[Senate Hearing 113-327]
[From the U.S. Government Publishing Office]
S. Hrg. 113-327
THE PRESIDENT'S FISCAL YEAR 2015 BUDGET FOR TRIBAL PROGRAMS
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HEARING
before the
COMMITTEE ON INDIAN AFFAIRS
UNITED STATES SENATE
ONE HUNDRED THIRTEENTH CONGRESS
SECOND SESSION
__________
MARCH 26, 2014
__________
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COMMITTEE ON INDIAN AFFAIRS
JON TESTER, Montana, Chairman
JOHN BARRASSO, Wyoming, Vice Chairman
TIM JOHNSON, South Dakota JOHN McCAIN, Arizona
MARIA CANTWELL, Washington LISA MURKOWSKI, Alaska
TOM UDALL, New Mexico JOHN HOEVEN, North Dakota
AL FRANKEN, Minnesota MIKE CRAPO, Idaho
MARK BEGICH, Alaska DEB FISCHER, Nebraska
BRIAN SCHATZ, Hawaii
HEIDI HEITKAMP, North Dakota
Mary J. Pavel, Majority Staff Director and Chief Counsel
Rhonda Harjo, Minority Deputy Chief Counsel
C O N T E N T S
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Page
Hearing held on March 26, 2014................................... 1
Statement of Senator Barrasso.................................... 22
Statement of Senator Begich...................................... 19
Statement of Senator Johnson..................................... 14
Statement of Senator Murkowski................................... 24
Statement of Senator Tester...................................... 1
Statement of Senator Udall....................................... 16
Prepared statement........................................... 17
Witnesses
Joseph, Jr., Hon. Andrew, Member-At-Large/Portland Area
Representative, National Indian Health Board; Chair, Northwest
Portland Area Indian Health Board.............................. 64
Prepared statement........................................... 65
Payment, Aaron, Midwest Area Vice President, National Congress of
American Indians; Chairman, Sault Ste. Marie Tribe of Chippewa
Indians........................................................ 32
Prepared statement........................................... 35
Roubideaux, Hon. Yvette, M.D., M.P.H., Acting Director, Indian
Health Service, U.S. Department of Health and Human Services... 8
Prepared statement........................................... 9
Washburn, Hon. Kevin, Assistant Secretary--Indian Affairs, U.S.
Department of the Interior..................................... 2
Prepared statement........................................... 4
Appendix
National Indian Child Welfare Association (NICWA), prepared
statement...................................................... 87
National Indian Education Association (NIEA), prepared statement. 92
Native Hawaiian Education Council, prepared statement............ 85
Patterson, Hon. Brian, President, United South and Eastern
Tribes, Inc., prepared statement............................... 78
Yazzie, Albert A., President, Crystal Boarding School Board of
Education, prepared statement.................................. 77
THE PRESIDENT'S FISCAL YEAR 2015 BUDGET FOR TRIBAL PROGRAMS
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WEDNESDAY, MARCH 26, 2014
U.S. Senate,
Committee on Indian Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 3:56 p.m. in room
628, Dirksen Senate Office Building, Hon. Jon Tester,
Chairman of the Committee, presiding.
OPENING STATEMENT OF HON. JON TESTER,
U.S. SENATOR FROM MONTANA
The Chairman. We will call this hearing to order on the
President's Fiscal Year 2015 Budget for Tribal Programs.
I want to welcome the two witnesses for this panel and also
the witnesses for the next panel.
We will be holding this Oversight Committee while there are
votes happening on the Floor right now. I honestly do not know
how that will impact the membership attending this hearing but
we will have questions as we move forward.
The President's request for Indian Affairs and the
Department of Interior is $2.6 billion, an increase of $33.6
million over fiscal year 2014. The Indian Health Service budget
was increased by $199 million to $4.6 billion.
Although these proposed increases are encouraging, we must
also acknowledge that these are harsh financial times. Tribes
have not recovered from sequestration which resulted in across
the board cuts to all Federal programs, including those
affecting tribes and nowhere was this more devastating than the
Indian Health Service where due to sequestration, continuing
resolutions and a 16-day government shutdown, health care to
Indian people was jeopardized.
That is why today and next week, the Committee is going to
talk about securing advanced appropriations for the Indian
Health Service. The delivery of health care to Indian people
should not be threatened because those of us who serve in
Washington cannot get our act together, prepare, and pass a
budget.
There is a bill now pending in Committee, S. 1570, that
would provide advance funding for the Indian Health Service.
This bill is tailored after a bill Congress enacted to advance
funding for the Veterans Administration system in 2009. I look
forward to working with my colleagues on both sides of the
aisle and the Administration on making this initiative a
reality.
Despite the budgetary constraints that we face, there are
some positive highlights in the President's fiscal year 2015
budget request. The Committee is pleased that the
Administration finally understands the legal obligation to
fully fund contract support costs for both the Indian Health
Service and the Bureau of Indian Affairs.
I am particularly encouraged by the $11 million increase
for social services and job training to support an initiative
to provide a comprehensive and integrated approach to address
violence, poverty and substance abuse in Indian Country.
As we learned from Dr. Costello, who testified at our early
childhood development hearing last month, we can either pay now
or we pay later, but we are going to pay. I think it is much
wiser to invest in preventive services today than pay for a
lifetime of treatment and remedial assistance later.
However, there are some areas that may not be receiving the
attention they deserve. For tribal communities to thrive now
and into the future, there must be economic development
opportunities and an educated workforce.
My colleagues and I have heard in numerous Committee
meetings of the poor conditions at many of the BIA schools. Yet
again, the BIA has only requested enough funding to do the site
development to construct one of three schools that remain on
the 2004 school construction list. In addition to that list,
there are another 60 schools considered in poor condition.
Finally, I am very concerned with the Administration's
request for drinking water and sanitation construction. There
is more than a $3 billion backlog in drinking water and
sanitation construction needs in Indian Country. However,
across all Federal agencies, including the EPA, the
Administration is only requesting $173 million to address
drinking water and sanitation needs in Indian Country.
Senator Barrasso obviously is not here. When he gets here,
opening statements will certainly be open to him. I am going to
move with the panel.
On our first panel is the Honorable Kevin Washburn,
Assistant Secretary, Indians Affairs, U.S. Department of the
Interior and the Honorable Yvette Roubideaux, Acting Director,
Indian Health Service, U.S. Department of Health and Human
Services.
Your entire written testimony will be made a part of the
record. I would ask that you be as close to five minutes as you
possibly can. That way, there will be enough time for me to ask
questions.
With that, we will start with you, Secretary Washburn.
STATEMENT OF HON. KEVIN WASHBURN, ASSISTANT
SECRETARY--INDIAN AFFAIRS, U.S. DEPARTMENT OF THE
INTERIOR
Mr. Washburn. Thank you, Chairman Tester.
Let me say the Secretary very much enjoyed her recent visit
to Montana. I heard wonderful stories about it.
The Chairman. Don't believe them.
[Laughter.]
Mr. Washburn. It is really important for her to get
firsthand experience and she really enjoyed it.
The Chairman. It was a great trip and we appreciate the
time she spent in Montana visiting Indian Country, water
projects, conservation projects and energy projects around the
State of Montana. Thank you.
Mr. Washburn. Larry Roberts is with me, the Deputy
Assistant Secretary who was on that trip and Pam Hayes, another
Deputy Assistant Secretary. Two Deputy Assistant Secretaries
are useless unless you have three so we have Tommy Thompson
here as well. They come in threes, so we are well staffed.
The Chairman. We appreciate them.
Mr. Washburn. The budget that we propose for Indian Affairs
this year is best characterized as a responsible budget. We
understand there is not dancing in the streets, but we also
understand there are serious budget caps here on the Hill with
the Murray-Ryan budget cap. We have promised to live within
that so the budget we propose fits within the Murray-Ryan cap.
It includes the $33 million increase, new money, for Indian
Affairs and also $42 million, new money, for fire in the
Department's overall budget. There is a nice increase for
tribes in this budget even though it is a very flat budget year
and a very strict fiscal environment.
We do propose to fully fund contract support costs. We know
that contract support costs are necessary for tribes to be able
to really perform under their self governance compacts and
their self determination contracts, so we have fully funded
them for fiscal year 2014 and propose full funding for fiscal
year 2015. We are grateful for the leadership of this Committee
on that issue.
We also propose a new approach to social services which you
recognized in your opening statement. The Tiwahe Initiative
which is sort of a double entendre, the idea is that we need to
be serving families.
Tiwahe is the Lakota word for family. The idea is we need
to be bringing our services together more around serving
families rather than leaving them in silos serving individuals.
That program will help with social services.
We have social workers running from crisis to crisis in
Indian Country. In part through people on this Committee,
Senators Hoeven and Heitkamp, we have seen some of the serious
problems that these social workers face when they are under
staffed and overworked.
That money will basically go in large measure to provide
more money for social workers to help get ahead of problems
instead of being reactive all the time and just going from
crisis to crisis.
That is one of our initiatives we really think can improve
things. We can all work together within the BIA and function
more like a family ourselves. We think that will be an
improvement.
As part of that initiative, we have asked for funding for a
housing improvement program, something we have talked about
zeroing out in the past but we heard from tribes that is a real
important part of their social services. We heard loud and
clear they want us to keep the funding for the housing
improvement program so we have asked for funding for that for
fiscal year 2015.
We have several other programs. One of them is somewhat
involved with the Tiwahe Initiative is we have embarked on a
program that would continue into 2015 that will reduce
recidivism in Indian Country.
Our chief law enforcement officer with the BIA tells me
that we have several people in Indian Country who are serving
life sentences a couple of days at a time because they
committed some very minor offense and they get locked up for a
couple of days and get out only to commit another offense soon
thereafter.
We are going to work on trying to reduce recidivism in
Indian Country and especially try to provide services to people
suffering those kinds of issues.
Those are two of the biggest things, contract support costs
and the Tiwahe Initiative. We have some modest increases in
other areas. It is a fairly flat budget though. We are trying
to improve but we are also trying to stay within the Murray-
Ryan cap.
The Obama Administration has worked very hard to improve
the Nation's commitment to Indian Country and we do think this
budget continues that commitment. We thank you, Senator Tester,
and this Committee for being such an important ally in that
mission.
Thank you very much.
[The prepared statement of Mr. Washburn follows:]
Prepared Statement of Hon. Kevin Washburn, Assistant Secretary--Indian
Affairs, U.S. Department of the Interior
Good afternoon, Chairman Tester, Vice Chairman Barrasso, and
members of the Committee. Thank you for the opportunity to provide a
statement on behalf of the Department of the Interior (Department) on
the President's Budget Request for Fiscal Year (FY) 2015 that was
presented to Congress on March 4, 2014. The FY 2015 budget request for
Indian Affairs programs within the Department totals $2.6 billion,
which is $33.6 million more than the FY 2014 enacted level.
As the Assistant Secretary for Indian Affairs, I have the
responsibility to oversee the numerous programs within the Bureau of
Indian Affairs (BIA) and the Bureau of Indian Education (BIE), along
with other programs within the immediate Office of the Assistant
Secretary for Indian Affairs. The Office of the Assistant Secretary for
Indian Affairs, BIA, and BIE programs expend over 90 percent of
appropriated funds at the local level. Of this amount, over 62 percent
of the appropriations are provided directly to Tribes and tribal
organizations through grants, contracts, and compacts for Tribes to
operate government programs and schools. In sum, tribal self-
determination and self-governance programs have eclipsed direct service
by the BIA and BIE to Indian people. Indian Affairs' programs serve the
more than 2.0 million American Indian and Alaska Natives living on or
near Indian reservations.
The FY 2015 President's Request supports continuing efforts to
advance self-governance and self-determination, promote efficient and
effective governance, prudently manage tribal natural resources, build
stronger economies and self-sufficiency and maintain safer Indian
communities. In November 2013, President Obama hosted the fifth annual
White House Tribal Nations Conference. The event included thirteen
Cabinet members and dozens of senior Administration officials who met
with representatives from the 566 federally recognized Tribes on a wide
range of issues including advancing the Nation to Nation relationship,
economic development, housing, excellence in education, energy,
infrastructure, law enforcement, cultural protection, natural
resources, and Native American youth.
Our funding priorities are guided, in part, by careful coordination
with Tribes through a regional-to-national planning process through the
Tribal Interior Budget Council. In addition, input from tribal leaders
gained since the first White House Tribal Nations Conference has helped
guide the Administration's priorities and decisionmaking processes.
These and other sources of tribal input have informed legislative and
programmatic initiatives and funding priorities in the 2015 budget,
including full funding for contract support costs.
To insure the continued success of tribal self-determination and
self-governance, the 2015 President's budget request proposes to
continue full funding for contract support costs. It includes a request
for $251.0 million, an increase of $4.0 million above the 2014 enacted
level. Based on the most recent analysis, the requested amount will
fully fund the estimated 2015 contract support need. The availability
of contract support cost funding is a key factor in tribal decisions to
assume responsibility for operating Federal programs, furthering tribal
self-determination and self-governance. The Interior Department fully
funded estimated contract support costs in 2014. The Bureau of Indian
Affairs will continue to consult with Tribes to develop streamlined
mechanisms and a long-term approach to advancing these shared goals.
To further enhance the Nation-to-Nation relationship, Indian
Affairs is continuing its comprehensive look at the regulations
addressing how Indian groups apply for and receive Federal recognition
as an Indian Tribe. The Department is reviewing comments recently
received and plans to proceed with a proposed rule for publication in
the Federal Register. After another round of consultations and a formal
comment period, Indian Affairs plans to publish the final rule in 2014
or early 2015. In addition, the 2015 budget proposes language to
clarify the Department's authority to take Indian land into trust and
amend the Indian Reorganization Act of 1934, thereby reducing
significant delays in processing land into trust applications
Supporting Indian Families and Protecting Indian Country
Supporting Indian families and ensuring public safety are top
priorities for the President and tribal leaders. As part of the
President's commitment to protect and promote the development of
prosperous tribal communities, BIA proposes the Tiwahe Initiative, a
new effort to support community and cultural awareness in Indian
Country. Child abuse and neglect are serious and persistent problems
among Indian populations in the United States. The impact of child
maltreatment in many Indian communities has been devastating. It has
disrupted extended family support networks and broken up families
through placements outside the community.
Children living in poverty are far more likely to be exposed to
violence and psychological trauma, both at home and in the surrounding
community. Indian communities are plagued by high rates of poverty,
substance abuse, suicide, and violent crime. The U.S. Census Bureau
recently reported that between the years 2007 and 2011, 23.9 percent of
the American Indian and Alaska Native population lived in poverty; a
figure that exceeded the national poverty rate of 14.3 percent.
The 2015 budget includes a comprehensive and integrated approach to
the interrelated problems of poverty, violence, and substance abuse
faced by Indian communities. The proposed increase of $11.6 million for
social services, child welfare and job training programs will support
the initiative by providing culturally appropriate services with the
goal of empowering individuals and families through health promotion,
family stability, and strengthening tribal communities as a whole. In
its initial phase, the Tiwahe Initiative will expand BIA's capacity in
current programs that address Indian children and family issues and job
training needs.
To promote public safety and community resilience in Indian
communities, the 2015 budget maintains resources to build on recent
successes in reducing violent crime and implements a new goal to lower
repeat incarceration in Indian Country. The goal of the pilot program
is to lower rates of repeat incarceration at the three targeted
reservations of Red Lake, Ute Mountain, and Duck Valley by a total of
three percent by September 30, 2015. To achieve this goal, BIA will
implement a comprehensive ``alternatives to incarceration'' strategy,
that seeks to address underlying causes of repeat offenses, including
substance abuse and social services needs, by utilizing alternative
courts, increased treatment opportunities, probation programs, and
interagency and intergovernmental partnerships with tribal, Federal,
and State stakeholders.
Supporting Sustainable Stewardship of Trust Resources
The BIA's trust programs assist Tribes in the management,
development, and protection of Indian trust land and natural resources
on 55 million surface acres and 57 million acres of subsurface mineral
estates. These programs assist tribal landowners in optimizing the
sustainable stewardship and use of resources, providing many benefits
such as revenue, jobs, and the protection of cultural, spiritual, and
traditional resources.
Taking land into trust is one of the most important functions
Interior undertakes on behalf of Indian Tribes. Homelands are essential
to the health, safety, social, cultural, and economic welfare of tribal
governments. In 2013, Interior acquired 32,148 acres of land in trust
on behalf of Indian Tribes and individuals and approved 438 fee-to-
trust applications. The Administration has set an ambitious goal of
placing more than 500,000 acres of land into trust by the end of the
Obama Administration. To that end, BIA has processed more than 1,500
land-into-trust applications, accepting more than 240,500 acres in
trust on behalf of Tribes since 2009. To put that in context, that
figure equals more than 375 square miles. The BIA intends to build on
this progress to meet or exceed the 500,000 acre goal.
The BIA is striving to increase the economic utilization of Indian
lands. In addition to implementing the Helping Expedite Responsible
Tribal Homeownership Act provisions for tribal leasing approval, Indian
Affairs continues to implement other new Federal leasing regulations
finalized in early 2013. The updated regulations encourage and
accelerate economic development in Indian Country. The revised
regulations reformed the former antiquated, one-size-fits-all Federal
surface leasing regulations for Tribes and individual Indians. The rule
defines specific processes, with enforceable timelines, through which
BIA must review leases and permits. The regulation establishes
separate, simplified processes for residential, business, and renewable
energy development, so that, for example, a lease for a single family
home is distinguished from a large solar energy project.
The 2015 budget will continue funding resource stewardship with
expanded science and technical support started in 2014, including
research, analysis, and technical support activities for the
development of alternative and conventional energy sources, sustainable
management of natural resources such as land, water, oceans, endangered
and invasive species, and climate adaptation and resilience. In
addition, the Indian Affairs budget proposes $35.7 million for Indian
land and water settlements in the 2015 budget, which is equal to the
2014 enacted level.
Advancing Indian Education
Native American youth are the most precious resource of any Tribe,
and educating our youth is vital to the well-being of Indian Country.
The 2015 budget request for the Bureau of Indian Education is $794.4
million, $5.6 million above the 2014 enacted level. Included within
this funding request are programs that will advance the Department's
continuing commitment to American Indian education.
A thriving educational system for American Indian students is
essential for the long-term health and vitality of Native American
communities and is a critical component of the broader initiative to
strengthen tribal communities. In 2013, Secretary Jewell and Secretary
of Education Arne Duncan convened an American Indian Education Study
Group to address needed reforms to American Indian elementary and
secondary education and seek higher levels of academic achievement.
The Study Group is overseen by myself, as Assistant Secretary for
Indian Affairs, and includes representatives from BIE, Department of
Education, leading academics, and Department of Defense educational
system. Foundational issues the group is evaluating include: the
creation of a relevant curriculum; the need for retention and
recruitment of effective teachers; the application of appropriate
teaching practices; and addressing the student achievement gap. The
work will be done in concert with President Obama's initiative to
support tribal self-determination. The group has traveled the Country
to listen to BIE and tribal school employees, parents, and students
directly impacted by the BIE system. They will conduct tribal
consultations to gather tribal views and input on recommendations for
improving educational outcomes in schools. The President's budget
proposes to include Indian education in the Opportunity, Growth and
Security Fund. The Fund would support incentives to promote
improvements in educational outcomes at schools funded through the
Bureau of Indian Education.
Land Buy-Back Program for Tribal Nations
Throughout 2013, the Land Buy-Back Program continued to implement
the land consolidation portion of the Cobell Settlement Agreement. In
the Settlement, $1.9 billion was set aside to consolidate fractionated
ownership of land interests held in trust or restricted status across
Indian Country. Under the terms of the Settlement, the Department of
the Interior has until November 2022 to expend the funding to acquire
fractional interests at fair market value from willing sellers.
Fractionation has been identified as a key impediment to economic
development and is a significant factor in the complexity and cost of
managing the Indian Trust. Lands acquired through the program will
remain in trust or restricted status and are immediately consolidated
for beneficial use by the tribal nation with jurisdiction. Some of the
beneficial uses of consolidated land include energy development,
farming, cultural preservation, and timbering.
In December 2013, the Department made initial purchase offers for
fractional interests at three locations: Pine Ridge Reservation, Makah
Indian Reservation, and Rosebud Reservation. In 2014, the Land Buy-Back
Program has extended offers to additional individual owners with
fractional interests at these locations and will send offers to owners
at other locations. Purchasing interests at fair market value from
willing sellers ultimately strengthens tribal sovereignty by increasing
tribal land bases. As a result of Buy-Back offers, tens of thousands of
acres have been consolidated and millions of dollars in payments have
gone to willing sellers. The program is focusing on the most
fractionated locations and using a detailed mass appraisal method where
feasible to achieve the most cost-effective acquisition of fractional
interests.
Other Bureau funding in the Department
As this Committee is aware, all the departments within the
Executive Branch of our Federal Government potentially have at least
one or more bureaus or programs that provide funding in support of
Native Americans and Tribes. The Department of the Interior
(Department) is no different. The Department's FY 2015 budget includes
$612 million for programs in other bureaus, not in Indian Affairs, in
support of Native Americans and Tribes. This reflects an increase of
$42 million or 7.4 percent from 2014 enacted levels. When added
together with the Indian Affairs budget, the total request for Indian
programs is $3.2 billion. This is an increase of $76 million or 2.5
percent over 2014 enacted levels.
Listed below are a few highlights of the programs outside the
Indian Affairs budget that support Tribes and American Indians and
Alaska natives, these include:
Wildland Fire: The Wildland Fire budget includes $200.1
million for emergency and non-emergency Fire Programs. The
Tribal initiative includes additional $52. 3 million in funds
for Fire Preparedness, Fuel Management, and the Resilient
landscapes program.. Funds will support contract support costs,
workforce development, firefighter and support personnel, and
to maintain veteran crews0.
The Bureau of Land Management (BLM) budget includes $16.9
million for programs such as Alaska conveyance, oil and gas,
and coal and other minerals to support Native Americans.
The Fish and Wildlife Service (FWS) budget includes $10.7
million for a wide-range of activities including fish hatchery
maintenance and Tribal Wildlife Grants.
The National Park Service (NPS) budget includes $13.5
million for Native American programs including grants for
Historic Preservation Fund and the Native American Grave
Protection programs.
The United States Geological Service (USGS) budget includes
$7.6 million for Tribal Science Partnerships which includes an
increase of $2.8 million for Tribal Science Partnerships.
The Office of Surface Mining (OSM) budget includes $2.1
million for programs with Crow, Hopi, and Navajo tribes.
The Office of the Special Trustee (OST) includes $139.0
million for programs that manage Indian funds held in trust by
the Federal Government.
The Office of Natural Resources Revenue (ONRR) budget
includes $35.0 million for the management of royalty assets
from Indian trust properties, an increase of $1.0 million.
The Bureau of Reclamation (BOR) budget includes $186.5
million for Native American programs including $112.0 million
for Indian Water Rights Settlements.
Conclusion
This FY 2015 budget supports the Administration's objectives to
strengthen tribal nations through economic development, protect Indian
communities through public safety and justice programs and social
services, improve Indian education to secure the long-term health and
vitality of Indian Country, and improve the government-to-government
relationship between tribal nations and the United States. The 2015
budget request maintains the President's commitment to meet our
obligations to tribal nations while exercising fiscal responsibility
and improving government operations and efficiency.
Chairman Tester and Members of the Committee, thank you for the
opportunity to appear before you today. I am happy to answer any
questions you may have.
The Chairman. Thank you for your testimony, Secretary
Washburn.
Dr. Roubideaux, you are up.
STATEMENT OF HON. YVETTE ROUBIDEAUX, M.D.,
M.P.H., ACTING DIRECTOR, INDIAN HEALTH SERVICE, U.S. DEPARTMENT
OF HEALTH AND HUMAN SERVICES
Dr. Roubideaux. Thank you and good afternoon, Chairman
Tester.
I am Dr. Yvette Roubideaux, the Acting Director of the
Indian Health Service. I am pleased to provide testimony today
on the President's fiscal year 2015 budget request for the
Indian Health Service.
The President's fiscal year 2015 budget request in
discretionary budget authority for the IHS is $4.6 billion, an
increase of $200 million or a 4.5 percent increase.
The request includes priority increases for medical
inflation, staffing and operation of four newly constructed
facilities, an increase for the Purchased/Referred Care
Program, formerly the Contract Health Services Program, pay
costs, funding for five new tribes, funding to restore
reductions made in 2014 to fund priorities and full funding for
the estimated need for contract support costs in fiscal year
2015.
We are very happy about this proposal and the outcome in
2014. We thank you for your partnership on this issue and I am
glad we were all able to work together to make sure we could
advocate and get the tribal priorities enacted.
The budget proposal also includes health care facilities
construction funding to complete construction on the Kayenta,
Ft. Yuma and Northern California Youth Regional Treatment
Center and funds to continue construction on the Gila River
Southeast Arizona facility.
The President's fiscal year 2015 budget request also
includes an Opportunity, Growth, and Security government-wide
initiative that proposes an additional $200 million for IHS
health care facilities construction.
The fiscal year 2015 budget also includes legislative
proposals to reauthorize the Special Diabetes Program for
Indians for an additional three years, to establish authority
for Medicare-like rates for non-hospital and physician/non-
physician services and to provide a tax exemption for the
Indian Health Service Health Professions Scholarship and Health
Profession Loan Repayment Programs.
The IHS budget is critical to our progress in accomplishing
our agency priorities, reforms and improvements. If this
proposed budget is enacted, the IHS appropriations will have
increased 38 percent since 2008, so thank you for your
partnership.
Appropriations increases received in the past six fiscal
years are making a substantial difference in the quality and
quantity of health care we are able to provide American Indians
and Alaska Natives. We are grateful that IHS remains a top
budget priority.
The budget request was developed after formal tribal budget
formulation process and incorporates tribal budget priorities.
Tribal consultation is a priority of President Obama who has
expressed a commitment to honoring treaty rights and making
tribal consultation a priority.
In order to continue our commitment to tribal consultation,
I plan to personally conduct listening sessions in all IHS
areas this year to hear views from tribes on how we can
continue to make progress in agency reforms. I do believe I am
holding a listening session next week in Montana.
IHS has made improvements in a number of areas detailed in
my written testimony. One of those areas is contract support
costs. In addition to working with tribes on a long term
solution for contract support costs or CSC appropriations, we
have also made substantial progress on settling past CSC
claims.
We heard input from Congress and tribes to accelerate the
settlement process and our recent dedicated increase in
resources and staff is making a difference. IHS has analyzers
in the process of analyzing over 550 claims and since Ramah,
IHS has made settlement offers on over 200 claims from 31
tribes. The total settlement amount to date for 104 claims that
have been formally settled or are in the process of settlement
totals over $133 million.
IHS is committed to fair, consistent, and speedy resolution
of claims through settlement wherever possible.
In summary, we are working hard and in partnership with
Congress and tribes to change and improve the Indian Health
Service through our reform efforts. We really thank you for
your support and partnership.
The increases IHS has received in the budget over the past
few years are making a difference but we know we still have
much more to do. We look forward to working with you on the
President's fiscal year 2015 budget request to help continue or
progress in changing and improving the Indian Health Service.
Thank you and I am happy to answer questions.
[The prepared statement of Dr. Roubideaux follows:]
Prepared Statement of Hon. Yvette Roubideaux, M.D., M.P.H., Acting
Director, Indian Health Service, U.S. Department of Health and Human
Services
Good morning Chairman Tester, Vice Chairman Barrasso, and Members
of the Committee. I am Dr. Yvette Roubideaux, Acting Director of the
Indian Health Service. I am pleased to provide testimony on the
President's Fiscal Year (FY) 2015 Budget request for the Indian Health
Service (IHS), and to update you on our progress in addressing our
agency mission to raise the physical, mental, social, and spiritual
health of American Indians and Alaska Natives (AI/ANs) to the highest
level.
Indian Health System
IHS is an agency within the Department of Health and Human Services
(HHS) that provides a comprehensive health service delivery system for
approximately 2.1 million American Indians and Alaska Natives (AI/ANs)
from 566 federally recognized Tribes in 35 states. The IHS system
consists of 12 Area offices, which are further divided into 168 Service
Units that provide care at the local level. Health services are
provided directly by the IHS, through tribally contracted and operated
health programs, through services purchased from private providers, and
through urban Indian health programs.
President's FY 2015 Budget Request
The President's FY 2015 Budget request in discretionary budget
authority for the IHS is $4.6 billion; an increase of $200 million, or
4.5 percent, over the FY 2014 enacted funding level.
The request includes priority increases: $63 million for medical
inflation, $70.8 million to staff and operate four newly constructed
health facilities, $15.4 million for a general program increase for the
Purchased/Referred Care (PRC) program (formerly known as Contract
Health Services) that results in a total increase of $50.5 million when
added to the $32.5 million for medical inflation for PRC and a program
increase of $2.6 million for New Tribes, $2.5 million for pay increases
for federal and Tribal health program staff, $8 million for five new
Tribes, $10 million to restore funding reductions made in FY 2014 to
fund priorities, and $29.8 million for contract support costs (CSC),
primarily for the estimated need for new and expanded contracts. The
budget proposal also includes $85 million for health care facility
construction to complete construction and the staff quarters for the
Kayenta, AZ facility, begin and complete construction of the Fort Yuma,
AZ facility, continue construction of the Gila River Southeast, AZ
facility, and complete construction of the Northern California Youth
Regional Treatment Center.
The President's FY 2015 Budget request also includes an
Opportunity, Growth and Security government-wide initiative to grow the
economy and create opportunities. For IHS, the initiative includes an
additional $200 million to continue progress in constructing facilities
on the IHS Health Care Facilities Construction priority list.
At the Program Level, the budget also estimates $1.2 billion in
third party collections in FY 2015 that includes an estimated increase
in Medicaid reimbursements of $22 million compared to FY 2014, which is
anticipated to result from additional enrollees as the Affordable Care
Act continues to be implemented. The Program Level funding also
includes $39 million in estimated reimbursements from the Department of
Veterans Affairs.
The FY 2015 President's budget also includes legislative proposals
to reauthorize the Special Diabetes Program for Indians for an
additional three years, to establish authority for Medicare-Like Rates
for non-hospital and physician/non-physician services for Indian Health
Service, Tribal and Urban Indian Health Programs, and to provide a tax
exemption for the Indian Health Service Health Professions Scholarship
and Health Profession Loan Repayment Programs similar to the National
Health Service Corps programs.
IHS--Continued Progress
Over the past few years, we have been working to change and improve
the IHS. The IHS budget is critical to our progress in accomplishing
our agency priorities and improvements. If this proposed budget is
enacted, IHS appropriations will have increased by 38 percent since FY
2008. The appropriations increases received in the past six fiscal
years are making a substantial difference in the quantity and quality
of healthcare we are able to provide to AI/ANs. IHS remains a top
Administration priority. In the President's FY 2015 Budget request the
HHS discretionary budget overall decreased while IHS' budget increased.
IHS has made considerable progress in addressing our Agency
priorities and reforms and the budget increases have been critical to
this progress. Tribal consultation is fundamental to our Agency reform
activities. This budget request was developed after a formal Tribal
budget formulation process and incorporates Tribal budget priorities.
Tribal consultation is a priority of President Obama, who has expressed
a commitment to honoring treaty rights and making tribal consultation a
priority. In order to continue our commitment to Tribal consultation, I
plan to personally conduct listening sessions in all IHS Areas this
year to hear views from Tribes on how we can continue to make progress
on Agency reforms.
Tribal consultation helps us focus on budget priorities. For
example, funding for the Purchased/Referred Care (PRC) program,
formerly called the Contract Health Service program, is a top budget
priority of IHS and Tribes and has increased by 60 percent since 2008.
This increased funding is making a difference. Four years ago, most
programs were funding only Medical Priority 1, or ``life or limb''
referrals. In FY 2013, 15 out of 66 Federal PRC programs were able to
fund referrals beyond Medical Priority 1. This means these programs are
paying for more than just life or limb care and more patients are
accessing the health services they need, including preventive services
such as mammograms and colonoscopies. The increased PRC funding also
means that the IHS Catastrophic Health Emergency Fund (CHEF), which
used to run out of funding for high cost cases in June, now is able to
fund cases through August.
In this budget request, the Administration demonstrates its
commitment to self-determination by continuing its FY 2014 commitment
to fully fund the estimated amount of CSC for FY 2015. Of particular
importance for the FY 2015 budget is Tribal consultation on a long term
solution for funding CSC, as requested in the Explanatory Statement
accompanying the Consolidated Appropriations Act of 2014. The
Explanatory Statement requested the Department of the Interior and IHS
consult with Tribes and work with Congress and the Office of Management
and Budget on long term accounting, budget, and legislative strategies.
IHS will be engaging Tribes in multiple forums over the next several
months to develop strategies for the long term CSC solution. A workplan
on the plan for consultation is under development and will be submitted
to Congress as requested.
Related to this is IHS' work to resolve all past claims for
underpayment of CSC. IHS has heard the request from Tribes and Congress
to accelerate the rate at which the Agency is resolving past claims. As
a result, IHS has devoted additional resources and staff to resolving
claims for unpaid CSC with a primary focus on speedy resolution through
settlement whenever possible. IHS must analyze each claim individually
and comply with the multi-step process required by the Contract
Disputes Act. IHS is working to resolve the claims expeditiously and
also believes that the Agency and Tribes working together to resolve
the claims will have the most benefit for our ongoing relationship. IHS
is also improving internal business practices related to the CSC claims
settlement process. IHS is also consistently reviewing methods to
enhance collaboration and streamline the process, and has offered an
alternative claim resolution process that is less burdensome for Tribes
but still is fair and consistent for all Tribes.
This work is showing results. As of March 18, 2014, IHS has
analyzed, or is in the process of analyzing, over 550 claims. Since
Ramah and as of March 18, 2014, IHS has made settlement offers on over
200 claims for 31 Tribes. Of those claims, 34 claims have been formally
settled with five Tribes, and an additional 68 offers have been
accepted by eight Tribes and are in the process of settlement. This is
a considerable increase from the three settled claims reported as of
November 2013. The total settlement amount for claims that have been
formally settled, or are in the process of settlement, totals over $133
million. Our goal is to resolve the majority of currently pending
claims with Tribes that are amenable to settlement and to extend
settlement offers to all Tribes by the end of calendar year 2014. I
personally have experienced the recent increased pace of our settlement
process since I now receive emails almost every day from Agency
attorneys requesting approval of settlement offers.
IHS is also continuing its work to reform the IHS. We are now
focused on implementation and outreach activities to ensure that our
patients benefit from the Affordable Care Act. We want every patient
who visits our facilities to get education and assistance primarily
from the business office, which is a place where every patient spends
some time in our facilities. All of our sites have been working hard to
educate our patients on the Affordable Care Act provisions.
We have also been working with national and regional Tribal
organizations to conduct outreach and education on the benefits of the
Affordable Care Act. Our partners include the National Congress of
American Indians, the National Indian Health Board, the National
Council of Urban Indian Health, and the Self-Governance Communication
and Education organization.
Our internal reform efforts are focused on improving the way we do
business and how we lead and manage our staff. Overall, we have
implemented many improvements. To improve the way we do business, we
are working with HHS and our Area Directors to improve how we manage
and plan our budgets and improve our financial management. We are
working to make our business practices more consistent and effective
throughout the system. We are also working on program integrity and
responding to recommendations from oversight agencies to ensure we are
effective and using federal resources wisely.
We are also working on strategies to improve recruitment and
retention, which are big issues at all of our sites. This includes
working on specific activities to make the hiring process more
efficient and proactive, and less time-consuming. We need to make sure
the way we do business is not causing us to lose the opportunity to
hire and keep quality staff.
We are also continuing work on our priority of improving the
quality of and access to care for our patients. We have emphasized the
importance of customer service, and we are also working on a number of
initiatives to help improve the quality of care and promote healthy
Indian communities.
One of the most important of these is our Improving Patient Care,
or IPC, program. The IPC is our patient-centered medical home
initiative that is designed to improve the coordination of care for
patients. This is about making changes that will result in measurable
improvements in patient-centered care, including reduced waiting times,
more access to appointments, and improvements in the quality of care.
The patient-centered medical home is a big focus of the changing health
care system in the United States.
We plan to expand this initiative throughout the entire IHS
system--currently we have 127 sites. Many of these sites are doing
really outstanding work, including reducing waiting times, improving
no-show rates, and arranging the system so that patients can see the
same providers each time they come to the clinic, which results in
better coordination of care.
A few other initiatives are also helping us improve the quality of
care. The Special Diabetes Program for Indians (SDPI) is continuing its
successful activities. In partnership with our communities, we can
prevent and treat diabetes in Indian country with innovative and
culturally appropriate activities. Our 2011 SDPI Report to Congress
clearly shows that the SDPI programs have done an incredible job of
implementing activities to prevent and treat diabetes in the
communities we serve. The data in the congressional report shows that
the SDPI programs have dramatically increased access to diabetes
treatment and prevention services. For example, access to diabetes
clinics has increased from 31 percent to 71 percent of grant programs
from the 1997 baseline before SDPI funding to 2010. Based on local
needs and priorities, the SDPI grant programs have implemented proven
interventions to address the diabetes epidemic, often where few
resources existed before.
The most important impact of these combined and sustained clinical
improvements is seen in the dramatic drop in the rate of end stage
renal disease (ESRD) in American Indian and Alaska Native people with
diabetes when compared with other racial and ethnic groups in the U.S.
Between 1995 and 2011, the incident rate of ESRD in American Indian
and Alaska Native people with diabetes fell by nearly 39 percent--a
greater decline than for any other racial or ethnic group. Given that
the Medicare cost per year for one patient on hemodialysis was $82,285
in 2009, this reduction in the rate of new cases of ESRD means a
decrease in the number of patients who would have required dialysis--
translating into millions of dollars in cost savings for Medicare, IHS,
and other third-party payers, as well as improved quality of life for
patients who do not need dialysis.
Diabetes health outcomes have also improved significantly in
American Indian and Alaska Native communities since the inception of
the SDPI. One of the most important improvements has been a 10 percent
reduction in the average Hemoglobin A1C levels of American Indians and
Alaska Natives with diagnosed diabetes. Improved blood sugar control
contributes to reductions in complications from diabetes. This FY 2015
President's Budget request includes a proposal to reauthorize the SDPI
for another 3 years to maintain and build upon this important progress.
We are also focusing on behavioral health issues, which Tribes have
identified as a top priority. IHS is making progress on implementing
its recently released National Behavioral Health Strategic Plan and its
National Suicide Prevention Plan. And the evaluation data from our
Methamphetamine and Suicide Prevention and Domestic Violence Prevention
initiatives show very promising results as the programs are
implementing evidence-based strategies.
IHS has a lead role in the First Lady's Let's Move! in Indian
Country initiative, which includes our IHS Baby-Friendly Hospital
initiative and a collaboration with the Notah Begay III Foundation
involving activities to prevent childhood obesity. We are promoting
breastfeeding in all IHS hospitals because it has been shown that
breastfeeding can reduce childhood obesity. We are also encouraging all
tribally-managed hospitals to join us in this effort.
We have also established a new hospital consortium to work on
improving quality and maintaining accreditation requirements in our
hospitals. We plan to establish a system-wide business approach to
accreditation.
We are meeting regularly with the Department of Veterans Affairs
(VA) to implement activities to better coordinate care for American
Indian and Alaska Native veterans who are eligible for both VA and IHS
care. We have also implemented the VA-IHS national reimbursement
agreement at all federal facilities and are billing and receiving
reimbursements from the VA for direct care provided to American Indian
and Alaska Native veterans.
We have accomplished a great deal as we work to meet our
priorities, and this is reflected in our Government Performance and
Results Act (GPRA) measures. In FY 2011, for the first time ever, we
met all of our clinical GPRA measurement goals. In FY 2012, we did
great again. And the results are now in for 2013, and once again, we
met all of our clinical targets. We are very proud of all the IHS and
tribal sites that worked so hard to make improvements in the quality of
the health care that we deliver. Our focus on improving the quality of
care, along with more accountability system-wide, is making a
difference. But we know that we still have much more to do.
In summary, we are working hard and in partnership with Tribes to
change and improve the IHS through our reform efforts, and we thank you
for your support and partnership. The increases IHS has received in its
budget over the past few years are making a difference, and we look
forward to working with you on the President's FY 2015 Budget request
to help continue progress. Although we are in a challenging fiscal
environment, the work of the past few years has clearly established
that by working together, our efforts can change and improve the IHS to
ensure that our AI/AN patients and communities receive the quality
health care that they need and deserve.
Thank you and I am happy to answer questions.
The Chairman. Thank you both for your testimony. We very
much appreciate it. Thank you for the work that you do.
I will start with you, Kevin. If I'm the only one here, we
will probably ask questions for a while. Then you can take a
break and we will go to Dr. Roubideaux.
This year's budget, as already pointed out, has a 1.2
percent increase over last year's enacted levels. There is a
chart up there that you can see of the Interior allocations. I
am not saying the National Park Service should not get 22.2
percent, because our national parks are in disrepair. I am not
saying that the BLM should not get 6.1 percent because the BLM
needs resources to be able to do their job.
What I am saying and what you know much better than I is
the challenges out there in Indian Country across this country.
Their increase is almost at the bottom, yet we have so many
challenges out there.
I don't know how your life works. I don't know if you come
in and say we need a 5, 10, or 20 percent increase over last
year and they just whittle you down and keep whittling you down
until you get to 1.2 percent or if you come in at zero and hope
they give you 1.2 percent. The chart is not right, it says 1.5
percent. It is 1.2 percent, lower than that.
How do we get budgets that will work? I know you have to
shed the best light you can on this budget but this needs some
work. Give me an idea of what you are up against? Who do we
need to talk to? Who do I need to get Senator Udall or Senator
Johnson to talk to so we can get some of these figures up so
the people and the agencies can do the job? It will help morale
and help folks on the ground.
Mr. Washburn. You put these charts up and they look pretty
bad. I feel there are some apples and oranges going on in these
charts.
I won't quibble with it too much except to say I think we
would provide different data and it would look a bit different
the way we would present it. For example, over the last five
years, in the Obama Administration you would find the
President's budget request for Indian Affairs has been higher
than for any other agency at the department.
If you pick out one year, you can cherry pick figures and
make it look bad. You are also comparing tiny budgets to big
budgets. Our overall budget is about $11 billion at the
Department of Interior. Ours is $2.6 billion, so it is a big
chunk of that. Some of these offices are tiny offices that $1
million can make a 10 percent swing in the office if it is a
$10 million office.
I guess we would quibble with this but the question is how
do we come up with these budgets. We work really hard and the
Secretary made a real commitment this year and really went to
bat for the Indian Affairs budget. Compared to the really big
budgets at the Department of Interior, we did okay.
If you compared apples to apples, I think you would find we
didn't get the request the National Park Service got for their
centennial year. There is a special occasion this year for them
next year and there is also this Opportunity Growth and
Security Initiative built into these numbers that you have
presented.
We didn't quantify our request for that initiative. It is
in there. We have a request for Indian education in that
initiative but we didn't put a number figure. We kind of got
shellacked here because we didn't attach a number to the
Opportunity Growth and Security Initiative which is the
President's way of saying if we do get more money than the
Murray-Ryan caps provide, we are going to put a significant
amount into Indian education.
I am not sure this graph is entirely fair.
The Chairman. That is a fair statement but here is what we
will argue. When you talk about this Administration putting in
record amounts of money, especially compared to previous
administrations, that is apples and oranges too because the
previous administrations haven't exactly been stellar when it
comes to Indian Country.
I would just say this. It comes down to things within these
programs and we can go down the list and you can pick any line
item and say it is deficient. Honestly, you might be able to do
that with the other budgets also but in this case because of
the trust responsibility we have and treaty responsibilities we
have, it is different.
I know where your heart is. I just think we need to figure
out how we can work together to make this happen.
The only other question I have is I know OMB plays a role
in all this budgetary stuff. Sometimes they are the hammer that
pares back things. I would like your honest assessment. Does
OMB know about the trust responsibilities and treaty rights
that this country has for Indian Country?
Mr. Washburn. Mr. Chairman, they have actually learned a
lot. I have to say they have really been much more engaged with
tribes over the last few years. I think they really have gotten
onboard and gotten much more engaged with tribes.
I think it might be fair to say they are sort of the adults
in the room who say hold on a second, we have to meet these
Murray-Ryan budget caps so we cannot give you everything you
dream of; we have to pare it back a little bit, but they do
have sense of the trust responsibility and have been learning a
lot.
The Chairman. I appreciate that.
We are going to do something a little different. I am going
to go down the line. I want seven minutes on the clock for
questioning because I think there are two people here who are
pretty important to everyone on this Committee.
I will start with you, Senator Johnson. You can do it with
an opening statement or go right into questions, whatever you
prefer.
Senator Johnson. I will give my opening statement for the
record.
STATEMENT OF HON. TIM JOHNSON,
U.S. SENATOR FROM SOUTH DAKOTA
Senator Johnson. Mr. Washburn, I appreciate the BIA is
focusing on reducing repeat incarceration in Native
communities. However, tribes are still struggling with the lack
of infrastructure.
Tribal law enforcement and agencies need detention centers
that are not falling apart and tribal courts need integrated
courts for drug and mental health issues. How is the Department
planning on addressing this infrastructure issue?
Mr. Washburn. Thank you, Senator Johnson. We have increased
our funding request for detention facilities in Indian Country.
We have 96 existing detention facilities. As Chairman Tester
said in the beginning we have about 180 schools. I don't like
those numbers. I wish we had a lot more schools than detention
centers. The fact is we don't take care of either one of them
enough.
In the fiscal year 2014 budget, we had a $14 million
increase for detention facilities and because we just got our
operating plan finalized about a month ago, that money is just
now to a place where we can use it. That money is continued
into the fiscal year 2015 budget request so there will be more
money available.
We fund the detention programs at about 55 percent of need.
That is not enough. Many of the poorest tribes cannot afford to
come up with the other 45 percent. This is going to be an
ongoing challenge for us but we are working hard to meet it.
Senator Johnson. Too often I hear from South Dakota BIA
funded tribal schools that they much continually use ISEP funds
to pay the heating and electrical bills. Can you please explain
why the President's budget does little to alleviate the burden
of administrative costs, facilities operations, and maintenance
costs?
Mr. Washburn. You are asking that question at a very
stressful time for tribes and for the Administration. The cost
of propane this winter was a serious problem in your State and
that really ate into those funds.
We pay for our maintenance program out of the same funds,
we pay for our electric bills and the propane bills. If you use
up all your money on propane, it doesn't leave a lot for
maintenance and repairs and that sort of thing. That has been a
real challenge to all of us.
We hope that is a one year problem and that the costs will
not repeat themselves. We have also worked on other strategies
of trying to pay in advance for propane so that we are paying a
more flat rate rather than dealing with the ups and downs in
the market. We are exploring ways to deal with those problems.
It is a tough fiscal environment. We are trying to do a lot
with a little amount of money.
Senator Johnson. The expense of propane exacerbates things.
This issue has long been in existence, the use of ISEP funds
for overhead.
Dr. Roubideaux, you noted the dramatic increase in funding
for the Purchased Referred Care Program. However, in a recent
GAO study, this program was given poor marks on the handling of
medical claims. Recently a South Dakota dialysis clinic
reported to me that the business has thousands of dollars of
unpaid claims and a number of patients were left to foot the
bill because their life-sustaining dialysis treatments were not
a high medical priority.
Can you please address how IHS will improve both the claims
process and approval of referred patient services?
Dr. Roubideaux. Thank you for that question. We will have
our staff connect with yours about that particular provider and
that particular issue.
The Purchase and Referred Care Program, how we pay for
referrals, we have been working very hard to try to improve our
ability to process and pay for those referrals and have been
working on education with outside providers on eligibility,
looking at our billing process and the GAO report you mentioned
looked at how we are measuring our progress. We are
implementing recommendations from that report.
We want to do everything we can to make sure we can pay or
authorize referrals in the quickest time possible. We
definitely want to work with you on this issue.
Senator Johnson. The Sanitation Facilities Construction
Program provides critical water supply and disposal for
individual homeowners and projects.
As Chairman of the Banking, Housing, and Urban Affairs
Committee, it is important to me to find solutions to our
critical housing needs. With a tremendous need for water
systems in Indian Country, how will IHS continue to work with
tribes and other agencies to address the need for this critical
infrastructure without a budgetary increase?
Dr. Roubideaux. We are very interested in finding solutions
in this area because you are correct, there is an incredible
need.
One of the things we have done in the past year is signed
an interagency memorandum of understanding with other Federal
agencies to try to leverage other resources and look at what
legal or regulatory things might be getting in our way. That
MOU is with EPA, HUD, DOI and the Department of Agriculture.
That will help us make sure we can look for some creative
solutions to this very significant challenge.
Senator Johnson. I yield back.
The Chairman. Senator Udall?
STATEMENT OF HON. TOM UDALL,
U.S. SENATOR FROM NEW MEXICO
Senator Udall. Thank you very much, Chairman Tester. I
really appreciate being here with you as our new Chairman.
I want to completely identify with the frustration of the
Chair and the passion he spoke of in terms of the budgets and
looking at these charts. He has outlined something and I would
adopt his comments.
In addition, I would point out it has been absolutely
devastating, the long terms effects sequestration has had on
Indian Country. Dr. Roubideaux, the IHS was the only direct
medical service agency that was subject to full sequestration
cuts. Medicare, Medicaid, children's health insurance, veterans
affairs, all were either exempt or received a smaller cut of 2
percent.
According to your testimony in April 2013, you estimated
that the reduction would include 3,000 in-patient admissions,
804 out-patient visits and this was a painful, unnecessary,
arbitrary cut to communities that can ill afford them.
I am not going to go on and on. I will put the statement in
the record because I want to ask you questions on BIE.
It is important we get the figures out there. BIE schools
lost $42.2 million as a result of sequestration. This had to be
absorbed by 183 already underfunded schools.
Tribal Head Start programs lost $11.9 million as a result
of sequestration, impacting 25,000 children in 26 States.
The Bureau of Indian Affairs, Office of Public Safety had
an $18.3 million sequestration cut and I could go on and on. I
know you both know and understand this very well. I would be
interested as we proceed with the hearing how these cuts are
going to affect us in terms of moving forward.
[The prepared statement of Senator Udall follows:
Prepared Statement of Hon. Tom Udall, U.S. Senator from New Mexico
I would first like to thank Chairman Tester and Vice Chairman
Barrasso for holding this important hearing. I am glad to see my friend
Assistant Secretary for Indian Affairs, Kevin Washburn, here today. I
look forward to hearing from him, as I do the rest of this
distinguished panel, as we discuss the President's FY 2015 budget and
the impact on Indian communities.
I'd like to begin by addressing the devastating and long-term
effects sequestration have had on Indian Country. The IHS was the only
direct medical service agency that was subject to full sequestration
cuts. Medicare, Medicaid, Children's Health Insurance Program, and
Veteran's Affairs were all either exempt, or received a smaller cut of
2 percent. According to her testimony in April 2013, Dr. Roubideaux
estimated that reduction would include 3,000 inpatient admissions and
804,000 outpatient visits. This was a painful, unnecessary, arbitrary
cut to communities that can ill-afford them.
The BIE schools lost $42.2 m as a result of sequestration. This had
to be absorbed by the 183 already underfunded schools. Tribal Head
Start programs lost $11.9 million as a result of sequestration,
impacting 25,000 children in 26 states. The Bureau of Indian Affairs
Office of Public Safety had a $18.3 sequestration cut. The Indian
Housing Block grant program was cut $34.5m by sequestration. And the
cuts continued. I will be interested in hearing how these cuts affect
programs moving forward.
Contract support costs are a vital part of tribal self-
determination and self-governance. I think everyone here can
confidently acknowledge the positive outcomes that have resulted from
tribes having the option to contract and carry out their own services.
Unfortunately, funding for contract support costs has consistently
fallen short, and I look forward to addressing with Dr. Roubideaux the
steps being taken to address the underpayments, in addition to hearing
from Mr. Washburn how the budget will try to anticipate these costs.
I look forward to working with my colleagues on this Committee to
help address the long-standing issues facing Indian country. I am
encouraged by the administration steps to take seriously our
responsibilities to Tribes, and look forward to hearing how the
President's budget reflects that commitment.
Senator Udall. Let me ask a couple questions. Dr.
Roubideaux, I appreciated your testimony about the work the
Indian Health Service is doing to address outstanding claims
for contract support costs. As you noted, these have real
impacts on tribes, including tribes in New Mexico. However,
while you have reported considerable progress overall, your
agency has stated that of the 93 claims, zero have been settled
and 81 are still pending.
What will you do to work with me and the Committee to
ensure that tribes receive the settlements they are entitled?
Dr. Roubideaux. We are absolutely committed to working with
you to try to resolve these past claims for contract support
costs as quickly as possible.
If you look at the claims in New Mexico, I think since we
sent you information, I think in my in-box a settlement offer
to one of the tribes popped up and I approved it. We will see
how that negotiation goes. We have also completed four analyses
and have 15 claims on the priority list for New Mexico.
We are working very hard and know that tribes need this
funding, they know it is owed to them and we want to work very
hard to resolve these claims. We are working hard. The numbers
are changing on a daily basis, so I am glad to be able to give
you a little update.
Senator Udall. I hope you will update us and keep us
apprized because as you have said, these contract support costs
are absolutely crucial for self determination and for the
tribes to be able to move forward with the things they believe
are important to them.
We have an Indian center in Gallup called the Gallup Indian
Medical Center. It has long been on the list. It is a facility
that needs to be renovated, if not replaced. At this time, how
is the IHS creatively thinking to advance the management of
facilities and construction to update or improve or replace
these outdated facilities and what other sources of funding,
what greater use of Tele-health or emerging models of care are
you contemplating to address this concern now and in the
future?
Dr. Roubideaux. We are absolutely trying to do everything
we can to address the health facility construction needs in
Indian Country and they are enormous. The current priority
list, which Gallup Indian Medical Center is on, has $2.1
billion of construction left on it.
In addition to our President's budget, the Opportunity
Security and Growth Initiative has the $200 million increase
for health facilities construction. We do hope that gets good
consideration.
We do a lot of creative things. The average age of our
facilities is 20-30 years, so we do things like save our third
party collections. Gallup Indian Medical Center was very
innovative and was able to build an entire outpatient center
doing that.
We look at leasing sites, we look at other innovative
things like modular construction, and we look at what kinds of
repairs we can make. Tele-health is an area that really does
help us expand services without having to do construction. New
Mexico leads in that with several programs that are happening
and help get services to rural areas.
In terms of delivery models, I think there is a lot of
change with the changing health care delivery system. We are
working on our Improving Patient Care Initiative which looks at
reorganizing the clinic to make sure patients waiting times go
down and there is more availability of appointments, with more
of a team approach to care. In some cases, that involves
reorganizing the actual space in the clinic to be more
efficient.
We are working on some of those things, but we know funding
is the quicker answer and we are working on that as well.
Senator Udall. Thank you.
Assistant Secretary Washburn, you heard me talk a bit about
the impacts of sequestration. Moving forward and coming up with
your budget, what are you trying to do, as best you can, to
fill the holes and make a difference in terms of the cuts that
have happened and how we are going to move forward to deal with
what has happened in the past?
Mr. Washburn. You are right, a lot of the tribes are still
feeling the sequestration because we did not backfill the five
percent that got cut. First of all, we paid full contract
support costs in the 2014 year when we did get funding, so we
couldn't backfill the five percent because we had other
purposes for that money suddenly.
We did a few other things we felt were important in the law
enforcement area and a little bit in education. We are doing
the best we can and tribes are frustrated and struggling. We
are in tight fiscal times. As long as we are in tight fiscal
times, it is going to be hard to get out of this.
Hopefully with the economy improving, we won't get another
sequestration, we will get past the Murray-Ryan budget caps and
go back to regular order where we can ask for what we need
rather than trying to live and fit into really tight caps. We
are working hard on that. I just came from two days of budget
meetings with tribes and they are really feeling the pinch.
Senator Udall. Thank you very much. I know you are both
working very hard to try to remedy some of this.
Thank you and I yield back.
The Chairman. Senator Begich.
STATEMENT OF HON. MARK BEGICH,
U.S. SENATOR FROM ALASKA
Senator Begich. Thank you, Mr. Chairman.
Thank you both for being here today and thanks for the work
that you do for Indian Country and Alaska Native communities
throughout my State.
As you know, we have the most remote parts of the country
and some of the most difficult challenges be they from health
care to education to infrastructure and many other things.
Thank you all very much for being here.
Dr. Roubideaux, thank you for your work at the Indian
Health Service. I know at times we have pushed back quite a bit
here and I am trying to get some resolution. Let me follow up
quickly on the data point you were sharing with Senator Udall.
I would love to see you submit something to the Committee
with regards to how many cases are still pending overall, how
many are being actively pursued for resolution and how many are
still kind of out there getting scheduled and what those time
schedules would be.
If you could answer that now, it would be great. If you can
submit something, that would be even better. If you can answer
that, I also have some additional questions in regards to the
past claims issues.
Dr. Roubideaux. For contract support past claims, we have
heard from Congress and tribes that they wanted us to
accelerate the claims process, so we committed additional
resources and staff.
Currently, there are 1,200 claims pending but we have about
550 of those in analysis or the analysis is done. We have
actually made offers on over 200 claims from 31 tribes. The
total amount of claims that either there have been offers
formally settled or accepted and in the process of settlement
is about $133 million worth.
Our progress definitely over the past couple of months has
increased and we are working hard to continue that increase
because we know it is important that we settle those as quickly
as possible.
Senator Begich. Do you think you would be able to give to
the Committee, with the numbers remaining in the process, what
that schedule would look like timewise? It doesn't have to be
specific but you expect another x amount of cases settled in x
amount of time. Is that something you could tell me now or
submit to the Committee so that we have a good sense of how
that progress will move?
Dr. Roubideaux. We would like to work with you and give you
frequent updates on that. It is hard to estimate because some
of the cases are in Federal court.
Senator Begich. Yes, and some are more complicated.
Dr. Roubideaux. Some are more complicated and the
negotiations are in process. The one thing we can control is
getting settlement offers out to the tribes. That is our
primary goal right now, as soon as possible to get settlement
offers out to the tribes.
Senator Begich. That is the 550 where you have done an
analysis. From that 550, 200 of those are in motion or have
been resolved and the remaining amount are ones you could make
offers to at some point because now you have an understanding
of where the parameters are. Is that a fair statement?
Dr. Roubideaux. Yes. We have worked collaboratively with
the tribal lawyers on this and have negotiated. I am really
seeing progress in my email inbox every day or offers that I
approved. I approved one while I was waiting for the hearing.
Senator Begich. Let's stop the hearing and you continue to
approve a few more.
Dr. Roubideaux. We are seeing the numbers go up like that,
so I am pretty confident we can make significant progress this
year.
Senator Begich. That is very good.
As you know, I have had regrets about this initiative and
sometimes I know you felt too aggressive from me maybe, but
this is important. It is contract provided services and we need
to settle them so we can move forward.
The next question I have, which I think is a great
statement, 2014 and 2015, and now the 2015 budget has full
funding of contract support services. We greatly appreciate
that. I want to make sure that at some point you will put
together a more detailed plan of how you can maintain that.
One of the big concerns people have is maintaining that may
mean other services get squeezed within the overall Interior
budget and/or within budgets like BIA and others. I don't know
if you are planning to submit something to the Congress or the
Administration, but this is something I would be very
interested in.
Now you have two years under your belt, one year and moving
to two years, hopefully, and that piece of the puzzle, it is
very important that it's sustainable, long-term and full
funding. Is that something you could provide at some point,
your plan of action?
Dr. Roubideaux. Yes, sir. The Consolidated Appropriations
Act of 2014 required a work plan to be submitted within 120
days. That is due in May. We are very interested in working
with all of you on the long term solution for contract support
costs, to be able to determine the more predictable amounts and
that would work in the overall budget formulation with other
priorities.
Senator Begich. In May when you submit that, is that to us
and the Administration or is it the Administration first and
then to us?
Dr. Roubideaux. Yes. It goes through our clearance and then
goes to Congress. We are happy to discuss it with you before we
develop the plan. It is a plan for consultation on the issue
because we want to develop this in consultation with the
tribes.
Senator Begich. Perfect. May is 30 some days away.
Dr. Roubideaux. Yes.
Senator Begich. Also, as you know, I am a lead sponsor on
the advance appropriations bill for Indian Health Services
which I know about a year ago we asked for the position you
would have on that. Do you have any new information you can
share? Do you support that legislation or does the
Administration have a position? Can you give me your thoughts
on that?
Dr. Roubideaux. We are very happy to work with this
Committee on this issue. We know it is a top tribal priority.
It would be so good to have more predictable and stable funding
levels.
Senator Begich. Can I take that as you are supportive of
the concept in the legislation and we could talk about the
details?
Dr. Roubideaux. We just saw the legislation and are now
reviewing it. We are talking with the VA to see their
experiences. We are hoping to have more definitive information
for you.
Senator Begich. I would love that soon. I know we have done
it with the VA very successfully. I actually have a bill for
the VA also to finish out their discretionary advanced funding.
Between VA and Indian Health Service, it would make a huge
difference long term.
I know we have done it on the medical side of VA. I
supported that when I first came in. Now I have the bill for VA
on discretionary and also now Indian Health Services. I would
love your thoughts on that.
I have some other things I will submit for the record. If I
could jump very quickly to Mr. Washburn, we have talked about
public safety issues. Based on conversations we have had
publicly and privately, there is always great stress on your
budget but tell me your thoughts on how we are going to go
after the issue based on the report.
We had a hearing here in regards to the report done on the
needs not only in Alaska but across the country in public
safety and how we can get these more unified and also how and
what you need to be successful.
I can tell you in Alaska, the incarceration rate with the
Alaska Native population is double the population percent which
is unacceptable. As you know, I have a bill which I think in a
week along with other bills, we will be doing a hearing on. I
would love to hear your thoughts on what you think we need to
be doing. Obviously we are not doing enough. I don't mean that
in a negative way but we just are not.
Mr. Washburn. Senator Begich, thank you for your leadership
on the contract support cost issue. You have made a difference
there and it has been helpful.
The law enforcement issues are important. I think we have
increased funding over the Obama Administration. That is the
area where we probably have already increased funding the most
in our budget or it is close to it. It is one of the highest
priorities. I just came out of two days of budget meetings with
tribes, including the Alaska region, where law enforcement,
once again, was one of the highest priorities.
It is no small challenge to try to start funding 229 Native
villages and 109 tribes in California in addition to the ones
we are already under funding. During really tight fiscal times
like we are in, I am not sure if we can make a big impact on
that.
Senator Begich. It is a resource issue.
Mr. Washburn. It is a resource issue and requires changing
our paradigm about how we do this stuff because in Public Law
280, States like yours, we just don't fund very much law
enforcement. That is a problem. Those tribes have public safety
issues as well.
Senator Begich. Serious issues.
Mr. Washburn. Absolutely.
Senator Begich. I know I am out of time, Mr. Chairman, but
I will submit other questions for the record if that is okay.
The Chairman. Absolutely. Thank you.
Senator Barrasso, we appreciate your being here. We
appreciate your courtesy for the previous ones.
STATEMENT OF HON. JOHN BARRASSO,
U.S. SENATOR FROM WYOMING
Senator Barrasso. Thank you, Mr. Chairman, for holding this
hearing on the President's Fiscal Year 2015 budget request for
tribal programs.
We all recognize the Federal Government has important
responsibilities in Indian Country. Public safety, education
and health care are just a few. Carrying out the
responsibilities requires money and as I have stated before,
priorities and spending will receive increasing scrutiny,
especially with the enormous Federal deficit.
Agencies are called upon to find a more efficient manner of
operating and promoting economic development, especially and
particularly for Indian communities. Earlier this month, I
introduced S. 2132, the Indian Tribal Energy Development and
Self Determination Act Amendments for 2014.
This bill is going to streamline the bureaucracy of Indian
energy resource development and in turn facilitate long term
job development and economic growth.
Secretary Washburn, I have a couple of things.
In reading the testimony from both you as well as from Dr.
Roubideaux, you highlight several behavioral health initiatives
as top priorities, appropriately. The Bureau of Indian Affairs
proposes a new family initiative to address violence and
substance abuse within Indian communities related to what
Senator Begich talked about in terms of crime.
How is your agency coordinating with tribes and the Indian
Health Service to effectively implement these interrelated
initiatives?
Mr. Washburn. Our Tiwahe Initiative, our family initiative,
is a request for the fiscal year 2015 budget which we do not
have yet. Let me say we have already started planning in the
hope we will have it funded and it will require coordination.
So far it is an initiative in concept. We have not had
lengthy conversations with our partners in IHS and elsewhere
about that but that is certainly something we need to do. We
need to take a much more holistic attitude towards these
problems.
Senator Barrasso. I appreciate your efforts and direction.
I mentioned the energy bill I introduced again this
session. Your written testimony notes that the Bureau of Land
Management is requesting $16.9 million for programs such as oil
and gas to support Native Americans.
The Bureau of Land Management also requested a $6,500 fee
for submitting an application for a permit to drill for energy.
The Bureau of Land Management has stated in recent budget
justifications that this fee is to offset the application
processing costs.
I am looking for an explanation in detail of what makes up
those processing costs for the applications for a permit to
drill?
Mr. Washburn. Thank you for your leadership on Indian
energy issues. We know you are concerned about those and have
been a constructive partner on those issues.
I can't tell you what all the specific costs are. We
probably need to get someone from BLM to do that better. I will
tell you there has always been frustration about how slow we
are to issue our APDs at BLM. The good news about those costs
is they go to offset the costs so that BLM can process more of
those. That is a good thing because it requires the people who
want to drill to bear the cost of the drilling, the processing
costs and the government.
I am not sure exactly what each of those costs is but we
work very closely with BLM on processing these APDs. We have a
part to play and they have a role to play as well. That is one
reason why, Mr. Chairman, those figures you put up on the board
where you say BLM is funded higher than BIA, some of the BLM
money actually benefits Indian tribes also. That happens and
that is why some of those figures aren't so obvious.
We would be happy to get back to you with a clearer answer
exactly accounting for those figures.
Senator Barrasso. I'd appreciate it.
Dr. Roubideaux, we talked a little bit in the past about
the cost to construct all facilities on the current Indian
Health Care Facility Priority List. It is over a billion
dollars. I think in your testimony was it was $1.2 billion. I'm
sorry, over $2 billion, I can't read my own writing.
I have also emphasized to you a number of times that the
primary health care facility on the Wind River Reservation in
Wyoming is nearly 140 years old. We have only been a State in
Wyoming for 124 years. It was there before we became a State.
It would astonish everyone in this room, I would imagine,
to know that the facility is not even on the priority list. We
are talking about a priority list of $2.1 billion and it has
not even made it to the priority list yet.
The last time I asked, you said you would be happy to work
with us. I just what to know what has happened since we last
visited? Have you personally worked with the Wyoming tribes to
develop a plan and a timeline for addressing their facility
needs?
Dr. Roubideaux. We address the facility needs in a number
of ways. The first is the list which by law we have to address
all of those facilities but we do have other ways to address
health care facilities construction. I know Wind River has been
interested in the joint venture program.
The good news I have to share today is that we are
approving the last three agreements from the last round of
applicants. Wind River is one of them. We can move forward with
that joint venture agreement.
We also plan to open a new round of applications for joint
venture later this year. We are trying to look at other
innovative ideas in addition to trying to fund the Health Care
Facilities Construction List and trying to move forward on some
of these other programs.
Senator Barrasso. Hopefully we can continue to work
together on this because it continues to be an issue of concern
for many.
Thank you, Mr. Chairman.
The Chairman. Senator Murkowski.
STATEMENT OF HON. LISA MURKOWSKI,
U.S. SENATOR FROM ALASKA
Senator Murkowski. Thank you, Mr. Chairman.
Welcome to you both, Mr. Washburn and Dr. Roubideaux. Thank
you for all that you do.
From a budgetary perspective today, I am going to focus my
questions on some of the programs that really have impact on
our tribal governments and our village clinics. These are the
small and needy tribes account at BIA and the Village Built
Clinic Lease Program at IHS.
We have clearly seen the benefit of these programs but
considering these programs keep the village governments, and
the village clinics open, it is important we pay attention to
them as priorities.
Oftentimes they get kind of swept under with all of the
other big things we are dealing with. I appreciate the
discussion you have had with Chairman Tester as well as Senator
Begich on contract support costs and the advances we have made
which were long and hard fought but I think we are on the right
track. I agree with Senator Begich, we need to make sure that
it continues on that track.
I am also very curious, Dr. Roubideaux, to hear greater
clarity from the Administration in terms of our request on the
advance appropriations. That is an area where I look at the
trust responsibility we have to our Native people which is akin
to our obligation to our veterans.
If we can provide greater certainty to our veterans, if we
can assure that during times of furloughs and cutbacks that
they don't see that reduction, I would certainly like to think
that we can afford the same to our Native people as well. I
would be curious to hear your response to that.
Mr. Washburn, on the small and needy tribes issue, the BIA
budget justification describes the background behind the small
and needy tribes account, the initiative that was advanced in
the early 1990s. It was the 1994 Joint Tribal Advisory Task
Force on BIA Reorganization that made the recommendation to
provide the small tribes with a base of $160,000 and in that,
the recommendation for Alaska tribes was $200,000 as a base. Of
course we know that this has never been met.
You always feel you have to make a special case but we
know, you know, both of you, that the costs in rural Alaska are
tremendously high. Utility bills are eight to nine times higher
than they are in the lower 48. In Noatak, in the northwest
Arctic area, they are looking at energy costs of 87 cents a
kilowatt hour as compared to about 11-11.5 cents in other parts
of the lower 48.
The cost to keep the lights on and the cost to heat a
building is extraordinarily expensive for our tribes. Given the
minimum amount of funding they receive, it is not penciling.
Our tribal populations are growing. We have seen a 19 percent
increase in the Bering Strait region in the past ten years.
Population has gone up, costs are going up and yet, the
assistance for our small and needy tribes has not moved. I
guess the question to you, Mr. Washburn, is given what we have
seen within BIA necessary budget increases for public safety
and school operations, and I am not complaining about it, we
know these programs are not eligible for our Alaska tribes.
Can you give me any kind of commitment or assurance that we
might see a base funding level to Alaska tribal governments of
the $200,000 that was recommended in that report? What is the
future of this?
Mr. Washburn. I am relatively new to this issue, so I guess
I would like to take it back and respond to you in writing.
We do have a Small and Needy Tribes Program. It sounds like
you are saying we have a shortfall that we don't provide
$200,000 to each of the Native villages in Alaska. My
understanding is we only have about five tribes in the lower 48
still involved in the Small and Needy Program because the base
of $160,000 has been eclipsed by the regular funding.
The idea behind the Small and Needy Program was it sort of
provided a base funding in case your ordinary funding didn't
rise to $200,000 or $160,000 in the lower 48. We can look at
that. We can look to see what the shortfall is and talk to you
more about that and try to figure out what is the shortfall and
what is needed to solve that. With 229 Alaska Native villages
and $200,000 for each, we are talking real money.
Senator Murkowski. We are talking real money. I clearly
understand and appreciate this. I also appreciate your
willingness to take a look at it if you are not familiar with
it. Again, some of the programs available for our tribes in the
lower 48 through BIA are simply not available to the Alaska
tribes.
If we are going to treat all of our Native people on some
level of funding parody, I think this is an area we need to be
looking at. If you are willing to explore it with your staff
and mine sitting down, I would certainly welcome that.
Mr. Washburn. We would be happy to.
Senator Murkowski. Dr. Roubideaux, we have had good
opportunity to talk about the success we have seen with our
dental health aid therapy program in our tribal communities. I
think it is something we point to as a source of pride, an
innovative way to be able to provide for oral health care needs
of our Native people in areas where we are not going to see
dentists out there on a regular basis.
I have been pleased with how we have built that forward. It
is important that we continue to see the support of the DHAT
program in the budget process in order to see these
improvements in access to the care.
The other program that we follow closely, on which you and
I have had a conversation, that is essential to delivering
basic health services in our remote Native communities is the
Village Built Clinic Lease Program. The Indian Health Care
Improvement Act mandates that IHS develop and operate the
community health aid program of which the funding for the VBCs,
these leases are essential. The Village Built Clinic Program
that really helps keep our health clinic doors open.
Going back to the rising costs that we see directly related
to energy that impacts our utilities, VBCs only cover 55
percent of clinic operating costs. IHS has not increased the
lease rental since 1989. I know we have had a chance to talk
about it before. In previous conversations, you indicated this
was something you would like to look into to gain a better
understanding.
I really think we are in a situation and I hear from so
many of our tribes that they just don't know where to turn. It
would appear that some of our more remote communities are just
kind of forgotten. I cannot forget them, will not forget them.
My question to you with both these programs is, the Dental
Health Aid Therapy Program and the Village Built Clinic, what
are you doing to address both of them within the context of
this budget we have before us?
Dr. Roubideaux. We definitely see the success of the Dental
Health Aid Program in Alaska. We actually posted on my
director's blog a very positive position paper showing our
support for that program. In terms of the budget formulation
process, we definitely want to continue to work with you on
that and also on the Village Built Program.
As I think about all the programs in Alaska are 638 and
there is the ability to rebudget their programs. We are
proposing an increase in medical inflation in 2015. I wonder if
maybe that kind of increase gives tribes the flexibility to put
funds into different areas they might have a need.
We are interested in talking with you more and working with
you. I know a work group has been formed in Alaska and I
believe there is some new information they want to share on the
needs related to village built clinics. We are definitely
willing to continue to work on this issue with you.
Senator Murkowski. My time has expired so I will be very
quick. Are you saying that contained within your fiscal year
2015 budget, you think you have funding flexibility with this
inflation factor or not?
Dr. Roubideaux. Because the tribes manage the programs
under the ISDA contracts and compacts, they can rebudget and
reprogram however they want. As we look at the increases in the
budget, we are proposing a $63 million increase in medical
inflation. It is really up to the tribes how they use those
funds. That might be a way to address some of these needs.
Senator Murkowski. It is not necessarily taking it from
another budget category where we are arm wrestling with
somebody else?
Dr. Roubideaux. This is on top of. In particular, we have
talked about the hospitals and clinics line item and the
medical inflation increase does include increased funding for
the hospitals and clinics line item. Under the ISDA, tribes are
able to rebudget funds however they want.
Senator Murkowski. Is there anything separate for VBCs, for
the village built clinics?
Dr. Roubideaux. There hasn't ever been a separate line item
for village built clinics in the budget. There was conference
language that mentioned it many years ago, but it really can be
in the hospital and clinic line item and any funds could be
used towards leases in that particular line item. That is part
of the great thing about tribal management, the flexibility
with ISDA.
The challenge, of course, is there are many other
priorities and each tribe makes decisions about what they need
to fund. We are hoping that this increase in medical inflation,
once it gets to the local level, each tribe can make choices
about how they allocate those funds.
Senator Murkowski. I would be interested in learning a bit
more about that. I recognize we can have very successful,
innovative programs like the DHAT Program and have these
programs like VBC that have been critical in maintaining these
clinics but we have to make sure that we have the funds in the
budget to allow for that going forward.
As you gain more information from some of our tribes on
this and we can better understand what is going on within the
medical inflation account, perhaps we can build on that.
Thank you, Mr. Chairman. Thank you for the additional time.
The Chairman. Absolutely. Thank you, Senator Murkowski. I
appreciate your line of questioning.
Secretary Washburn, over the last month and a half I have
toured most of the reservations, some of them twice. I will
tell you they have some great new facilities I can think of
across Highline 3, as a matter of fact, that have facilities
that are brand new that aren't open and they are done. They are
not open because they don't have staffing.
I was wondering how your department works with other
Federal partners, DOJ, the Indian Health Service, the
Department of Education, to ensure that operations and
maintenance expenses are being fully funded for these new
facilities because it is really frustrating that we have
literally state of the art facilities that are either partially
open or not open at all.
Mr. Washburn. To the extent those are detention facilities,
we fund our existing detention facilities at 55 percent of
need, which is not adequate. Tribes are frustrated by that. We
increased our funding in the operating plan we just finished
for fiscal year 2014. We increased the fund by $14.3 million
for new facilities that have come on line.
If we used all of that $14 million for the new facilities,
including one at Ft. Peck, we would be funding those facilities
at 88 percent of need but meanwhile, our existing facilities
would be at 55 percent of need.
We are trying to figure out a more fair way to allocate
that money. We may very well be spreading around that money a
little bit more to not just include the six newest facilities
but some of the other relatively new ones like the ones you are
talking about that have come online in the last few years.
That will not be 100 percent of need for staffing but it
will be much closer to what the tribes need.
The Chairman. The bottom line in almost every other
question I have asked, you understand this and I know you get
it, right now there just aren't the resources there to open
these facilities. I am not going to say it is almost criminal
because it is criminal because in a lot of these cases, we have
criminals walking the streets because they don't have a
facility to put them in.
Ft. Peck's water system and the O&M associated with this is
a BIA obligation. You know the BIA and the tribe negotiated the
amount of money that is required to operate this project and
that the tribes executed the Indian Self Determination Act
contract based on those negotiations.
The BIA only requested $750,000 for the operation,
maintenance and repair of the water project that provides water
to frankly most of the folks on the Ft. Peck Reservation. Why
is BIA having so much trouble determining the cost of
operation, the cost of repair and maintenance of this project?
Mr. Washburn. Chairman Tester, I am not sure why that is.
Last year I think we over funded the project for operation and
maintenance. Because of that, this year we lessened that
amount. We are committed to funding it at the proper amount
going forward, but we were trying to average out for the last
two years basically so we get to the right amount.
We do want to see that project with the right amount now
that it is finished so it can continue going forward. We will
certainly work with you when it comes to the fiscal year 2016
budget formulation to get it right. We hope it averages out for
fiscal years 2014 and 2015.
The Chairman. Which brings up another issue, an issue we
tend to create around here, not you, and that deals with
government shutdowns and reserve accounts. What is your
perspective on reserve accounts as they apply to government
shutdowns?
Mr. Washburn. The government shutdown is the best reason I
see to having tribes running these programs because they can
keep operating even if the Federal Government is shutdown but
they have to have the money to do so. We need to create
flexibility in the system to ensure they can do so.
The Chairman. I would hope we can figure out what the
amount is supposed to be and get it there. Quite frankly, if I
was running the water system right now, seeing what I saw last
fall, I wouldn't deplete my reserve account either.
I want to talk a little bit about education and I will move
on to Dr. Roubideaux because I know she doesn't want to get
left out of this conversation.
Secretary Jewel testified before this Committee that Indian
education is an embarrassment. We have looked at the budget and
I am curious to know, Secretary Washburn, what you think is in
this budget that would change that perception?
Mr. Washburn. Thank you for asking the question. I do have
the BIA Director, a new permanent BIA Director, Monty Roessel,
here with me today.
We are studying Indian education really hard right now.
Secretary Arne Duncan is very interested in this and of course
Secretary Jewel. She knew when she made that statement, she
needed to do something about it, so I have clear marching
orders.
We have a study group working on this. I notice you put up
some charts about the Department of Defense education.
The Chairman. It's right there.
Mr. Washburn. It's right there.
The Chairman. That is not apples and oranges.
Mr. Washburn. No, that is not apples and oranges. That
makes we think maybe we should move the BIA back into the War
Department because they are funding their schools well in the
Department of Defense.
One of the things I mentioned early on was the President
has proposed we are going to live within the Murray-Ryan budget
caps, but if there are new revenues, we have already projected
how we would spend those new revenues. One of the areas is for
Indian education.
We have a study group. I know study group doesn't sound
like a big deal. You can certainly put together a study group
at any time but we are really committed to doing something with
Indian education once the study group comes up with
recommendations.
The White House has been engaged in this and two Cabinet
Secretaries and Mr. Roessel, the Director. I am confident we
are going to be moving forward with some real improvements in
Indian education.
The Chairman. I appreciate that. Do you agree that Indian
education is a trust responsibility?
Mr. Washburn. It certainly is. It is in some of the
treaties. Some of the treaties include words about education.
The Chairman. You answered that correctly. Thank you.
Do you think the OMB understands that education is a trust
responsibility?
Mr. Washburn. Yes. I know in theory they think it is a
trust responsibility.
The Chairman. I think it is really important. Secretary
Jewel thinks it is important, the Secretary of Education thinks
it is important, and I would dare say I absolutely do and I
think a vast majority of people on this Committee agree when it
comes to getting people out of poverty, this is the best way to
get it done. There is a lot of poverty in Indian Country.
Thank you very much. I appreciate your testimony. I have
some other questions for the record.
Dr. Roubideaux, correct me if I am wrong, there are about
1,500 claims out there for contract services, correct?
Dr. Roubideaux. It depends on who you ask, but the running
tally of total claims is over 1,300, probably over 1,400. The
pending ones now are about 1,200 and some.
The Chairman. Let's use the smaller number, let's say it is
1,200. There have been about 200 claim offers to tribes of that
1,200, correct?
Dr. Roubideaux. Yes.
The Chairman. How long have we been working on this?
Dr. Roubideaux. We have been working on this since the
Ramah decision came down which was in June 2013.
The Chairman. June 2013, so we are about nine months in?
Dr. Roubideaux. Yes.
The Chairman. How many of those 200 claims that have been
offered, not counting the ones on your blackberry today, have
been settled?
Dr. Roubideaux. Of the 200 claims, we have 41 claims
formally settled with tribes, 68 offers accepted by tribes but
they are in process, so it is about 104 settled. That is $133
million worth.
The Chairman. How many settled out of the 200?
Dr. Roubideaux. 104.
The Chairman. 104 have been settled out of the 200. Did you
say the process started in June 2013 or June 2012?
Dr. Roubideaux. I'm blanking right now, so I will get back
to you but we have been working very hard on it for so long, I
can't remember.
The Chairman. I will just tell you this. We had this
conversation in my office before and I know you guys are
working hard to get it done, but in the overall scheme of
things, with 1,200 claims, potentially more than that, 104 have
been settled, 200 have been offered, the reason I am hearing
from tribes and the reason many people on this Committee are
hearing from tribes is because they are frustrated that it is
not moving faster.
I would tell you that we have to figure out how to move the
ball forward. We just have to figure it out because it is not
going to get easier for me or for you if this doesn't move
quicker.
I want to talk about Indian health care and sanitation
facilities. I think the Ranking Member talked about it from an
Indian health care facility standpoint. I want to talk about it
from both because this Administration has reported that there
is a $10 billion backlog for health care facility and
sanitation facility construction, yet the request is $150
million. I know those are all big numbers but $150 million of
$10 billion is 1.5 percent.
Talk to me. We are it even keeping up with inflation and
inflation is pretty low.
Dr. Roubideaux. I hear your frustration on this. We are
frustrated as well. These are difficult budget times and with
available funds, we are not able to fund all tribal priorities
but we do believe these are extremely important priorities.
That is why trying to use the Opportunities Growth and
Security Initiative to get more construction funds for health
facilities could help us. That is why we are collaborating with
other agencies to leverage other funds to try to see if we can
make some progress. It is an enormous need and we are very much
interested in working with you on this.
The Chairman. I could go down the same list of questions I
did with Secretary Washburn but I won't. I will tell you if you
look at this backlog, we are talking about backlogs in health
care facilities construction and talking about sanitation
facilities construction. There is no way we are going to get
our arms around the health impacts of these two deficiencies.
I dare say that we are running way, way more than $150
million in additional expenses because we are this far behind
on these two arenas.
When we talk to OMB in all these things, I just think it is
very, very important that we talk about what is happening on
the ground because it is really important. This quality of
life, this is health care, this is the ability to go to school,
this is the ability to get educated. We need to fix it.
Eighteen million dollars for health care education in this
budget request, as I alluded in my opening comments, we can
invest now in a lot of these things or we can invest later. I
can tell you on a lot of the reservations in Montana, and I am
learning more about it since I have gotten this position around
the country, we are seeing unemployment rates through the roof
and we are seeing a shortage of nurses and an incredible
shortage of doctors.
It would seem to me that this is just an incredible
opportunity, with the challenges that are out there, to make
some investments, whether it is through tribal college, which
would be my first choice, or some other arena to help push
Native American people into health care to take care of their
own.
They are good paying jobs, there is a huge need out there.
The question is, when you go to OMB, the President, Sally
Jewel, or whoever it may be, what are we talking about when it
comes to investment in health care education? Have we talked
about it? It is a priority but it doesn't seem to be a priority
when it comes to money.
Dr. Roubideaux. It is definitely a priority to our agency
because we know there is a great need. Our fiscal year 2015
budget proposal includes the medical inflation which could be
used to hire more providers. We also have the proposal to
exempt our scholarship and loan repayment programs from
taxation which would allow us to give more awards which would
allow us to be able to improve the pipeline.
We are definitely interested in working with you on this in
the budget formulation process.
The Chairman. I will make a statement and we will get to
the next panel. I appreciate your patience, I appreciate your
testimony and I appreciate your willingness to sit here and
answer questions over a budget.
When Byron Dorgan was Chairman of this Committee, we had
the same conversation with different people sitting in your
chairs. I would just say that when we look at budgets for
Indian Country, we need to look at it from the standpoint of
what challenges are out there and what needs are out there and
if we are doing anything to close the gap.
I will be honest. If you just took health care, if you just
took the facilities budget, or if you just took loan
forgiveness or this $18 million for health education or
whatever it might be, my daughter happens to be a nurse. It is
a good job. There is a lot of opportunity out there to take
care of folks.
I also live in a small town in rural America, frontier
America, and I know how hard it is to get people off
reservations to come and work there. We have a tremendous
opportunity. Whether it is your department, your agency, Health
and Human Services and Secretary Sebelius or OMB, we need to
try to get across this message.
All you have to do is step into Indian Country. Some of
them who have the resources are doing a great job but those who
don't have the resources, it is not good. It is just not good.
We have some other questions for the record that we will
put in for you, Dr. Roubideaux, as well as Secretary Washburn.
Once again, I want to thank you for your testimony and we will
be visiting as we move forward on budget issues and everything
else.
Thank you for your service to the country.
We will start with the next panel. The next panel consists
of the Honorable Aaron Payment, Midwest Area Vice President,
National Congress of American Indians and Chairman, Sault Ste.
Marie Tribe of Chippewa Indians of Sault Ste. Marie, Michigan.
Mr. Payment was elected October 16, 2013 to serve a two
year term as Midwest Area Vice President of the National
Congress of American Indians. His resume is good and
impressive. It is good to have you here and look forward to
your testimony.
Then we have the Honorable Andrew Joseph, Jr., Member-at-
Large and Portland Area Representative, National Indian Health
Board here in Washington and Chair, Northwest Portland Area
Indian Health Board in Portland, Oregon.
Andrew Joseph, Jr. was elected in March 2013 as Member-at-
Large and Portland Area Representative of the National Indian
Health Board. Andrew also has a very impressive resume which I
could go through but their testimony is more important than the
accolades at this point in time.
I would say thank you very much for being here. Before you
give your testimony, I very much value it and I appreciate you
taking the time to tell us what is going on from your
perspective.
As with the previous presenters, we are going to give you
five minutes but your entire written testimony will be made a
part of the record. It might just be you and I on question and
answer but maybe someone will show up again.
At any rate, we will start with you, Mr. Payment, and then
go to Mr. Joseph.
STATEMENT OF HON. AARON PAYMENT, MIDWEST AREA VICE PRESIDENT,
NATIONAL CONGRESS OF AMERICAN INDIANS; CHAIRMAN, SAULT STE.
MARIE TRIBE OF CHIPPEWA
INDIANS
Mr. Payment. Good day. My name is Aaron Payment. I am
Chairperson of the Sioux Tribe.
As Congress considers the fiscal year 2015 budget and
beyond, tribal leaders call on Congress to ensure that the
promises made to Indian Country are honored in the Federal
budget. Please remember just as we do not have the discretion
to renege on our millions of acres of land cessation, we ask
that you no longer exercise your trust obligation as
discretionary.
With accumulated impacts of level funding, budget cuts and
sequestration in some cases amounting to up to 30 percent cuts
since the Clinton era, the continued trust obligation of the
Federal Government is threatened. These cuts feel very much
like an abrogation of the treaty and trust obligations.
NCAI's President Cladoosby would remind you this is your
duty, you are our trustee. Please serve with honor and put the
trust in trustee. When people ask why honor such antiquated
documents like Indian treaties, I remind them that they are
pursuant to the U.S. Constitution and judicial decisions and
remember the Constitution is older.
My written testimony calls for the equitable funding for
tribal governments across the board and then addresses specific
proposals in the Administration's fiscal year 2015 budget,
including the Bureau of Indian Affairs, Indian Health Services,
Natural Resources and Environment, Education and Public Safety
and Justice.
NCAI, in collaboration with national, regional and issue
specific tribal organizations has developed comprehensive
recommendations included in the fiscal year 2015 Indian Country
budget request. We request for the document to be entered into
the record.
For the remainder of my time, I would like to hit a few
highlights to sound the clarion call for equitable funding for
tribes.
Even with the inroads and understanding of trust
obligation, Indian Country continues to experience what the
U.S. Commission on Civil Rights in 2002 called the ``quiet
crisis of Federal funding and unmet needs.''
The Indian Health Service is currently funded to meet only
about 56 percent of the need despite being the primary provider
of health care for many tribal communities. In 2002, IHS per
capita expenditures for patient health services were just
$2,896 compared to $7,535 per person for health care spending
nationally. This is a disparity of nearly the magnitude of
three times.
For my tribe, for 66 percent of the citizens not residing
near our health care delivery system, their health needs remain
unmet. The response, intended or not, to access Medicaid fails
to recognize the trust obligation, besides hundreds of
thousands of tribal citizens across the country live in States
where Medicaid expansion simply did not occur.
Please restore leftover 2013 IHS budget cuts due to
sequestration. We lost ground. The rural nature of our health
care system, so far my tribe lost six providers just since last
fall due to the shutdown and sequestration. I fear this will be
even more devastating if special diabetes is not renewed and
one year is the least of what we are looking for.
Due to these losses, we desperately ask Congress to move
our funding from discretionary to non-discretionary and support
advance funding to further avoid losing ground.
We ask that Congress fully fund contract support and
reinstate sequestration losses. Again, fully funding contract
support is mandated by the Supreme Court in the Ramah case.
However, fully funding contract support but cutting other areas
appears like a sleight of hand or punishment.
We support the President's request for $251 million to
fully fund contract support but please don't cut services to
IHS or infrastructure to do so. Otherwise, we will experience a
net loss.
To give you the importance of health care in our community,
life expectancy for American Indians and Alaska Natives is 4.1
years less than it is for the general population. In my family,
our life expectancy is 60 years, with one exception. How many
years would you have left? I have 12 if we live the expectancy.
We support the BIA's increase of at least $33.8 million or
1.4 percent above the fiscal year 2014 enacted level. However,
with congressional mandate to fully fund contract support, this
will mean inevitable cuts to Indian programs and essential BIA
infrastructure. After a year of sequester cuts, now making do
with sequestration is an impossible burden to place on the BIA.
With Interior budgets, some budgets are projected to
increase up to 22 percent. Ours is really the least of it. Ours
is the very least. A joke was made the other day, maybe Indians
should move to the national parks. However, that is to a good
idea either because the Navajo haven't been able to move
forward some of their housing development because they are
located in national parks, so that is really not the solution.
We have the highest dropout rate of any racial ethnic
population in this country. This has not increased in the last
ten years. We need greater effort in Indian education. Impact
aid is critically important because 90 percent of our kids go
to public schools and depend on the funding that comes from
impact aid. I hope there are questions so we can flush that out
later.
I have much, much more that I could address but I think I
am out of time. There is a lot more in my written testimony. I
hope that you lots and lots of questions for me.
Thank you.
[The prepared statement of Mr. Payment follows:]
Prepared Statement of Hon. Aaron Payment, Midwest Area Vice President,
National Congress of American Indians; Chairman, Sault Ste. Marie Tribe
of Chippewa Indians
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
The Chairman. Thank you, Mr. Payment.
Mr. Joseph, you are up.
STATEMENT OF HON. ANDREW JOSEPH, JR., MEMBER-AT-LARGE/PORTLAND
AREA REPRESENTATIVE, NATIONAL
INDIAN HEALTH BOARD; CHAIR, NORTHWEST
PORTLAND AREA INDIAN HEALTH BOARD
Mr. Joseph. Good afternoon, Chairman Tester.
I thank you for holding this important hearing on the
fiscal year 2015 budget.
On behalf of the National Indian Health Board and the 566
federally-recognized tribes we serve, I submit this testimony.
My name is Andrew Joseph, Jr. I am an at-large executive
committee member of the National Indian Health Board. I also
serve as the Chair of the Northwest Portland Area Indian Health
Board and as tribal co-chair to the National Tribal Budget Work
Formulation Work Group.
First, I would like to thank the Committee for the work it
has done to advance health care priorities for our people. In
fact, due to the help of many members of this Committee, we
were able to change the mind of the Administration on contract
support costs. For this and all you have done and continue to
do for the first people of this country, thank you.
Despite important changes in health care funding we have
achieved over the last several years, we still experience many
disparities. I look back home to my tribe and see us burying
too many people. It is tough to be here at meetings in
Washington and see three or four of our people have passed by
the time I get home. This has to stop. The Federal Government
has not fulfilled its promise and our people continue to
suffer.
Considering the level of funding appropriated to IHS, these
statistics are not surprising. In 2013, the IHS per capita
expenditure for patient health services was $2,800 compared to
almost $8,000 per person for health care spending nationally.
The first people of this Nation should not be last when it
comes to help. Let's change that now.
For fiscal year 2015, NIHB echoes the recommendations for
the Tribal Budget Formulation Work Group and recommends $5.3
billion for IHS overall. This request would allow the funding
of current services and include program expansion increases in
several key areas including Purchased/Referred Care hospitals
and clinics, mental health, alcohol and substance abuse.
These programs represent the core of IHS work and areas of
most critical need to our people. You will see in NIHB's
written testimony greater details about each priority.
We also ask that sequestration cuts from fiscal years 2013
and 2014 be fully restored. Congress did not provide enough
funding to fund contract support costs and restore the
sequestration or provide increases in the other crucial service
areas. Some accounts even received cuts beyond the fiscal year
2013 sequestration level in fiscal 2014. This, combined with
medical inflation and additional staffing costs has not really
allowed these budgets to move forward. We are once again losing
ground in addressing health disparities suffered by our people.
I would also like to support several policy changes that
would enable our IHS budget to be used in a better way. NIHB
strongly supports Medicare-like rates for IHS Purchase/Referred
Care. In 2003, Congress enacted legislation to require hospital
providers to only pay Medicare-like rates when billing IHS
through the Purchase/Referred Care Program, but non-hospital
providers do not have this requirement.
We also echo the recommendation of the GAO who said that
reimbursements for providers should be capped at Medicare-like
rates.
Advance appropriations for IHS would allow tribally
operated IHS programs to know what kind of funding they have a
year in advance. This would mean that we could not only save
the administration cost but would also be able to provide a
better compendium of care for our people.
Finally, we support the immediate renewal of the Special
Diabetes Program for Indians. This is saving lives and taxpayer
dollars and must be renewed now.
You will see additional policy recommendations detailed in
our written testimony. Thank you again for this opportunity to
testify before the Committee today and for all the work you do
to support Indian health.
I am happy to answer any questions you might have.
[The prepared statement of Mr. Joseph follows:]
Prepared Statement of Hon. Andrew Joseph, Jr., Member-At-Large/Portland
Area Representative, National Indian Health Board; Chair, Northwest
Portland Area Indian Health Board
Chairman Tester, Vice Chairman Barrasso, and Members of the
Committee, thank you for holding this important hearing on the FY 2015
President's Budget Request. On behalf of the National Indian Health
Board and the 566 federally-recognized Tribes we serve, I submit this
testimony.
First, I would like to start by thanking the members of this
committee for their dogged determination in advocating for the rights
of American Indian and Alaska Native (AI/AN) peoples. Consistently,
this committee has been willing and ready to stand up for the trust
obligations the Federal Government has toward American Indians and
Alaska Natives. The United States assumed this responsibility through a
series of treaties with Tribes, exchanging compensation and benefits
for Tribal land and peace. The Snyder Act of 1921 (25 USC 13)
legislatively affirmed this trust responsibility. To facilitate
upholding its responsibility, the Federal Government created the Indian
Health Service (IHS) and tasked the agency with providing health
services to AI/ANs. Since its creation in 1955, IHS has worked to
fulfill the federal promise to provide health care to Native people.
In passing the Affordable Care Act, Congress also reauthorized and
made permanent the Indian Health Care Improvement Act (IHCIA). In
renewing the IHCIA, Congress reaffirmed the duty of the Federal
Government to American Indians and Alaska Natives, declaring that ``it
is the policy of this Nation, in fulfillment of its special trust
responsibilities and legal obligations to Indians--to ensure the
highest possible health status for Indians and urban Indians and to
provide all resources necessary to effect that policy.''
Health Discrepancies for American Indians and Alaska Natives
Despite these promises, the health of AI/ANs continues to fall far
short of the health status of all other Americans. The AI/AN life
expectancy is 4.1 years less than the rate for the U.S. all races
population. AI/ANs suffer disproportionally from a variety of diseases.
According to IHS data from 2005-2007, AI/AN people die at higher rates
than other Americans from alcoholism (552 percent higher), diabetes
(182 percent higher), unintentional injuries (138 percent higher),
homicide (83 percent higher) and suicide (74 percent higher).
Additionally, AI/ANs suffer from higher mortality rates from cervical
cancer (1.2 times higher); pneumonia/influenza (1.4 times higher); and
maternal deaths (1.4 times higher).
Devastating health risks from historical trauma, poverty and a lack
of adequate treatment resources also continue to plague Tribal
communities. According to IHS data, 39 percent of AI/AN women
experience intimate partner violence, which is the highest rate of any
ethnic group in the United States. One in three women in AI/AN
communities will be sexually assaulted in her lifetime. AI/ANs suffer
at higher rates from psychological distress; feelings of sadness,
hopelessness and worthlessness; feelings of nervousness or restlessness
and suicide. Additionally, public health risks due to alcohol and
substance abuse are sadly widespread in many Tribal communities,
leading to other health disparities such as poverty, mental illness,
and increased mortality from liver disease, unintentional injuries and
suicide. Dental health concerns also continue to affect AI/ANs at
higher rates than other Americans. Ninety percent of AI/AN children
suffer from dental caries by the age of eight, compared with 50 percent
for the same age in the US all races population. Our children ages 2 to
5 have an average of six decayed teeth, when children in the U.S. all
races population have only one.
Clearly, more must be done to alleviate these health risks for our
people and to fulfill the trust obligations to AI/ANs. When considering
the level of funding appropriated to IHS, these statistics are not
surprising. In 2013, the IHS per capita expenditures for patient health
services were just $2,849, compared to $7,717 per person for health
care spending nationally. Despite the historic increases that Congress
has given to the IHS budget over the last several years, funding
discrepancies unambiguously remain. The First People of this nation
should not be last when it comes to health. Let's change that now.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Sequestration in FY 2013 and the FY 2014 Budget
As the Committee is well aware, the IHS budget lost $220 million
due to sequestration in FY 2013. This, combined with the two week long
government shutdown at the start of FY 2014 was devastating many Tribal
health programs. Many sites cut patient visits, furloughed staff and
delayed or denied needed medical procedures. The tragedy of
sequestration in Indian Country was a clear denial of the federal trust
responsibility to Tribes and our communities became, yet again, an
unfortunate victim of unrelated political battles in Washington. As
then Senate Committee on Indian Affairs Chairwoman Maria Cantwell
stated on November 14, 2013, ``Our country's financial troubles are not
really stemming from our obligations to Indian Country, and frankly,
we're not doing a good job in fulfilling those obligations.''
The Congress, in the FY 2014 budget did make a commitment to
replace some of the funding lost due to sequestration in the previous
year. However, due to priorities outlined by Congress and the rightful
funding of Contract Support Costs, the IHS was not able to alleviate
sequestration across most accounts and provided only nominal increases
for those where the funding was restored. Some accounts even received
cuts beyond the FY 2013 sequestration level in FY 2014. This, combined
with medical inflation and additional staffing costs, have not really
allowed these budgets to move forward. Despite receiving these urgently
needed increases, we are once again losing ground in addressing health
disparities suffered by our people.
For FY 2015, Congress, at a bare minimum must truly restore these
sequestration cuts, and adjust for inflation and population growth.
Otherwise, our people will continue to experience some of the worst
health disparities in the nation and continue to experience loss of
lives due to sequestration cuts. To that end, Tribes also request that
Congress enact legislation to exempt IHS and all programs serving
Indian Country from any future sequestration. While discretionary
spending is not facing sequestration in FY 2015, we urge this committee
to continue to advocate with your colleagues in Congress to create a
permanent, full exemption from sequestration, as well as rescissions,
for Tribal programs for FY 2016 and beyond.
FY 2015 President's Budget Request
NIHB echoes the recommendations of the Tribal Budget Formulation
Workgroup for FY 2015. The Tribal Budget request continues to be full
funding of the Total Tribal Needs base budget of 28.7 Billion dollars
over a 12 year period. This includes amounts for personal health
services, wrap-around community health services and facility capital
investments. However, for FY 2015, Tribes request total funding amount
of $5.3 billion. This request would enable the funding of current
services and include program expansion increases in several key areas
including purchased/referred care; hospitals and clinics; mental health
and alcohol and substance abuse.
The NIHB and Tribes believe that the President's FY 2015 request a
positive step forward for Indian Country. The President's overall
proposal restores the cuts caused by sequestration and the cuts made in
the FY 2014 IHS operating plan. NIHB commends the Administration for
including a $63 million increase to account for medical inflation and
an additional $2.6 million for pay cost increases at both the IHS and
Tribal level. However, other challenges still remain in the federal
budget, such as a long-term solution on Contract Support Costs when a
long-term commitment is required; increased funding for Purchased/
Referred Care (formerly Contract Health Services); increase for Mental
Health care, screenings and services; and alcohol and substance abuse.
Contract Support Costs
Importantly, the FY 2015 budget request also fully funds Contract
Support Costs (CSC) in accordance with the U.S. Supreme Court decision
in Salazar v. Ramah Navajo Chapter. The request includes a $30 million
increase in order to fund the increases requested for the IHS in FY
2015. This represents a historic shift in a decades-long battle. As you
recall, in FY 2014, the Administration proposed capping CSC for
individual contracts, which Indian Country unanimously pointed out was
a violation of both the federal trust responsibility and the principles
of Ramah decision. Congress rejected this proposal in FY 2014 and
provided a pathway for the Administration to fund CSC in FY 2014. NIHB
would like to again, thank this committee for the work it did to not
only elevate the issue, but also to change the position of the
Administration.
However, as noted above, this CSC funding obligation should not
have been achieved at the expense of other Tribal programs. It is
unfair to force Tribes to choose between increased services and funding
of costs already owed to us to operate our programs. Funding CSC at the
expense of other direct services is a continuation of the injustice,
and is simply ``robbing Peter to pay Paul.'' The increases provided in
the FY 2014 budget to fund CSC only restored obligations to the Federal
Government has already made to Tribes, and did not provide a true
increase to the overall budget in terms of real health dollars.
NIHB is encouraged by statements that the Administration recently
made that it wants to continue to find a long-term solution for funding
CSC. We urge Congress and the Administration to work together with
Tribes in order to ensure that funding for CSC can be maintained
without making sacrifices to other areas of the budget.
Purchased/Referred Care
Over the last several years both Congress and the Administration
have heard the call of Tribes to increase funding for Purchased/
Referred Care (PRC) (formerly called Contract Health Services).
Purchased/Referred Care dollars fund for IHS patients health care
services that cannot be directly provided by an IHS or Tribal health
facility. These dollars have historically been so scarce that many
health programs run out of funding by June 1 of the fiscal year. This
dearth of funding creates an emergency ``life or limb'' scenario
(Priority I) where an amputation will be paid for when the preventative
care that could prevent the amputation will not--or where painkillers
will be paid for when orthopedic surgery is needed. This has to stop.
Tribes are grateful that since FY 2009 PRC has increased by $244.1
million, or 38 percent. Before sequestration, some clinics were
actually able to start treating cases that were nonlife threatening
(Priority II). In FY 2015, the President's request includes an $18
million increase for PRC. However, funding is so short for this program
that Tribes have requested $1.1 billion for PRC in FY 2015, which is
$22 million above the FY 2014 enacted level and $17 million above the
FY 2015 request. At current levels (and especially after
sequestration), the IHS budget typically only covers Priority I or
``Life or Limb'' referrals. Through lack of funding and de-prioritizing
preventative opportunities, this cycle creates increased costs for
needed health care by increasing costs to the Purchased/Referred Care
programs specifically, and to the IHS health delivery system overall.
Medicare Like Rates for PRC
In addition to providing additional funding for PRC, one common-
sense solution to enable these funds to go further is for Congress to
enact legislation that would require that PRC reimbursements to
nonhospital providers are made at ``Medicare Like Rates.'' In 2003,
Congress amended the Medicare law to authorize the Secretary of Health
and Human Services to establish a rate cap on the amount hospitals may
charge IHS and Tribal health programs for care purchased from hospitals
under the PRC program. However, hospital services represent only a
fraction of the services provided through the PRC system. The IHS PRC
program may be the only Federal Government entity that does so; neither
the Veterans' Administration nor the Department of Defense pay full
billed charges for health care from outside providers.
On April 11, 2013, the Government Accountability Office (GAO)
issued a report that concluded ``Congress should consider imposing a
cap on payments for physician and other nonhospital services made
through IHS's CHS program that is consistent with the rate paid by
other federal agencies.'' We agree: these savings would result in IHS
being able to provide approximately 253,000 additional physician
services annually. This number will even be greater when you consider
Tribally-run programs, which means that total savings are more likely
to be around $100 million annually. NIHB and Tribes encourage Congress
to swiftly enact the legislative change to make PRC subject to Medicare
Like Rates.
Hospitals and Clinics
In FY 2015, Tribes request $2.1 billion for Hospitals and Clinics
(H&C) in order to better provide health services for 2.1 million AI/
ANs. This represents an increase of $297 million, or 16 percent over
the FY 2014 enacted level. H&C includes medical and surgical inpatient
care, routine and emergency ambulatory care, and other medical support
services. H&C funds also support community health initiatives targeting
health conditions disproportionately affecting AI/ANs, such as
specialized programs for diabetes, maternal and child health, women's
health, and elder health.
The services provided by H&C are constantly being challenged by
many factors including inflation, population growth and an increased
rates of chronic diseases. Additionally, IHS/Tribal/Urban-managed
facilities often have great difficulty in recruiting and retaining
medical staff meaning due to remote locations and funding difficulties.
If the health status of AI/ANs is ever going to improve, Congress must
prioritize this core program now.
Mental Health
For FY 2015, NIHB recommends $130 million for mental health
services. This represents a $52.7 million increase over the FY 2014
enacted level. As noted above, American Indians and Alaska Natives
suffer from a high incidence of mental health disorder, illnesses and
suicide rates; in fact, suicide is the second leading cause of death
for AI/AN children and youth. Failure to treat mental health conditions
and providing appropriate and timely interventions and care,
effectively results in community-wide public health risks both on and
off reservations for AI/ANs. For example, the Navajo Area suicide rate
that is four times greater than the US all races rate for youth aged 5-
14. In 2010, in one town with a population of only 8,000, there were 15
suicides. Sadly, many communities throughout Indian Country also
experience this tragic story. The trauma and emotional injury stemming
from a suicide in Tribal communities impacts elders, mothers and
fathers, sons and daughters, friends and destabilizes the cultural and
community fabric of our Nations. Our young people in Indian Country
often experience a life filled with a variety of social problems such
as substance abuse and poverty, and envision a future without promise
or hope for a better life. For the sake of the next Seven Generations,
we must all work together to find a serious, comprehensive solution to
end this disturbing epidemic.
Treating these issues among AI/ANs must utilize a comprehensive
approach that targets early intervention and engages all aspects of
life. Services that IHS currently provides, when resources are
available, include comprehensive outpatient mental health treatment,
crisis response services, prevention programming, collaborative
treatment planning with alcohol and substance abuse treatment
providers, group therapies, and traditional healing methodologies, in
addition to other evidence-based approaches to mental health treatment.
Overall, these solutions are more reactive than they are proactive.
Services generally not available at IHS or Tribally-operated
facilities, but instead must be procured through third party contracts,
include inpatient and residential treatment services, group homes, and
independent living centers.
One of the most critical problems Tribal communities face is the
recruitment and retention of qualified fulltime psychiatrists and
psychiatric nurse practitioners. This is one of the many reasons NIHB
supports a legislative fix that would enable IHS Student Loan Repayment
Program and Health Professions Scholarship Program to have tax exempt
status. It would enable IHS to fund an addition 105 new repayment
awards to combat the 1,550 vacancies for health care professionals in
the IHS system. In the House of Representatives (H.R. 3391), bipartisan
legislation has been introduced to address this concern. We urge the
members of this committee to introduce a Senate companion bill to H.R.
3391 and swiftly pass it out of committee.
NIHB also urges this committee to seriously investigate the
contributing factors to mental health and work with Tribes, federal
agencies and other stakeholders to find a real solution to this
difficult problem.
Alcohol and Substance Abuse
Closely linked with mental health issues are chronic problems
stemming not only from historical trauma, but from emotional injuries
related to domestic violence as well as alcohol and substance abuse in
Tribal communities. As mentioned above, AI/ANs are consistently
overrepresented in statistics relating to alcohol and substance abuse
disorders, leading to widespread health issues for individuals,
families and even entire communities.
For FY 2015, we recommend $236 million for Alcohol and Substance
Abuse, or $50 million above the FY 2014 enacted level and $43 million
above the FY 2015 President's request. IHS programs and Tribally
operated alcohol and substance abuse programs employ a variety of
treatment modalities consistent with evidenced-based approaches to
address substance abuse disorders and addictions through individual and
group counseling, peer support, and inpatient and residential
placement. However, it is essential that treatment approaches also
include traditional healing techniques designed to improve outcomes and
to tie services provided back to valuable cultural practices and the
individual AI/AN's spiritual journey.
IHS funding supports the operation of adult and youth residential
facilities and placement contracts with third party agencies, but
limited funding often results in placement decisions based on the
availability of alternate resources and the providers' clinical
recommendations. IHS-funded alcohol and substance abuse programs
continue to focus on integrating primary care, mental health and
substance abuse services, and the exploration and development of
partnerships and alliances with other community stakeholders.
Again, treatment for alcohol and substance abuse must be approached
from a community-wide perspective and integrate not only health
programs, but also Tribal justice, and education initiatives.
Communities in Indian Country experience these tragic issues due to a
large and complex list of contributing factors, so approaches to solve
these problems must also address all aspects of society.
Fund IHCIA New Authorities
The adoption of the Patient Protection and Affordable Care Act
(ACA) (P.L. 110-148) in 2010 was historic for Tribes in many ways. Most
importantly, it renewed the Indian Health Care Improvement Act (IHCIA).
The effort to renew IHCIA took 10 years and represents a true victory
for Indian health. The Act updates and modernizes health delivery
services, such as cancer screenings, home and community based services
and long-term care for the elderly and disabled. It also establishes a
continuum of care through integrated behavioral health programs (both
prevention and treatment) to address alcohol/substance abuse problems
and the social service and mental health needs of Indian people.
However, many of these provisions remain unfunded, which again,
represents another failure to follow through on promises to our people.
All provisions of the IHCIA are critcal to advancing the health care of
American Indian and Alaska Native people and should be implemented
immediately. Adequate funding for the implementation of these long
awaited provisions is needed now. Tribes recommend funding of $300
million in order to fully implement IHCIA in FY 2015.
Definition of Indian in the Affordable Act
As NIHB testified previously, we urge Congress to enact a
legislative ``fix'' for the Definition of Indian in the Affordable Care
Act. The ``Definitions of Indian'' in the ACA are not consistent with
the definitions already used by the Indian Health Service (IHS),
Medicaid and the Children's Health Insurance Plan (CHIP) for services
provided to American Indians and Alaska Natives. The ACA definitions,
which currently require that a person is a member of a federally
recognized Tribe or an Alaska Native Claims Settlement Act (ANCSA)
corporation, are narrower than those used by IHS, Medicaid and CHIP,
thereby excluding a sizeable population of AI/ANs that the ACA was
intended to benefit and protect. Unless the definition of Indian in the
ACA is changed, many AI/ANs will not be eligible for the special
protections and benefits intended for them in the law.
NIHB requests that the committee use all methods at its disposal to
resolve this issue. On October 16, 2013, Senator Mark Begich (D-AK)
introduced S. 1575 which would address this issue. NIHB encourages the
committee to swiftly consider and favorably report S. 1575 to ensure
that all AI/ANs are eligible for the benefits intended for them in the
ACA.
Other Policy Recommendations
The Administration's FY 2015 Budget Request Contains three
legislative policy provisions: (1) Provide Tax Exempt Status for the
Indian Health Service Health Professions Scholarship Program and the
Health Professions Loan Repayment Program; (2) Renew the Special
Diabetes Program for Indians at $150 million for three years. NIHB
supports these legislative priorities, in addition to Advance
Appropriations for the Indian Health Service.
Renewal of the Special Diabetes Program for Indians
As part of the Balanced Budget Act of 1997, Congress established
the Special Diabetes Program for Indians (SDPI) to address the growing
epidemic of Type II diabetes in American Indian and Alaska Native (AI/
AN) communities. The Special Diabetes Program for Type 1 Diabetes (SDP)
was established at the same time to address the serious limitations in
Type 1 diabetes research resources. Together, these programs have
become the nation's most strategic, successful and comprehensive effort
to combat diabetes. SDPI is transforming lives and changing the
diabetes landscape in America.
According to the Centers for Disease Control and Prevention (CDC),
AI/AN adults have the highest ageadjusted prevalence rate of diagnosed
diabetes compared to other major racial and ethnic groups at 16.1
percent. By comparison, this is almost twice the rate for the total
U.S. adult population. Some regions of Indian Country have diabetes
rates as high as 33.5 percent, with specific communities having Type II
diabetes reach a level as high as 60 percent.
Today, SDPI is funded at a level of $150 million per year and
supports 404 diabetes treatment and prevention programs in 35 states.
With funding for this critical program set to expire on September 30,
2014, Tribes are requesting a renewal of this program of $200 million/
year for 5 years. While we understand an increase in funds during this
budgetary environment is difficult, SDPI has been level-funded since
2002. This represents an effective decrease. Calculating for inflation,
$150 million in 2002 would be about $115 million in 2014--or 23 percent
less. In order to keep the momentum of this important program alive, it
is critical that Congress continue to invest in SDPI, which will save
millions in preventative care over the long term. When taking into
account additional Tribes that have gained federal recognition since
2002, the dollars are even scarcer.
NIHB wishes to express its gratitude for the work that members of
this committee have done so far to support renewal of SDPI. With the
deadline of September 30th in mind, I urge you to support a multi-year
reauthorization of the SDPI by March 31st of this year. We have a
critical opportunity to see the program renewed by March 31, when
Congress must renew the Medicare Extender legislation--and that
legislative vehicle is typically the legislative vehicle for SDPI
renewals. Without an immediate, long-term reauthorization, critical
infrastructure that the Tribes have built to address the Diabetes
epidemic in Indian Country has greatly contributed to the success of
SDPI. A delay in renewal will mean loss of SDPI staff--loss of jobs--
that will severely impact tribal health: both in terms of patient
health and community economic health. Also, because SDPI is a grant
program, the Indian Health Service requires four months to advertise
and complete the grant process--so please actively shepherd through the
reauthorization of SDPI by March 31, 2014.
Support for Advance Appropriations
In addition to the policy recommendations outlined by the
Administration, NIHB would like to reiterate its support for Advance
Appropriations for the Indian Health Service. On October 10, 2013,
Senator Lisa Murkowski (R-AK) introduced legislation, S. 1570, to
provide advance appropriations for the IHS. While this measure will not
solve the complex budget issues at IHS, it will be an important first-
step in ensuring that AI/ANs receive the health care they deserve.
Advance appropriations would allow Indian health programs to
effectively and efficiently manage budgets, coordinate care, and
improve health quality outcomes for AI/ANs. The need for advance
appropriations was no more obvious during the Federal Government
shutdown at the start FY 2014. Many Tribal health programs were forced
to furlough employees, close their clinics and deny services during
this period.
This change in the appropriations schedule will help the Federal
Government meet its trust obligation to Tribal governments and bring
parity to the federal health care system. Adopting advance
appropriations for IHS would result in the ability for health
administrators to continue treating patients without wondering if--or
when--they would have the necessary funding. Additionally, IHS
administrators would not waste valuable resources, time and energy re-
allocating their budget each time Congress passed a continuing
resolution.
At the Department of Health and Human Services Budget FY 2016
Tribal Budget Consultation on March 7, 2014, agency officials noted
that they are seriously considering this issue with the Office of
Management and Budget. They are also engaged in conversations with the
Veterans' Administration to learn how they implemented advance
appropriations when they received this status in 2010. NIHB is highly
encouraged by these statements and urges this Committee to quickly
consider S. 1570 and report the bill favorably to ensure that Tribes
can move forward to a more stable funding mechanism.
Conclusion
On behalf of the National Indian Health Board and the 566 federally
recognized Tribes we serve, thank you to the Committee for holding this
important hearing on the FY 2015 budget. While we have made important
gains in the IHS funding budget over the last several years, the
scourge of sequestration has eliminated much of that progress. Tribal
communities still continue to suffer greatly from chronic public health
risks exacerbated by grossly underfunded health services in Indian
Country.
For FY 2015, Tribes are requesting:
1) Begin implementation of a plan to achieve a Needs Based
Budget for IHS at 28.7 billion.
2) Fund IHS at $5.3 billion for FY 2015.
3) Restore Cuts/Shortfalls in FY2013-15 resulting from
sequestration, inadequate increases to cover Congressionally
mandated budget categories, and no provision for inflation for
Continuing Services & Binding Obligations and advocate that
Tribes and Tribal programs be permanently exempted from any
future sequestration.
4) Provide an additional $300 million to implement the
provisions authorized in the Indian Health Care Improvement Act
(IHCIA).
State and local governments have the power to tax in order to fund
government services. Tribes do not have that option. In many remote
Tribal communities, economic development is also unfeasible. Tribal
governments depend more heavily on Federal Government sources, thereby
making the need to fund Tribal programs at a sustainable level even
greater. It is a matter of justice and equity--failure to prioritize an
IHS budget that makes a meaningful investment in the health of AI/ANs
is a violation of the federal trust responsibility and denial of the
sacrifices that our people have made to this country.
Thank you for the opportunity to offer this testimony.
The Chairman. Thank you, Mr. Joseph. I appreciate your
testimony.
I appreciate both your testimonies and both of you taking
time from your busy schedules to be here today to advocate for
causes I know you both feel are very, very important. I feel
the same.
I will start with you, Mr. Payment. With the President's
fiscal year 2015 budget request for $2.6 million for Indian
Affairs at the Department of Interior, my understanding from
your testimony is that the NCAI full budget request is, at
almost every line item in the Indian Affairs budget,
underfunded.
NCAI testimony mentions an across the board $139 million
increase, knowing that there are unmet needs for basically all
the Indian Affairs programs. Is an across the board increase
the best place to start or would it be better to start with
specific programs and if so, could you prioritize a few of
those?
Mr. Payment. I would say we have a critical need with law
enforcement right now. We do have a detention center and it
actually covers its own costs. We are able to use the revenue
from the detention center but have been doing that for the last
couple of years, so that fund is almost gone.
We have used that to make up for the Federal Government not
adequately funding our law enforcement and conservation. In
about a year that fund will be depleted and it then will
compete with our other self governance funds.
We have a very rural area like a lot of tribes, so our law
enforcement is minimally covered right now. We just signed a
couple years ago the permanent settlement of our treaty rights,
so the conservation portion of that is going to increase. I am
not sure how we are going to cover that, so law enforcement
would be one.
Education is critical. I am working on my doctorate in
education. We have a 50 percent dropout rate. The solution is
not only in the BIE. Ninety percent of our kids don't go to
school in Indian schools. We do have a tribal school in my
community and we just got the highest MEAP scores in the
region, higher than the local schools. When we do it, we do it
right.
We can't abandon those who attend public schools because
there needs to be a focused attention there. How does impact
aid benefit communities? A friend of mine is a superintendent
of a school that serves about 50 percent Native American
children. They are underfunded.
With the cuts that happened last year, the funding to
impact aid happened in the middle of the school year so they
didn't have time to adjust. When cuts happen to public schools,
to impact aid, it impacts the highest need people because that
is the first thing cut. Our people happen to be the highest
need people. The connection with impact aid is there.
Social welfare, we need a new commitment in social welfare,
especially with mixed messages coming from the Supreme Court in
Indian child welfare. We need much, much more resources in
Indian child welfare. Juvenile placements in detention, we need
direct funding for that.
The last one I will say is suicides. We have a very high
rate of suicide in our community. We need direct funding from
SAMHSA to tribes. We need to skip the State compacting process
and come directly to the tribes because I think we know best
how to serve our people and meet those needs.
The Chairman. A very good point.
I am going to cut to another area that has to do with
consultation. When I go around the State and around the country
as far as that goes, there is an understanding that Indian
Affairs does a reasonable job in consultation. Other
departments, not so much.
I don't want to be critical of them because, quite frankly,
they don't deal with Native American issues all the time and
consultation is a different way of doing business than they are
used to.
I want your input or NCAI's input. We will start with the
two biggies, the Department of Interior and the Office of
Management and Budget. Do they give sufficient opportunity to
talk about the resources for programs?
Mr. Payment. I would say that the Obama Administration
especially consultation has been a priority for many Federal
agencies. What is consultation? It is not completely and
universally understood how it should actually happen. There are
some templates that suggest how it should happen.
I would say there is definitely a need to educate OMB to
carry forward the trust obligation and to understand and
appreciate it better. I think something is lost in the
translation when it gets to OMB. I think more work is needed
there.
NCAI has requested that a Native American desk be
established in the OMB so they better understand so the
translation from the President's office and from Congress'
commitment make its way to the OMB.
I think the problem is systemic and it is much bigger. I
think with creation of the White House Counsel and in fact,
this week the Midwest Alliance of Sovereign Tribes passed a
resolution which I drafted calling for some infrastructure that
will go along with the commitment and asking the White House
Counsel to put in place some consultation and maybe an advisory
council of tribal leaders across the country to advise the
White House Counsel.
I think the silo problem of the different departments and
OMB being kind of over here leads to lack of communication. The
problems that happened with IHS not being exempted from
sequestration is a perfect example of that.
The Chairman. I would just say this. I don't like to point
fingers without a few pointing back to us but Congress hasn't
been particularly helpful on a lot of these issues too. I would
just say to both of you if there are things we can do to help
with consultation, getting input to people who need to have
input, please let us know so we can try to help facilitate.
You make good decisions based on good information. Let's
just put it that way. If you don't have good information, you
aren't going to make good decisions.
I want to go to you for a second, Mr. Joseph, on IHS
staffing. The Northwest Portland Area Indian Health Board has
often had concerns about staffing levels in the region's Indian
Health Service facilities. I am aware this is not just a
problem in that region. Have you seen any change in staffing of
facilities in Indian Country? Has it been static? Has it gotten
better or has it gotten worse?
Mr. Joseph. Right now, my tribe has declared a state of
emergency for staffing. It is an IHS Federal service unit. The
Portland Board and the California Rural Indian Health Board
have a joint resolution on staffing needs. A lot of our tribes
have built their own facilities, we couldn't wait for the
government. We are kind of like the Wind River Tribe that was
talked about earlier.
We built our clinics. Two of the four were written into the
master plan by IHS. We still have the staffing from I'd say the
1950's or maybe before then. The Affordable Health Care Act is
an excellent bill, I helped write it, but tribes like mine that
have poor staffing or low staffing are not able to take
advantage of all of the good language written in that bill.
I believe every tribe needs to look at facilities and
staffing across the country. I am really grateful for the ones
that get it because they get the full deal, they get the
facilities, staffing and then they get to take advantage. Some
tribes have been waiting as long. If we could have staffing, it
would be helpful.
I took my son to the dentist, he had an emergency a couple
of weeks ago, and there is only one dentist. We have one we
brought back from retirement and he comes in part-time. I was
waiting for my son and an elder came in and asked if he could
get an appointment. He was told, give me your name and number
and we will call you maybe in two or three months. There is
about a six month waiting time for an actual appointment.
Staffing is a big need.
The reason why Portland is opposed to staffing is because
they that increase right off the top of the budget and it
affects the overall medical part of health that IHS has to
provide. Based on last year's 2013 budget when we did get
sequestered, there was $53 million that went into staff two new
facilities and that was taken right off the top of the
increase. The real medical increase wasn't as high as the
Senate thought it would be.
Like I said, I am grateful there are tribes who got it but
the rest of us kind of suffered from it.
The Chairman. In your opinion, is the problem with staffing
budgetary or is it lack of availability of professionals for
IHS?
Mr. Joseph. It kind of hits on the question you asked Aaron
about OMB. We have been submitting our budget and asking for
what we really need for quite a few years now. The real need
for the IHS budget is $28.1 billion. We are stuck at the $4
billion level.
When I first started working on the budget 11 years ago, I
was wishing they would just round off the number to $3 billion.
We were really struggling then. Our population and the cost of
providing medical health has gone way up.
The Chairman. For sure.
You both talked about advance funding. I would just say the
Veterans Administration already has advance funding. You
probably know that. You Native Americans serve at a higher rate
than other minority in this country. We have some questions
that we are going to talk to Dr. Roubideaux about.
I want to tell you guys since you are part of organizations
that one of the ways the Veterans Administration got advance
funding was because all the groups out there wanted it. I think
it would be an incredible plus for Indian Country if we got
advance funding. I think it is possible to get done. In fact, I
have a bill to do that, a piece of legislation to do exactly
that.
I think it is going to take some real force from Indian
Country to get it done, to get in there and talk about how
important it is and how it can help in a very big way. I think
if everyone gets on the same sheet and is very focused, it can
happen. Anything short of that is going to be very difficult.
I would thank you very much for your testimony. We have a
few more but this hearing has gone two hours which is a little
longer than I anticipated but there were some good questions
here today.
I want to thank all witnesses for their testimony, the two
of you included. It is great to hear the information not only
from the Administration but the folks out on the ground. Once
again, this testimony shows the agencies and the tribes are
resourceful but you can't get blood out of a turnip. We need to
make sure we do what we can do here and through the
Appropriations Committee to try to plus up this budget. It
needs to be.
I know there is always a lot of interest in this testimony.
I think the fact we had the folks here even though I can tell
you right now I missed three meetings while this hearing was
going on so everyone else is in that same boat, no disrespect.
This hearing record will remain open for two weeks for any
additional comments that anyone may add to it.
Once again, gentlemen, thank you for your testimony.
This hearing is adjourned.
[Whereupon, at 5:45 p.m., the Committee was adjourned.]
A P P E N D I X
Prepared Statement of Albert A. Yazzie, President, Crystal Boarding
School Board of Education
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
______
Prepared Statement of Hon. Brian Patterson, President, United South and
Eastern Tribes, Inc.
Introduction.
Chairman Tester, Vice Chairman Barrasso and members of the
Committee, my name is Brian Patterson. I serve as president of the
United South and Eastern Tribes, Inc. (USET), as well as on the Men's
Council of the Oneida Nation of New York. Thank you for this
opportunity to provide written testimony regarding the budget
priorities of USET.
USET is an inter-tribal organization representing 26 federally
recognized Tribes from Texas across to Florida and up to Maine. The
USET Tribes are within the Eastern Region of the Bureau of Indian
Affairs (BIA), covering a large expanse of land compared to other BIA
Regions. Due to this large geographic area, the Tribes in the Eastern
Region have great diversity. From an economic standpoint, some of our
Tribes have highly developed economies, while others remain mired in
poverty. All of our Tribes, however, look to the United States to live
up to its trust responsibility, to support Tribal sovereignty, and to
work with us on a government-to-government basis, especially on a
matter as central to the trust responsibility as Federal budget policy.
The Role of this Committee--Defending American Values, such as the
Trust Responsibility
The role of this Committee, or that of any of the Congressional
committee, is ultimately not about dividing up money and power, but
rather determining, deciding and defending American values. For
example, under budget sequestration the Veterans Administration's
hospital system was exempt. That demonstrates a great American value--
fulfilling the commitment to honor our obligations to those who put
their lives on the line to defend American freedom. However, it is not
an American value that the Indian Health Service was not exempted,
putting the life, health and well-being of generations of Native
peoples at risk in a system that already strains to deliver basic
healthcare. This Committee can and should demand that the IHS be funded
in a manner consistent with an important American value--our Nation's
commitment to its First Peoples.
Similarly, the sequestration exempted many low-income programs
(e.g., Child Care Entitlement to States; Child Health Insurance Fund;
Family Support Programs and Temporary Assistance for Needy Families)
demonstrating the great American value that we will leave nobody behind
when it comes to basic needs. And yet, the sequestration applied fully
to virtually all Federal Indian programs, even though many Native
communities suffer the worst social and economic statistics in the
country, largely due to Federal action and policies in place over the
last two hundred years. The application of sequestration to Native
programs was not an American value. Federal budget problems should not
be addressed on the back of Native peoples. USET respectfully asks that
this Committee support funding increases for Federal Indian programs
that consistently exceed the relevant rate of inflation in order to
achieve real progress in closing the services gap for Natives. As
described below, Federal Indian program should not be deemed
discretionary, but rather mandatory.
The Constitution, Indian Tribes, Treaties and the Laws of the United
States
From the earliest days of the United States, the Founders
recognized the importance of America's relationship with Native nations
and Native peoples. They wove important references to those
relationships into the Constitution (e.g., Art. I, Section 8, Cl. 3
(Indian Commerce Clause); Article II, Section 2, Cl. 2 (Treaty Clause).
Natives influenced the Founders in the development of the
Constitution as recognized by the 100th Congress, when the Senate and
the House passed a concurrent resolution acknowledging the ``historical
debt'' the United States owes to Indian tribes.
[O]n the occasion of the 200th Anniversary of the signing of
the United States Constitution, acknowledges the historical
debt which this Republic of the United States of America owes
to the Iroquois Confederacy and other Indian Nations for their
demonstration of enlightened, democratic principles of
government and their example of a free association of
independent Indian nations;. . .
S. Con. Res. 76, 100th Congress. One has only to walk the halls of
the Capitol to see many works of art and sculpture that depict the
central role that Native nations have played in the development of
America's national identity. Not depicted on the walls of the Capitol
are the many injustices that Native peoples have suffered as a result
of Federal policy, including Federal actions that sought to erode
Native territories, learning, and cultures. Out of those injustices,
and from other legal sources, there has arisen a Federal trust
obligation to support Native governments and Native peoples.
The Indian provisions in the Constitution were given immediate life
in treaties that the United States entered into with Indian nations
beginning with the Treaty with the Delaware in 1778 and continuing
through another 373 treaties. Additionally, in the first decades of the
United States, numerous laws were enacted addressing the details of the
Federal-Tribal relationship (e.g., Trade and Intercourse Acts of 1790,
1793, 1796, 1799, 1802, and 1834), even as the Federal courts defined
the Federal Government's trust obligation to Indian nations (e.g.,
Cherokee Nation v. Georgia (1831)). Notwithstanding this Constitutional
foundation, the Federal Government engaged in many actions that
betrayed the treaties and trust obligation to Indian nations, such as
the seizure of Indian lands and the forced assimilation efforts of the
Indian boarding school system. Fortunately, American greatness has led
to more enlightened policies since the boarding school era, reflected
in a host of laws that support tribal sovereignty and are critical to
the vitality and well-being of tribal communities. Regrettably, these
laws are rarely funded to the level necessary to achieve their intended
purposes.
Because of this history, the Trust obligation of the Federal
Government to Native peoples, as reflected in the Federal budget, is
fundamentally different from ordinary discretionary spending and should
be considered mandatory in nature. As a 1977 U.S. Congress/American
Indian Policy Review Commission Report stated:
The purpose behind the trust is and always has been to ensure
the survival and welfare of Indian tribes and people. This
includes an obligation to provide those services required to
protect and enhance Indian lands, resources, and
selfgovernment, and also includes those economic and social
programs that are necessary to raise the standard of living and
social well-being of the Indian people to a level comparable to
the non-Indian society.
The World has its Eyes upon the United States and its Leadership--the
United Nations Declaration on the Rights of Indigenous Peoples
As a sovereign nation, the United States exercises jurisdiction
within its boundaries. However, the United States is also part of a
community of nations that has come together through the United Nations
to develop common principles for the benefit of all mankind. These
principles are used to place a light on those in the international
community who do not live up to international human rights standards.
With regard to Indigenous peoples, the United Nations has adopted
the Declaration on the Rights of Indigenous Peoples (UNDRIP). With
regard to the improvement of the economic and social conditions of
Indigenous peoples, Article 21(2) provides: ``States shall take
effective measures, and, where appropriate, special measures to ensure
continuing improvement of their economic and social conditions.''
Further, Article 38 provides that: ``States, in consultation and
cooperation with indigenous peoples, shall take the appropriate
measures, including legislative measures, to achieve the ends of this
Declaration.'' Those ends include advances in well-being of Indigenous
peoples in the social, economic, cultural, political, environmental,
and other areas. One of the primary mechanisms or ``effective measure''
that States routinely use to address such problems is funding to
achieve UNDRIP's standards, which Article 43 summarizes as: ``. . . the
minimum standards for the survival, dignity and well-being of the
indigenous peoples of the world.'' Federal Indian program funding
should also be measured against international standards.
The Spectre of Sequestration Remains
The budget sequestration of FY 2013 was devastating to Federal
Indian programs and to the tribal communities they serve. While
Congress has provided an alternative budget structure for FY 2014 and
FY 2015, sequestration could be re-imposed in FY 2016. Although this
may seem early to raise this concern, USET urges the Committee to
educate other members of the Senate that the application of
sequestration to Indian programs violates the trust responsibility,
does not make economic sense, and should not be countenanced going
forward. For example, when some Federal health programs were rightfully
exempted from sequestration, it was morally wrong that the Indian
Health Service was not. That should not happen again.
Contract Support Costs--Robbing Peter to Pay Paul
Congress provided that the Indian Health Service and the Bureau of
Indian Affairs must pay the full amount of contract support costs in FY
2014, as they are contractually obligated to do anyway! However,
Congress, while fully funding CSC in FY14, did so principally through
restoration of pre-sequestration funding. This meant that fully funding
CSC was at the expense of other Federal Indian programs.
Full funding for CSC must not come with a penalty--namely, a
reduction in program funding or effective permanent sequestration of
Indian program funds. That result would have the same devastating
effect on our service delivery as the failure to fully fund CSC. Yet
Congress, in the Joint Explanatory Statement accompanying the FY 2014
Consolidated Appropriations Act, noted that ``since [CSC] fall under
discretionary spending, they have the potential to impact all other
programs funded under the Interior and Environment Appropriations bill,
including other equally important tribal programs.'' Moreover, without
any permanent measure to ensure full funding, payment of CSC remains
subject to agency ``discretion'' from year to year, even though tribes
are legally entitled to payment under the ISDEAA. Noting these ongoing
conflicts of law, Congress directed the agencies to consult with tribes
on a permanent solution.
In our view, there is a logical permanent solution which Congress
is empowered to implement: CSC should be appropriated as a mandatory
entitlement. The full payment of CSC is not discretionary; it is a
legal obligation, affirmed twice by the U.S. Supreme Court. Yet the
budget authority for CSC is currently provided and controlled through
appropriation acts--as if it were a discretionary program. The solution
then is to bring the appropriations process in line with the statutory
requirements and to recognize CSC for what it is: a mandatory
entitlement, not a discretionary program. We therefore strongly urge
the Congress to move to appropriate funding for CSC on a mandatory
basis.
Additionally, the settlement of past CSC claims continues to move
at an unacceptable slow pace. The settlement of past CSC claims must be
prioritized and resolved expeditiously.
Fundamental Philosophical Flaw in the Tribal Interior Budget Council
(TBIC) Format
The Tribal/Interior Budget Council (TIBC) was established to allow
Tribes and Tribal organizations to work with Interior officials in the
formulation of the Indian Affairs and Office of the Special Trustee
(OST) annual budget requests and performance plans in the spirit of the
President's Government-to-Government consultation and collaboration
policy.
However, TBIC is structured in a fashion that results in a warping
of Tribal views. Federal representatives to TBIC urge Tribal leaders to
prioritize areas of need, a virtually impossible task for many Tribal
communities where deficiencies are found in all areas of development
and social need. Although this is pointed out, Federal officials
respond that in the absence of Tribal guidance the officials themselves
will set the priorities. At that point Tribal leaders, reluctantly,
attempt to prioritize the needs of their communities.
While we understand that the budget planning process pushes Federal
officials to in turn push Tribal officials to establish a limited
number of priorities, setting such priorities should not be used
against important Tribal interests. For example, when a Tribal leader
brings up a ``non-prioritized'' need, Federal officials should not use
as an excuse for not supporting that need that Tribal leaders did not
prioritize it. One example of this is education funding. Education
funding did not make it on a recent ``priority'' list. When Federal
officials were questioned by Congress about education funding, they
said it was not a Tribal priority. That is a misuse of this process.
Essentially, the TBIC process is being used in a way that allows
Federal officials to affirmatively argue against a particular need even
though that was never the Tribal intent. The Committee should provide
corrective guidance to Interior on this point.
The bottom line: while the Federal-Tribal Nation relationship is
understood to be ``special'' and ``unique'', the budget process
currently utilized does not allow for the United States to fulfill its
fiduciary trust responsibilities and obligations. The process needs to
move away from a ``needs based'' understanding to a ``fulfilling
obligations'' understanding. A significant part of the challenge is in
the reality that OMB approaches this budgeting process no different
than any other area; resulting in an expressed disrespect for the
uniqueness of the sacred federal fiduciary responsibilities and
obligations.
Advancing the Appropriations Process by Providing for Advance
Appropriations
Advance appropriations are enacted a year before the funds become
available, thus allowing the federal agency knowledge of its funding
level a year in advance. The advance appropriations process does not
put additional pressure on the appropriations subcommittees'
allocations. For instance, if FY 2015 IHS advance appropriations were
included in the FY 2014 Interior, Environment, and Related Agencies
Appropriations Act, those advance appropriations would not be counted
against the FY 2014 Interior Appropriations Subcommittee allocation but
rather would be counted against its FY 2015 allocation. For the first
year of advance appropriations Congress would enact two years of IHS
funds, and thereafter revert to appropriations one year at a time.
Veterans organizations advocated for years for Congress to provide
the Veterans Administration (VA) with advance appropriations, noting
that chronically late funding negatively affected their ability to
properly plan and manage its resources, including recruitment and
retention of medical personnel. In 2009 Congress responded by
authorizing advance appropriations for the VA medical accounts. Like
the VA, the IHS and tribal organizations provide direct, federally-
funded health care services to a specific population.
Just like the VA, the IHS has been very adversely affected by
recurrent delays in the passage of appropriations bills and by Federal
Government shutdowns. Advance appropriations would dramatically reduce,
if not eliminate, this problem.
For example, if IHS was receiving funding on an advance
appropriations schedule, its FY 2014 appropriations would have been
enacted as part of a FY 2013 appropriations act and the IHS and tribal
health care providers would not have entered FY 2014 with no knowledge
of what amount of funding to expect. Instead, the IHS had to furlough
some employees and had others working on an unpaid status. Tribal
health care providers were similarly affected.
Enactment of legislation authorizing advance appropriations is the
first step in actually realizing such funding. The Budget Resolution,
while not having the effect of law, lists particular programs which may
have advance appropriations. In order for IHS advance appropriations to
not be subject to a point of order, the IHS Services and the IHS
Facilities accounts should be included on that list in the Budget
Resolution.
Medicare-Like Rate Caps--Stretching Precious Federal Health Care
Dollars
As this Committee fully understands, the unmet health needs of
American Indians and Alaska Natives are severe and the health status of
American Indians and Alaska Natives is far below that of the general
population of the United States, resulting in an average life
expectancy for American Indians and Alaska Natives 4.1 years less than
that for the U.S. all races population.
The Indian Health Service and Tribal Purchased/Referred Care
programs purchase primary and specialty care services from private
health care providers when those services are not available at Indian
Health Service or Tribal health facilities. However, Purchased/Referred
Care funds have been insufficient to ensure access to care for American
Indians and Alaska Natives, resulting in rationed care and diagnosis
and treatment delays that lead to the need for more intensive and
expensive treatment, further reducing already scarce Purchased/Referred
Care funds.
In 2003, Congress amended XVIII of the Social Security Act to
require Medicareparticipating hospitals to accept patients referred
from the Indian Health Service and Tribal Purchased/Referred Care
programs and to accept payment at no more than Medicare rates--the
Medicare-Like Rate cap--for the services provided. However, the
Medicare-Like Rate cap only applies to hospital services, and does not
apply to other types of Medicare-participating providers and suppliers.
Unlike other federal health care programs, the IHS and Tribal
Purchased/Referred Care programs routinely continue to pay full billed
charges for non-hospital services, resulting in needless waste of
scarce federal Purchased/Referred Care funds. Because Purchased/
Referred programs continue to pay full billed charges for non-hospital
services, in many cases the Indian Health Service may only treat the
most desperate ``Life'' or ``Limb'' cases, leading to many undesirable
health outcomes for American Indians and Alaska Natives, and ultimately
increasing costs to the Purchased/Referred Care programs.
In the near future, legislation will be introduced to provide for
the application of the Medicare-Like Rate cap to all IHS Medicare-
participating providers and suppliers. In April 2013, GAO recommended
that Congress enact such legislation, and HHS concurred in that
recommendation. USET urges this Committee to strongly endorse such
legislation and support its rapid advancement.
Carcieri Fix
This Committee has strongly supported Carcieri fix language over
the last several years. In doing so, this Committee has sought to
overturn the unjust Supreme Court decision in Carcieri v. Salazar,
which has led to two classes of Tribes--those that can take land into
trust and build up their communities and those that cannot. Further,
this holding has severely hampered economic development in Indian
Country and created a public safety risk through jurisdictional
confusion. President Obama has requested this Fix in his budget and
USET asks that this Committee elevate the urgency to resolve this
injustice and once again take up the fight for fair and equal treatment
of all Tribal nations and advance a Carcieri fix. In an era of Tribal
Nation rebuilding and the pursuit of economic success and prosperity,
the confusion and chaos that has resulted from this SCOTUS decision
serves as one of our most significant barriers and challenges to this
pursuit.
Support Tribal Sovereignty in the Area of Taxation
With Federal budget restrictions in place for years to come, Tribal
tax rights become more important, both for Tribal economic success and
as a matter of sovereignty.
USET calls upon Congress to ensure that federal tax law treats
Indian Tribes in a manner consistent with their governmental status, as
reflected under the U.S. Constitution and numerous federal laws,
treaties and federal court decisions. Indian Tribes have a governmental
structure, and have the power and responsibility to enact civil and
criminal laws regulating the conduct and affairs of their members and
reservations. They operate and fund courts of law, police forces and
fire departments. They provide a broad range of governmental services
to their citizens, including education, transportation, public
utilities, health, economic assistance, and domestic and social
programs. Like states and local governments, Tribes--as political
bodies--are not subject to income tax under the Code. The non-taxable
status of Tribal governments is a matter of governmental fairness and
parity. Improvements to the Tax Code are also vitally needed to align
federal tax policy with the critical federal policy objectives of
Tribal self-determination, Tribal economic growth and self-sufficiency
and the promotion of strong Tribal governments on equal footing with
other sovereigns within the federal system. Tax policy fairness toward
Tribal governments and the promotion of economic growth are of central
importance in Indian Country. Tribal governments must stimulate
reservation-based economic growth to generate the level of revenue
needed to deliver vital programs and services within their territories.
While Tribal governments carry out responsibilities in their
communities that are similar in many respects to those of states and
local governments; Tribal governments are not able to rely on a robust
tax base for revenue. Instead, Tribal governments rely on revenue
generated from economic development to meet and supplement vital
programs and services. This makes clear that Congress must create
reliable and effective federal tax policy to firmly support Tribal
governance while protecting the ability of Tribes to generate and
retain the full use of Tribal revenue.
Tribal governments also have responsibilities that are distinct
from those of other sovereigns. Tribes and their elected
representatives have the added responsibility of ensuring they have the
revenue needed to fulfill responsibilities to maintain Tribal language,
culture, and ceremonies. Preservation and restoration of Tribal culture
remains a significant federal policy objective.
We ask that this Committee be supportive of this effort as we work
on addressing the larger budget picture for all of Indian Country.
Fair Funding for Newly Recognized Tribes
Federal recognition obligates the government to provide for the
health and welfare of Tribal nations. Yet, two recently recognized
Tribes in the Nashville Area, the Shinnecock and Tonawanda Nations are
forced to operate without the appropriated funds for health care
services to which they are legally entitled. This has gone on for
several years, in spite of previous requests for funding from the IHS.
While other Tribes have access to their apportionment of IHS dollars,
these Tribes have only a small amount of ``bridge'' funding through the
Purchased and Referred Care program, access to which was only given in
February of 2013.
USET was pleased to learn that IHS has, once again, requested
funding for these Tribes and that the Administration acknowledged their
obligation to the Tribes and proposed $8 million in the FY 2015
President's Budget Request for five newly recognized or restored Tribes
in the California and Nashville Areas. However, as the Congressional
Justification reveals, the Administration has requested only $4.2
million and $1.7 million for Shinnecock and Tonawanda, respectively.
These levels are far below those formulated and requested by the
Nashville Area IHS Office in previous years: $6.2 million in 2012 for
Shinnecock and $2.6 million in 2010 for Tonawanda. Adjusting for
inflation, IHS' FY 2015 funding requests for Shinnecock and Tonawanda
are markedly insufficient.
This Administration and Congress must deliver on the promise made
to these ``new'' Tribes and provide new appropriations that will allow
for parity with other Indian health programs nationally. We urge the
Committee to advocate for funding for new Tribes at a level reflective
of their true need.
Definition of ``Indian''--Support the Indian Definition of ``Indian''!
USET joins other Tribes and Tribal Organizations in calling for a
fix to inconsistencies in the definition of ``Indian'' in the
Affordable Care Act (ACA). While we believe the intent of Congress was
to allow all IHS beneficiaries access to the special benefits and
protections reserved for American Indians and Alaska Natives (AI/AN) in
the ACA, the ACA has been interpreted to limit access to only enrolled
Tribal members and Alaska Native Claims Settlement Act Shareholders.
The result is an uneven and unfair application of the law to IHS'
patients, including those served by facilities in the Nashville Area--
USET's area-and confusion across Indian Country. In addition to a fix
through regulation, USET fully supports passage of S. 1575, which would
streamline the definitions of Indian in the ACA to reflect the
statutory definition of Indian used to determine eligibility for IHS
services. While the Committee works to favorably report S. 1575, we ask
that Congress clarify its intent to the Department of Health and Human
Services (HHS) that the special benefits and protections for AI/ANs in
the ACA are intended to apply all IHS beneficiaries. As millions of
Americans begin to experience the benefits of the ACA, the Committee
should use all methods at its disposal to ensure that all AI/AN receive
the benefits Congress intended for them.
Health Information Technology--Renew Funding for FY 2015 for the
Successful Nashville Area Program
Due in part to congressional reporting requirements like the
Government Performance and Results Act (GPRA) and improving efficiency
in health care delivery, Health Information Technology (HIT) is an
ongoing need throughout Indian Country. The Indian Health Service
Resource Patient Management System (RPMS) Electronic Health Record
(EHR) is a data system designed to meet the varying needs of the IHS
and Tribal hospitals and clinics. The goal of RPMS EHR is to provide
meaningful and rapid access to information for direct support of health
care delivery and resource management. Although HIT has advanced to
make it easier for IHS/Tribes/Urban (I/T/U) programs to report on the
quality of health care they deliver to their beneficiaries, additional
advancement is needed to modernize the I/T/U systems to be at par with
other health care delivery systems across the United States.
The IHS has been providing USET with funding to assist Tribes in
taking full advantage of their RPMS systems in an attempt to increase
GPRA reporting. For FY15, USET was disappointed to learn that IHS does
not plan to renew funding for the GPRA program in the Nashville Area.
These funds have been vital to the success of USET Tribes, and the IHS
in meeting health indicators that are reported to Congress each year.
Over time, this data has shown the efficacy of increased funding to the
Indian Health Service. We urge Congress to consider additional funds to
assist I/T/U in advancing their HIT needs.
Inflation and the Budget for Federal Indian Programs
In evaluating whether the Federal budget fulfills the Trust
responsibility, USET believes that it is critical to take into account
the effects of inflation. From FY 2002 through FY 2008, despite annual
increases, after taking into account the effect of inflation, most
Federal domestic programs, including the Indian programs, saw a
purchase power decrease of approximately 14 percent. The large budget
increase in FY 2009, including ARRA funding, was approximately enough
to make up for this effective cut and bring the purchase power of
Indian programs back to FY 2002 levels, but in the intervening 12
years, Indian country needs have grown substantially. And, of course,
the FY 2002 levels were inadequate to address the needs of Indian
country or to fulfill the Federal Government's trust obligation.
Further, with regard to inflation, the rate the Federal Government
uses does not accurately reflect true levels of inflation. In the FY15
President's Budget Request, IHS requested $34 million for inflation.
This reflects a blanket rate of 3.6 percent for medical inflation and
1.5 percent for non-medical identified by OMB, the same they used last
year, and is earmarked for increases in Purchased/Referred Care
(formerly CHS). However, the Consumer Price Index (CPI) contains
different rates that correspond to different parts of the IHS delivery
system. Inpatient hospital care is at 4.3 percent and outpatient is at
3.8 percent. Inflation for various line items in the IHS budget, H&C,
PRC, Mental Health, etc. should be calculated based on relevant
components in the CPI.
In a very real way, the budget of the United States government
reflects the values of the American people. Courtesy of the National
Congress of American Indians (NCAI), set forth below is a chart that
depicts the percentage of the Federal budget dedicated to funding the
BIA. As you can see, as a percentage of the overall budget, the BIA
budget has declined from .115 percent in FY 1995 to .075 percent
(correcting chart typo) in FY 2011, approximately a one-third decline
as a percentage of the overall budget (despite a small bump up in FY
2010). Below that chart is another which demonstrates that over the
last ten years, when funding increases have come to the Department of
the Interior they have been greater for other major agencies within the
Department than for the Bureau of Indian Affairs.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Conclusion
USET recognizes that in challenging times, all Americans must be
called upon to sacrifice for the common good of all. USET suggests,
however, that when it comes to sacrificing for the good of all
Americans, the historic record demonstrates that nobody has sacrificed
more than Native Americans. We ask that this Committee support and
advocate for a budget based on American values that reflects the trust
responsibility and fair dealing for Indian Tribes.
______
Prepared Statement of the Native Hawaiian Education Council
Aloha Chairman Tester and members of the Senate Committee on Indian
Affairs,
Mahalo, thank you, for allowing us an opportunity to submit
comments at your oversight hearing on the President's FY 2015 Budget.
We are seeking continued funding at pre-sequestration levels for
the Native Hawaiian Education Program (NHEP) that targets the Native
Hawaiian student population. The NHEP is an important part of
fulfilling the trust relationship between the U.S. and Native
Hawaiians, and it helps to improve the educational status of Native
Hawaiians. It is an important element in the Native community's effort
to control its education programs and policies and to achieve
educational parity. NHEP aims to close the education achievement gap
between Native Hawaiians and the general population, and also functions
to fulfill the trust relationship between the United States and Native
Hawaiians, the indigenous people of a once sovereign nation. During the
time of their own sovereignty in the kingdom of Hawai`i, Native
Hawaiians had a higher rate of literacy than citizens of the United
States. The educational achievement gap has occurred during the
intervening years since the loss of Native Hawaiian sovereignty, so
that today Native Hawaiians are among the most disadvantaged groups in
the state.
The NHEP Works
NHEP has been effective over the years in meeting the goals of the
program. For example, NHEA has been instrumental in preserving and
protecting the Native Hawaiian language through funding projects that
are designed to address the use of the Native Hawaiian language in
instruction, one of the priorities named in the NHEA. The number of
speakers nearly doubled in 18 years from 8,872 speakers in 1990 to
16,864 in 2008 (Source: OHA Data Book 2011 Tables 4.19 and 4.44)
The NHEP has funded programs that incorporate culture and
indigenous teaching practices in the classroom that leads to better
outcomes for Native Hawaiian students. An example is the improvement in
the graduation rates for Native Hawaiians and math and reading scores.
Graduation rates for Native Hawaiians between 2002 and 2010 rose from
70 percent to 72.2 percent (Sources: Kamehameha Schools' Native
Hawaiian Education Assessment Update 2009, Fig. 9 and HI DOE 2005-06 to
2009-10).
Similarly, math and reading scores have risen for Native Hawaiians.
The percent of Native Hawaiians scoring ``Proficient or Above `` from
2007 to 2012 rose from 27 percent to 49 percent in math and from 41
percent to 62 percent in reading (Source: Hawaii DOE Longitudinal Data
System ).
School attendance rates in schools with student populations that
are over 50 percent Native Hawaiian have increased from 90.1 percent in
the 2000-01 school year to 91.3 percent in the 2011-12 school year
(Source: Kamehameha Schools' draft Ka Huaka`i update, p. 58)
The Need Still Exists
In spite of the gains that Native Hawaiians have made
educationally, the need for innovative programs to assist Native
Hawaiians to improve their academic performance still exists, since
Native Hawaiians have not yet attained parity with the rest of the
students in the state.
Timely high school graduation rates for students in the state rose
from 77 percent to 79.6 percent in the same time period that it rose
from 70 percent to 72.2 percent for Native Hawaiians (Sources:
Kamehameha Schools' Native Hawaiian Education Assessment Update 2009,
Fig. 9 and HI DOE 2005-06 to 2009-10).
Native Hawaiians still lag behind the rest of the state in academic
performance; however the gap between the Native Hawaiians and others is
decreasing. From 2007 to 2012 the increase in the percentage of Native
Hawaiians scoring ``Proficient or Above'' in math rose 22 percentage
points, while the increase for the state during the same time period
was 21 percentage points. The increase for Native Hawaiians in reading
was even more dramatic during that time period, increasing 21
percentage points compared to the state increase of only 11 percentage
points. Unfortunately those gains were not enough to bring Native
Hawaiians to parity. In 2012 Native Hawaiians were still 10 points
behind the state in the percentage scoring ``Proficient or Above'' in
math and nine points behind in the percentage scoring ``Proficient or
Above'' in reading.
Percent Scoring Proficient or Above
------------------------------------------------------------------------
2007 2012 Change
------------------------------------------------------------------------
Native Hawaiians Math.............. 27% 49% 22
State Totals Math.............. 38% 59% 21
Difference........ -11 -10
Native Hawaiians Reading........... 41% 62% 21
State Totals Reading........... 60% 71% 11
Difference........ -19 -9
------------------------------------------------------------------------
Source: Hawaii DOE Longitudinal Data System
In the area of Native Hawaiian language immersion, although the
gains have been tremendous, the nearly 17,000 speakers in 2008 only
represents 6 percent of the approximately 290,000 Native Hawaiians in
Hawai`i (2010 U.S. Census).
Appropriations Request
The pre-sequestration appropriations level for the NHEP was $34
million. Sequestration reduced the amount by $2 million to $32 million,
which is the amount entered into the President's budget. For such a
small program as the NHEP, the $2 million reduction makes a significant
negative impact on the program. We would like to continue to make gains
in the educational achievement of Native Hawaiians, and request the
pre-sequestration level of $34 million so that we don't lose the
momentum of improvement.
NHEP funds programs to help improve the educational attainment of
Native Hawaiians in ways that are linguistically and culturally aligned
to the needs of our Native students and communities in Hawai`i.
Improving education, particularly for the most depressed groups,
eventually leads to cost savings over time through decreased
incarceration, poor health, and public assistance.(Barnett, W. S., &
Ackerman, D. J. 2006. Costs, benefits, and the long-term effects of
early care and education programs: Cautions and recommendations for
community developers. Journal of the Community Development Society,
37(2), 86-100.) Academic achievement is also correlated with positive
economic outcomes. (Belfield, C. 2008, June. The economic investments
of early education in Hawaii. Issue Brief. Flushing, NY: Queen's
College, City University of New York.)
Please help us sustain the NHEP to its pre-sequestration level in
order to continue the educational gains that have taken this program
years to accomplish.
______
Prepared Statement of the National Indian Child Welfare Association
(NICWA)
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
______
Prepared Statement of National Indian Education Association (NIEA)
The National Indian Education Association (NIEA) appreciates the
work of the Senate Committee on Indian Affairs for making education a
priority. As the Committee works with appropriators and the
Administration, we request this written testimony be submitted into the
record, so Native education stakeholders are represented. NIEA was
incorporated in 1970 and is the most representative Native education
organization in the United States. NIEA's mission is to advance
comprehensive and equal educational opportunities for American Indian,
Alaska Native, and Native Hawaiian students. NIEA supports tribal
sovereignty over education as well as strengthening traditional Native
cultures and values that enable Native learners to become contributing
members of their communities. As the most inclusive Native education
organization, NIEA membership consists of tribal leaders, educators,
students, researchers, and education stakeholders from all 50 states.
From communities in Hawaii, to tribal reservations across the
continental U.S., to villages in Alaska and urban communities in major
cities, NIEA has the most reach of any Native education organization in
the country.
The State of Native Education
Native education is in a state of emergency. Native students lag
behind their peers on every educational indicator, from academic
achievement to high school and college graduation rates. Just over 50
percent of Native students are graduating high school, compared to
nearly 80 percent for the majority population nationally. Further, only
one in four Native high school graduates who took the ACT scored at the
college-ready level in math and only one-third in reading
comprehension, as compared to more than half for white graduates.
Increasingly alarming, only 40 percent of Native college enrollees in
2004 actually graduated college with a bachelor's degree by 2010.
Nearly 62 percent of the majority students graduated. For Native
students to succeed in college and careers, they must have a strong
education foundation that also meets their local needs and strengthens
their linguistic and cultural identity.
Uphold the Trust Responsibility
The federal government has a trust relationship with tribes
established through treaties, federal law, and U.S. Supreme Court
decisions. This relationship includes a fiduciary obligation to provide
parity in access and equal resources to American Indian and Alaska
Native students. National fiscal and policy concerns should not be
addressed by decreasing funds and investment to Native students or the
programs that serve them.
Native education is one of the most effective and efficient
investments the federal government can make. Unfortunately, historical
funding trends illustrate that the federal government is abandoning its
trust responsibility by decreasing federal funds to Native-serving
programs by more than half in the last 30 years. Sequestration only
exacerbated those shortfalls. As tribes and Native communities work
with Congress to increase their role and responsibility in
administering education, federal support should increase for tribal
governments and Native education institutions to repair the damage
caused by shrinking budgets.
Fiscal Year 2014 Funding Requests
While FY 2014 funding increases over sequestration levels are
welcome, funding continues to be insufficient for effectively and
equally serving Native students. Until the federal government fully
appropriates funding to bridge the educational attainment gap among
Native and non-Native students, the trust responsibility will be
undermined. The federal government should fund Native education
programs at the levels below as the programmatic requests detail the
minimum appropriations needed to maintain a system that is already
struggling and underfunded. Further, NIEA supports the budget requests
of the National Congress of American Indians and the American Indian
Higher Education Consortium.
Department of Education--Labor, Health and Human Services and Education
Appropriations Bill
Title I, Part A Local Education Agency Grants
Provide $25 billion for Title I, Part A. An increase of $10.6
billion.
Title I of the Elementary and Secondary Education Act
provides critical financial assistance to local educational
agencies and schools with high percentages of children from
low-income families that ensure all children meet challenging
state academic standards.
Currently, there are over 600,000 Native students across the
country with nearly 93 percent of those students attending non-
federal institutions, such as traditional public schools in
rural and urban locations.
A drastic increase in funding to counter annual inflation
and sequestration, as well as match the amount appropriated
under the American Reinvestment and Recovery Act, is necessary
to meet the needs of Native students and students from low-
income families.
State-Tribal Education Partnership (STEP) Program
Provide $5 million. An increase of $3 million.
Congress appropriated roughly $2 million dollars for the
STEP program to five participating tribes in FY 2012 and FY
2013 under the Tribal Education Department appropriations.
In order for this program to continue to succeed and thrive,
it must receive its own line and authorization of
appropriations in FY 2015.
Collaboration between tribal education agencies and state
educational agencies is crucial to developing the tribal
capacity to assume the roles, responsibilities, and
accountability of Native education departments and increasing
self-governance over Native education.
Impact Aid
Provide $2 billion for Impact Aid, under ESEA Title VIII. An
increase of $711 million.
Impact Aid provides direct payments to public school
districts as reimbursement for the loss of traditional property
taxes due to a federal presence or activity, including the
existence of an Indian reservation.
With nearly 93 percent of Native students enrolling in
public schools, Impact Aid provides essential funding for
schools serving Native students.
Funding for Impact Aid must not be less than this requested
amount.
Title VII (Indian Education Formula Grants)
Provide $198 million under ESEA Title VII, Part A. An increase of
$76 million.
This grant funding is designed to supplement the regular
school program and assist Native students so they have the
opportunity to achieve the same educational standards and
attain parity with their non-Native peers.
Title VII funds support early-childhood andfamily programs,
academic enrichment programs, curriculum development,
professional development, and culturally-related activities.
Title VII programs were maintained at the 2013 sequestration
level of $124 million.
While these levels are higher than what would have been
incurred under another year of sequestration, current funding
results in inadequate support for critical culturally-relevant
educational services.
Native Hawaiian Education Program
Provide $35 million under ESEA Title VII, Part B. An increase of $3
million.
This program funds the development of curricula and
education programs that address the education needs of Native
Hawaiian students to help bring equity this Native population.
The Native Hawaiian Education program empowers innovative
culturally appropriate programs to enhance the quality of
education for Native Hawaiians. When establishing the Native
Hawaiian Education Program, Congress acknowledged the trust
relationship between the Native Hawaiian people and the United
States.
These programs strengthen the Native Hawaiian culture and
improve educational attainment, both of which are correlated
with positive economic outcomes.
Native Hawaiian-serving programs under Title VII were also
maintained at the 2013 sequestration level, reducing much-
needed services to Native students.
Alaska Native Education Equity Assistance Program
Provide $35 million under ESEA Title VII, Part C. An increase of $4
million.
This assistance program funds the development of curricula
and education programs that address the unique educational
needs of Alaska Native students, as well as the development and
operation of student enrichment programs in science and
mathematics.
This funding is crucial to closing the gap between Alaska
Native students and their non-Native peers.
Other eligible activities include professional development
for educators, activities carried out through Even Start
programs and Head Start programs, family literacy services, and
dropout prevention programs.
Alaska Native-serving programs under Title VII were also
maintained at the 2013 sequestration level, reducing much-
needed services to Native students.
Tribal Colleges and Universities: Supporting Financially Disadvantaged
Students
Provide $60 million ($30 million in discretionary funding and $30
million in mandatory funding) for Title III-A grants under the Higher
Education Act for Tribal Colleges and Universities. An increase of
$35.5 million.
Titles III and V of the Higher Education Act, known as Aid
for Institutional Development programs, support institutions
with a large proportion of financially disadvantaged students
and low cost-per-student expenditures.
Tribal Colleges and Universities (TCUs) clearly fit this
definition. The nation's 37 TCUs serve Native and non-Native
students in some of the most impoverished areas in the nation.
Congress recognized the TCUs as emergent institutions, and
as such, authorized a separate section of Title III (Part A,
Sec. 316) specifically to address their needs.
Additionally, a separate section (Sec. 317) was created to
address similar needs of Alaska Native and Native Hawaiian
institutions. Sixty million should be provided ($30 million
discretionary/appropriations and $30 million in mandatory
funding under SAFRA) in FY 2015 to continue to fund grants to
these vital institutions.
Tribal Colleges and Universities: Adult/Basic Education
Provide $8 million for American Indian Adult/Basic Education at
Tribal Colleges and Universities, from existing funds appropriated for
state block grant funding. An increase of $8 million.
Despite an absence of dedicated funding, TCUs must find ways
to continue to provide basic adult education classes for those
American Indians that the present K-12 Indian education system
has failed.
At TCUs, the number of students in need of remedial
education before embarking on their degree programs is
substantial.
There is a wide-ranging need for basic adult education and
literacy programs and TCUs need adequate funding to support the
ever increasing demand for basic adult education and
remediation program services.
Tribally Controlled Post-Secondary Career and Technical Institutions
Provide $8.2 million for postsecondary career and technical
institutions program funds under Carl Perkins Technical and Career
Education Act. An increase of $.5 million.
Section 117 of the Carl Perkins Career and Technical
Education Improvement Act authorizes funding for operations at
tribally-controlled postsecondary career and technical
institutions.
Vocational education/training programs are very expensive to
conduct, but are vital to preparing a future workforce that
will operate safely and efficiently contributing greatly to the
global economy.
Currently, two TCUs participate in this funding program:
United Tribes Technical College in Bismarck, North Dakota, and
Navajo Technical College in Crownpoint, New Mexico. The TCUs
urge Congress to appropriate $8.5 million for Sec. 117 of the
Act.
Native American-Serving, non-Tribal Institutions (Higher Education Act
Title III-F)
Provide $10 million for non-tribal, Native-serving institutions of
higher education. An increase of $7 million.
As the primary federal funding for Native-serving, non-
tribal institutions of higher education, the current
appropriation of $5 million is insufficient.
With nearly 100 institutions potentially qualifying as
Native-serving, non-tribal institutions, this strains the small
amount of available funding.
To ease the high-level of competition between Native-serving
schools, increasing the funding will provide the opportunity
for more Native-serving institutions to better serve their
students and increase graduation rates among Native students.
Department of Education and Department of the Interior--Labor, Health
and Human Services and Education Appropriations Bill, and Interior--
Environment Appropriations Bill
Tribal Education Departments
Provide $10 million to fund Tribal Education Departments. An
increase of $5 million, collectively.
Five million dollars should be appropriated to the
Department of the Interior, and $5 million should be
appropriated to the Department of Education to support tribal
education departments (TEDs).
This funding assists TEDs, who are uniquely situated at the
local level to implement innovative education programs that
improve Native education.
Because they are administered by tribes, TEDs are best
equipped to deliver education programs tailored to improve
education parity for Natives.
TEDs would use this much-needed funding to develop academic
standards, assess student progress, and create math and science
programs that require high academic standards for students in
tribal, public, and Bureau of Indian Education schools.
Tribes utilizing self-governance over education have been
very successful because they better understand the
circumstances of their populations and can develop initiatives
that meet local needs.
Department of the Interior--Interior--Environment Appropriations Bill
School Construction and Repair
Provide $263.4 million for Bureau of Indian Education (BIE) school
construction and repair. An increase of $153.3 million.
This funding category includes school construction,
facilities improvement and repair, and replacement school
construction.
Schools operating within the BIE system are woefully
outdated and in some cases, dangerous for student and staff.
Currently more than 60 BIE schools are rated in ``poor''
condition, which puts Native students at an unfair
disadvantage.
Johnson O'Malley
Provide $42 million for full funding. An increase of $27 million.
The Johnson O'Malley program has provided grants to
supplement basic student needs since 1934.
It is currently being used across the country in innovative
ways to assist with the unique cultural and scholastic needs of
Native students.
Current funding provides less than $76 per student, which
are often the only source through which Native students--
including those in public schools--can engage in basic
activities expected of all American students.
$95 per student was the allocation of JOM funding per
student in 1995.
Student Transportation
Provide $73 million for student transportation in the BIE system.
An increase of $20 million.
BIE schools incur significant costs in transporting Native
students to and from school.
These costs are considerably higher than most school systems
due to the often-rural location of BIE facilities.
Poor road conditions that link the BIE-funded schools
increase vehicle maintenance costs.
These high costs often lead to funding shortfalls, which
then must either go unpaid or funded by diverting funds from
other education programs.
Tribal Grant Support Costs
Provide $73 million for tribal grant support costs for tribally-
operated schools. An increase of $26 million.
Tribal Grant Support Costs fund the administrative costs of
existing tribally-operated schools.
The current funding levels only pays 65 percent of the
current need and must not be reduced in the upcoming budget
cycle.
This funding also help tribes expand self-governance and
tribal control over education programs by allocating monies for
administrative costs such as accounting, payroll, and other
legal requirements.
Schools must divert critical teaching and learning funding
to cover any shortfalls in operational costs.
Facilities Operations
Provide $109 million for BIE facilities operations. An increase of
$50 million.
BIE schools use this funding for costs such as electricity,
heating fuels, communications, GSA vehicle rentals, custodial
services, and other vital operating expenses.
For years, schools have only received roughly 50 percent of
funding needed for these expenses. This shortfall is
unacceptable as costs continue to rise for vital services.
Facilities Maintenance
Provide $76 million for BIE facilities maintenance. An increase of
$25 million.
BIE schools use this funding for the preventative and
routine upkeep, as well as for unscheduled maintenance of
school buildings, grounds, and utility systems.
Underfunding of maintenance continues to be an issue as
buildings are in poor conditions and cannot maintain proper
standards.
Indian School Equalization Program (ISEP)
Provide $431 million for the Indian School Equalization Program. An
increase of $35 million.
These funds provide the core budget account for BIE
elementary and secondary schools by covering teacher salaries,
aides, principals, and other personnel.
ISEP funds are often reallocated to cover the program cuts
in other areas of education.
ISEP must have adequate funding to ensure all program needs
are fulfilled and must not be reduced to provide funds for new
initiatives that have not been vetted by tribes.
Juvenile Detention Education
Reinstate $620,000 for juvenile detention education in BIA-funded
facilities.
These critical funds were eliminated for FY 2012.
This essential funding was used to provide educational
services to detained and incarcerated youth at 24 BIA-funded
juvenile detention facilities.
One of the best methods to rehabilitate individuals is
through education.
Eliminating this program creates additional costs by
increasing the rate of repeat offenders.
Tribal Colleges and Universities' Institutional Operations
Provide $94.3 million for Titles I and II under the Tribally
Controlled Colleges and Universities Assistance Act. An increase of $30
million.
Title I: To fully fund Title I of the Tribally Controlled
Colleges and Universities Assistance Act of 1978 (Tribal
College Act), which provides day-to-day operating funds for 26
TCUs, would require $77.3 million.
Since the Act was first funded in 1981, the number of
TCUs has more than quadrupled and enrollments have increased by
more than 325 percent.
Title I TCUs receive $5,665 per Indian student toward
their institutional operating budgets. Accounting for
inflation, the program's funding level is more than $1,500 less
per Indian student than it was under the program's initial FY
1981 appropriation, which was $2,831 per Indian student.
Despite the constraints of the current economy, Congress
has an obligation to make these critical institutions whole now
rather than continuing to make hollow promises for the future.
Title II: Dine College has indicated a need for $17 million
to operate its multiple campuses and education sites located on
the Navajo Nation.
Five other TCUs receive institutional operating funds
through the annual Department of the Interior Appropriation
measure, under separate various authorities.
To support the basic day-to-day operating budgets of these
TCUs, NIEA requests the following:
$9.3 million for institutional operations of tribally-
chartered career and technical institutions under Title V of
the Tribally Controlled Colleges and Universities Assistance
Act of 1978;
$4.8 million in a one-time payment to allow the
institutions to be forward funded;
Adequate funds for continued and expanded operations of
Haskell Indian Nations University in Kansas and Southwestern
Indian Polytechnic Institute in New Mexico under the Snyder Act
of 1921; and
$27.7 million for a one-time appropriation, equal to 75
percent of the current combined funding of the institutional
operations grants of those TCUs not funded under Titles I or II
of the Tribally Controlled Colleges and Universities Assistance
Act of 1978, necessary to transition these programs to be
forward funded.
Forward Fund Remaining Five Tribal Colleges and Universities
Provide a One-Time Appropriation of $22 million to forward fund
five TCUs.
All other TCUs are able to plan multi-year budgets and start
each school year with predictable funding for operations.
Forward funding these remaining five institutions is necessary
for Haskell Indian Nations University; Southwestern Indian
Polytechnic Institute; Institute of American Indian Arts;
Navajo Technical University; and United Tribes Technical
College.
These five tribal colleges, which are the only education
institutions funded through the BIE that are not forward
funded, have received no new operating funds and were in danger
of closing their doors to the thousands of Native students they
serve during the October 2013 federal government shutdown.
Institute of American Indian Arts (IAIA) and Center for Lifelong
Education
Provide $13.3 million to the Center & Museum under the American
Indian, Alaska Native, and Native Hawaiian Culture and Art Development
Act. An increase of $5.3 million.
IAIA is the only four-year degree fine arts institution
devoted to the study of contemporary Native American and Alaska
Native arts.
IAIA has graduated more than 3 ,800 students from federally-
recognized tribes and beyond. Of the $13.3 million requested,
provide $9.3 million, with an additional one-time payment of $4
million to allow for forward funding.
Haskell Indian Nations University (HINU) and Southwestern Indian
Polytechnic (SIPI)
Provide $36.9 million to HINU and SIPI under the Snyder Act. An
increase of $19.4 million.
As the first TCUs, these institutions are funded separately
from the other institutions and require additional funding
considerations.
Appropriations of $14.3 million to HINU and $8.5 million to
SIPI are necessary to ensure adequate services are provided to
Native students.
A one-time payment of $13.2 million would help forward fund
the institutions.
Department of Agriculture--Agriculture Appropriations Bill
1994 Extension Program
Provide $6 million for the 1994 Extension Grants Program. An
increase of $2.1 million.
The 1994 Extension Program is designed to complement, not
duplicate, the federally recognized tribe extension program
(FRTEP). Ironically, the 1994 Institutions--tribal colleges and
universities--are the only members of the land grant system
that are not eligible to compete for these grant dollars.
The 1994 Extension Program activities include: outreach to
at-risk youth; business skills development for local
agriculture entrepreneurs; Native plant restoration and
horticulture projects; environmental analysis and water quality
projects; and nutrition projects aimed at addressing health
disparities, such as high rates of diabetes among Native
populations.
Ten years ago, while the 1994 Extension Program suffered a
13 percent cut in appropriated funding, the 1862 and 1890
extension programs were reduced by just 0.59 percent. In the
years since, the 1994 Extension Programs has been struggling to
recovered lost funds and opportunities. It is time that
Congress adequately invests in the extension programs
benefiting our reservation communities.
1994 Institutions Research Grants
Provide $3 million for the 1994 Research Grants Program. An
increase of $1.2 million.
The 1994 Research Grants Program allows TCUs to partner with
communities in research areas such as agriculture marketing,
renewable energy, nutrition and health, Native plants and
horticulture, water quality, and land management.
These research areas are of increasing importance as tribal
economies and tribes' efforts to address pressing challenges
depend on access to quality data and evidence.
Challenges include the disproportionate impacts of climate
change on tribal lands and people, as well as the impact of
poor economic conditions.
TCUs need and deserve a level of funding that will increase
their capacity for further developing and conducting research
and to strengthen education and sustainable economic
development important to their tribal communities.
In FY 2013, the program was cut a further 7.6 percent by
sequestration to only $1.664 million.
Educational Equity Grant Program
Provide $6 million to the Educational Equity Grant Program for 1994
land-grant institutions. An increase of $2.7 million.
The Education Equity Grant Program assists TCU land-grants
to establish academic programs within the field of agriculture
that explore areas such as natural resource management,
nutrition, environmental science, horticulture, sustainable
development, and forestry.
The funding requested will help in preparing to address
issues of climate change and its impact on agriculture,
ecosystems, and natural resources focusing on remote
reservation communities.
This investment will support TCU efforts to provide
increased nutrition education to their reservation communities,
who experience diabetes and other health issues at rates far
greater than the national average.
In FY 2013, the program was cut a further 7.6 percent by
sequestration to only $3.081 million.
The 1994 Native American Institutions Endowment Fund
Provide a $136 million endowed payment into the 1994 Institutions
Native American Endowment Fund. An increase of $124 million.
The Native American Institutions Endowment Fund, managed by
the US Treasury, provides funds to TCU land-grant institutions
through dissemination of the annual interest yield. Although
Congress has made regular contributions to the corpus of the
endowment, the latest interest yield shared by the 32 eligible
1994 institutions amounted to just $4.5 million.
These funds assist in strengthening academic programs,
including agriculture curricula development, faculty
development, instructional delivery, and experiential learning.
Funds are also used to enhance student recruitment and
retention in the agricultural sciences, as well as to address
the ongoing need for improved facilities at the 1994 land-grant
institutions.
The 1994 institutions request that a payment of $136 million
be made, which would essentially double the principle amount
funded for the 1994 Native American Institutions Endowment.
Since only the annual interest yield is distributed to the
1994 land-grant institutions, only the interest on the Fund-and
not the appropriated payment amount-is scored as budget outlay,
yet the additional interest available to the TCUs, will yield
get dividends in community-based programs.
Essential Community Facilities at Tribal Colleges and Universities
Grant Program
Provide $10 million for the TCU Essential Community Facilities
Grant Program. An increase of $6.9 million.
The USDA-Rural Development program provides grants for
Essential Community Facilities at TCUs funds the ever-growing
need for construction, improvement, and maintenance of TCU
facilities, such as advanced science laboratories, computer
labs, student housing, day care centers, and community service
facilities.
Although the situation has improved at many TCUs over the
past several years, some institutions still operate partially
in temporary and inadequate buildings.
Few TCUs have dormitories, even fewer have student health
centers, and only a handful of TCUs have full research
laboratories.
The 1994 land-grant institutions need a commitment of $5
million each year for the next five fiscal years to support
construction, improvement, and maintenance of TCU facilities.
Department of Health and Human Services--Labor, Health and Human
Services--Education Appropriations Bill
Head Start
Provide $9.6 billion in total funding for Head Start, which
includes Indian Head Start. An increase of $1 billion.
Head Start has been and continues to play an instrumental
role in Native education.
In 2012, Head Start funds provided early education to over
24,000 Native children.
This vital program combines education, health, and family
services to model traditional Native education, which accounts
for its success rate.
Current funding dollars provide less for Native populations
as inflation and fiscal constraints increase.
It is now conventional wisdom that there is a return of at
least $7 for every single dollar invested in Head Start
Congress should increase funds to Head Start and Early Head
Start to ensure Indian Head Start can reach more tribal
communities and help more Native people by triggering the
Indian special expansion funding provisions (after a full Cost
of Living Allowance has been paid to all Head Start programs).
The definition of ``expansion'' for funding purposes should
include not only new positions, but also the establishment of
new programs in unserved Indian communities, as well as quality
improvements (e.g., increased staffing, professional
development, transportation equipment, computer technology/web
access, facility renovations and repair, etc.).
Expansion should also include going from part-day to full-
day, from home-based to center-based, full year services and
from Head Start to Early Head Start.
Native Languages Preservation (Esther Martinez Program Grants)
Provide $12 million for Native language preservation with $5
million designated to fund the Esther Martinez Language Programs. An
increase of $3 million.
Native language grant programs are essential to revitalizing
Native languages and cultures, many of which are at risk of
disappearing in the next decades.
With adequate funding, Esther Martinez Program Grants
support and strengthen Native American language immersion
programs.
In addition to protecting Native languages, these immersion
programs have been shown to promote higher academic success for
participating students in comparison to their Native peers who
do not participate.
The federal budget should include $12 million as part of the
appropriation to the Administration for Native Americans for
Native language preservation activities.
The appropriation should include $5 million designated to
support Esther Martinez Language Programs' Native language
immersion initiatives, as they have demonstrated success in
supporting Native language revitalization.
Department Of Housing And Urban Development (HUD)--Transportation,
Housing and Urban Development Appropriations Bill
HUD-University Partnership Program for Tribal Colleges and Universities
Provide $5.5 million to the HUD-University Partnership Program for
TCUs. An increase of $5.5 million.
Executive Order 13592, ``Improving American Indian and
Alaska Native Educational Opportunities and Strengthening
Tribal Colleges and Universities,'' holds federal agencies
accountable for developing plans to integrate TCUs into their
programs.
TCUs work with tribes and communities to address all aspects
of reservation life, including the continuum of education,
housing, economic development, health promotion, law
enforcement training, and crime prevention.
Likewise, federal agencies need to work with TCUs. To
achieve results, Congress needs to hold the Administration
accountable for strengthening the TCUs, including their
physical plants and that they are routinely included as full
partners in all existing and potential federal higher education
programs.
The HUD-TCU competitive grants program, administered by the
Office of University Partnerships, is an excellent place to
start.
This competitive grants program has enabled TCUs to expand
their roles and efficacy in addressing development and
revitalization needs within their respective communities.
National Science Foundation (NSF)--Commerce, Justice, and Science
Appropriations Bill
Education and Human Resources (EHR)
Provide at least $13.3 million to the Tribal Colleges and
Universities Program. An increase of $1 million.An increase of $1
million.
In FY 2009, NSF awarded $4.2 billion in science and
engineering (SE) funding to the nation's institutions of higher
education, and TCUs only received $10.5 million, or one-quarter
of one percent of this funding.An increase of $1 million.
Among other minority serving institutions, NSF awarded
$144.2 million in SE funding to 174 historically black colleges
and universities and Hispanic serving institutions, averaging
$828,545 per institution, while 29 TCUs received an average of
only $362,000 per institution.An increase of $1 million.
This disproportionate distribution trend must be addressed
in FY 2015.An increase of $1 million.
Conclusion
NIEA appreciates the continued support of this Committee and we
look forward to working closely with its members under the leadership
of Chairman Tester and Ranking Member Barrasso. We share your
commitment to Native education and want to strengthen our partnership
with you to ensure programs serving Native communities are as efficient
and effective as possible.
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