian Health Board | Buford Rolin | Joseph Saulque |
The Five National Workgroups
The national process divided substantive work among five workgroups — leadership positions, not claims of individual authorship; each depended on broader participation by Tribal representatives, health professionals, program administrators, attorneys, and technical advisers.
- Health Services — Dr. Taylor McKenzie
- Health Facilities — Julia Davis-Wheeler, Robert Nakai
- Health Financing — Buford Rolin
- Miscellaneous — Tony Largo
- Preamble — Henry Cagey
The Drafting Team & Legislative Counsel
Detailed legislative language was produced by a Drafting Team — National Steering Committee co-chairs, Tribal attorneys, program staff, and legislative/legal drafting personnel — rather than by a single author.
Myra M. Munson — a core participant in the legislative drafting process; contemporary congressional records specifically acknowledge her work drafting the reauthorization bill and developing and refining legislative language. Her role illustrates an important distinction: the people who drafted legislative language were not necessarily the people who originated the Tribal policy positions it expressed. Documentation: A
Lisa Daly — legislative drafting/support. Documentation: A/B
Edward Grossman — legislative drafting/support. Documentation: A/B
Pierre Poisson (House Legislative Counsel) — legislative drafting. Documentation: A
Carol Barbero (Hobbs, Straus, Dean & Walker) — legislative/legal drafting support. Documentation: A/B
Cynthia A. Ahwinona (House Resources Committee, Office of Native American and Insular Affairs) — congressional committee/legislative support. Documentation: A/B
Tribal Attorneys
The congressional record indicates that dozens of Tribal attorneys were involved at various points in the drafting process, converting Tribal policy positions into detailed statutory language. The complete list has not yet been reconstructed; this is an important research gap, and names will be added only when supported by contemporaneous records.
Technical & Facilitation Support
Jo Ann Kauffman (Kauffman and Associates) — provided substantial facilitation, coordination, technical, and drafting support during the early national process; the IHS archive preserves the firm’s July 1999 draft. Her role is part of the technical and facilitation infrastructure of the national Tribal process, not sole authorship of the legislation, and continued through the May 2002 Portland meeting. Documentation: A/B
IHS and Federal Participants
Michael H. Trujillo, MD (IHS Director) — convened the National Reauthorization Steering Committee in 1999. Documentation: A
Michael Mahsetky (IHS Legislative Affairs) — participated in the early national process, an important legislative contact. Documentation: A
Kitty Rogers, RN, MS (IHS) — participated in the early national reauthorization effort and was a principal IHS representative at the 2002 Portland meeting. Documentation: A/B
June Tracy (IHS) — documented as a principal IHS participant at the May 2002 Portland meeting. Documentation: B
Charles W. Grim, DDS (IHS Director) — participated in the renewed National Steering Committee process beginning December 2002. Documentation: A
NPAIHB and the Legislative Phase
The Northwest Portland Area Indian Health Board played several roles at different stages — Tribal leadership, policy analysis, organizational infrastructure, meeting support, communications, technical assistance, congressional advocacy, and staff support — not simply that of an advocacy organization.
Ed Fox — his role changed substantially over the period. In 1999, supported through NPAIHB to assist the “Speaking With One Voice” effort (policy analysis and support for Northwest Tribal leaders). From 2000–2002, as NPAIHB Executive Director, supported the Board’s continuing involvement, and served as the Board’s logistics/organizational coordinator (not facilitator) for the May 2002 Portland meeting. From 2003–2005, continued policy analysis, editing, and technical support; in meetings with Senate staff on specific provisions, Myra Munson took the lead on legislative language while Fox provided editing and advice on the Tribal policy positions the language was meant to express. His direct IHCIA involvement diminished substantially in 2006, when he was serving in Nevada, and the roster does not characterize him as a continuing central participant in the 2007 legislative effort. Documentation: A/B, role changing substantially over time.
Jim Roberts — role best understood as legislative and policy advocacy during the later phase; NPAIHB records document his work with Tribal leaders and congressional offices to advance IHCIA reauthorization. Documentation: A/B
The May 2002 Portland Meeting
The May 28–30, 2002 meeting is a major but incompletely documented part of the history. More than 200 Tribal representatives, federal personnel, and congressional staff participated, considering Administration and congressional concerns — including the Congressional Budget Office’s assessment of the proposed legislation — and producing recommendations transmitted to Congress.
Organizational participants included NPAIHB, other Area Health Boards, IHS, congressional staff, Tribal representatives, and technical/facilitation personnel. Individuals presently documented in connection with the meeting: Ed Fox (NPAIHB), Jo Ann Kauffman (facilitation/technical support), Kitty Rogers (IHS), Michael Mahsetky (IHS), and June Tracy (IHS). This is not the meeting’s complete participant list — the original attendance/registration record remains a research gap.
2003–2007 Legislative Advocacy
The later phase involved a changing group of Tribal leaders and advocates. Presently documented roles: Rachel Joseph — National Steering Committee leadership; Julia Davis-Wheeler — National Steering Committee leadership and congressional testimony; Buford Rolin — National Steering Committee leadership and Health Financing (still identified as an NSC co-chair in 2007 Senate records, showing the Committee’s continuing role well after the 1999 drafting phase); Jim Roberts — legislative/policy advocacy. Additional names will be added as contemporary congressional and Area Health Board records establish their participation.
Institutional Participants
The IHCIA effort depended on organizations as well as individuals.
Area Health Boards: Northwest Portland Area Indian Health Board, Alaska Native Health Board, California Rural Indian Health Board, United South and Eastern Tribes, and other Area Health Boards participating in consultation and advocacy.
National Indian organizations: National Indian Health Board, National Congress of American Indians, National Council of Urban Indian Health, and other national organizations.
Federal institutions: Indian Health Service, Senate Committee on Indian Affairs, House committees and legislative counsel.
The role of these institutions varied over time and should not be treated as uniform.
What remains incomplete
This roster is deliberately unfinished. The most important gaps: (1) a complete May 2002 Portland participant list; (2) full membership of the five national workgroups; (3) a complete list of the Tribal attorneys involved in drafting; (4) complete membership of the later National Steering Committee; (5) a full list of Tribal leaders involved in 2003–07 congressional advocacy; (6) complete identification of the IHS and congressional staff who worked on specific provisions. These gaps are left visible rather than filled with assumptions — corrections and additions are welcome at edfoxphd@icloud.com.
Building Consensus: NPAIHB’s Role in the IHCIA Reauthorization
Edward J. Fox, PhD — September 2026
This paper argues that the Northwest Portland Area Indian Health Board was arguably the most important organization in the development of the IHCIA reauthorization — a view the author believes many, especially in the Northwest, would share — not as an author of legislative text, but as the institution that turned sophisticated analysis into positions other Tribes and Areas could stand behind, through policy analysis, meeting facilitation, and sustained support to other national Indian health organizations. Tracing NPAIHB’s role across nearly a decade — from the 1998 groundwork in Northwest state Medicaid policy, through the Board’s hosting of the May 2002 Portland meeting, to the handoff from direct drafting support to congressional advocacy carried through Jim Roberts and Joe Finkbonner to elected Tribal leadership — the essay argues that NPAIHB’s importance lay in continuous capacity rather than continuous authorship, and that no single organization, including NPAIHB, could have produced the IHCIA of 2010 alone.