[House Hearing, 115 Congress]
[From the U.S. Government Publishing Office]
IMPROVING AND EXPANDING INFRASTRUCTURE IN TRIBAL AND INSULAR
COMMUNITIES
=======================================================================
OVERSIGHT HEARING
BEFORE THE
SUBCOMMITTEE ON INDIAN, INSULAR AND
ALASKA NATIVE AFFAIRS
OF THE
COMMITTEE ON NATURAL RESOURCES
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED FIFTEENTH CONGRESS
FIRST SESSION
__________
Thursday, March 9, 2017
__________
Serial No. 115-1
__________
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COMMITTEE ON NATURAL RESOURCES
ROB BISHOP, UT, Chairman
RAUL M. GRIJALVA, AZ, Ranking Democratic Member
Don Young, AK Grace F. Napolitano, CA
Chairman Emeritus Madeleine Z. Bordallo, GU
Louie Gohmert, TX Jim Costa, CA
Vice Chairman Gregorio Kilili Camacho Sablan,
Doug Lamborn, CO CNMI
Robert J. Wittman, VA Niki Tsongas, MA
Tom McClintock, CA Jared Huffman, CA
Stevan Pearce, NM Vice Ranking Member
Glenn Thompson, PA Alan S. Lowenthal, CA
Paul A. Gosar, AZ Donald S. Beyer, Jr., VA
Raul R. Labrador, ID Norma J. Torres, CA
Scott R. Tipton, CO Ruben Gallego, AZ
Doug LaMalfa, CA Colleen Hanabusa, HI
Jeff Denham, CA Nanette Diaz Barragan, CA
Paul Cook, CA Darren Soto, FL
Bruce Westerman, AR Jimmy Panetta, CA
Garret Graves, LA A. Donald McEachin, VA
Jody B. Hice, GA Anthony G. Brown, MD
Aumua Amata Coleman Radewagen, AS Wm. Lacy Clay, MO
Darin LaHood, IL
Daniel Webster, FL
David Rouzer, NC
Jack Bergman, MI
Liz Cheney, WY
Mike Johnson, LA
Jenniffer Gonzalez-Colon, PR
Jason Knox, Chief of Staff
Lisa Pittman, Chief Counsel
David Watkins, Democratic Staff Director
------
SUBCOMMITTEE ON INDIAN, INSULAR AND ALASKA NATIVE AFFAIRS
DOUG LaMALFA, CA, Chairman
NORMA J. TORRES, CA, Ranking Democratic Member
Don Young, AK Madeleine Z. Bordallo, GU
Jeff Denham, CA Gregorio Kilili Camacho Sablan,
Paul Cook, CA CNMI
Aumua Amata Coleman Radewagen, AS Ruben Gallego, AZ
Darin LaHood, IL Darren Soto, FL
Jack Bergman, MI Colleen Hanabusa, HI
Jenniffer Gonzalez-Colon, PR Raul M. Grijalva, AZ, ex officio
Vice Chairman
Rob Bishop, UT, ex officio
-----------
CONTENTS
-----------
Page
Hearing held on Thursday, March 9, 2017.......................... 1
Statement of Members:
LaMalfa, Hon. Doug, a Representative in Congress from the
State of California........................................ 1
Prepared statement of.................................... 2
Torres, Hon. Norma J., a Representative in Congress from the
State of California........................................ 3
Prepared statement of.................................... 4
Statement of Witnesses:
Honanie, Herman G., Chairman, Hopi Tribe, Kykotsmovi, Arizona 6
Prepared statement of.................................... 7
Joseph, Andrew Jr., Chairman, Northwest Portland Area Indian
Health Board; Member, Colville Business Council, Nespelem,
Washington................................................. 16
Prepared statement of.................................... 17
Supplemental testimony submitted for the record.......... 19
Kitcheyan, Victoria, Great Plains Area Representative,
National Indian Health Board, Washington, DC............... 20
Prepared statement of.................................... 22
Payment, Aaron, Secretary, National Congress of American
Indians, Washington, DC.................................... 29
Prepared statement of.................................... 31
Pula, Nikolao, Acting Assistant Secretary, Office of Insular
Affairs, U.S. Department of the Interior, Washington, DC... 43
Prepared statement of.................................... 44
Questions submitted for the record....................... 46
Teuber, Andy, Board Chair and President, Alaska Native Tribal
Health Consortium, Anchorage, Alaska....................... 38
Prepared statement of.................................... 40
Additional Materials Submitted for the Record:
Torres, Ralph Deleon Guerrero, Governor of the Commonwealth
of the Northern Mariana Islands, prepared statement of..... 67
OVERSIGHT HEARING ON IMPROVING AND EXPANDING INFRASTRUCTURE IN TRIBAL
AND INSULAR COMMUNITIES
----------
Thursday, March 9, 2017
U.S. House of Representatives
Subcommittee on Indian, Insular and Alaska Native Affairs
Committee on Natural Resources
Washington, DC
----------
The Subcommittee met, pursuant to notice, at 10:03 a.m., in
room 1324, Longworth House Office Building, Hon. Doug LaMalfa
[Chairman of the Subcommittee] presiding.
Present: Representatives LaMalfa, Young, Radewagen,
Bergman, Colon, Bishop; Torres, Bordallo, Sablan, and Soto.
Also present: Representative Westerman.
Mr. LaMalfa. Good morning. The Subcommittee on Indian,
Insular, and Alaska Native Affairs will come to order. Welcome,
everyone.
The Subcommittee is meeting today to hear testimony on the
hearing titled, ``Improving and Expanding Infrastructure in
Tribal and Insular Communities.'' Under Committee Rule 4(f),
any oral opening statements at hearings are limited to the
Chairman, our gracious Ranking Minority Member, the Vice Chair,
and the Vice Ranking Member. This will allow us to hear from
our witnesses sooner, and help Members keep to their schedules.
Therefore, I ask unanimous consent that all other Members'
opening statements be made part of the hearing record if they
are submitted to the Committee Clerk by 5:00 p.m. today, or the
close of the hearing, whichever should come first.
Hearing no objection, so ordered.
All right, opening statements. Recognizing myself, first.
STATEMENT OF THE HON. DOUG LaMALFA, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF CALIFORNIA
Mr. LaMalfa. As we know, infrastructure plays an extremely
important role in providing the basic services to people, no
matter where they live. Quality infrastructure boosts economic
development, creates jobs, and quality of life increases.
Nowhere is this more important than tribal and insular
communities.
There is, however, a great need in tribal communities,
especially with tribal healthcare infrastructure. Established
in 1955, the Indian Health Service (IHS) provides health care
for approximately 2.2 million American Indian and Alaska Native
community members. Today, there are approximately 650 IHS and
tribal health facilities throughout the Nation. IHS facilities
offer a range of care, including primary care services,
pharmacy, laboratory services, only to name a few.
In recent years, several reports to Congress have
highlighted the state of many health facilities to fall into
dire conditions. Most facility capacity is about 52 percent of
need. This creates crowded and unsafe conditions which affect
the delivery of health care.
In 2016, the average age of IHS hospitals was estimated to
be about 40 years old. The average age of hospitals throughout
the United States is said to be about 10 years.
This information is not unfamiliar to those in Indian
Country. Both the Centers for Medicare and Medicaid Services
and the HHS Office of the Inspector General have found that
aging facilities are direct threats to patient care. Again,
this is not something new to Indian Country; this problem has
existed for decades.
Beginning in the 1990s, early 1990s, as directed by
Congress years prior, the Indian Health Service developed a
Health Care Facilities Construction Priority List. Nearly 30
years later, IHS is still working through that priority list.
At the current appropriation levels for facility construction,
if a new facility were built today, it would not be replaced
for another 400 years.
Infrastructure needs in Indian Country do stretch beyond
health care. I also look forward to discussing these, too, and
creative ways to address all infrastructure needs in Indian
Country.
Today we will also be hearing from the Acting Assistant
Secretary of the Office of Insular Affairs on the Capital
Improvement Project (CIP) grant program. The CIP grant program
is the largest resource offered to the territories by the
Office of Indian Affairs (OIA), and provides upwards of $27.7
million annually for vital infrastructure projects in some of
the country's most remote locations in the Pacific and the
Caribbean.
[The prepared statement of Mr. LaMalfa follows:]
Prepared Statement of the Hon. Doug LaMalfa, Chairman, Subcommittee on
Indian, Insular and Alaska Native Affairs
Infrastructure plays an extremely important role in providing basic
services to people no matter where they live.
Quality infrastructure boosts economic development, creates jobs,
and quality of life increases. Nowhere is this more important than
tribal and insular communities.
There is, however, a great need in tribal communities, especially
with tribal healthcare infrastructure.
Established in 1955, the Indian Health Service provides healthcare
for the approximate 2.2 million American Indian and Alaska Native
communities. Today, there are approximately 650 IHS and tribal health
facilities throughout the country.
IHS facilities offer a range of care, including primary care
services, pharmacy, and laboratory services, only to name a few.
In recent years, several reports to Congress have highlighted the
state of many health facilities to fall into dire conditions. Most
facility capacity is 52 percent of the need.
This creates crowded, unsafe conditions which affect the delivery
of care.
In 2016, the average age of IHS hospitals was estimated to be 40
years old. The average age of most hospitals throughout the United
States is only 10 years.
This information is not unfamiliar to those in Indian Country. Both
the Centers for Medicare and Medicaid Services and the HHS Office of
the Inspector General have found that aging facilities are direct
threats to patient care.
Again, this is not something new to Indian Country. This problem
has existed for decades.
Beginning in the early 1990s, as directed by Congress years prior,
the Indian Health Service developed a Healthcare Facility Construction
Priority List.
Nearly 30 years later, the IHS is still working through that
priority list. At the current appropriation levels for facility
construction, if a new facility were built today, it would not be
replaced for another 400 years.
Infrastructure needs in Indian Country do stretch beyond
healthcare, and I also look forward to discussing those too and
creative ways to address all infrastructure needs in Indian Country.
Today we'll also be hearing from the Acting Assistant Secretary of
the Office of Insular Affairs on the Capital Improvement Project grant
program.
The CIP grant program is the largest resource offered to the
territories by OIA and provides upwards of $27.7 million annually for
vital infrastructure projects in some of the country's most remote
locations in the Pacific and the Caribbean.
______
Mr. LaMalfa. At this point I would like to recognize our
Ranking Minority Member, Mrs. Torres, for any opening
statement.
STATEMENT OF THE HON. NORMA J. TORRES, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF CALIFORNIA
Mrs. Torres. Good morning, and thank you, Mr. Chairman.
First, let me say I am honored to have the opportunity to serve
as Ranking Member of this Subcommittee for the 115th Congress.
I am also pleased to serve alongside you, Mr. Chairman. We had
the opportunity to work together in the State Assembly, and I
am really looking forward to continuing our work together in
this Committee.
Indian Country continues to face significant disparities in
access to health care and education, as well as few
opportunities for job growth and economic development. Mr.
Chairman, I look forward to working with you to find bipartisan
solutions to these challenges.
I also want to welcome our witnesses, especially the tribal
leaders, who have traveled to be here with us this morning.
Mr. Chairman, our Federal trust responsibility and
obligations to tribes is laid out in many treaties, as well as
hundreds of years of Federal legislation. We must do a better
job of honoring our obligations. Investment in tribal
infrastructure has not even remotely kept up with local needs--
a direct result of the lack of investment by Congress.
Over the years, this lack of investment has drastically and
disproportionately affected the health, well-being, and
livelihoods of Native people. The Indian Health Service (IHS),
faces substantial backlogs in the construction of healthcare
facilities, and with the maintenance of existing facilities.
The average age, as you stated, of IHS hospitals is now 40
years, almost four times older than the average U.S. hospital.
At the existing replacement rate, a new 2016 facility would not
be replaced for 400 years, if we continue at this rate.
While the focus of this hearing is IHS facilities, I would
be remiss if we did not highlight other infrastructure
shortfalls in Indian Country, because infrastructure is more
than buildings, roads, and bridges. Over a half-million people
in Native communities across the United States do not have
access to reliable water sources, clean drinking water, or
basic sanitation.
Again, lack of investment by the Federal Government has
resulted in a backlog of needed sanitation facilities,
construction projects estimated to be $2.8 billion.
Native Americans also live in some of the worst housing
conditions in the country. Forty percent of on-reservation
housing is considered substandard. The majority of BIA-run
schools are in substandard condition, and estimates to replace
or repair these facilities exceed $1.3 billion.
Overall, it is estimated that there is $50 (five zero)
billion in unmet infrastructure needs in Indian Country. It
seems like a lot to hear, but it is not an insurmountable
problem. It simply requires a commitment and focus from this
Congress and this Administration to address the issue head on.
Today, I look forward to hearing ideas on how we can
streamline the process, especially to provide flexibility to
tribes. But we must not use these ideas as an excuse to reduce
our financial commitment to Indian Country. The solution is a
renewed focus and increased investment in Indian Country
infrastructure, combined with tribal self-determination and
self-governance. But the longer we wait, the higher the price
tag. We must seize this opportunity to revitalize Indian
Country.
I want to conclude by touching on one last underserved
population: the U.S. Insular Areas, which have unique
challenges to providing the infrastructure necessary for
economic development. My colleagues from the territories will
expand further on those challenges during their questioning.
But first, let me state that any infrastructure bill considered
this Congress must include a significant investment in the
Insular Areas. And, going forward, any future authorizations or
appropriations must prioritize the improvement and
modernization of their infrastructure.
Thank you again, Mr. Chairman, and I look forward to a
productive discussion, and I yield back.
[The prepared statement of Mrs. Torres follows:]
Prepared Statement of the Hon. Norma J. Torres, Ranking Member,
Subcommittee on Indian, Insular and Alaska Native Affairs
Thank you, Mr. Chairman.
First, let me say, I'm honored to have the opportunity to serve as
Ranking Member of this Subcommittee for the 115th Congress.
I am pleased to serve alongside you, Mr. Chairman. We had the
opportunity to work together a while back in the State Assembly and I
hope we are able to have the same productive relationship here.
Indian Country continues to face significant disparities in access
to health care and education, as well as few opportunities for job
growth and economic development.
Mr. Chairman, I look forward to working with you to find bipartisan
solutions to these challenges.
I also want to welcome our witnesses, especially the tribal
leaders, who have traveled to be here with us today.
Mr. Chairman, our Federal trust responsibility and obligations to
tribes is laid out in many treaties, as well as hundreds of years of
Federal legislation. We must do a better job of honoring these
obligations.
Investment in tribal infrastructure has not even remotely kept up
with local needs--a direct result of the lack of investment by
Congress.
Over the years, this lack of investment has drastically and
disproportionally affected the health, well-being, and livelihood of
Native peoples.
The Indian Health Service (IHS) faces substantial backlogs in the
construction of healthcare facilities, and with the maintenance of
existing facilities.
The average age of IHS hospitals is now 40 years, almost four times
older than the average U.S. hospital. And at the existing replacement
rate, a new 2016 facility would not be replaced for 400 years.
While the focus of this hearing is IHS facilities, I would be
remiss if we didn't highlight other infrastructure shortfalls in Indian
Country, because infrastructure is more than buildings, roads and
bridges.
Over a half million people in Native communities across the United
States do not have access to reliable water sources, clean drinking
water, or basic sanitation.
Again, lack of investment by the Federal Government has resulted in
a backlog of needed sanitation facilities construction projects
estimated to be $2.8 billion.
Native Americans also live in some of the worst housing conditions
in the country. Forty percent of on-reservation housing is considered
substandard.
A majority of BIA-run schools are in sub-standard condition, and
estimates to replace or repair these facilities exceed $1.3 billion.
Overall, it is estimated that there is $50 billion in unmet
infrastructure needs in Indian Country.
It seems like a lot to hear, but it is not an insurmountable
problem--it simply requires a commitment from this Congress and this
Administration to address the issue head on.
Today, I look forward to hearing ideas on how we can streamline the
process, especially to provide flexibility to tribes.
But we must not use these ideas as an excuse to reduce our
financial commitment to Indian Country.
The solution is a renewed focus and increased investment in Indian
Country infrastructure, combined with tribal self-determination and
self-governance.
But the longer we wait, the higher the price tag. We must seize
this opportunity to revitalize Indian Country.
I want to conclude by touching on one last underserved population--
the U.S. Insular Areas, which have unique challenges to providing the
infrastructure necessary for economic development. My colleagues from
the Territories will expand further on those challenges during their
questioning, but first let me say that any infrastructure bill
considered this Congress must include a significant investment in the
Insular Areas. And going forward, any future authorizations or
appropriations must prioritize the upkeep, improvement, and
modernization of this infrastructure.
Thank you, Mr. Chairman. I look forward to a productive discussion,
and I yield back.
______
Mr. LaMalfa. Thank you, Ranking Member Torres. Indeed, I
look forward to working with you in the friendly way we have
been able to, and I am very excited to be the Chairman of this
Subcommittee. It is the first time I ever chaired anything,
coming from California, as you know. So, I am looking forward
to a great bipartisan discussion on these issues that will be
coming up.
Now we will introduce our witnesses here. Again, thank you
for your travel. It is always something else, trying to get to
Washington, DC, especially, as we know, from the West Coast--
but the rural areas of the country. So, thank you for your time
and efforts to get here to be part of today's hearing.
First we have the Honorable Herman G. Honanie, Chairman of
the Hopi Tribe. Next, we have Mr. Andy Joseph, Jr., who is also
chairman of the Northwest Portland Area Indian Health Board,
and a member of the Colville Business Council; Ms. Victoria
Kitcheyan, Great Plains Area Representative for the National
Indian Health Board; the Honorable Aaron Payment, Secretary of
the National Congress of American Indians; Mr. Andy Teuber,
Board Chair and President of the Alaska Native Tribal Health
Consortium; and Mr. Nikolao Pula, Acting Assistant Secretary
for the Office of Insular Affairs.
Welcome. Let me remind you that, under our Committee Rules,
witnesses are to limit their oral statements to 5 minutes, but
their entire written statement will appear in the hearing
record. So, if it is beyond 5 minutes, know that we have it in
the record.
As a reminder, of course, when you begin, the lights on the
witness microphone will turn green. After 4 minutes, the yellow
light will come on. Your time expires when the red light comes
on. So if you don't want to find out what is behind door number
3, please finish up at that red light.
And further, the microphones are not automatic. You need to
press the talk button right in front of you before speaking
into the microphone.
With that said, we will let the entire panel make your
presentation before questions will come from the Members up
here. So, let's go ahead and start.
I will recognize Chairman Honanie for his testimony.
STATEMENT OF HERMAN G. HONANIE, CHAIRMAN, HOPI TRIBE,
KYKOTSMOVI, ARIZONA
Mr. Honanie. [Speaking native language.] Thank you very
much. [Speaking native language] from the Hopi Tribe. [Speaking
native language.]
I want to express my appreciation on behalf of my Hopi
people to be here this morning, and on behalf of my people from
northeastern Arizona. I appreciate the time.
Good morning Chairman LaMalfa, Ranking Member Torres, and
honorable members of Subcommittee. It is a pleasure to be here
today to testify on some of the infrastructure challenges
facing the Hopi Tribe. My name is Herman Honanie and I have the
privilege of serving as chairman of the Hopi Tribe. I am
Pipwugwa tobacco clan from Kykotsmovi, which sits below
Orazivi, the oldest continuously inhabited community in North
America. Today this village has no modern infrastructure.
The Hopi Reservation is located in northeastern Arizona and
is the size of Rhode Island. Our reservation is unfairly
landlocked by the Navajo Nation, which completely surrounds us.
We have approximately 14,000 enrolled citizens across the 12
villages. Our reservation is plagued by poverty and suffers
from a 60 percent unemployment rate. Due to its remoteness,
economic development on the reservation is incredibly
difficult.
Today, I will discuss three issues: arsenic contamination
of the reservation's water supply, our lack of a detention
facility, and a Navajo generating station.
The Hopi Reservation's water supply is contaminated by
arsenic. In the mid-1960s, the Federal Government designed and
constructed our water well supply and wells. In 2001, the EPA
decreased the allowable level of arsenic. Today, arsenic levels
in Hopi are up to three times the maximum contaminant level
allowed by the EPA.
The Hopi Tribe, Indian Health Service, and EPA work
together to develop a Hopi arsenic mitigation project. We
concluded that treating the water is not practical, and the
best solution is to find a new source of arsenic-free water.
The project will pipe water to villages to the First and Second
Mesa. The entire project is estimated to cost between $18 and
$20 million. This is a shovel-ready project that is only
awaiting the necessary capital to begin construction.
The tribe is working on a Federal funding package, but time
is of the essence. The tribe recently received notice of
violation from EPA, due to the elevated arsenic levels. The
reality is that every day we do not solve the problem is
another day that Hopis are drinking water contaminated by
arsenic.
Another major concern is the BIA's closure of the tribe's
detention facility, which caused me to declare an emergency on
the reservation in December 2016. Originally built as a
treatment center in 1981, it was never intended for
incarceration. But over the past years, the BIA converted it
into a detention facility. The building's condition began to
deteriorate in the early 2000s.
In February 2015, BIA informed the tribe that it would
provide a new facility. However, in October 2016, before a new
facility was obtained, the BIA condemned the detention facility
and closed it. BIA did not consult with the tribe prior to the
closure, nor did they inform the tribe of its actions. The BIA
said that it would deliver a temporary facility by November
2016, but to date none has been delivered.
The lack of a detention facility has created a public
safety situation on the reservation. Law enforcement is forced
to book suspects from their squad cars, and await a transport
to take the suspects to the detention facility more than 80
miles off the reservation. This has put a substantial hardship
and strain on our already limited law enforcement personnel. At
any given time there may be only two officers on duty to patrol
an area the size of Rhode Island.
We also learned that officers are practicing cite-and-
release and de-prioritizing low-level crime because of the lack
of resources. The tribe is concerned that low-level crimes will
escalate into major crimes because of lack of deterrents.
The BIA informed us last week that it has money to pay for
a permanent structure, but it is awaiting construction funds
from DOJ. The tribe cannot operate and continue to have the
patience for a facility that is no longer there. We need the
facility.
The final issue I want to touch on is the Salt River
Project, with the closure of SRP wanting to close the NGS
station. This will be disastrous for the tribe, because 80
percent of our revenue comes from the sale of coal. In light of
this, the tribe is focusing on economic diversity.
One area where this Subcommittee can assist the Hopi Tribe
is by assisting us in fulfilling the Act of 1996, Hopi Land
Dispute Act. This settlement will require 50,000 acres of land
to replace lands illegally taken from us. So with this, on
behalf of the Hopi Tribe, I humbly ask of this Committee to
assist us in any way possible to achieve these goals, as far as
the 1996 Land Settlement Act is concerned.
Thank you very much for your attention.
[The prepared statement of Mr. Honanie follows:]
Prepared Statement of the Hon. Herman Honanie, Chairman, Hopi Tribe,
Kykotsmovi, Arizona
Good morning Chairman LaMalfa, Ranking Member Torres, and honorable
members of the House Natural Resources Subcommittee on Indian, Insular,
and Alaska Native Affairs. It is a pleasure to be here today to testify
on improving and expanding critical infrastructure in Indian Country.
My name is Herman Honanie and I have the privilege of serving as
chairman of the Hopi Tribe. I am Pipwugwa (tobacco) clan from
Kykotsmovi, which sits below Orazivi, the oldest continuously inhabited
community in North America. Today the village has no modern
infrastructure.
The Hopi Tribe's ancestral lands span across northern Arizona and
include the Grand Canyon. The Hopi people have resided in this area
since time immemorial. The Hopi Reservation is located in the northeast
corner of Arizona and is approximately 2.5 million square miles, which
is about the same size as the state of Rhode Island. The Hopi Tribe has
14,282 enrolled tribal citizens, over half of whom reside on the Hopi
Reservation--this number does not include non-Indian and non-enrolled
Indians living on the Hopi Reservation.
The Hopi Reservation is plagued by poverty and suffers from a 60
percent unemployment rate. Due to the remote nature of the Reservation
economic development is incredibly difficult leaving the tribe to rely
on only a few sources of income. This situation is exacerbated by the
fact that the Hopi Reservation is completely landlocked and surrounded
by the Navajo Reservation making it difficult to create off-reservation
economic development opportunities. The Hopi Tribe does not have a
casino facility and its only meaningful economic development
opportunity on the Reservation is revenue generated by coal royalties.
I would like to take this opportunity to cover several difficult
situations that the Hopi Tribe is coping with when it comes to
infrastructure development.
i. landlocked nature of the reservation
The Hopi Reservation is completely surrounded by the Navajo
Reservation landlocking the tribe and forcing it to cross Navajo Nation
lands to reach the outside world. When the Federal Government created
the Navajo Reservation and encircled our reservation, it did not retain
a utility corridor right-of-way for the Hopi Tribe. The Hopi Tribe has
no natural access to the Western Area Power Grid, to cellular 911
emergency call service, utility distribution and natural resources
transportation corridors. This means that anytime the Hopi Tribe needs
access to off-reservation services it must pay the Navajo Nation for a
right-of-way across the Navajo Reservation to connect to fiber optic
networks, the electrical grid, and other utilities. This significantly
increases the cost for the Hopi Tribe for on-reservation economic
development. The landlocked nature of the Hopi Reservation also makes
it difficult to create off-reservation economic development because of
the distances the tribal citizens must travel to embark on those
enterprises.
ii. implementation of the 1974 navajo and hopi relocation act
With the enactment of the Navajo and Hopi Indian Relocation Act of
1974 (the Relocation Act), referred to as Public Law 93-531, as amended
by Public Law 96-305, the Office of Navajo and Hopi Indian Relocation
(ONHIR) was created to facilitate the relocation of tribal members to
their respective reservation land. One purpose of ONHIR was to ``insure
that persons displaced are treated fairly, consistently and equitably
so that these persons will not suffer the disproportionate, adverse,
social, economic, cultural and other impacts of relocation.'' 25 CFR SS
700.1.
This has not held true for our Hopi relocatee families, who have
not been treated fairly, consistently, or equitably, as witnessed by
the U.S. House Appropriations Subcommittee leadership on their visit to
the Hopi relocatee community of Yuh Weh Loo Pahki in January of 2015.
These Hopi relocatees have consistently asked that funds be provided to
meet the needs of the families for safe and sanitary housing, roads,
infrastructure, and economic benefits as proscribed by the Relocation
Act, but their pleas go ignored.
For example, in the early 1990s a road feasibility study was
conducted by ONHIR for 13 miles of upgraded roads near Yuh Weh Loo
Pahki at a cost of $6.0 million dollars, but ONHIR later rejected the
proposal, informing the tribe and families that it was not feasible to
serve the Hopi relocatee families. Meanwhile, ONHIR has built entire
communities (Coalmine Mesa, Pinon, Tuba City, etc) for Navajo
relocatees on the Navajo Nation and New Lands-Sanders/Chambers with
infrastructure, fire suppression, and paved roads, even a replacement
of a bridge over the Rio Puerco River. The Hopi relocatees, especially
the residents of Yu Weh Loo Paki, have requested assistance numerous
times from the ONHIR for discretionary funds to improve their living
conditions, make home repairs, and to provide for essential community
needs. ONHIR has finally in the past 5 years provided a community
building-modular trailer. This structure is insufficient to meet the
long-term needs of the relocatee families. These measures are minimal
and do not meet the intent of the Act. The Hopi relocatee families
should be entitled to the same benefits allowed for Navajo relocatee
families.
A high school and medical center/hospital were also to be built
under the Relocation Act. The Hopi Junior-Senior High School was
finally built in 1986, but was scaled down due to increased costs. The
Hopi Health Care Center was built in 1996, but only as an ambulatory
care center with less than 16 beds for patients. The Hopi Tribe had to
lobby and submit funding requests to build these facilities, while on
Navajo--specifically New Lands--schools and a hospital with complete,
modern infrastructure were built using ONHIR funds. Without proper
funding for the Hopi Health Care center, Hopi tribal citizens still
have to be flown out to off-reservation hospitals for care on a regular
basis, including in emergency. It is apparent that the Hopi Tribe has
received far less and has given up the most under the Act.
iii. implementation of the 1996 navajo-hopi land dispute settlement act
The Navajo-Hopi Land Dispute Settlement Act (Settlement Act) was
enacted in 1996. See Pub. L. 104-301. The Settlement Act was a
successor to the Relocation Act and was meant to provide the Hopi Tribe
with appropriate compensation for Navajo families illegally residing on
and occupying Hopi Partitioned Land. The U.S. Government interceded to
find a mutually acceptable settlement. It is important to note that the
only parties to the settlement were the Hopi Tribe and the Federal
Government; not the state of Arizona or the Navajo Nation.
The Settlement Act sought to allow Navajo families to remain on
Hopi land subject to a 75-year lease agreement. In exchange for these
leases and the loss of lands the Hopi Tribe was promised replacement
lands. Since the Navajo Reservation completely surrounds the Hopi
Reservation, these replacement lands would need to be located outside
of the existing reservation.
The Settlement Act provides the Tribe with the ability to regain
lands and have them placed into Federal trust status; this includes
interspersed Arizona State trust lands. Id. Sec. 6. In order to obtain
Arizona State trust land the Settlement Act requires the State to
concur that the acquisition is in the interest of the State and the
Tribe must pay the State the fair market value of the land. Id.
The Settlement Act states that ``it is in the best interest of the
Tribe and the United States that there be a fair and final settlement
of certain issues remaining in connection with the Navajo-Hopi Land
Settlement Act of 1974, including the full and final settlement of the
multiple claims that the Tribe has against the United States.'' Id.
Sec. 2 (2). However, it has been over 20 years and the Hopi Tribe does
not have its fair and final settlement because the state of Arizona
refuses to initiate condemnation proceedings to allow the Tribe to
obtain the 144,000 acres of interspersed State trust land. The State
and the Tribe have been in negotiations but to no avail and those talks
have often stalled or been delayed over the years. The Tribe is eager
to have its full and final settlement but it needs engagement from the
State.
The United States has a duty to provide the Tribe the ``full and
final settlement'' it promised under the terms of the 1996 Settlement
Act. The severe delay in implementing the Settlement Act sets a bad
precedent and could serve to cool settlement negotiations between the
United States and other tribal nations.
It also prevents the Tribe from engaging in meaningful economic
development off-reservation. The land has increased in value over the
interceding 20 years making the eventual purchase of it from the state
of Arizona even more expensive. Meanwhile, the Hopi Tribe is paying the
State for grazing rights on the State trust land. This situation is
untenable and the United States must live up to its obligations under
the Settlement Act and its trust responsibility to the Hopi Tribe.
iv. hopi arsenic mitigation project
The Hopi Tribe's water infrastructure was funded and engineered by
the Federal Government. In 2001, the Environmental Protection Agency
(``EPA'') revised its drinking water regulations and decreased the
allowable level of arsenic in drinking water. In 2006, EPA funded a
study to assist the Tribe in evaluating existing conditions for public
water systems in the First and Second Mesa areas that were known to
exceed the maximum contaminant level (MCL) for arsenic and recommend
viable engineering solutions to ensure regulatory compliance. Beginning
in 2008, the Hopi Water Resources Program began working with the Indian
Health Service (``IHS'') and EPA to complete an arsenic mitigation
study. As a baseline, the following data was collected at local well
sites to quantify the water quality issues relating to arsenic and
begin the process of seeking sustainable solutions.
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
.epsAs indicated in the table above, all wells serving the First
and Second Mesa region exceed the MCL for arsenic which is set at 10
parts per billion (ppb). Generally, the arsenic concentrations in
Second Mesa range from 15-20 ppb and increase as one moves eastward
toward First Mesa where Keams Canyon wells register the highest arsenic
concentration in the region at 38 ppb. The exception to this trend
occurs at the newly drilled Shungopavi well which was sampled after
drilling and was shown to have an arsenic concentration of 33 ppb. Also
noted was the unusually high pH of the tested waters coupled with high
alkalinity and the absence of hardness (calcium and magnesium). This
odd combination of water quality attributes makes the water of this
region very difficult and potentially expensive to treat for arsenic
removal. All of the treatment techniques evaluated (adsorption,
coagulation filtration (CF), reverse osmosis, ion exchange) to remove
arsenic from the regions' groundwater will require pH adjustment which
will prove difficult and costly given the high buffering capacity
indicated by the high alkalinity. Also noted, was the likelihood that
water in the First Mesa area would require preconditioning through a
process known as oxidation to convert the naturally occurring arsenic
into a form that has a higher affinity for removal.
These, among other complicating factors led the arsenic mitigation
team to advise against water treatment options if a non-treatment
solution could be identified. Based on the stated observations, high
anticipated operating cost of treatment facilities, the operational
difficulties experienced by existing local treatment systems and lack
of financial resources, the team looked elsewhere to identify a higher
quality water source that could be developed to serve the region.
After reviewing Hopi area wells, research identified a region 15
miles north of the Hopi Cultural Center referred to as ``Turquoise
Trail/Tawa'ovi'' which, according to a report completed by Thompson
Pollari and the WLB Group in 2005, has an existing well with superior
water yield potential and an arsenic concentration of 3-4 ppb. The
report contains pump test data and water quality information for the
Navajo Aquifer in the Turquoise Trail region that suggests favorable
conditions that may support development of this area as a primary water
source for the villages that are currently out of compliance with
Federal regulations related to arsenic. Alternate locations were
evaluated for well field development near the Hopi Veteran's Center
(HVC) near Kykotsmovi. Although the existing wells in the HVC area
demonstrate compliant arsenic concentrations of 7 ppb, they do not
yield anywhere near the quantity of water that is obtainable in the
Turquoise Trail region.
Below is a table generated using data presented by TetraTech EM Inc
in a Hopi Source Water Assessment conducted from 2005 to 2006. The
table offers a summary of water usage statistics organized by each of
the public water systems that are out of compliance with the arsenic
rules.
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
.epsAs indicated above, the minimum required yield needed to serve
the identified users is 208,200 gallons per day or a continuous
equivalent pumping rate of 289.2 gallons per minute based on a 12-hour
day. It is anticipated, based on the previously discussed existing well
data, that the Turquoise Trail region is capable of supporting wells
that can produce as much as 500 GPM+. As reported in the Thompson
Pollari-WLB Group report, the existing well (Tawa'ovi/Turquoise) was
pump tested at 345 GPM for 21 hours with a corresponding drawdown of
125 feet. The static water level was 521 ft bgs prior to pumping and
the terminal dynamic water level was measured at 646 ft bgs at the end
of the test. The pump was set at 1,700 ft bgs so at the end of the pump
test there was still a water column of 1,054 ft over the pump. This is
emphasized to demonstrate that the final pumping rate of 345 gpm was
likely a limitation of the test pump and not necessarily reflective of
the true yield potential of the well/aquifer.
After assessing the water needs of the area and reviewing the
Turquoise Trail well data, the Hopi Water Resources Department, IHS and
EPA collaboratively developed the Hopi Arsenic Mitigation Project
concept. This concept proposes to develop a new well field in the
vicinity of the existing Turquoise Trail well to take advantage of the
higher quality water which appears to be available in sufficient
quantity to serve the First and Second Mesa villages. The water would
be delivered to each of the communities by a large piped network that
would be constructed over the course of several construction phases.
The concept-level cost estimate to design and construct the proposed
water system is between $20 to $25 million. It is anticipated that the
cost estimate will vary as the concept is further developed through the
collection of design data during the ongoing planning process. During
the past 5 years, the EPA and IHS have committed grant funding to
further explore and develop the arsenic mitigation concept.
HAMP Proposed Wellfield and Piping Route
Over the course of the years, several informational meetings
pertaining to the arsenic mitigation concept have been held with
various stakeholders including community members, community leaders,
utility operators, Federal water system regulators and Federal funding
agencies. At each of the individual gatherings there has been
overwhelming support for the project as the meeting participants
acknowledge that this is a project devised to improve the health of the
served communities. On the other hand it has been difficult to assemble
multi-community meetings which will be critical as the arsenic
mitigation team solicits comments from the affected communities to
determine how best to operate and maintain a shared water system. This
project is substantially larger in scope and cost than ordinary
sanitation projects in the area. The Tribe has been informed that in
order to qualify for Federal grants for this project it must have a
defined plan detailing how the system would be operated and maintained.
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
.epsThe Hopi Arsenic Mitigation Project (HAMP) will pump water from
the Turquoise wellfield located approximately 15 miles north of Second
Mesa and pipe it to the Hopi villages at First and Second Mesas and to
the Keams Canyon Water System and the water systems for Hopi Junior-
Senior High School and Second Mesa Day School. HAMP will provide water
that complies with the Safe Drinking Water Act and will replace the use
of low-producing, high arsenic wells in the vicinity of First and
Second Mesa and Keams Canyon. The new water supply will allow the
villages at First and Second Mesa to come into compliance with Safe
Drinking Water Act standards and will provide a permanent alternative
water supply to Bureau of Indian Affairs and Bureau of Indian Education
facilities that does not require the interim use of expensive and
difficult to maintain arsenic removal technology.
At this point, several million Federal dollars have been invested
into the project, and various impacted agencies remain fully supportive
of the project and reaching operation of the new wells. Through
discussion with Tribal Council, the Tribe is now considering next steps
and how to proceed with this project. An outline of remaining action
items and options follows:
A. Project Summary
In January 2014, the Tribe provided a briefing to the Department of
the Interior. The summary included highlights of the project, which
heavily featured the creation of the Hopi Tribe's Public Utility
Authority. The new Utility Authority is responsible for setting water
rates and addressing other regulatory requirements for HAMP.
The largest funding for this project will come from the USDA-RD
application. Several other Federal agencies have invested millions of
dollars into this project and continue to support the effort, they are
of the understanding that the newly created utility will run HAMP.
This need is urgent in light of EPA planning to bring an
enforcement action against the Tribe and/or village(s) out of
compliance, potentially this year.
i. Action items left for the Utility Authority
Staffing and setting up the utility accounting operation;
initially the Hopi Public Utility Authority will oversee completion of
the HAMP planning followed by management of HAMP construction
Tribal Council agreed to contribute $350,000 to get the
Public Utility Authority and Utility Commission up and running
Both agencies need to sign the Indian Affairs and Hopi
Tribe MOA to get the work done that was proposed by IHS in their
Planning Agreement--the Planning Agreement will then develop the
information to allow the BIA/BIE connections to be part of HAMP and the
USDA-RD Application
ii. USDA-RD Application
A significant amount of work has been done on this
application, which will ultimately secure $13-16M for HAMP
iii. IHS Preliminary Engineering Report
The expected USDA loan amount is $1,978,500, after a total
of $2.25 million in up-front cash and grant contributions from the
Tribe
Estimated user costs for the HAMP are expected to be a
$35/month plus $2.55 per 1,000 gallons of water used per month--total
costs per home is $49.82/month, plus local delivery costs
This is made with the understanding that these stets
remain:
-- Submission of the USDA funding application
-- Formalization of agreements between Tribe and the villages
-- Staffing the new Hopi Public Utility Authority
-- Acquiring full construction funding and awarding a construction
contract, construction of project
-- Transfer of the new facilities to the HPUA
B. The BIA's Relationship to the HAMP
The BIA wishes to partner with HAMP to be included on a
construction line
The Tribe and the Department of the Interior (DOI)
initiated a potential HAMP related partnership, which would provide a
source of revenue to tribe via user fees
A draft MOA was being reviewing by IHS counsel but no
progress has been made since
The Preliminary Engineering Report will need to be amended
if BIA/BIE and Tribe enter into agreement
The HAMP is absolutely essential to the health and safety of Hopi
tribal citizens. The Tribe is greatly appreciative of its Federal
partners in this project.
v. hopi detention facility
The Hopi Tribe has been in need of a detention facility for several
decades. The detention facility that was initially established on the
Hopi Reservation in 1981 was not intended for incarceration. The
existing adult detention facility in First Mesa was originally built as
a treatment facility. Over the years the building was converted and
used as an adult detention facility. With the security requirements and
special operation needs, the building did not meet the standards for a
secure and safe detention facility.
In 2005, Hopi Tribal Council authorized Tribal Resolution H-042-
2005, which established the Hopi Detention Facility Steering Committee
and directed the committee to pursue the planning, design and
construction of a new Hopi Detention Facility on the Hopi Reservation.
The committee was tasked with the responsibility of searching for funds
to build a permanent facility. The Tribe allocated $1 million to the
committee to fulfill this project. The committee was able to develop
plans for a permanent facility; however the Tribe was unable to secure
funding to build a facility. At the same time, similarly to the
Relocation issues raised above, the Federal Government built a new
detention facility for the Navajo Nation in Tuba City. That facility is
now approximately half empty while the Hopi Tribe does not have any
detention facility at all. In 2016, by Tribal Council resolution, the
committee was disbanded because Tribal Council did not see any progress
being made.
The committee was a direct result of actions taken by the Office of
Inspector General in 2004. In 2004, the Office of Inspector General
conducted a health and safety inspection, which resulted in the
immediate closure of the juvenile correctional component. Up until that
time, corrections held minors with adults in joint spaces. Juveniles
are currently being housed in Navajo County Jail in Holbrook, Arizona.
Despite these serious issues facing Hopi, the Navajo Nation was
provided a detention center at that time while Hopi's needs for
detention space and a psychiatric treatment facility has yet to be
addressed.
In February 2015, David Little Wind, Director of Bureau of Indian
Affairs-Office of Justice Services, met with tribal leaders, including
myself, and Councilman Mervin Yoywtewa, Chairman of the Law Enforcement
Task Team, to discuss the building of a new detention facility. BIA-OJS
recognized that there was a need for a new facility and the
recommendation at that time was to repair by replacement.
The detention facility was still being used and operated to
incarcerate inmates who had either been sentenced to 30 days or less or
were awaiting hearings in the Hopi Tribal Courts. Between 2013 and
2015, there had been an inspection of the facility, which resulted in
portions being deemed unsafe and uninhabitable. Those inmates who had
been formally sentenced to more than 30 days of incarceration were
transported to other facilities. These facilities included Navajo
County Jail, in Holbrook, Arizona; Coconino County Jail, in Flagstaff,
Arizona; Arizona State Prison Complex, in San Luis, Arizona; and Chief
Ignacio Adult Detention Facility, in Towoac, Colorado. However, the
facility remained partially open.
In October 2016, the Hopi Detention Facility was formally closed.
Structural issues were cited as the cause of closure. As part of the
closure, all inmates and staff were to evacuate the building
immediately. Any new arrestees were to be booked and transported to
Navajo County Jail within 1 hour of being booked. The Tribe was not
given any notice of the closure. A charge of orders was issued from
BOI-OJS Hopi Agency instructing all officers that the officer would
have to conduct the transport related to any arrests they made. This
instruction was also given to the Hopi Resource Enforcement Services
(HRES) officers. HRES acts as a secondary law enforcement agency when
services are requested by BIA-OJS. There was no formal agreement from
the Hopi Tribe on the charge of orders. Due to the high costs and
liability concerns associated with the courtesy transport the Hopi
Tribe concluded it could no longer provide this support and have
declined any transports of arrestees.
BIA-OJS was aware for the need for a new facility and had indicated
plans for a transition from the old facility to a temporary facility
while the new facility was constructed. BIA-OJS Hopi Agency met with
Chairman Honanie in late October 2016 to discuss the temporary
facility. The temporary facility would include two components to cover
the needs of the Correctional staff and Administrative staff. The
temporary facility would also allow detaining individuals for up to 8
hours. The Hopi Tribe through various meetings was verbally told that
the temporary facility would be in place by November 2016. However, as
of this date, the temporary facility has not been received; BIA-OJS has
cited administrative issues as the cause of delay.
Not having a facility places a burden on the personnel and
administrative costs continue to rise. Officers conduct booking of
arrestee from their units. Additional costs are being incurred in the
areas of transportation, additional staff hours, and incarceration.
The BIA informed the Tribe last week that it costs the BIA
$100,000/month in contract costs to house the inmates at other
facilities.
The irony of this situation is that the BIA-OJS has the money to
replace the facility, but the BIA does not receive construction dollars
for installation. The BIA-OJS is meeting with the Department of Justice
to find out if the DOJ would be able to provide the construction
funding for the project.
As the Hopi community waits to have its detention facility needs
met, crime does not cease. As a result of having no facility, law
enforcement officers must use their own personal discretion when
arresting individuals who have committed violations of the Hopi Code.
There is no deterrent factor to keep individuals from committing crimes
when they know they will not be arrested. It is only a matter of time
until a minor incident turns into a much more serious crime of
violence.
vi. hopi telecommunications
The Federal Communications Commission considers the Hopi
Reservation a high cost project area. Anytime that the Hopi Tribe seeks
to connect to the outside world it must cross the Navajo Nation, Indian
allotments, and State land. This requires the Hopi Tribe to pay massive
amounts for easements in order to lay or connect fiber. The cost of
building telecommunications projects on Hopi land is 27 percent more
than in other parts of Arizona. The Hopi Tribe received an American
Recovery and Reinvestment Act (``ARRA'') to construct and purchase
fiber and electronics to connect to the internet. The Tribe was not
allowed to use ARRA funds to purchase the rights-of-way so Hopi
Telecommunications Inc. (``HTI'') had to absorb those costs. The entire
project cost to build a fiber optic cable route from Jeddito Community
to Holbrook, Arizona--roughly 61 miles--cost the HTI was $3.3 million.
Included in this cost was $500,000 paid in right-of-ways, which
accounts for approximately 15 percent of the entire project cost. If
this same fiber optic route was constructed on non-Indian land it would
cost approximately $2.4 million (or 74 percent of the cost for building
it on tribal land).
vii. hopi road infrastructure
The Hopi Department of Transportation (``HDOT'') is charged with
1,235.1 miles of Hopi's official inventoried road mile consists of:
625.1 miles of unimproved earth roads
5.8 miles of gravel roads
99.6 miles of asphalt surface roads
405.5 miles of jeep trail roads
1,136 total BIA & Tribal road miles
99.1 total miles of AZ State Highways
1,235.1 combined total Hopi inventory road miles
10 bridges with a combined length of 1,258.0 feet
The Tribal Transportation Program (``TTP'') is the only continuous
funding source for Hopi's construction program inclusive of all
components from planning, design, and construction and now including
road maintenance as result of the need expressed in Indian Country that
regulations be amended to allow use of TTP funds for road maintenance.
The remote nature of the Hopi Reservation has led the cost to construct
new roads to increase from $900,000/mile in 2013 to $1.2 million/mile
now. Dealing with these technical challenges increases operational
costs at an estimated rate of 3 percent annually. The current TTP
annual allocation provides for at least for 3 miles of roadway
construction with support to the road maintenance program of $500,000
and now includes the Hopi Senom Transit Program.
The Interior Appropriation allocations for the road maintenance
program have not kept up with true costs for the past 30 years. The
Hopi Tribe had no other options but to take responsibility for the
BIA's road maintenance duties/program as the threat to life and safety
were becoming more evident on Hopi's roadways. In order to achieve
maintenance goals the Tribe has been forced to draw from its
construction accounts but is necessary as lives are being impacted. In
addition to the already severe and inadequate funding, Hopi sustained a
severe decrease to its road maintenance allocation by 40 percent in
Fiscal Year 2012 from $500,000 to $300,000 with no justifiable or
adequate reasoning taken by the BIA. We have repeatedly met with the
BIA requesting them to remedy this reduction.
The majority of HDOT's calls relate to the construction of new
roadways and maintenance issues on existing roadways (an average of 15/
week). The lack of suitable material and resources to maintain the
625.1 miles of unimproved roads makes traveling them a potentially
life-threatening situation. Roads within the hearts of villages where
the majority of residents reside are no better than outside of the
villages. HDOT is responsible for maintaining the roads for emergency
service providers, school buses, and everyday commuters but it is a
daunting task given the lack of available resources.
HDOT continue its daily assessment and documents challenges with
not just BIA roads but with state highways as well. The state highways
are no better than the BIA roads. It leaves the Tribe to believe that
it has been forgotten by the Federal Government and the state of
Arizona. There are currently no major plans to remedy these unsafe
roadways on the part of either the Federal Government or the State.
vii. conclusion
I appreciate the Subcommittee's time and attention to the Hopi
Tribe's infrastructure concerns and challenges. The Tribe encourages
the Subcommittee and its staff to visit the Hopi Reservation to witness
the issues covered in my testimony firsthand.
______
Mr. LaMalfa. Thank you, Chairman Honanie. We will now
recognize Chairman Joseph.
STATEMENT OF ANDREW JOSEPH, JR., CHAIRMAN, NORTHWEST PORTLAND
AREA INDIAN HEALTH BOARD; MEMBER, COLVILLE BUSINESS COUNCIL,
NESPELEM, WASHINGTON
Mr. Joseph. Good morning, Chairman LaMalfa and Ranking
Member Torres. [Speaking native language.] My name is Andy
Joseph, Jr. I am a chair of the Northwest Portland Area Indian
Health Board, and also a member of the Colville Business
Council, Confederated Tribes of the Colville Indian
Reservation. I chair the Health and Human Services Committee.
I thank you for this opportunity to provide testimony today
on the challenges that Colville Tribe and other tribes in the
IHS Portland area face in getting healthcare facilities built
under the IHS system. The board and the Colville Tribes request
the Committee and Congress to address Indian health facilities
construction as part of the administrative infrastructure
initiative. In doing so, we specifically ask that all IHS areas
access benefits from the facilities construction funds, and not
just a handful.
By way of background, the Northwest Portland Area Indian
Health Board is a tribal organization of 43 tribes of
Washington, Idaho, and Oregon. The Colville Tribes is a member
of the board. And the present-day Colville Reservation is
located in north central Washington State. Most of the 1.4
million-acre Colville Reservation is rural timberland, ranch
land. The tribe has a large IHS service area, and its four main
communities are separated by significant drive times. The
tribe's primary Indian health facility is located in Nespelem,
Washington, and residents from Inchelium that require care
there must drive, in many cases, more than 90 minutes through
two mountain passes.
Health facilities have always been a challenge for Colville
and other Portland area tribes. For the past three decades,
most of the IHS facilities construction dollars have gone to
projects in the Health Care Facilities Construction Priority
List. The priority list was last updated in 1991, and no new
projects have been added to the list since then. Projects built
on a priority list receive reoccurring funds from IHS for an 80
percent facility staffing needs.
The construction priorities in the priority list were last
updated 26 years ago. The current IHS funding for facilities
construction is inadequate, because it provides a
disproportionate share of funding to a few select tribal
projects on the priority list, based on decades-old data. In
many cases, the priority list either did not reflect facility
needs at the time, or do not reflect the current needs of
tribal communities.
For example, in the 1980s, the Colville Tribe sought to
replace the Nespelem facility with a new facility. A Nespelem
facility was originally constructed in the 1920s, as a U.S.
Department of War building, and was converted to use in the
1930s as a clinic for the U.S. Public Health Service. We were
told by a former IHS official that at one point the tribe
requested a new facility, and Nespelem was near the top of the
priority list, but was removed because of concerns the facility
was a historical site.
The Colville Tribe ended up using tribal dollars to build a
new facility with no increase in staffing. The lack of staffing
remains a chronic problem for the Colville Tribe--none of the
more than 40 tribes in the IHS Portland area have ever had a
facility constructed under the priority list system. Several of
the IHS areas are in the same situation. Going forward on the
Committee, we should direct IHS to develop and update priority
list methodology, accurately reflecting current needs, and
allow for changes.
The Area Facility Distribution Fund (ADF)--When Congress
reauthorized the Indian Health Care Improvement Act in 2010, it
included a new section 301(f), that authorized IHS to establish
a new area facility fund. We believe that the ADF is a path
forward, ensuring all IHS areas receive benefits from any funds
made available and administration. A joint Federal-Tribal
advisory committee, called the Facilities Appropriations
Advisory Board, developed the ADF concept as a compromise to
allow existing projects to be grandfathered into the priority
list, while at the same time allowing for new proposals to be
considered and funded.
The ADF is intended to allow each IHS area to improve,
expand, or replace existing healthcare facilities. ADF makes it
possible for IHS to extend the benefits and appropriate funds
to a significantly larger number of tribes and communities than
the priority list alone.
ADF was supported by 7 of the 12 IHS area organizations,
representing more than 500 tribes, but despite that the IHS has
not taken steps to implement the ADF in the intervening years
since its enactment.
Again, I thank you for this opportunity to testify before
you.
[The prepared statement of Mr. Joseph follows:]
Prepared Statement of the Hon. Andrew Joseph, Jr., Chairperson,
Northwest Portland Area Indian Health Board, and Council Member,
Confederated Tribes of the Colville Reservation, Nespelem, Washington
Good morning Chairman LaMalfa, Ranking Member Torres, and members
of the Subcommittee. On behalf of the Northwest Portland Area Indian
Health Board (``NPAIHB'' or the ``Board'') and the Confederated Tribes
of the Colville Reservation (``Colville Tribes''), I thank you for this
opportunity to provide testimony.
I am here today to discuss the challenges that the Colville Tribes,
and other Indian tribes in the Indian Health Service (``IHS'') Portland
Area, face in getting healthcare facilities constructed under the
existing programs administered through the IHS. These issues are of
great importance to the Colville Tribes and to other Indian tribes in
other IHS areas where IHS facility construction dollars have not
traditionally been available. My testimony is on behalf of both the
Board and the Colville Tribes.
The Board and the Colville Tribes urge the Subcommittee to do
everything in its power to ensure that Congress addresses Indian health
facilities needs when it drafts legislation to implement the expected
Trump administration infrastructure initiative. In doing so, we also
urge this Subcommittee to ensure that all IHS areas benefit from
facilities construction and not just a handful of projects.
background on the npaihb and the colville tribes
Established in 1972, the NPAIHB is a P.L. 93-638 tribal
organization that represents 43 federally recognized tribes in the
states of Washington, Oregon, and Idaho on healthcare issues. The
NPAIHB is dedicated to improving the health status and quality of life
of Indian people and is recognized as a national leader on Indian
health issues.
The present-day Colville Reservation is approximately 1.4 million
acres and occupies a geographic area in north central Washington State
that is slightly larger than the state of Delaware. The Colville Tribes
has more than 9,500 enrolled members, about half of whom live on the
Colville Reservation. In terms of both land base and tribal membership,
the Colville Tribes is one of the largest Indian tribes in the Pacific
Northwest.
Most of the Colville Reservation is rural timberland and rangeland
and most residents live in one of four communities on the Reservation:
Nespelem, Omak, Keller, and Inchelium. The Colville Tribes has a large
IHS service area and these communities are separated by significant
drive times. The CCT's primary IHS facility is located in Nespelem, WA,
and residents from Inchelium that require care there must drive in many
cases more than 90 minutes through two mountain passes.
health facilities under the ihs system
There are currently three IHS programs that allow Indian tribes to
construct new health facilities. The first is the Health Care
Facilities Construction Priority List (``Priority List''), which has
been in effect for more than two decades and provides funding for
construction of the facilities included on the list, as well as 80
percent of the annual staffing costs. The projects on the Priority List
have been locked since 1991 and in the intervening decades Congress has
directed most of the IHS health facilities construction funding to
projects on the Priority List.
The second is the Joint Venture (JV) program, which requires an
Indian tribe to pay the up-front cost of constructing a facility in
exchange for the IHS providing a portion of the annual staffing costs.
Because the JV program provides for the possibility of recurring
staffing for selected projects, it is extraordinarily competitive. The
IHS has solicited applications for the JV program only twice over the
past decade.
The third is the Small Ambulatory Health Center Grants program,
which is the opposite of the JV program in that the IHS provides funds
for the construction of the facility, but not for recurring staffing.
Congress has not provided any funding to this program in more than a
decade.
It is important to note that when new facilities are constructed
under the Priority List and JV programs, it carries a budgetary
commitment for staffing packages that must be funded on a recurring
basis. The construction priorities in the Priority List were last
updated 26 years ago. As the NPAIHB has noted in previous testimony,
the current IHS funding for facilities construction is inequitable in
that it provides a disproportionate share of funding to a few select
tribal communities based on decades-old data.
In many cases, the Priority List either did not reflect facilities
needs at the time or do not reflect the current needs of tribal
communities. For example, the Colville Tribes sought in the 1980s and
the early 1990s to replace its Nespelem, WA facility with a new
facility. The Nespelem facility was originally constructed in the 1920s
as a U.S. Department of War building that was converted for use in the
1930s as a clinic for the U.S. Public Health Service and, later, the
IHS. The Colville Tribes were told by former IHS officials that at one
point, its request for a new clinic in Nespelem was near the top of the
priority list but was removed because of concerns that the facility was
a historical site. None of the more than 40 tribes in the IHS Portland
Area, of which the Colville Tribes is a part, have ever had a facility
constructed under the Priority List system.
It has been more than 17 years since the Interior Appropriations
Subcommittee directed the IHS to revamp its facilities construction
system. The IHS, however, has ignored this request and has never
provided an updated facilities construction Priority List system. Going
forward, this Committee should direct the IHS to develop an updated
Priority List methodology that accurately reflects current needs and
allows for changed circumstances.
the area distribution fund would provide a mechanism to more equitably
distribute facilities construction resources
When Congress reauthorized the Indian Health Care Improvement Act
in 2010, it included a new Section 301(f) that requires the IHS to
consult with Indian tribes and tribal organizations in developing
innovative approaches to address all or part of the total unmet needs
for construction of health facilities. That section also provides that
the IHS may establish an Area Distribution Fund (``ADF'') in which a
portion of health facility construction funding could be devoted to all
IHS areas.
The Facilities Appropriations Advisory Board, a joint Federal-
Tribal advisory committee, developed the ADF concept as a compromise to
allow existing projects to be grandfathered into the health facilities
Priority List, while at the same time allowing a method for new
proposals to be considered and funded. The ADF is intended to allow
each IHS area to improve, expand, or replace existing healthcare
facilities. The IHS could extend the benefits of appropriated funds to
a significantly larger number of tribes and communities throughout
Indian Country than would be possible by relying solely on funding for
line-item projects.
Section 301(f) was supported by more than 500 Indian tribes
represented in 7 of the 12 IHS Areas, including Alaska, Bemidji,
California, Nashville, Oklahoma, Phoenix (Nevada tribes), and Portland.
Since then, the National Tribal Budget Formulation Workgroup has
recommended that Congress fund the ADF. That Workgroup's
recommendations are based on consensus. Despite the tribes' support,
the IHS has not taken steps to implement Section 301(f) in the
intervening years since its enactment into law.
The Board and the Colville Tribes urge the Subcommittee to do
everything in its power to ensure that Congress addresses Indian health
facilities needs when it drafts legislation to implement the expected
Trump administration infrastructure initiative. We specifically urge
the Subcommittee to direct the IHS to distribute a significant portion
of any facilities construction funds that may be available under an
infrastructure initiative through the ADF to ensure that all IHS areas
have an opportunity to address facility needs.
This concludes my testimony. I would be happy to answer any
questions that the Subcommittee may have.
*****
Supplemental Testimony Submitted for the Record from the Hon. Andrew
Joseph, Jr.
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
March 20, 2017
Hon. Doug LaMalfa, Chairman,
Hon. Norma Torres, Ranking Member,
House Committee on Natural Resources,
Subcommittee on Indian and Alaska Native Affairs,
1324 Longworth House Office Building,
Washington, DC 20515.
Dear Chairman LaMalfa and Ranking Member Torres:
On behalf of the Confederated Tribes of the Colville Reservation,
thank you again for inviting me to testify at the March 9, 2017,
oversight hearing on ``Improving and Expanding Infrastructure in Tribal
and Insular Communities.'' The hearing was timely in that it
illustrated the need for infrastructure in Indian country and offered
potential solutions, specifically for health facilities.
Chairman Bishop asked me the following question regarding the
remaining projects on the Health Care Facility Construction Priority
List: ``As you look at the 13 remaining projects, do you think they
represent the greatest need?'' The beginning of my response did not
accurately reflect my entire answer or my written statement, and I
would like to clarify it for the record.
The projects on the Priority List reflect criteria that IHS
utilized nearly three decades ago and there has not been an intervening
examination of whether those remaining projects reflect actual, current
need. Much has changed in 30 years, and since then some tribes have
been able to obtain new facilities through the Joint Venture program or
through congressional directed spending prior to the adoption of rules
prohibiting earmarks.
I am not familiar with all 13 of the remaining projects on the
Priority List. To the extent, however, that any of those projects were
included on the Priority List because the applicable tribe may not have
had any IHS facility at the time but have since been able to obtain an
IHS facility through the Joint Venture program or by congressional
directed spending, then the list does not reflect current need.
Regardless, and as noted in my written statement, the Priority List
must updated. In fiscal year 2000, the Interior Appropriations
Committee directed the IHS to update its facilities construction
system. The IHS, however, has never done so, and the Committee should
now direct the IHS to develop an updated Priority List methodology that
accurately reflects current needs and allows for changed circumstances.
Finally, I would like to reiterate that should funds be made
available in any infrastructure initiative, a significant portion
should be distributed through the Area Distribution Fund authorized in
Section 301(f) of the Indian Health Care Improvement Act so that all
IHS areas can benefit. In 2009, Congress appropriated $227 million for
IHS facilities construction in the American Recovery and Reinvestment
Act of 2009, all of which went to only two projects on the Priority
List. If directing a significant portion of funding through the ADF is
not feasible, then the funding should instead be directed to IHS's
Maintenance and Improvements or Sanitation Facilities programs, which
do not utilize antiquated priority lists and would benefit a larger
number of tribes and regions.
Please feel free to contact me with any questions and thank you
again for holding this important hearing.
Sincerely,
Andy Joseph, Jr.,
Chair, Health and Human Services Committee
Colville Business Council
______
Mr. LaMalfa. Thank you, Chairman Joseph, for your
testimony. I appreciate it. Now we will be hearing from
Victoria Kitcheyan from the National Indian Health Board, who
is our Great Plains area representative. Thank you.
STATEMENT OF VICTORIA KITCHEYAN, GREAT PLAINS AREA
REPRESENTATIVE, NATIONAL INDIAN HEALTH BOARD, WASHINGTON, DC
Ms. Kitcheyan. Good morning, Chairman LaMalfa, Ranking
Member Torres, and members of the Subcommittee. On behalf of
the National Indian Health Board, thank you for allowing me
this opportunity to offer testimony on healthcare
infrastructure in Indian Country. My name is Victoria
Kitcheyan, and I am a member of the Winnebago Tribe of
Nebraska, where I also serve as Tribal Treasurer on the Tribal
Council.
As you are aware, Federal promises to improve Indian health
services were made long ago. Our people entered into treaties
with the Federal Government to provide health care in exchange
for tribal land and peace. Unfortunately, the Federal
Government has yet to live up to this trust responsibility. Our
people live sicker, they die younger, and most times
unnecessarily. On average, 4.5 years younger and, in some
states, 20 years.
While IHS is funded far below need, the infrastructure and
the facilities improvements are some of those most critical
needs in Indian Country. Indian Health Service is made up of 45
hospitals, 529 outpatient facilities, and, on average, these
facilities, as you mentioned, are 40 years old, four times that
of other healthcare facilities in the United States. And these
facilities are expensive, 26 percent more expensive to operate
than a 10-year facility. These facilities are not only
expensive, but have caused huge barriers to providing quality
patient care and improving the safety of our patients.
Improving healthcare facilities is essential for reducing
medical errors in facility-acquired infection rates, and
improving staff and operational efficiency. In fact, the poor
quality of some of these federally operated facilities have
been documented, and have led to direct threats to the patient
care. They have been documented by HHS Office of Inspector
General, Government Accountability Office, and, most recently,
the Centers for Medicare and Medicaid Services. They are
literally shutting hospitals down because of these
shortcomings.
As Congress considers investments in infrastructure, we
urge you to look to the Indian Health Service as a top
priority. From 2010 to 2016, the construction budget has been
about 76 million. And you mentioned if there was one built
today, it would be 400 years until that facility would be
considered for improvements.
So, currently, IHS uses its healthcare facility
construction appropriations to fund these grandfathered
projects. But even then, these 13 remaining projects on the
grandfathered list are estimated to cost $2.1 billion. Once
those 13 projects are funded, the remaining $8 billion of need
is funded on a revised priority list. As Congress looks to
improve infrastructure, it should turn to IHS and its list of
priorities in line for development. The need is there, we just
need the funding, and we would easily be able to expend that--
not ``we,'' IHS.
Congress should also consider major fiscal improvements and
maintenance of current facilities, which would greatly lead to
improved patient care. Investments in sanitation facilities for
tribal communities has also been a major direct correlation
with improving health outcomes for American Indians and Alaska
Natives. The current backlog for that is $2 billion.
The Committee should also consider investments in creating
staffing quarters. That has been identified as a barrier to
recruitment and retention in some of our most remote
reservations and healthcare facilities. We need the qualified
medical professionals to come to our communities and live
amongst our tribal members, and we lack the capability to offer
that housing.
In addition to basic infrastructure needs, it is critical
that Congress provide necessary resources for IHS to make
serious upgrades to the Health Information System. Failing to
do this puts patients at risk, and will leave IHS unequipped
for the 21st century healthcare environment. This includes
allocating $3.5 billion to replace the current Health
Information System and other investments to increase network
bandwidth. A robust telecommunications infrastructure is
critical to a modern healthcare delivery system.
The vast majority of IHS and tribally-operated facilities
are in rural areas lacking connectivity, and it is much slower
than urban settings. Capabilities such as telehealth, patient
access to records, and medical data and images are severely
hampered by the bandwidth insufficiency. Upgrading bandwidth is
extremely expensive, and often paid out of the health care's
already-underfunded operating budget.
Due to some of these constraints, IHS cannot take full
advantage of some of the technology, telehealth. And while some
areas have been successful in telehealth, it is not IHS-wide,
and the infrastructure is not there. It is our understanding
that the IHS estimates an operational enterprise telehealth
program could cost $75 million. These would have to be new
resources, as IHS does not have the ability to transfer funds
from one program to fund telehealth. But once these funds would
be made available, there would be great cost savings to the
agency.
The current IHS Health Information System is called the
Resource and Patient Management System, or RPMS, and it is a
comprehensive suite of applications supporting virtually all
clinical and business operations. There is limited funding
available to continue to upgrade and maintain this old system.
This old system is a ticking time bomb, and if we continue to
put Band-Aids on this, we are going to have a much greater
problem than if we were to modernize it.
We call on Congress to make these investments in Indian
Country, and to update RPMS, or completely replace it. Our
facilities can have a fully functioning health IT system, which
could lead to better health outcomes for Alaska Natives and
American Indians.
In conclusion, I would like to thank you for this attention
to these issues. I urge you to continue considering health
investments in any infrastructure plan, going forward. Failing
to make these improvements will result in continuing neglect of
the trust responsibility, and we thank you for your
consideration in this time, and we just look forward to
continuing this dialogue as we work toward better health
outcomes for all Native people.
[The prepared statement of Ms. Kitcheyan follows:]
Prepared Statement of Victoria Kitcheyan, Great Plains Area
Representative, National Indian Health Board, Washington, DC
Chairman LaMalfa, Ranking Member Torres, and members of the
Subcommittee, thank you for the opportunity to offer this testimony on
``Improving and Expanding Infrastructure in Tribal and Insular
Communities.'' On behalf of the National Indian Health Board (NIHB) and
the 567 tribal nations we serve, I submit this testimony on Fiscal Year
2018 budget for the Department of Health and Human Services (HHS).
The Federal promise to provide Indian health services was made long
ago. Since the earliest days of the Republic, all branches of the
Federal Government have acknowledged the Nation's obligations to the
tribes and the special trust relationship between the United States and
tribes. The United States assumed this responsibility through a series
of treaties with tribes, exchanging compensation and benefits for
tribal land and peace.\1\ In 2010, as part of the Indian Health Care
Improvement Act, Congress reaffirmed the duty of the Federal Government
to American Indians and Alaska Natives (AI/ANs), 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.'' \2\
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\1\ The Snyder Act of 1921 (25 U.S.C. 13) legislatively affirmed
this trust responsibility.
\2\ 25 U.S.C. 1602.
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Yet, when it comes to facilities and infrastructure in Indian
health, the Federal Government has not lived up to its responsibility.
The Indian Health Service (IHS) was founded in 1955 to help the Federal
Government fulfill the trust responsibility for health. As part of the
Indian health system, more than 650 IHS and tribal facilities operate
across the country to serve about 2.2 million AI/ANs.
Yet, Congress has never provided IHS with enough funding to meet
the needs of Indian Country, and the infrastructure budget is no
different. Federally operated IHS hospitals range in size from 4 to 133
beds and are open 24 hours a day for emergency care needs. IHS
facilities offer a range of care, including primary care services,
pharmacy, laboratory, and x-ray services. Therefore, IHS facilities
infrastructure is directly tied to improved quality of healthcare for
AI/ANs. With a life expectancy of 4.5 years less (and in some states
more than 20 years) AI/ANs continue to lag behind the rest of the
country when it comes to access to health services. It is clearly time
to do something about health facilities and infrastructure for Indian
Country.
The following testimony will focus on ways that Congress can
improve health in AI/AN communities through infrastructure
improvements. This includes not only construction and maintenance of
brick and mortar facilities but investments in the Health IT
infrastructure which will make meaningful progress toward improving
patient care, and health outcomes while serving the dual purpose of
providing Congress with more information about what care looks like at
IHS.
importance of strong infrastructure
The Indian Health Service health infrastructure is comprised of 45
hospitals (26 IHS operated, 19 tribal) and 529 outpatient facilities
(125 IHS operated, 411 tribal). At these facilities in 2016, there were
an estimated 39,300 inpatient admission as 13.7 million outpatient
visits.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Hospitals Health Centers Alaska Village Clinics Health Stations
--------------------------------------------------------------------------------------------------------------------------------------------------------
IHS............................................. 26 51 N/A 32
Tribal.......................................... 19 287 163 79
--------------------------------------------------------------------------------------------------------------------------------------------------------
On average, IHS hospitals are 40 years of age, which is almost four
times as old as other U.S. hospitals with an average age of 10.6
years.\3\ A 40-year-old facility is about 26 percent more expensive to
maintain than a 10-year facility. The facilities are grossly
undersized--about 52 percent of need--for the identified user
populations, which has created crowded, even unsafe, conditions among
staff, patients, and visitors. In many cases, the management of
existing facilities has relocated ancillary services outside the main
health facility; oftentimes to modular office units, to provide
additional space for primary healthcare services. Such displacement of
programs and services creates difficulties for staff and patients,
increases wait times, and create numerous inefficiencies within the
healthcare system. Furthermore, these aging facilities are largely
based on simplistic, and outdated design which makes it difficult for
the agency to deliver modern services.\4\ Improving healthcare
facilities is essential for:
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\3\ Almanac of hospital financial & operating indicators: a
comprehensive benchmark of the nation's hospitals (2015 ed., pp. 176-
179): https://aharesourcecenter.wordpress.com/2011/10/20/average-age-
of-plant-about-10-years/.
\4\ The 2016 Indian Health Service and Tribal Health Care
Facilities' Needs Assessment Report to Congress. Indian Health Service.
July 6, 2016. Accessed at https://www.ihs.gov/newsroom/includes/themes/
newihstheme/display_objects/documents/RepCong_2016/IHSRTC_on_Facilities
NeedsAssessmentReport.pdf on November 7, 2016, p. 12.
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Eliminating health disparities
Increasing access
Improving patient outcomes
Reducing operating and maintenance costs
Improving staff satisfaction, morale, recruitment and
retention
Reducing medical errors and facility-acquired infection
rates
Improving staff and operational efficiency
Increasing patient and staff safety
The absence of adequate facilities frequently results in either
treatment not being sought; or sought later, prompted by worsening
symptoms; and/or referral of patients to outside communities. This
significantly increases the cost of patient care and causes travel
hardships for many patients and their families. The amount of aging
infrastructure escalates maintenance and repair costs, risks code
noncompliance, lowers productivity, and compromises service delivery.
AI/AN populations have substantially increased in recent years
resulting in severely undersized facility capacity relative to the
larger actual population, especially the capacity to provide
contemporary levels of outpatient services. Consequently, the older
facility is incapable of handling the needed levels of services even if
staffing levels are adequate.
Over the last several years, investigators at the Centers for
Medicare and Medicaid Services (CMS) and the HHS Office of the
Inspector General (OIG) have cited outdated facilities as direct
threats to patient care. For example, in more than half of the
hospitals surveyed by the OIG in 2016, administrators reported that old
or inadequate physical environments challenged their ability to provide
quality care and maintain compliance'' with the Medicare Hospital
Conditions of Participation (CoPs).\5\ ``Further, according to
administrators at most IHS hospitals (22 of 28), maintaining aging
buildings and equipment is a major challenge because of limited
resources. In FY 2013, funding limitations for essential maintenance,
alterations, and repairs resulted in backlogs totaling approximately
$166 million.'' \6\ In fact, over one-third of all IHS hospitals'
deficiencies have been found to be related to facilities with some
failing on infection control criteria and others having malfunctioning
exit doors. Other facilities are just not designed to be hospitals, and
IHS has had to work around historical buildings which are not equipped
for a modern medical environment.\7\
---------------------------------------------------------------------------
\5\ Indian Health Service Hospitals: Longstanding Challenges
Warrant Focused Attention to Support Quality Care. Department of Health
and Human Services, Office of the Inspector General. October 2016. OEI-
06-14-00011.
\6\ Ibid, p. 14.
\7\ Ibid, 15.
For many AI/AN communities, these outdated and inefficient
facilities are the only option that patients have. Tribal communities
are often located in remote, rural locations, and patients do not have
access to other forms of health insurance to treat them elsewhere.
ihs facilities construction
From 2010 to 2016, IHS facilities infrastructure construction
budget has been about $76 million annually. At that rate, a new
facility built today would not be replaced for another 400 years! \8\
Currently, IHS uses its Health Care Facility Construction (HCFC)
appropriations to fund projects off the ``grandfathered'' HCFC priority
list until it is fully funded. This priority system was developed in
the late 1980s at the direction of Congress. The original priority list
was developed in the early 1990s with 27 projects on the list. There
are 13 remaining projects on this ``grandfathered'' list which is
currently estimated to cost $2.1 billion. Once those 13 projects are
funded, the remaining $8 billion can be funded with a revised priority
system that will periodically generate updated lists.
---------------------------------------------------------------------------
\8\ ``Federal Indian Trust Responsibility: The Quest for Equitable
and Quality Indian Healthcare--The National Tribal Budget Formulation
Workgroup's Recommendations on the Indian Health Service Fiscal Year
2018 Budget.'' June 2016. P. 64.
The appropriations provided to Congress are the primary source for
new or replacement healthcare facilities. Because of the shortage of
appropriations, IHS funds multiple projects over several fiscal years
which allows projects to move forward simultaneously and helps
distribute the funds geographically benefiting more than one service
area. Importantly, the IHS development process ensures that the newly
designed facilities are culturally appropriate, and are done in
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consultation with the tribes they serve.
As Congress looks to create infrastructure investments, it should
turn to IHS which has a list of projects in line for development. The
need is there, and IHS could easily be ready to expend these funds if
they were to be available. We request that IHS construction projects be
given priority in any infrastructure investments, as these projects are
directly correlated with safer patient care, meaning improved health
outcomes for AI/ANs, even saved lives.
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
maintenance and improvement
As noted above, deteriorating maintenance of facilities in the IHS
system poses a huge challenge for health administrators. Maintenance is
necessary to comply with hospitals and facility accreditation standards
and meet basic safety codes, but since 2011, the agency has not
received enough appropriations to keep up with need resulting in a $500
million backlog that will only increase the longer it is not addressed.
By 2015, appropriations were only about 80 percent sufficient to cover
the costs. Currently, Maintenance and Improvement is funded at $73.6
million.
According to OIG, some facilities have been cited for sewage
leaking into an operating room and equipment that is no longer suited
for a modern medical environment.\9\ America is too great a nation to
allow health facilities to languish in this condition. Congress must
invest in keeping up with aging IHS facilities to ensure that our
patients have basic, and safe delivery services.
---------------------------------------------------------------------------
\9\ Indian Health Service Hospitals: Longstanding Challenges
Warrant Focused Attention to Support Quality Care. Department of Health
and Human Services, Office of the Inspector General. October 2016. OEI-
06-14-00011, p. 14-15.
---------------------------------------------------------------------------
equipment
Hand in hand with deferred construction and maintenance is the
aging equipment at IHS health facilities. Up-to-date equipment is
necessary to ensure effective mental diagnosis, treatment and for
recruiting medical staff. Medical and laboratory equipment has a useful
life of 6 years, but in IHS facilities it is used twice as long.\10\
However, aging or outdated equipment plagues facilities throughout the
IHS. In November 2015, for example, CMS surveyed the Rosebud Indian
Hospital located in the Great Plains Region of the IHS. Among the many
findings in their report, they found that the sterilization machine had
been broken and medical staff were washing surgical instruments by
hand; an exam table had exposed foam rendering it unable to be
sanitized; and that dental x-ray equipment had not been installed for
several years because of inadequate wiring.
---------------------------------------------------------------------------
\10\ ``The 2016 Indian Health Service and Tribal Health Care
Facilities' Needs Assessment Report to Congress,'' p. 10.
---------------------------------------------------------------------------
Again, critical investments in equipment for IHS are critical to
ensuring patient safety and ensuring that IHS can function as a 21st
century healthcare delivery system.
sanitation facilities and construction
Since 1959, IHS has used Sanitation Facilities Construction to as
an ``integral component of IHS disease prevention activities'' which
has decreased mortality rates from environmentally related diseases by
80 percent since 1973.\11\ ``However, as of the end of FY 2015 about
24,200, or 6 percent of all AI/AN homes were without access to adequate
sanitation facilities; and, about 188,228 or approximately 47 percent
of AI/AN homes were in need of some form of sanitation facilities
improvements.'' \12\
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\11\ IHS FY 2017 Congressional Budget Justification, CJ 168.
\12\ Ibid, CJ 169.
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Currently, IHS estimates the backlog for sanitation facilities at
$2.5 billion. IHS maintains a priority system for construction projects
known as the Sanitation Deficiency System (SDS). Project selection is
driven by objective evaluation criteria including health impact,
existing deficiency level, adequacy of previous service, capital cost,
local tribal priority, operations and maintenance capacity of the
receiving entity, availability of contributions from non-IHS sources,
and other conditions that are locally determined. Congress should also
make considerable investments in sanitation infrastructure to ensure
that the health of AI/ANs is not jeopardized by substandard sanitation
facilities.
housing for medical professionals
As a rural healthcare provider, IHS currently has over 1,550
vacancies for medical staff across the system, which impacts the direct
delivery of healthcare. IHS has many challenges to recruit and retain
medical professionals including competition from other providers; lack
of opportunities for families in rural areas; and a low number of AI/
ANs going to medical school. However, we have long heard from
healthcare professionals on isolated reservations that a lack of
housing and quality education are barriers to long-term tenure at
Indian health facilities. To rectify this, there will need to be
further collaboration among the tribes, government agencies such as HHS
and the U.S. Department of Housing and Urban Development (HUD), and
Congress to make investments in housing so that people working in IHS
facilities have adequate living quarters available. It is also critical
to provide support for schools so that the families of medical
providers will have access to adequate educational opportunities.
Congress should provide a separate stream of funding as part of
infrastructure reform to make major investments in staff quarters on
tribal lands for not only medical staff but other professionals like
teachers as well.
health it
In addition to basic infrastructure needs, it is critical that
Congress provide resources necessary for the IHS and other Federal
health providers like the Department of Defense (DoD) and Veterans'
Administration (VA) to make serious upgrades to their health
information technology system. Failure to do puts patients at risk and
will leave IHS behind unequipped for the 21st century healthcare
environment. When investing in infrastructure projects, Congress should
prioritize Health IT needs for health facilities in Indian Country.
This includes allocating $3.5 billion to replace the current Health
Information System, and other investments to increase network
bandwidth.
The biggest barrier to achieving this has been the lack of
dedicated and sustainable funding to adequately support health
information technology infrastructure, including full deployment and
support for Electronic Health Record (EHR). Resources, including
workforce and training, have been inadequate to sustain clinical
quality data and business applications necessary to provide safe
quality health services to the 2.2 million AI/ANs. The IHS/Tribal/Urban
health delivery system represents some of the most remote locations in
the United States and many reservations and villages are further
isolated by lack of roads and public utilities.
Telecommunications Infrastructure
A robust telecommunications infrastructure is critical to a modern
healthcare delivery system, not just for providers but for patients and
their families as well. The vast majority of IHS and tribal healthcare
facilities are in rural locations with connectivity that is much slower
and less reliable than that available in urban settings. Capabilities
such as telehealth, patient access to records, staff and patient
education, clinical decision support, and transmission of medical data
and images, are severely hampered by bandwidth insufficiency. Upgrading
bandwidth can be extremely costly and often must be paid from the
facility's health care operations budget. In some cases, local
telecommunications providers are simply unable to provide the upgrades
needed for the healthcare facilities. An unacceptable proportion of
network IT equipment at IHS facilities has exceeded reliable operating
life span and vendor support, but insufficient funds exist to upgrade
this equipment.
Network bandwidth is a key requirement to successfully provide
healthcare services. Many IHS sites are experiencing challenges to fund
the cost of the necessary bandwidth upgrades to make telehealth
services successful. Approximately 75 percent of IHS sites are located
in areas defined as `rural' by the Federal Communications Commission
(FCC). These rural sites pay a higher percentage of their operating
budget than urban locations on monthly circuit costs. When bandwidth
upgrades are required, rural IHS sites are frequently asked to fund the
capital costs of these upgrades. These projects can range from tens of
thousands to over a million dollars in cost, and can take years to
complete. In some cases, telecommunication providers are not able to
offer any upgrade options for IHS locations.
At rural IHS sites, circuit outages and restoration times are above
industry averages, due to outdated equipment and small regional
telecommunication providers covering large geographical areas with long
travel times and limited staff. This creates challenges and risks in
relying on network connectivity to provide clinical services. During
2016, IHS upgraded network bandwidth at over 50 locations. Furthermore,
IHS is moving away from slow speed circuits such as T1 lines (1.5
Mbits) to Ethernet circuits which offer bandwidth in the 10 to 100
Mbits range. To help fund the monthly recurring circuit costs
associated with these upgrades, IHS is increasingly leveraging the
financial support provided by the Healthcare Connect Fund (HCF). The
HCF is an FCC program to provide rural healthcare providers with
financial support for bandwidth charges.
However, large numbers of IHS facilities do not currently have
sufficient bandwidth to offer telehealth and related services.
Approximately 50 percent of the IHS sites are still depending on
circuit connections based on one or two T1 lines (3 Mbits). Their
circuits are constantly saturated with staff experiencing slow response
times when using traditional IT applications. The addition of
telehealth and mobile health services is not an option at these
locations. Services like this are critical in rural communities where
recruitment and retention of medical professionals is continually a
challenge.
Telehealth
The successful utilization of a variety of telehealth technologies
and services in Indian Country is well documented. However, these
successes were achieved on a largely regional basis, driven by
visionary leaders, with various and not reliably sustainable funding
sources. The IHS has not yet been resourced to establish either a
sustainable telehealth infrastructure or governance program that would
prioritize resources in accordance with identified need, establish and
promote best practices, and formally evaluate and report on successes
and issues. The IHS recently awarded a large contract for tele-
emergency and other specialty telehealth services in the Great Plains
Area, but the costs for this have been imposed on already underfunded
Service Units, and again without any program structure that will ensure
success and apply lessons learned to future telehealth initiatives.
While we applaud this necessary investment to address urgent quality of
care issues brought through congressional oversight, we must urge that
equal investments be made in the rest of Indian Country who suffer
similar issues of poorly resourced facilities and lack of capacity to
bring up standards of care to minimal level of safety, much less to
meet national accreditation standards.
It is our understanding that the IHS estimates a fully operational
enterprise telehealth program could be supported at a cost of $75
million annually. These would have to be new resources, as the agency
has no capacity to transfer dollars from other programs to support
telehealth. Operational costs would be augmented by third party
revenues generated from telehealth encounters, but these revenues will
not be sufficient to enable the telehealth program to exist without
additional appropriations.
Biomedical Equipment
As noted above, medical equipment at IHS facilities is far older
than the average for the rest of the country. The current inventory of
biomedical equipment at IHS facilities is valued at approximately $500
million. This does not include equipment located at tribally-operated
facilities, which are far more numerous. According to the American
Hospital Association, medical equipment has a typical life span of 5 to
6 years. This means that the IHS should budget $90 million annually for
biomedical equipment upgrades and replacement at Federal facilities.
However, for most of the past decade and more, the IHS has funded only
about a quarter of the level of need. This limited funding has only
been able to replace the very oldest equipment. As a result, most IHS
facilities continue to use outdated health technology with unacceptable
probability for failure and consequent risks to patient safety.
With the evolving state-of-the-art in biomedical technology, the
majority of medical devices are embedded with microprocessors that
connect to the hospital or clinic network via Bluetooth, wireless or
Ethernet connections. The cybersecurity risks these devices pose both
to the facility and the connected enterprise are substantial.
Government organizations including the IHS are obligated to ensure
compliance with applicable statutes and regulations (Clinger-Cohen,
FISMA, FITARA, etc.) in order to minimize these risks. The Congress
must take this additional layer of acquisition planning and governance
into consideration with all funding decisions.
Health Information Systems
The information systems that support quality healthcare delivery
are critical elements of the operational infrastructure of hospitals
and clinics. The current IHS health information system is called the
Resource and Patient Management System (RPMS), and is a comprehensive
suite of applications that supports virtually all clinical and business
operations at IHS and most tribal facilities, from patient registration
to billing. The IHS remains the only Federal agency to have
successfully certified its electronic health record (EHR) product
according to criteria published by the Office of the National
Coordinator for Health Information Technology (ONC).
The explosion of Health Information Technology (HIT) capabilities
in recent years, driven in large part by Federal regulation, has caused
the IHS health information system to outgrow the agency's capacity to
maintain, support and enhance it. The IHS was fortunate to receive
Recovery Act dollars and benefit from incentives available through the
HITECH Act, and used these dollars to grow RPMS in response to the new
regulatory requirements. However, those funds are no longer available,
and no new funds have been appropriated to support operations and
maintenance for the certified RPMS suite. This has resulted in a mass
exodus of Self Governance Tribes who have opted to withdraw their IT
shares to seek other commercial HIT solutions which promise to more
readily address their needs; and, in fact, this has caused a domino
effect in that the IHS agency technology budget is decreasing more
rapidly because of the withdrawal of these IT shares. For example, one
large tribe recently withdrew its shares, resulting in a -$2.5 million
impact (-3.7 percent) on the Headquarters IT budget. This is a
harbinger of the vicious cycle that will result if the IHS cannot
sustain the RPMS and related systems. Tribal programs, concluding that
IHS solutions no longer support the best quality of care and patient
safety, will be forced to adopt commercial solutions at considerable
expense. They should not have to do this because HIT is among the
programs and services that the Federal Government has historically
provided for the tribes. But, without a realistic investment in RPMS,
they will have no choice if they are to fulfill their responsibilities
to their people, and the resulting diminution of resources retained
with the IHS will further injure both the direct service tribes and
those self-governance tribes continuing to rely on IHS HIT.
There is no question that the IHS electronic health record and
other health information systems need to be further modernized to build
on the growth in recent years. The agency just awarded a new
development contract that, if sufficiently funded going forward, will
go far in addressing this need, and will enhance the RPMS as a public
utility that serves both Indian Country and any other healthcare entity
that chooses to adopt it. Failure to sufficiently fund RPMS
modernization by at least doubling the IHS HIT budget, will not only
hasten but ensure the collapse of the HIT infrastructure in Indian
Country.
If the joint tribal-IHS decision is for replacement of RPMS as the
IT-solution, there is an urgency to expedite the decision-making
process to allow time to acquire the software and ensure a smooth
transition. It will take a minimum of a year to select a replacement
and a couple of years beyond that for a complete transition to be
planned and implemented. The operating system that RPMS currently runs
on is a ticking time bomb, and needs immediate investment to modernize
it. Microsoft is expected to put it on an end of life schedule in the
near future. Its predecessor, Server 2008, which was released a year
prior to 2008 R2 has already been put on an end of life schedule. This
creates urgency for strategic decisions which must be made now.
To further illustrate the urgency to act now, there is a cautionary
tale of a medium-sized city that similarly failed to upgrade their
enterprise software. Opting instead to forgo their annual maintenance,
they supported the application in house. When Microsoft ended support
for Windows XP, the enterprise software needed to be upgraded. The
resulting replacement budget cost the city approximately $45 million.
In contrast, the maintenance contract that would have allowed the city
to keep up with upgrades only cost $750,000. There's a real lesson to
be gathered here about not forgoing maintenance and acting with a sense
of urgency in imperative for cost controls. We are quickly moving past
the point of no return.
Some may be tempted to quickly suggest that the best answer is to
that IHS should follow the lead of the Department of Defense (and
possibly the Department of Veterans Affairs at some point) in adopting
commercial HIT solutions. It is critical to understand that, while this
might be a desirable and perceived easy solution, such an approach is
not possible without a massive allocation of new funding. The IHS
estimates that it could cost up to $3.5 billion, over 2-3 years to
transition the agency from RPMS to a full commercial suite of
comparable capability (the entire annual budget of the IHS is under $5
billion). As Congress invests in infrastructure improvements it should
certainly include the replacement of RPMS as one of the top priorities
by adding supplemental appropriations of $3.5 billion to purchase or
develop a new HIT system for the I/T/U system. Any such investment must
be preceded and informed by an independent expert and thorough analysis
of alternatives, with full consultation and collaboration by the
tribes.
conclusion
Clearly the needs for improved facilities maintenance and
construction across the Indian Health System is a critical need.
Facilities improvements are critical to ensuring that the health of
American Indians and Alaska Natives is able to reach the highest
possible levels. For too long, appropriations have not met up with the
demand for improved IHS facilities, which in some cases are among the
most outdated in the United States. As Congress considers
infrastructure improvements it should ensure that Indian health
receives critical investments. IHS already maintains a priority list of
projects ready for funding so actual construction would be able to
begin in a relatively expedient manner. Furthermore, investments in
staff housing will have major impacts for Indian Country who are trying
to attract needed health and other professionals.
Additionally, in order for the I/T/U system to function in the 21st
century, it is essential that major investments are made in the Health
IT infrastructure in order to ensure that I/T/U facilities are safe and
efficient places to receive care. This means, a major financial
investment to improve HIT also network improvements. Because IHS
provides services in mainly rural and remote areas, there is much to be
gained by embracing new methods of care like telehealth. But there are
few areas where this capability is possible due to network constraints
and a lack of IHS-wide infrastructure to support such a program.
Congress should not hesitate to supplement additional funding to make
these needed upgrades so the health of AI/ANs can improve.
______
Mr. LaMalfa. Thank you, Ms. Kitcheyan. We appreciate your
testimony today.
The next witness will be the Honorable Aaron Payment from
the National Congress of American Indians. Welcome. Good to see
you.
STATEMENT OF AARON PAYMENT, SECRETARY, NATIONAL CONGRESS OF
AMERICAN INDIANS, WASHINGTON, DC
Mr. Payment. Good morning, Chairman LaMalfa; Ranking Member
Torres; my Congressman, Jack Bergman; and members of the
Committee. My name is Aaron Payment. I am the Secretary for the
National Congress of American Indians (NCAI), and also
Chairperson for the Sault Ste. Marie Tribe of Chippewa Indians.
Thank you for holding this very important hearing on improving
and expanding infrastructure in Indian Country.
NCAI is encouraged by the conversations that have been
occurring in Congress and the Administration focusing on
comprehensive infrastructural planning. That this Committee has
chosen to focus on tribal infrastructure for your first hearing
is heartening, thank you. In order for a national
infrastructure investment plan to be truly comprehensive and
transformative, it must include Indian Country.
For Indian tribes across the country, there is no more
important issue than providing for our tribal citizens and our
communities. To do so, tribal governments require investment in
infrastructure, which will not only provide for the basic
services to our citizens, but also spur long-term economic
opportunities which benefit surrounding communities.
The infrastructural needs in Indian Country are long-
standing and result from sustained under-investment for
decades. In 2009, a Senate letter to the Administration
estimated $50 billion in unmet need for infrastructure on
Indian reservations. When you consider our greatest
infrastructure needs are related to healthcare facilities,
school construction and maintenance, roads, broadband, water
and sanitation facilities, and housing, it becomes clear that
lack of adequate infrastructure has a significant impact on the
social, physical, and mental well-being of tribal communities.
Unmet infrastructure needs also impact job opportunities on
and near tribal lands, which has the potential to benefit our
neighbors. The lack of economic development and job
opportunities in Indian Country is evident in places where key
infrastructure, such as roads, water access, and broadband is
under-developed or in disrepair.
If there is one benefit to a long history of unmet needs,
it is that Federal agencies have a record of these needs in
Indian Country. And, while not ideal, there are systems in
place for addressing the backlogs. While there is little
agreement on how to prioritize funding, in most cases existing
travel programs provide an efficient system to distribute
infrastructural investments. This is especially true for
housing and transportation-related programs.
Other programs, such as construction of health facilities
or schools, have priority lists developed through agency
mechanisms designed to address the needs of those facilities in
most need of construction or repair. A sustained and targeted
funding investment by Congress is required to have the
significant and long-term lasting impact on the existing
infrastructure backlog. Funding should be supplemented by
mechanisms that encourage government parity and self-
determination.
NCAI urges the Committee to look at ways to streamline the
regulatory process and modernize outdated regulations and
statutes to provide tribes with flexibility and greater control
over decision-making; government parity to ensure that tribal
governments are offered the same opportunities as states and
local governments; opportunities where tribes can collaborate
with local governments and private and industry partners to
develop solutions to infrastructural needs; and coordination
and collaboration when multiple Federal agencies are involved
in projects, due to the nature of the Federal relationship with
tribal governments.
In addition to requesting direct and proportional funding
for tribal governments in the infrastructural package, we urge
you to ensure that tribes are able to fully participate in any
funding that may be derived from tax incentives. This includes
direct access to Federal tax credit programs, such as the new
markets and low-income housing tax-credit programs, as well as
tax-exempt bond authority. These incentives would also help
encourage public-private partnerships in Indian Country.
As Congress and the Administration consider large-scale
infrastructure projects across the United States, tribal lands
and natural resources will inevitably be impacted. It is
imperative that tribes are a part of the planning process when
developments occur on or near reservations, ancestral, or
sacred lands.
NCAI advocates for inclusion of tribal nations from the
earliest stages of decision-making and permitting. Tribal
governments seek economic development opportunities and
recognize that infrastructure projects benefit both tribal and
neighboring communities. Early consultation and informed prior
consent with respect to deference to the Federal trust
obligations can ensure that projects meet the needs of all
parties, and can proceed in a timely and efficient manner.
In closing, I want to thank you again for holding this
important hearing to make sure that Indian Country priorities
are included in the infrastructural package. To aid in your
work, I request that NCAI's tribal infrastructure report, this
comprehensive report, be included for the record of this
hearing, and I am happy to answer any questions that you may
have.
And NCAI stands ready to help as a resource, going forward,
with your continuing work to identify infrastructure needs in
Indian Country. Thank you.
Mr. LaMalfa. Thank you. That will be admitted, without
objection.
[The prepared statement of Mr. Payment follows:]
Prepared Statement of the National Congress of American Indians
On behalf of the National Congress of American Indians (NCAI),
thank you to the opportunity to provide testimony on ``Improving and
Expanding Infrastructure in Tribal and Insular Communities.'' NCAI is
the oldest and largest national tribal organization in the United
States that is dedicated to protecting the rights of tribal governments
to achieve self-determination and self-sufficiency. As such NCAI looks
forward to working with Chairman LaMalfa, Ranking Member Torres and
members of this Committee to address the infrastructure needs of Indian
Country, and we look forward to working with you to address tribal
policy in the 115th Congress.
There is growing support to address the vast infrastructure needs
in the United States, and it is vital that tribes are part of any
infrastructure plan that is proposed by Congress of the Administration.
NCAI has prepared a report detailing many of the infrastructure needs
of Indian Country, ``Tribal Infrastructure--Investing in Indian Country
for a Stronger America.'' This report (attached) is intended as a
resource to Congress and the Administration as the Federal Government
undertakes legislation to address the infrastructure needs in Indian
Country.
For Indian tribes across the country, there is no more important
issue than providing for tribal citizens and tribal communities. To do
that, tribal governments require investment in infrastructure which
will not only provide the basic services to tribal citizens, such as
water, housing, safe roads, healthcare facilities and schools, but also
the opportunity to attract jobs and economic development on tribal
lands. Indian Country is poised to partner with the Federal Government
on any legislative or administrative efforts and seeks to do so as a
governmental partner, keeping in mind the following:
Tribal Nations are governments: As recognized by the U.S.
Constitution, Tribal Nations are part of the original American family
of governments, possessing a legal and political status equivalent to
that of state governments and foreign nations. Today, the inherent
sovereignty of Tribal Nations is exercised by 21st century tribal
governments that are full-fledged governments in every sense of the
word. They are determining their own citizenship, establishing and
enforcing criminal and civil laws on their lands, administering
justice, taxing, licensing, and regulating, among many other functions.
They are providing a wide range of governmental services, from
education to healthcare to environmental protection. Like other
governments, tribal governments recognize and accept the fundamental
responsibilities of governance--with building and maintaining the vital
infrastructure upon which their constituents rely among the most
critical responsibilities. As governments, Tribal Nations need and
deserve to be at the decision-making table when it comes to developing
and implementing an infrastructure investment plan for the Nation. They
deserve to be at the table because they have the capacity, experience,
and know-how to craft, inform, and execute solutions to the
infrastructure challenges facing their communities and those of their
neighbors.
Indian Country's infrastructure needs are acute and long-standing:
The infrastructure crisis facing Indian Country is not a recent
phenomenon. For generations, the Federal Government--despite abiding
trust and treaty obligations--has substantially under-invested in
Indian Country's infrastructure, evident in the breadth and severity of
its unmet infrastructure needs as compared to the rest of the Nation
(see the following sections for details). In 2009, as one indication, a
contingent of U.S. Senators penned a letter to the Administration
citing a $50 billion unmet need for infrastructure on Indian
reservations. The number of ``shovel ready'' infrastructure projects in
Indian Country remains too many to count, and many of those have been
that way for years if not decades. This chronic underinvestment and the
growing backlog of critical infrastructure projects not only negatively
impacts the social, physical, and mental well-being of tribal and
neighboring communities, it hampers the ability of Tribal Nations to
fully leverage their economic potential and the ability of their
citizens to fully participate in the American economy. The more than $3
billion in funding designated for Indian Country by the American
Recovery and Reinvestment Act supported important first steps in
addressing Tribal Nations' needs for justice infrastructure, health
facilities, roads projects, water systems development, and other vital
infrastructure projects, but collectively they amounted to a ``drop in
the bucket'' of what it will take to energize self-determined,
sustainable community development and economic opportunity in tribal
communities.
Tribal governments prove that local decision making and solutions
work best: An extensive body of research built over the past three
decades concludes that tribal self-determination/self-governance is a
successful policy which allows tribes the ability to meet the needs of
tribal citizens through local decision making. Tribal governments know
best the nature and intricacies of the particular challenges their
communities face, and are best-positioned and best-equipped to make
innovative decisions that address the needs of tribal communities. As
President Ronald Reagan astutely recognized in 1988, ``Tribes need the
freedom to spend the money available to them, to create a better
quality of life and meet their needs as they define them. Tribes must
make those decisions, not the Federal Government.'' Tribal governments
also boast a growing track record of partnering with other surrounding
governments (state, county, municipal) to construct and enact solutions
aimed at addressing shared community challenges, from healthcare to law
enforcement to public transit.
Much of Indian Country is an integral part of rural America: Rural
America faces its own distinct and often daunting infrastructure
challenges--from existing infrastructure (telecommunications,
transportation, water and energy infrastructure, etc.) that has long
since fallen into disrepair to the pressing need to develop the tech-
driven infrastructure necessary to make rural areas economically viable
now and in the future. Compounding these challenges are the high costs
of addressing them as compared to more densely populated areas. What's
more, the vast majority of this country's land area (72 percent) is
rural. Meanwhile, Indian lands--totaling more than 100 million acres
spread across 34 states--are predominantly rural, inextricably linking
the state and fate of Indian Country's infrastructure with that of the
rest of rural America. For any infrastructure investment plan to be
truly national, it will need to assess and account for the particular
and often shared infrastructure needs of rural communities--both Native
and non-Native. It must also draw on the innovative infrastructure
development fixes that tribal and other governments that serve rural
geographies together have forged--including the growing number
involving intergovernmental and public-private partnerships--for they
offer important lessons for how to undertake such development
elsewhere.
Tribal Nations have proven success in innovative solutions to
infrastructure needs: In the 1960s, rural Neshoba County in
Mississippi--home to the Mississippi Band of Choctaw Indians--was one
of the most economically impoverished areas in the United States. The
infrastructure was undeveloped with most houses in substandard
condition, 9 in 10 had no indoor plumbing, and a third had no
electricity. Seeking to uplift its community, the Band embarked on
creating a diversified, sustainable economy, appropriately targeting
the strategic building of its physical infrastructure as a critical
first order of business. Fifty years later, the Band has not only
transformed its reservation's quality of life, it has become a major
economic engine in its part of the state, employing thousands of
Natives and non-Natives through its suite of Band-owned enterprises. A
growing number of other Tribal Nations are authoring equally impressive
stories of community revitalization and local and regional economic
success empowered by strategic investments in infrastructure
development. From the Citizen Potawatomi Nation's Iron Horse Industrial
Park to the Tulalip Tribes' state-of-the-art waste water treatment
facility to Ohkay Owingeh's Tsigo Bugeh Village, Tribal Nations across
the country are turning tribal, Federal and other investments in their
infrastructure into lasting economic and social benefits for Native
people and other local residents who rely on said infrastructure to
support a good quality of life.
However, there still remains great need for infrastructure
investment in Indian Country. The following chart estimates unmet needs
for some of the major infrastructure projects in Indian Country along
with details regarding each of these programs:
Estimates of Unmet Needs for Infrastructure in Indian Country
------------------------------------------------------------------------
Construction Deferred
In Billions of Dollars Backlogs Maintenance
------------------------------------------------------------------------
IHS Health Care Facilities, New and 10.3
Replacement Cost.......................
IHS Sanitation Facilities Construction 2.5
backlog................................
IHS Maintenance & Improvement deferred 0.5
maintenance backlog....................
IHS Workforce Staff Quarters, new and 0.4409
replacement units......................
BIE to replace or rehabilitate the 68 1.3
worst schools..........................
BIE Deferred Maintenance Backlog........ 0.3889
BIA Safety of Dams Deferred Maintenance. 0.556
BIA Irrigation Program--Rehabilitation 0.567
Deferred Maintenance...................
BIA Roads Maintenance Deferred 0.289
Maintenance Backlog....................
Indian Housing, additional 68,000 33
housing units..........................
Construction of Tribal Multi-Justice 0.21189
Centers and Detention Facilities.......
-------------------------------
Total................................. 47.8 2.3
------------------------------------------------------------------------
Indian Health Service Health Care Facilities, New and Replacement Cost:
$10.3 billion
Estimated costs to construct the needed additional 18
million ft2 of new and replacement space totaled
$10.3 billion in 2016.
Existing space in IHS facilities (14 million
ft2) is substantially less than required (27
million ft2) for the 2015 AI/AN user-population.
Insufficient capacity and resources severely restrict
healthcare services that can be provided. An additional 4.7
million ft2 is becoming outdated and should be
replaced. Unless these needs are addressed, the growing AI/
AN population and gradual deterioration of older space will
further expand the need.
At the existing replacement rate, a new 2016 facility
would not be replaced for 400 years.
Of the U.S. annual health expenditures, about 5 percent
are investments in healthcare facility construction. In
2013, $118 billion investment in healthcare facility
construction equaled about $374 per capita. IHS healthcare
facility construction appropriation of $77 million is about
$35 per AI/AN. Thus the U.S. per capita annual investment
in healthcare facility construction is over 10 times the
amount for IHS healthcare facility construction per capita.
Sanitation Facilities Construction backlog: over $2.5 billion
A recent cost benefit analysis indicated that, for every
dollar IHS spends on sanitation facilities to serve
eligible existing homes, at least a 20-fold return in
health benefits is achieved.
Projects are cooperatively developed and transferred to
tribes who assume responsibility for the operation of safe
water, wastewater, and solid waste systems, and related
support facilities. The SFC program receives funds for
three types of projects:
-- Water, Wastewater, and Solid Waste facilities for
Existing Homes and/or Communities,
-- Water, Wastewater, and Solid Waste facilities for New
Homes and/or New Communities, and
-- Special or Emergency projects. The sanitation project
need is almost $2.5 billion, including almost 14,000 AI/AN
homes without potable water.
With inflation, new environmental requirements, and
population growth, the current sanitation appropriations
are not reducing the backlog.
IHS Maintenance and Improvement deferred maintenance, alteration and
repair backlog: $500 million
In 2015, the maintenance budget ($53.6 million) was
sufficient to cover only 77 percent of maintenance needs
arising annually even with deferring needed improvements to
outdated space. The reported backlog of deferred
maintenance, alteration and repair as of the end of year
2015 was approaching $500 million.
IHS Workforce Staff Quarters: $440.9 million needed for new and
replacement units
Staff Quarters unmet need at existing healthcare sites is
$440.9 million. 1100 units are needed to staff IHS and
tribal healthcare facilities (recruit and retain health
professionals).
Bureau of Indian Education
Need: $1.3 billion to replace or rehabilitate the 68 worst schools
BIE Deferred Maintenance Backlog: $388.9 million
The 2010 estimate for upgrading BIE schools in poor
condition to satisfactory condition was $1.3 billion.
At the end of FY 2015, BIA has 82 schools in ``good''
condition, 46 in ``fair'' condition and 55 in ``poor''
condition with an overall average of building conditions at
``fair'' as measured by the Facilities Condition Index.
This means the majority of BIE schools (approximately 55
percent) are in either poor or fair condition.
BIA Safety of Dams
Deferred Maintenance: $556 million
The Bureau of Indian Affairs (BIA) currently lists 31
high- or significant-hazard dams; fund the High-Hazard
Indian Dam Safety Deferred Maintenance Fund authorized at
$22.75 million annually for FY 2017-2023; fund the Low-
Hazard Indian Dam Safety Deferred Maintenance Fund
authorized at $10 million annually for fiscal year 2017-
2023.
BIA Irrigation Program--Rehabilitation
Deferred Maintenance: $576 million
The BIA Irrigation Program provides irrigation water to 17
projects spanning over 780,000 acres. Among other things,
this water helps with the production of over $300 million a
year in gross crop revenues. However, most of these
projects are nearly 100 years old, reached or exceeded
their useful life span, were never fully completed, and/or
have extreme deferred maintenance.
BIA Roads Maintenance Deferred Maintenance Backlog: $289 million*
*Not including tribal roads
The BIA has maintenance responsibility for approximately
29,000 miles of roads and 900+ bridges. The road mileage
consists of 7,150 miles of paved, 4,720 miles of gravel,
and 17,130 miles of unimproved and earth surface roads. The
total public road network serving Indian Country is
140,000+ miles according to the National Tribal
Transportation Facility Inventory. The Office of Indian
Services Division of Transportation in Washington, DC
provides oversight and distribution for the annual
maintenance program.
Indian Housing Block Grant needs additional 68,000 housing units
(cost): $33 billion
A recent report stated it would take approximately 33,000
new units to alleviate overcrowding and additional 35,000
to replace existing housing units which are in grave
condition. To meet the total need of approximately 68,000
housing units (new and replacement), with the average
development cost of a three-bedroom home, the total cost is
in excess of $33 billion.
Construction of Tribal Multi-Justice Centers and Detention Facilities
Unmet Need: $211,898,628 (as of FY 2011)
Prioritization of Infrastructure Projects: As is detailed above,
the need for infrastructure development in Indian Country is great. The
lack of sufficient funding has created backlogs that in many cases will
take decades or longer to clear. The existing process Priority In many
cases, existing processes at the Federal agencies determine how
projects are prioritized especially in the case of schools, and health
clinics.
How IHS Uses and Distributes Health Care Facilities Construction
(HCFC) Funds. In the late 1980s Congress directed IHS to develop the
HCFC priority system. The system was implemented in the early 1990s
with 27 projects on the initial list. Most projects are major capital
investments exceeding annual HCFC funding resulting in projects being
funded over several fiscal years. Projects are funded in phases
according to acquisition, engineering, and project management
requirements. Portions or phases of several projects are funded during
a given fiscal year. This allows several projects to move forward
simultaneously and helps distribute the funds geographically benefiting
more than one Area.
There are separate lists for facility types, for instance,
Inpatient, Outpatient, Youth Regional Treatment Facilities or Staff
Housing. Budget documents identify the specific projects off the
grandfathered HCFC List, the phases and the estimated costs for that
fiscal year. There are 13 remaining facility projects on the
``grandfathered Priority List'' with a current estimated completion
cost of $2.1 billion. Once those 13 projects are funded, the remaining
$8 billion can be funded with a revised priority system that will
periodically generate updated lists.
The current ``Grandfathered'' HCFC Priority List consists of the
following sites:
Gila River PIMC SE ACC, AZ
Salt River PIMC NE ACC
PIMC Central Hospital & ACC
Whiteriver, AZ
Gallup, NM
Ft. Yuma, AZ
Rapid City, SD
Winslow-Dilkon, AZ
Alamo Navajo, NM
Pueblo Pintado, NM
Bodaway Gap, AZ
Albuquerque West
Albuquerque Central
Sells, AZ
Bureau of Indian Education Construction List. The BIA Education
Construction Program reconstructs and rehabilitates BIE schools and
dormitories. There are 183 BIE schools and dormitories in 23 states,
and serve approximately 48,000 students from K through 12th grade. In
addition, BIE owns and operates two post-secondary institutions. The
Facilities Condition Index is a system used by the BIA to calculate,
manage and develop constructions plans for repair and rehabilitation of
school facilities. In FY 2015, there were 82 schools that were
considered in good condition, 46 in fair condition, and 55 in poor
condition. It would take approximately $388 million in deferred
maintenance to bring the schools up to good conditions.
For Fiscal Year (FY) 2016, the National Review Committee identified
the 10 schools listed below and invited those schools to present at a
public meeting in February 2016, in Albuquerque, New Mexico.
Blackwater Community School
Chichiltah-Jones Ranch Community School
Crystal Boarding School
Dzilth-Na-O-Dith-Hle Community School
Greasewood Springs Community School
Laguna Elementary School
Lukachukai Community School
Quileute Tribal School
T'iis Nazbas Community School
Tonalea Redlake Elementary School
Improving Infrastructure Permitting Processes to Consult With
Indian Tribes and Gain Consent. As Congress and the Administration
consider large-scale infrastructure projects across the United States,
tribal lands and natural resources will inevitably be impacted. Because
tribal lands and natural resources are a primary source of economic
activity for tribal communities it is imperative that tribal
governments are part of the planning process when those projects are
located on, or near, reservation or on ancestral lands.
Tribal Nations should be included in infrastructure decision making
from the very earliest stages, including being involved in key
decisions regarding priorities for development and tribes should also
be included in any discussions regarding particular projects. For
instance, as soon as Federal agencies are discussing projects with
private parties or state governments, they should also be talking to
Tribal Nations. Early consultation ensures that problems are identified
and resolved in a timely fashion, preventing costly delays down the
line.
An important part of addressing the Nation-to-Nation relationship
is, in the context of infrastructure decision making, the need for
responsible economic development, with a specific focus on how tribes
can benefit from infrastructure development. Based on the input from
tribal leaders across Indian Country, NCAI developed a set of
Principles and Best Practices for Infrastructure Permitting Relating to
Tribal Nations and the Federal Trust Responsibility that we believe can
fit into the existing regulatory framework.
For any project affecting tribal lands, waters, treaty rights, or
sacred spaces, at the outset the United States must expressly consider
the following five principles: (1) recognition of tribal sovereignty;
(2) respect for treaty rights; (3) compliance with the Federal trust
responsibility, including seeking tribal informed consent; (4)
upholding all statutory obligations; and (5) ensuring environmental
justice. How these principles were addressed should be reflected in the
written record for any decision.
We also recommend that the Federal Government implement the
following seven best practices: (1) regional mapping and tribal impact
evaluation; (2) consultation in early planning and coordination; (3)
early, adequate notice and open information sharing; (4) funding for
tribal participation in processes; (5) training for agencies to improve
understandings of Tribal Nations; (6) creation of tribal impact
statements and a Trust Responsibility Compliance Officer; and (7)
evaluation of cumulative impacts and regional environmental impacts.
Infrastructure permitting must respect the Federal responsibilities
to Tribal Nations who continue to struggle to protect their lands,
resources, sacred sites, and cultures in processes that too frequently
authorize projects despite their threats to these Nations. Time
invested early to identify a project site that avoids ecologically or
culturally sensitive areas can lead to a more efficient process and
shorter overall project time frames, and can even avoid the need for
Federal reviews, approvals, or licenses pertaining to those resources.
Similarly, project planning and the submitted proposal should reflect
the results of early consultations with tribal leaders to ensure the
proposed project accounts for tribal perspectives and needs up front.
Streamlining Regulatory Processes. Tribal Nations have also
consistently requested that the Federal Government modernize outdated
regulations and statues to provide them with more flexibility and the
option of greater control over decision-making and self-governance, the
ability to be more responsive to the needs of their citizens, and to
bolster economic development in Indian Country. The trust relationship
and responsibility must be modernized to be consistent with self-
determination and rooted in inherent sovereign authority to create a
21st century trust for 21st century tribes.
The first step in this process will be to nominate an Under
Secretary for Indian Affairs, and implement the Indian Trust Asset
Management Reform Act. Last year Congress passed an important new law
authorizing the Secretary of the Interior to establish an Under
Secretary for Indian Affairs. When established, the Under Secretary
will report directly to the Secretary and serve as a cross-agency
advocate for Indian Country to ensure that all agencies and bureaus
within the Department work together efficiently on tribal issues and
implement policies that consider their trust obligations to Indian
tribes. The position will address a major issue that has been raised in
every significant study of trust management at Interior: the lack of
clear lines of authority and responsibility to ensure accountability
for trust reform efforts by the various divisions of the Department of
the Interior.
We also urge that the Department of the Interior consider working
with tribal leaders to adopt many of the latest innovations in
streamlining approvals for tribal projects. For major projects, the
agency should develop a Coordinated Project Plan in consultation with
the tribal applicant. This plan must designate a lead Federal agency
for project approval, to avoid the problems of stovepiping that so
frequently cause approvals to bog down. Federal permitting and review
processes must rely upon early and active consultation with tribal
governments to schedule the necessary permits and approvals, set
deadlines with oversight, avoid conflicts or duplication of effort,
resolve concerns, and allow for concurrent rather than sequential
reviews.
Innovation in Financing of Infrastructure Projects in Indian
Country. As a primary matter, we urge that tribal governments must be
fully and proportionally included in the direct funding for any
infrastructure package. These dollars are a sound investment in
development in rural America, and also a part of the Federal trust
responsibility to Indian tribes.
If funding is derived from tax incentives, we urge that tribal
government be fully included and eligible. Tribal governments should be
provided with direct access to Federal tax credit programs such as the
New Markets and Low Income Housing Tax Credit programs--among other
Federal incentives, which will help spur public-private partnerships to
rebuild Indian Country infrastructure.
We urge Congress to consider the urgent and continuing need for
economic development on Indian reservations in the context of the
Indian Employment Tax Credit and Accelerated Depreciation for on-
reservation business infrastructure. Both expired on December 31, 2016.
Congress should make both tax incentives permanent so employers can
rely on the incentives when planning to locate their business on tribal
lands.
Congress should also empower Tribal Governments to access tax-
exempt bond markets. Currently, tribes may only use tax-exempt bonds
for ``essential government functions.'' The IRS has interpreted this
provision to exclude economic development as a governmental function,
while state and local governments frequently use tax-exempt financing
for development projects. This unnecessarily prevents tribes from
securing the funding needed to revitalize their communities.
conclusion
Investing in Indian Country's infrastructure furthers tribal self-
governance and self-determination by acknowledging tribal governmental
parity and the Federal trust responsibility. For any national
infrastructure investment plan to be effective, it will need to emerge
from the concerted, coordinated efforts of all governmental players,
including tribal governments.
*****
The following document was submitted as a supplement to the National
Congress of American Indians' testimony. This document is part of the
hearing record and is being retained in the Committee's official files:
-- `` Tribal Infrastructure--Investing in Indian Country for a
Stronger America,'' by the National Congress of American
Indians.
______
Mr. LaMalfa. All right, thank you for your testimony.
Next, I would like to recognize our Chairman Emeritus of
the Committee on Natural Resources, the gentleman from Alaska,
to make an introduction of our next panelist.
Mr. Young. Thank you, Mr. Chairman. And Emeritus means I
have been here so long I can't be Chairman again.
[Laughter.]
Mr. Young. Everybody gives a sigh of relief. But I want to
congratulate you, and I am confident you will do a great job.
You have a fantastic Minority partner, and I think we can work
together on these issues. So, congratulations to both of you.
Mr. LaMalfa. Thank you, sir.
Mr. Young. I am sitting, listening to this testimony, and I
couldn't help but think I have been on this Committee of Indian
Affairs for a long time, and we have come a long way from where
we were when we started. We still have a long way to go, and we
can only do that through leadership. And we have some great
Alaskan leaders, Native leaders in the state of Alaska. We have
done a good job, but we are still short. It is a big area, lots
of different tribes, small tribes, and the larger ones, too.
But today we have a witness, Andy Teuber, who has been a
friend of mine. He has been--well, a young man, good leader. He
is the president of the Alaska Native Tribal Health Consortium,
which covers the whole state. He also serves as the president
of the Kodiak Area Native Association.
Again, I want to stress the fact that we have built a lot
of clinics. And one of the biggest problems we have, Mr.
Chairman, is actually running the clinic. Once you build
something, you have to have the money, you have to have the
staffing, the maintenance. Otherwise, you defeat yourself.
So again, Andy, I welcome you to testify before this
Committee.
And, Mr. Chairman, congratulations. And I am willing to
listen to what Andy has to say now.
Andy, you are up.
STATEMENT OF ANDY TEUBER, BOARD CHAIR AND PRESIDENT, ALASKA
NATIVE TRIBAL HEALTH CONSORTIUM, ANCHORAGE, ALASKA
Mr. Teuber. Thank you, Chairman LaMalfa and Ranking Member
Torres. And, most especially, thank you, Chair Emeritus,
Representative Young. I appreciate you providing my testimony
for me this morning.
[Laughter.]
Mr. Teuber. Indeed, we are good friends, and we rely on our
Congressman. He is our only Congressman, and he is, in fact, a
champion of the infrastructure that is so badly needed across
the state of Alaska.
As I was introduced, my name is Andy Teuber. I serve as the
Chairman and the President for the Alaska Native Tribal Health
Consortium (ANTHC) in Anchorage, Alaska. We co-manage the
Alaska Native Medical Center with the Southcentral Foundation.
And that Alaska Native Medical Center is Alaska's only Alaska
Native tertiary hospital, which serves all 229 tribes in the
state, and also 158,000 Alaska Native people.
In addition, I also serve in a primary care capacity,
managing the Kodiak Area Native Association, a small island in
the Gulf of Alaska that serves seven communities.
I want to thank the members of this panel of witnesses for
their testimony. They covered a great deal of what I intended
to cover today, and those are three items: the IHS Health Care
Facilities Construction Priority List, which Mr. Andy Joseph,
Ms. Kitcheyan, and Aaron Payment have also referred to; also, I
intend to cover the Sanitation Facilities Construction Program;
and the Village-Built Clinic Leasing Program.
First, I will start with the Sanitation Facilities
Construction Program, as it plays a critical role in the health
of our communities. Babies born in communities without adequate
sanitation are 11 times more likely to be hospitalized for
respiratory infections, and 5 times more likely to be
hospitalized for skin infections. In villages with very limited
water service, one in three infants requires hospitalization
each year for lower respiratory tract infections.
In Alaska, there are more than 49,000 people in 140
communities who would significantly benefit from critical water
and sewer projects, including 31 communities that have never
had access to water or sewer service. IHS sanitation facilities
construction funding complements funding provided through the
EPA and the USDA. However, both agencies have minimum operation
and maintenance score requirements, as well as requiring
certified operators, while the IHS has neither of those
requirements.
Many of the majority of the unserved communities cannot be
served by a traditional piped water system, and possess
virtually no ability to generate the needed revenue to employ
full-time certified operators. This reality requires regulatory
flexibility and, in many cases, alternative technology to bring
water and sewer services to the remaining unserved rural Alaska
communities.
With support from the IHS in December of 2013, ANTHC began
a pilot program, what ultimately became known as PASS, or the
Portable Alternative Sanitation System, to install completely
home-based systems to address basic sanitation needs in nine
homes. We would like to expand PASS to other homes in Kivalina,
as well as other communities in Alaska, and hope for expanded
support from IHS for the PASS program. But such alternatives
are necessary to reach communities in Alaska that cannot be
otherwise reached by a conventional piped water system.
Next, I intend to cover the Village-Built Clinic Leasing
Program (VBC), which was established in 1970, and serves as the
foundation of the tribal healthcare delivery system in Alaska,
providing the only local source of care for over 44,000 Alaska
Native people living in rural isolated communities across the
state.
As of June 2016, there were over 160 clinics supported
through the VBC program. These clinics are primarily staffed
with community health aides, mid-level practitioners, or
community health practitioners, and serve as the base for
visiting physicians, mid-level practitioners, pharmacists,
dentists, optometrists, and other medical specialists. VBC has
also served as the patient referral link to the tribal regional
hospitals and to the Alaska Native Medical Center based in
Anchorage.
Over time, the cost to operate and maintain VBCs has
increased, due to the expanding scope and level of medical
services provided, expanded healthcare programming, and
technology to better integrate clinics into the tribal
healthcare delivery system, as well as meeting the higher
accreditation standards necessary for certification by
accrediting agencies like the AAAHC and Joint Commission.
The IHS has responsibility to fully fund the VBCs. IHS
provided the first step in fulfilling its responsibility by
providing an increase of $2 million in payments in Fiscal Year
2016 for full-service leases that are not eligible for
maintenance and improvement--or M&I--funds, and a larger-step
by including an additional $7 million in the IHS Fiscal Year
2017 congressional justification for such clinics. It is
essential that the IHS provide funding for VBCs that adequately
cover the cost to operate them.
In conclusion, additional funding support and policy
changes are needed to address the current deficiencies of the
Indian healthcare infrastructure, and meet the needs of
American Indian and Alaska Native people.
Thank you to the members of this Committee, Mr. Chair,
Ranking Member, Chair Emeritus. I look forward to answering any
questions.
[The prepared statement of Mr. Teuber follows:]
Prepared Statement of Andy Teuber, Chairman and President, Alaska
Native Tribal Health Consortium; President and CEO, Kodiak Area Native
Association, Anchorage, Alaska
My name is Andy Teuber, I am the Chairman and President of the
Alaska Native Tribal Health Consortium (ANTHC), a statewide tribal
health organization that serves all 229 tribes and more than 158,000
Alaska Native and American Indian (AN/AI) people in Alaska. ANTHC and
Southcentral Foundation co-manage the Alaska Native Medical Center, the
tertiary care hospital for all AN/AIs in Alaska. ANTHC also provides
statewide health services, including construction and operational
support for rural sanitation projects, and technical assistance to
other tribal health organizations for the maintenance and repair of
regional hospitals and clinics including construction of new
facilities.
I am also the President and CEO of the Kodiak Area Native
Association (KANA), a regional non-profit tribal organization formed in
1966 to provide health and social services to AN/AI people in the
Kodiak Island Area. The KANA service area includes the city of Kodiak
and six Alaska Native villages. ANTHC and KANA are both self-governance
tribal organizations that compact with IHS to provide health services
to AN/AIs under the authority of the Indian Self-Determination and
Education Assistance Act, P.L. 93-638.
My testimony today will focus on the health care and public health
infrastructure needs in tribal communities. The healthcare
infrastructure in tribal communities is in great need of improvement
and expansion. While there have been some increases in Indian Health
Service funding over the past several years, the large majority of it
went toward inflationary and fixed costs, for things such as population
growth and pay costs increases, which has left the Indian healthcare
infrastructure largely behind.
I am going to limit my discussion to three areas in particular
where, in addition to increased funding, policy changes could improve
the current system--IHS healthcare facilities construction, sanitation
facilities construction and village built clinics.
health care facilities
According to the IHS 2016 Report to Congress on healthcare
facilities need, over half of all IHS-owned healthcare facilities are
over 30 years and the average age of IHS hospitals is 40 years old,
nearly four times the average age of private-sector hospitals. And
unfortunately the number of antiquated IHS facilities is only going to
get worse unless things change. At the recent rate of IHS healthcare
facility construction funding, a new facility built in 2016 would not
be scheduled for replacement for over 400 years.
As existing facilities age, without renovation or expansion, they
become increasingly inefficient to operate and costly to maintain. The
age of facilities also negatively impacts the ability of IHS and tribal
health programs to efficiently and effectively provide healthcare
services to AN/AIs in overcrowded and outdated facilities. The quality
of health care is also compromised when facilities are not adequately
maintained and kept up to date.
The IHS report estimated that a total of $10.3 billion would be
needed for construction of adequate healthcare facilities to serve all
AN/AIs. The estimated cost just to complete the 13 inpatient and
outpatient facilities currently on the IHS planned facilities
construction list is approximately $2.1 billion. At the current level
of funding for IHS healthcare facilities it would take 20 years to
complete construction of the existing list, before any funding would be
available to address the other $8.2 billion needed for facilities
construction. In Alaska alone, there is a need for $2.16 billion for
healthcare facility construction, and there are no Alaska facilities on
the existing construction priority list. As no funds are currently
provided to IHS for renovation or expansion of existing facilities, the
current system leaves most IHS Areas, all of which have very old
facilities, without a way to improve them.
One way to ensure that all IHS Areas have access to at least some
resources to renovate and expand existing IHS and tribal health
facilities would be to ensure that the IHS Maintenance and Improvement
(M&I) line item is increased. Beginning in FY 2011 through 2015, the
funding for IHS M&I was insufficient for even basic maintenance and
repair deficiency needs. This has led to a backlog at the end of 2015
of nearly $500 million for deferred maintenance, alteration and repair.
Another option to ensure that all IHS Areas have access to
resources to address facility needs would be to establish an area
distribution fund. The reauthorization of the Indian Health Care
Improvement Act (IHCIA) in 2010 (S. 1790) amended section 301 of IHCIA
to direct the Secretary ensure that the ``renovation and expansion
needs of Service and non-Service facilities . . . are fully and
equitably integrated into'' the IHS healthcare facility priority
system, and to consult and cooperate with tribes to develop innovative
approaches to address unmet need for construction of health facilities.
The establishment of an area distribution fund for the renovation
and expansion of existing healthcare facilities would provide funding
for all IHS Areas and also address the dire unmet need to renovate and
expand existing IHS and tribal health facilities to provide more
efficient and better care to AN/AIs throughout Indian Country.
sanitation facilities construction
Sanitation facilities play a critical role in the health of our
communities. Babies in communities without adequate sanitation are 11
times more likely to be hospitalized for respiratory infections and 5
times more likely to be hospitalized for skin infections. In villages
with very limited water service, one in three infants requires
hospitalization each year for lower respiratory tract infections. In
Alaska alone we had over $1.2 billion in unmet need for sanitation
facilities construction in 2016. Funding for IHS sanitation facilities
construction finally saw an increase in FY 2016, but that was after
many years of no increases. Given the enormous, growing unmet need and
the significant health benefits derived from sanitation facilities
continued support of IHS sanitation facilities construction is
essential, but regulatory and policy flexibility is also needed.
In Alaska, there are more than 49,000 people in 140 communities in
rural Alaska who would benefit from critical water and sewer projects,
including 31 communities that have never had water or sewer service.
According to the state of Alaska in 2015, over 3,300 rural homes have
been identified as lacking running water and a flush toilet. Most of
these are Alaska Native homes in the 31 unserved communities.
IHS sanitation facilities construction funding complements funding
provided through EPA and USDA. Unlike funding through the Environmental
Protection Agency (EPA) and the United States Department of Agriculture
(USDA), IHS funding has no minimum operation and maintenance score
requirements. While systems that have robust operation and maintenance
programs are more likely to be funded, this does not prevent funding
from being allocated. Additionally, rural Alaska communities often
struggle to obtain qualified and certified operators. EPA funding
requires systems be operated by certified operators, whereas IHS
funding does not have this requirement.
Because of regulatory barriers on USDA and EPA grants for water and
sewer, IHS' cooperation and support is critical to providing water and
sewer services to most of the 31 remaining unserved rural Alaska
communities. Many of these unserved communities cannot be served by a
traditional piped water system, and therefore need an alternative
solution.
With support from IHS, in December of 2013 ANTHC began a pilot
project, what ultimately became known as the portable alternative
sanitation system (PASS), to install completely home-based system to
address basic sanitation needs in nine homes. A report on PASS was just
issued (see Attachment) that was very positive regarding the
effectiveness of the system. We would like to expand PASS to other
homes in Kivalina as well as other communities in Alaska and hope for
expanded support from IHS for PASS or other such alternative systems
that are necessary to reach the communities in Alaska that cannot be
reached by conventional piped water systems.
village built clinic lease program
Established in 1970, the Village Built Clinic (VBC) program serves
as the foundation of the tribal healthcare delivery system in Alaska,
providing the only local source of care for over 44,000 Alaska Native
people living in rural, isolated communities across the state. As of
June 2016, there were over 160 clinics supported through the VBC
program.
These clinics are primarily staffed with Community Health Aides
(CHAs) or Community Health Practitioners (CHPs), both essential to
carrying out the congressionally-mandated Community Health Aide Program
(CHAP) authorized by section 119 of the Indian Health Care Improvement
Act. Over 80 percent of clinics supported by VBC leases are owned and
operated by small, rural communities.
VBCs serve as the base for visiting physicians, mid-level
practitioners, pharmacists, dentists, optometrists, and other medical
specialists, as well as the referral link to the tribal regional
hospitals and to the Alaska Native Medical Center based in Anchorage.
VBCs are the local contact and emergency station for public health and
emergency preparedness efforts in these communities.
Over time, the cost to operate and maintain VBCs has increased due
to the expanding scope and level of medical services provided; expanded
healthcare programming and technology to better integrate clinics into
the tribal healthcare delivery system; as well as meeting the higher
accreditation standards necessary for certification by the Joint
Commission.
Yet current funding from the Indian Health Service only covers
approximately 30 percent of the clinic's ongoing operating costs.
Current lease payments for most of the clinics have not been
significantly increased in over 20 years, aside from a small increase
in FY 2016. In addition, the current VBC lease amounts provide
virtually no funds for basic rent, long-term maintenance and
improvements, depreciation, or replacement reserves needed to sustain
services in the community. This lack of funding poses an immediate and
significant threat to the substantial investment made by the Federal
Government in establishing the VBC program.
Without adequate VBC funding, community health aides are forced to
provide services in unsafe facilities with insufficient resources.
Individual communities are increasingly forced to subsidize the day-to-
day operating costs of their clinics, defer long-term maintenance and
improvement projects, reduce clinic operations, and forgo funding
depreciation and replacement reserve funds. Nearly all of these
communities are not located on the road system and without access to
the electrical grid, have virtually no tax or revenue base.
Many of Alaska's villages are unable to maintain support of their
VBC, with serious consequences for the health and safety of residents
living these remote communities. Tribal health organizations have
subsidized emergency and routine costs with their limited funds, but
they cannot sustain these subsidies while continuing to operate their
other programs.
In fact, some VBCs have closed, suspending CHAP services and
cutting off the only local source of care. This lack of access at the
local level necessitates costly travel as primary and preventive
services become increasingly unavailable, diminishing the otherwise
available resources at the secondary and tertiary levels of care.
The IHS has a legal responsibility to fully fund the VBCs. IHS
provided the first step in fulfilling its responsibility by providing
an increase of $2 million in payments in FY 2016 and a larger step by
including an addition $7 million in the IHS FY 2017 Congressional
Justification. It is essential that IHS provide funding for VBCs that
adequately cover the costs to operate them.
conclusion
I commend this Committee for holding this hearing on this important
subject. It is clear that additional support and policy changes are
needed to address the sagging Indian healthcare infrastructure. Thank
you for the opportunity to provide this testimony.
*****
The following document was submitted as a supplement to Mr. Teuber's
testimony. This document is part of the hearing record and is being
retained in the Committee's official files:
-- Portable Alternative Sanitation System, Final Report--Kivalina,
Alaska, by the Alaska Native Tribal Health Consortium.
______
Mr. LaMalfa. Thank you, Mr. Teuber. I appreciate it. The
Chair now recognizes Mr. Pula to testify.
STATEMENT OF NIKOLAO PULA, ACTING ASSISTANT SECRETARY, OFFICE
OF INSULAR AFFAIRS, U.S. DEPARTMENT OF THE INTERIOR,
WASHINGTON, DC
Mr. Pula. [Speaking native language] from Guam and
Commonwealth of the Northern Mariana Islands. And good old top
of the morning from the U.S. Virgin Islands.
Mr. Chairman and members of the Subcommittee on Indian,
Insular, and Alaska Native Affairs, thank you for the
opportunity to speak regarding the Office of Insular Affairs
capital infrastructure projects program for the U.S.
territories of Guam, American Samoa, the United States Virgin
Islands, and the Commonwealth of the Northern Mariana Islands.
The 1996 passage of Public Law 104-134 established the CIP
program, approximately $28 million in annual current mandatory
funding. CIP funds address a variety of infrastructure needs in
the U.S. territories, including critical infrastructures such
as hospitals, schools, wastewater, and solid waste systems.
These critical infrastructure improvements not only benefit the
local population, but they attract new investment and economic
development to the territories.
These funds are allocated among ports, hospitals, schools,
water, public buildings, solid waste, energy, and public
safety. This allocation is depicted in my written statement as
a pie chart to show the relative emphasis given to each
category of projects. For example, 30 percent goes to schools.
OIA CIP program often yields positive results for our
island communities. For example, in Guam, the $3 million public
health environmental laboratory was completed last year. It was
designed to identify vector-borne diseases that make way across
the Pacific.
In American Samoa, $8 million went to procure a 134-foot
ship, the MV Manu'atele, that now plies the waters between
Manu'a and the main island of Tutuila, providing both cargo and
passengers transport.
In the Virgin Islands, the 388-year-old Fort Christian was
renovated just in time for the centennial celebration
commemorating the transfer of the United States Virgin Islands
from Denmark to the United States. They will be commemorating
that at the end of this month. It will be a significant tourist
attraction.
In the CNMI, $29 million in CIP funds facilitating the
transformation of the Puerto Rico dump into a public park next
to the lagoon for residents and tourists to enjoy. It will be
dedicated next week.
Last year, $4.9 million in CIP funding was used to replace
the HVAC equipment at the Saipan Hospital, and it was later
certified by CMS.
While numerous CIP projects are locally conceived and
promoted, OIA has assisted on numerous occasions with
substantial sums of CIP funding that have brought territorial
compliance with Federal directives and court orders. The
funding serves a wide variety of purposes, and enjoys the
support of the local communities and governors.
Beginning with 2004, OIA implemented a competitive
allocation system for the $28 million in mandatory CIP grants.
The annual allocation is made on the basis of set competitive
criteria that measured a demonstrated ability of the
governments to exercise prudent financial management practices,
and to meet Federal grant requirements. OIA CIP program has two
goals: assist territorial governments with infrastructure
funding, and encourage improved financial management by the
territorial governments.
The governors of Guam, American Samoa, the U.S. Virgin
Islands, and the Commonwealth of the Northern Mariana Islands
assert that capital improvement needs in the U.S. territories
amount to over $1 billion. Much of the public infrastructure in
the U.S. territories is well used, and difficult for small
communities to replace or upgrade. Overall, the territory
school facilities average 40 years of age, and show the marks
of generations of school children and the effects of the
tropical climate.
The governors' top priorities for the new and replacement
infrastructure include hospitals in American Samoa and the U.S.
Virgin Islands; high schools in Guam; and enlargement of the
landfill in Saipan, Northern Mariana Islands.
Aging infrastructure can create risks to human health, a
diminishment of educational opportunities for youth, and a
less-than-desirable environment for cultivating an investment
in territorial economies.
In conclusion, thank you for this opportunity to present
testimony on the Office of Insular Affairs' capital
infrastructure project program, and we look forward to
continuing to work with the Committee on this issue. Thank you.
[The prepared statement of Mr. Pula follows:]
Prepared Statement of Nikolao I. Pula, Acting Assistant Secretary of
the Interior for Insular Areas, Washington, DC
Mr. Chairman and members of the Subcommittee on Indian, Insular,
and Alaska Native Affairs, thank you for the opportunity to speak
regarding the Office of Insular Affairs' (OIA) capital infrastructure
project (CIP) program for the U.S. territories of Guam, American Samoa,
the United States Virgin Islands and the Commonwealth of the Northern
Mariana Islands (CNMI).
the cip program of the office of insular affairs
The 1996 passage of Public Law 104-134 established the CIP program
with $27.72 million in annual current mandatory funding. CIP funds
address a variety of infrastructure needs in the U.S. territories,
including critical infrastructure such as hospitals, schools,
wastewater and solid waste systems. These critical infrastructure
improvements not only benefit the local population, but they attract
new investment and economic development to the territories.
allocation of oia cip funds
OIA CIP funds are allocated among ports, hospitals, schools, water,
public buildings, solid waste, energy, and public safety. This
allocation is depicted in my written statement as a pie chart to show
the relative emphasis given to each category of project.
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
positive results
OIA's CIP program often yields positive results for our island
communities. For example--
In Guam, the $3 million public health environmental laboratory was
completed in 2016. It was designed to identify vector-borne diseases
that may make their way across the Pacific.
In American Samoa, the $8 million, 134-foot ship, the MV
Manu'atele, now plies the waters between Manu'a and the main island of
Tutuila, providing both cargo and passengers transport.
In the Virgin Islands, the 388-year-old Fort Christian was
renovated just in time for the centennial celebration commemorating the
transfer of the United States Virgin Islands from Denmark to the United
States. It will be a significant tourist attraction.
In the CNMI, $29 million in CIP funds facilitated the
transformation of the Puerto Rico dump into a beautiful public park
next to the lagoon for residents and tourists to enjoy. It will be
dedicated this month. In 2016, $4.9 million in CIP funding was used to
replace the HVAC equipment at the Saipan hospital. CMS certification
followed.
While numerous CIP projects are locally conceived and promoted, OIA
has assisted on numerous occasions with substantial sums of CIP funding
that have brought territorial compliance with Federal directives and
court orders. The funding serves a wide variety of purposes and enjoys
the support of the local communities and governors.
competitive allocation system
Beginning with 2005, OIA implemented a competitive allocation
system for the $27.72 million in mandatory CIP grants. It is based on a
premise that the annual $27.72 million will be limited to defraying
capital costs for the U.S. territories.
The governments of the U.S. territories compete each year for a
portion of the guaranteed funding, which they use for CIP in addition
to other assistance or local funding that might be available.
Base level funding was established in 2005, utilizing historic CIP
trends with an overlay of the competitive allocation system
requirements. The allocation system was adjusted for fiscal year 2012
and again for 2017. The performance of each territory was analyzed, as
required in the Covenant section 702 funding agreement of 2004 between
OIA and the CNMI.
For fiscal year 2017, OIA's CIP funding will be distributed
follows:
American Samoa $9,780,000
CNMI 9,249,000
Guam 5,911,000
U.S. Virgin Islands 2,780,000
-----------------
TOTAL $27,720,000
The determination of the annual allocation is made on the basis of
a set of competitive criteria that measure the demonstrated ability of
the governments to exercise prudent financial management practices and
to meet Federal grant requirements.
OIA's CIP program has two goals: assist territorial governments
with infrastructure funding, and encourage improved financial
management by the territorial governments.
the territories' stated capital improvement project needs
The governors of Guam, American Samoa, the United States Virgin
Islands, and the Commonwealth of the Northern Mariana Islands assert
that the capital improvement needs in the U.S. territories amounts to
over $1 billion. Much of the public infrastructure in the U.S.
territories is well-used and difficult for the small communities to
replace or upgrade. Overall, the territories' school facilities average
40 years of age, and show the marks of generations of school children
and the effects of the tropical climate. The governors' top priorities
for new and replacement infrastructure include hospitals in American
Samoa and the Virgin Islands, high schools in Guam and enlargement of
the landfill in Saipan, Northern Mariana Islands. Aging infrastructure
can create risks to human health, a diminishment of educational
opportunities for youth, and a less than desirable environment for
cultivating tourism and investment in territorial economies.
conclusion
Thank you for this opportunity to present testimony on OIA's
capital infrastructure project program, and we look forward to
continuing to work with the Committee on this issue.
______
Questions Submitted for the Record by Representative Sablan to Nikolao
Pula, Acting Assistant Secretary, Office of Insular Affairs
Mr. Pula did not submit responses to the Committee by the appropriate
deadline for inclusion in the printed record.
Question 1. When was the CNMI baseline under the CIP program
reduced from $11 million to $9 million and why?
Question 2. How would you say that the amount of funding provided
under CIP compares to the infrastructure needs of the Insular Areas? Is
it enough to meet the needs?
Question 3. As you know, President Trump is proposing a $1 trillion
program to improve our Nation's infrastructure. Naturally, the Insular
Areas are hoping that they will be able to benefit from this initiative
to finally have some of their long-standing addressed.
Has OIA have done an inventory or assessment of the infrastructure
needs of the territories?
Question 4. You mentioned that insular governors are asserting that
their capital improvement needs exceed over $1 billion. What accounts
for infrastructure projects generally being more costly in the islands?
Is it because all project materials have to imported over long
distances?
Question 5. Questions have been raised in the past by GAO and
others, about internal control weaknesses in insular governments which
have led to mismanagement of OIA grants. Do you have a sense of whether
such concerns have been corrected? Are you still seeing cases of abuse
or fraud in the expenditure of CIP grants?
Question 6. U.S. territories have had a history and culture of
using diesel engines to generate energy. This has led to much higher
prices delivering energy to residents, $.25 and higher per/kilowatt
hour. However, I understand that OIA began an initiative in 2010 to
encourage utilizing advanced energy systems to help bring their costs
down by burning less fuel and taking advantage of indigenous sources of
energy.
Can you comment on whether OIA continues to support its past
initiative, how it has assisted our Insular Areas create new energy,
and are you able to quantify any savings (past and future) that
territories will realize resulting from continuing to pursue advanced
energy system solutions?
______
Mr. LaMalfa. Thank you, Mr. Pula, for your testimony. And
again, we thank the panel for all of your participation today,
and the effort that it takes to get here and to be prepared for
it.
And now, reminding our members of the Committee that there
is, under Rule 3(d), a 5-minute limit on questions--we have to
live under the same rules as everybody else, as American
people. The Chairman will now recognize Members for any
questions they may wish to ask the witnesses. And, as I see,
our Chairman of the Natural Resources Committee, Mr. Bishop, is
here. I would offer you that first shot.
He wants to go last. OK. Also, normally, the Chairman would
go first. But, as I know, our Ranking Member has two places to
be at one time. I would offer her the first question, and I
will go second, if you wish.
Mrs. Torres. That is very kind of you. Thank you very much,
Mr. Chairman. And, once again, thank you to our witnesses for
being here.
Mr. Payment, I want to applaud you on the report that you
highlighted and entered into the record on tribal
infrastructure that your organization, NCAI, recently released.
And I wanted to commend you and the staff at NCAI for putting
together such a comprehensive document. This is very
informative, and I would recommend my colleagues to review it
for further information.
I specifically like the connection that you have made, or
that the report has made, between the infrastructure of rural
America and Indian Country, and how their fate is tied
together. I wonder if you could expand more on that, how rural
communities and tribes could possibly work together on
infrastructure needs. What does that look like? Is it JPAs that
must be formed between the two governmental organizations? What
is your opinion on that?
Mr. Payment. Oh, I have a perfect example for you. I am
glad you asked me that question.
In my community, the last time that we had access to some
infrastructural investment dollars a few years back, we
acquired additional property outside of the city limits and
outside of our existing reservation. And when we first started,
we put all the systems in place for wells and septics, and
found there was a contaminant, a carcinogen. So, we were doing
bottled water for a long time.
Then, we gained access to these infrastructural dollars. We
partnered with IHS sanitation dollars, with the city, with the
township, and with the county. So, it was a win-win-win-win
situation. In doing so, we helped pay down the infrastructure
for the city by 20 percent of the time period for their debt
retirement; and, in doing so, we did a contractual annex
through the township, which is not easy to do, as you know, in
local government. But everybody had a piece of the pie, and
everybody benefited from it.
And in our rural communities, that is essential. In the
Upper Peninsula of Michigan, we are all rural. In order for us
to reach out and provide basic sanitation and sewer to our
communities, we have to have those partnerships. So
infrastructure, as we look forward for infrastructure
investment, anything that can facilitate that kind of
cooperation with tribes and local governments and the state to
benefit from it, I would encourage that.
Mrs. Torres. How could we do more of that, encouraging
other tribes and local governments to do more of that?
Mr. Payment. I would say create incentives for it, tax bond
financing incentives, to collaborate with tribes to do that.
But I also think, while we are requesting specific funding
for Indian Country, I think if we build into the
infrastructural request incentives for states and local
governments to collaborate with tribes; it doesn't happen
automatically. And in our community, we have a long-term good
relationship with the local community. But I think creating
those incentives might facilitate that.
Mrs. Torres. Rural communities, though, in itself, they
don't have, necessarily, employees and the technical expertise
to be able to do that. Is there a need to help, in order to
bring those two together, to collaborate in projects? Is there
a need to increase support for technical assistance for such
partnerships?
Mr. Payment. Absolutely. If we limit our talent pool from
what we already have, when we know we already do not have
resources, then we are unduly limiting ourselves.
So, additional technical expertise to identify need--we are
limited in transportation funding and housing funding, based on
our collection of data. So, providing technical assistance to
bring tribes along to help collect this data--we look like we
are going into an era of being able to justify our programs and
services and funding. I think that technical assistance is
critical.
Mrs. Torres. I have less than a minute, so let me refer to
Ms. Kitcheyan.
Can you expand on how lack of funding for the housing for
medical professionals is affecting Indian Country, especially
in rural tribal areas?
Ms. Kitcheyan. There is a lack of housing on the
reservation, and many of our rural areas do not have the
capability to recruit or retain our health professionals. They
drive great distances to come to work, and they----
Mrs. Torres. Is this another partnership that could be
realized between rural communities and Indian Country, to build
housing outside of reservations?
Ms. Kitcheyan. I think tribes need to start looking and
thinking outside the box in looking for other funding sources
outside of private investors, philanthropy, and different
things that could be available to tribes, through building
those partnerships.
And these doctors burn out. They work long shifts, and then
they have to drive great distances.
Mrs. Torres. Thank you. My time has expired, I yield back.
Thank you, Mr. Chairman.
Mr. LaMalfa. You are welcome. Recognizing myself, let me
follow up with Mr. Payment here on what you were just speaking
of.
Beyond tax incentives, what other incentives might be
available that Congress could consider to be helpful? Yes, Mr.
Payment, yes.
Mr. Payment. OK. So new markets and low-income housing tax
credits. But specifically, what I am looking for is, in the
announcement that we put drivers in place that encourage local
municipalities that have their infrastructural needs as well to
reach out to and give points and credits toward the
infrastructural dollars that might be available.
Again, in some communities, it is not automatic. And I
think it is a win-win situation when we bring to bear and we
collaborate with local government.
Mr. LaMalfa. All right, thank you.
Ms. Kitcheyan, coming back to some of our earlier
testimony, as well, the IHS also maintains a priority list for
sanitation facility projects. So, hearing how it has gone with
the hospital priority system, are they similar? Do you know? Is
that priority list established using a similar methodology or
criteria, so to speak, as the healthcare facility construction,
which again, we are going back to the 1980s in its
establishment and 1990s in implementation.
Ms. Kitcheyan. We understand that list is to be re-
evaluated, but tribes do not have control over that list. So,
we look toward IHS to give full consideration----
Mr. LaMalfa. Well, I understand IHS maintains that list for
sanitation facilities. But I just wondered, is it the same
system, or is it as old a system as the hospital construction
priority system that we were speaking of earlier?
Ms. Kitcheyan. It is a dated system, and it continues to
address our real needs. So, along with our data technology, we
have a dated system of prioritizing these needs.
Mr. LaMalfa. Well, you say it is a data system, but again,
is it the same as the hospital one, or more or less only for
sanitation?
Ms. Kitcheyan. Yes, it is the same.
Mr. LaMalfa. So is it about as----
Ms. Kitcheyan. The criteria is different, but we will
provide some follow-up information to explain the differences.
Mr. LaMalfa. OK. Do you find there is some of the same
frustration? Is it as speedy as it is for the hospital
construction system?
Ms. Kitcheyan. It is extremely frustrating, and----
Mr. LaMalfa. OK, all right. I thank you for that.
Last month, the GAO added Indian health on its biannual
risk list. What are some of the unmet need impacts for the
quality of care being provided at health facilities with that
new information?
Ms. Kitcheyan. What is--excuse me, I don't understand.
Mr. LaMalfa. Well, I said the GAO added Indian health on
its biannual high risk list. Can you discuss how the unmet need
impacts the quality of care being provided at the health
facility?
Ms. Kitcheyan. Certainly. It is the underfunding of these
facilities and these equipments that are leading to the
inequality of patient care across America. We have sanitation
equipment that is being--we have people washing tools by hand.
We have sanitation equipment that is dated and broken. And,
rather than the lack of funding to address those needs, we have
facilities who are making their own way. And that is extremely
dangerous for the patient, for that infection in the hospital.
And for something as simple as that, I had mentioned
unnecessary deaths. This underfunding leads to unnecessary
deaths. And it is like a domino effect.
Mr. LaMalfa. What about the Health Information System, the
IT system used by IHS? Is that keeping up?
Ms. Kitcheyan. RPMS is old. I mentioned it is a ticking
time bomb. It is more expensive to continue to drag it out than
it is to provide the resources to just do away with it. But the
technical assistance is not there, the programmers are
retiring, and it is just not feasible for tribes to continue to
put money into this system with no positive outcome.
Mr. LaMalfa. OK. Thank you.
Mr. Honanie, indeed, natural resources are a very important
part of your tribe's economic base and, you know, coal being
very important to the tribe's income. What are you facing these
days in the further development of coal or other energy
possibilities that would be, indeed, an important part of your
economic base? What kind of regulations or other infrastructure
challenges are there that might be keeping you from developing
more?
Mr. Honanie. Thank you for that question, sir. The current
situation is the coal mining on the reservation, the coal is
sold to the Navajo generating plant for producing electricity.
But with the proposed closure after 2 years, we face this
dilemma. And our dilemma and challenge is who do we market this
coal to, much less how do we transport the coal from mining
area to, say, a railroad to deliver the coal to, say, the West
Coast, East Coast, wherever we may have a market for. So----
Mr. LaMalfa. Is the transportation of the coal also impeded
by being surrounded?
Mr. Honanie. The transportation of coal is strictly from
the mine to the generating plant at this time.
Mr. LaMalfa. OK.
Mr. Honanie. It does not go beyond that. So, our thought is
that we would need infrastructure, such as a railroad, to be
able to mine the coal and to transport the coal to the rail
line that runs across northern Arizona to ports where we can
export it or sell to other potential customers.
Mr. LaMalfa. OK, thank you. I have blown through my time. I
will now recognize our Chairman Emeritus for his 5 minutes of
questions.
Mr. Young. Thank you, Mr. Chairman.
Andy, I appreciated your testimony. But in your testimony
is that the IHS funding covers approximately only 30 percent
operating costs of the villages clinics built in Alaska. Can
you describe the impact of that, the underfunding, and how is
it made up? Who pays the 70 percent?
Mr. Teuber. Thank you, Chair Emeritus, for your thoughtful
question. The challenges that are confronted in rural Alaska
and elsewhere, where funding is lacking for the ongoing
operations of these clinics, is one of many challenges.
Workforce, transportation costs, the communications that were
referred to by members of this panel of witnesses, all of these
things compound and cascade.
When the IHS fails to fully fund the ongoing operations and
maintenance of these village-built clinics, for instance, it
hampers those communities in the delivery of health care. In
many of our communities across the state, hours have to be
restricted, the hours of operation, obviously, are important
for access to care. The clinics fall into a state of disrepair.
The opportunity for improving energy efficiency and
effectiveness is lost, and the increasing costs are exacerbated
by the ability of these tribes and organizations to recruit
individuals who would be working in those facilities.
Many of our clinics across the state have had to close.
Basic health services, when they are not provided, compound,
and we find that the ongoing costs for delivery of services to
individuals who have been precluded from accessing primary care
and preventative care services early on in their communities is
exponentially higher in treating some of the healthcare
disparities and outcomes that we have seen encountered across
our state, outcomes like the highest levels of heart disease,
cancers, diabetes and pre-diabetes, childhood obesity, many of
the behavioral health issues that we are seeing across the
Nation, opioid addictions. So, I appreciate your question.
Mr. Young. Well, Mr. Chairman, this all leads up to money.
That is really our problem.
But I want to stress, Andy, again. I have a clinic in Fort
Yukon. Is that clinic leased to the IHS for the Tanana chiefs,
or is that clinic operated by the Tanana chiefs? And how does
that work, as far as dollars go? I mean do we just add more
money and it gets there, or--who pays for that clinic, when
they only cover 30 percent?
Mr. Teuber. Yes, thank you for your question. Oftentimes,
and in Fort Yukon, the communities end up owning facilities
that they end up leasing to the Indian Health Service. The
Indian Health Service then reserves those facilities for the
use and occupancy by providers that are either direct service
or self-governance individuals who provide those services
within those communities.
So, in Fort Yukon and across the state, when village-built
clinic leases are in the $1,000- to $2,000-a-month range, and
the cost of fuel exceeds $3,000 or $4,000 a month, the
community has to find ways to just keep the heat on and the
lights on.
So, the problem is 10-fold when it comes to the
deterioration of those communities' clinics; and so the answer,
as you have stated, is money, and that if the tribes and tribal
organizations that operate these clinics had more resources,
then they could do a better job delivering sufficient health
care.
Mr. Young. Mr. Chairman, I suggest to staff--remember, the
President does not write the budget, we do. And I think we have
a responsibility to make sure that the Indian Health gets some
money. We all should work for that, so we can take care of some
of these problems, because we do have a responsibility, a trust
responsibility to make sure it works.
I want to thank the panel and thank you, Mr. Chairman.
Mr. LaMalfa. Thank you, sir. I appreciate it. We now
recognize Ms. Bordallo for 5 minutes.
Ms. Bordallo. Thank you very much, Mr. Chairman. And I
would like to congratulate you on your leadership role with
this Subcommittee, and also our Ranking Member, who had to
leave, and to our witnesses for being here.
The territories face unique challenges when dealing with
infrastructure projects and the needed resources. And many
times we are not included in Federal funding opportunities or
formulas that do not truly recognize our needs.
Further, I would like to point out our distance from the
U.S. mainland. And I have five Members here this morning,
including our esteemed leader, Mr. Bishop, and American Samoa--
I think she just stepped aside--and Ms. Puerto Rico, and the
CNMI, and Guam. We all traveled there on a CODEL. Very
interesting. We visited all the territories, and so forth. But
they can attest to the long distance. And this makes it
difficult to source needed materials, and often we are
forgotten when it comes to funding.
Additionally, due to our local workforce, it is not being
sufficient among our own labor, so we have to rely on foreign
labor to supplement these workforce challenges. And I will just
let you know that Guam is about--Guam and CNMI--approximately
9,000 miles from the mainland. So, all of this contributes
greatly to increased cost of our infrastructure.
As Guam's representative, I have worked to have Guam and
the other territories treated equitably in Federal funding
opportunities. But it has been inadequate. And I am even more
concerned with findings by the OIA that, out of about $80
million in Federal infrastructure funding available to the
territories, only about $20 million was utilized last year. And
that is including all of us--I mean the $20 million divided
among all of us. And at a time when our governments are
financially strained, those resources could have been used for
capital improvement projects that have been stalled, due to
lack of funding.
For example, Guam's only commercial port is endeavoring to
expand its capabilities, but lacks a dedicated funding source
that TIGER grants have been insufficient in providing.
Additionally, Guam's public auditor recently reported that on
Guam agencies spend about $14 million per year in renting
space.
So, I hope that the OIA and Federal partners will provide
further guidance and assistance to territories, so that we can
better utilize Federal opportunities. I do appreciate the small
increase that Guam received from OIA's CIP grant program, and
let me explain that. Twenty-eight million dollars was
allocated. Guam received $6 million. And, with that increase
last year, only $900,000. Very small. But again, I think we are
utilizing a disproportionate share of resources available to
us.
I have a question for Mr. Pula. Mr. Pula, as I noted,
Guam's challenge is that many of our infrastructure projects
have been lacking funding for years and years. And, aside from
much-needed upgrades to our port, for example, there are
several uncompleted bridge and road projects in southern Guam
that make it nearly impossible for normal traffic flow. It is a
safety hazard, a quality of life issue, and an environmental
liability.
So, my question is how is the Department of the Interior
working within the Administration to consider funding for the
territories, and ensure that we are included in increases in
funding, as the Trump administration plans much, much more
money for infrastructure?
Mr. Pula. Thank you, Congresswoman. You are absolutely
correct about the needs and the demands in the U.S. territories
for years, and the limited funding that the Department has in
the CIP program, with the Office of Insular Affairs.
To respond to your questions, as I had mentioned in my
testimony, the governors of the four territories have submitted
their list, and it is about $1 billion of their needs for
infrastructure. With the new Administration's notion on
infrastructure increase, it is too early to say anything about
how that is going to develop. But we are working within the
Department, and also with the list provided by the governors.
Hopefully, as time goes on and it is fleshed out, we will be
able to do some work in that regard for the territories.
Ms. Bordallo. Well, my only answer to that is I hope that
your voice is going to be loud and clear for the territories,
Mr. Pula.
Mr. Pula. We will do our best.
Ms. Bordallo. Mr. Chairman, I have a second round, but I am
going to give the others an opportunity.
Mr. LaMalfa. All right. Thank you, Ms. Bordallo.
Recognizing now our new Vice Chair of the Subcommittee, Ms.
Gonzalez. Congratulations, as Vice Chair.
Miss Gonzalez-Colon. Thank you, Mr. Chair. Buenos dias to
the people of Puerto Rico.
I have a question to you, Assistant Secretary Pula. What is
the estimated total cost of the capital improvements needed in
the U.S. territories?
Mr. Pula. I am sorry, I missed--total cost of?
Miss Gonzalez-Colon. Of the capital improvement needs in
all territories.
Mr. Pula. Oh, in all the territories? As I mentioned, the
list that we have just received from the four governors--not
including Puerto Rico, of course, because it is not under our
auspices--is over $1 billion.
I recall, over 20 years ago, the Army Corps of Engineers
did an assessment of infrastructure needs of the territories at
the time, and it was around, over $600 million. So, just to
answer your question, now it is up.
Miss Gonzalez-Colon. Can you provide a list of those
requirements from the governors to this Committee?
Mr. Pula. We can.
Miss Gonzalez-Colon. In your statement, you say that the
capital improvement projects program has two goals. One, assist
the territorial governments with the infrastructure funding,
and to encourage improved financial management by territorial
governments. Are there any aspects of the program that need
improvement?
Mr. Pula. With the notion that we--in 2005 we began to have
categories because, as I mentioned, we only have $27.7, or
approximately $28 million of mandatory funding for the CIPs.
So, historically, because CNMI and American Samoa are the
smaller communities and Guam and the U.S. Virgin Islands have
better economic activities and are much larger, we provided
about $9 or $10 million for American Samoa and CNMI, and the
rest divided between Guam and the U.S. Virgin Islands.
Now, when we developed the categories to assist them,
within the baseline that we usually set every 5 years a
territory could improve their financial management, in terms of
getting their single audits clean, providing in time, so that
the other Federal agencies will also benefit, especially that
they don't get a high risk, and then the improvements of their
financial systems. Those are the two categories we looked at,
and we kind of score. So, a territory can go between $2 million
up or $2 million down, based on these categories, as we do the
scoring.
Miss Gonzalez-Colon. So, besides money, you don't need
anything from this Committee?
Mr. Pula. Oh. Well, as the Chairman Emeritus said, I think
everybody here needs money.
Miss Gonzalez-Colon. Yes, but besides that.
[Laughter.]
Mr. Pula. Well, along with--I think, as one of my
colleagues here on the panel mentioned, it is not just the
infrastructure. The economic bases of Indian Country, as well
as the territories, thrives on this infrastructure in many
ways.
For example, when the incentives have been taken away, for
example, the tax incentives like section 936, and these kind of
things, therefore the territories miss those opportunities to
kind of have their activities. In the CNMI--well, actually, in
the Virgin Islands, with the rum fund that they receive, with
that economic activity in that island, that really helps them.
And when the other territories don't have as much of economic
activity, it doesn't really help them.
So my point about the infrastructure, because it really
helps companies' economic activity to move, and the tax base
start to increase, so that they can help themselves in having
funds to build these things.
Miss Gonzalez-Colon. If you have any direct recommendation
of those possible amendments, I would be more than glad to have
them here.
Mr. Pula. Thank you. We would be happy to do that.
Miss Gonzalez-Colon. And one last question.
Mr. Pula. Sure.
Miss Gonzalez-Colon. I am just curious. You mentioned the
restoration of Fort Christian on St. Thomas, the fort that has
been designated a national historic landmark in 1977, and that
received Federal money to their restoration. I am just
wondering. We have La Fortaleza in San Juan, Puerto Rico, which
is a 477-year-old building that was also designated as a
national historic landmark in 1960.
I am just curious, if La Fortaleza would qualify for
capital improvements grants as restoration at Fort Christian in
the U.S. Virgin Islands, can we compete on that?
Mr. Pula. Puerto Rico is under----
Miss Gonzalez-Colon. I know that part.
Mr. Pula [continuing]. The White House----
Miss Gonzalez-Colon. I know, but both parks are national
historic landmarks.
Mr. Pula. Yes.
Miss Gonzalez-Colon. So that is the question here.
Mr. Pula. Well, the only problem there--well, for Puerto
Rico--is because the mandatory funding that the Department of
the Interior has is just for the four territories.
Mr. LaMalfa. I will have to ask you to----
Miss Gonzalez-Colon. Thank you. I yield back.
Mr. LaMalfa. We can do a second round of questions here in
a little bit, if Members wish.
I would like to recognize Mr. Sablan now for 5 minutes.
Mr. Sablan. Yes. Thank you very much, Mr. Chairman. Before
I start, I would like to submit additional questions for Mr.
Pula, because I do have a lot of questions. I appreciate it.
And thank you. Your timing for this hearing is actually
perfect. The President promised a $1 trillion infrastructure
program in his address to Congress last week. Now our job is to
make sure that the U.S. Insular Areas and Indian Country, the
tribal communities, participate fully in the President's plans.
Insular and tribal people are among the Nation's poorest.
And the key to raising standards of living and developing our
economies is first-rate infrastructure. Today's hearing can
establish a strong record for what our infrastructure needs are
so that, when the President's proposal is legislated, this
Subcommittee will be able to advocate for the islands and the
tribes.
For that reason I would like to request, Mr. Chairman, that
the record remain open until my governor, Ralph Torres, has had
sufficient time to submit his testimony. Notice for this
hearing was short. The governor wants his response to be
substantive and to reflect the real complexities of the
infrastructure needs, so he was not able to provide his views
to us today, but he promised that he would do it as soon as
possible.
Mr. LaMalfa. [No response.]
Mr. Sablan. Yes, I need a ``without objection.''
Mr. LaMalfa. Yes, I understand. So, pursuant to Committee
Rules, you are allowed up to 10 days for----
Mr. Sablan. We will try and get it in in 10 days.
Mr. LaMalfa. OK, thank you.
Mr. Sablan. Thank you very much, Mr. Chairman. The $27.72
million CIP program that Mr. Pula spoke of originated in the
covenant agreement that brought the Northern Mariana Islands
and the United States into political union. The funds were
meant to help the Marianas ``achieve a progressively higher
standard of living, and to develop the economic resources
needed to meet the financial responsibilities of local self-
government.'' And the money has been instrumental to that
economic growth of our islands, and we are very grateful to the
American taxpayers for that.
However, over time the money was diverted so that now, in
Fiscal Year 2016, the Marianas receive only $9 million, less
than one-third of what we agreed to in the covenant, less than
one-third of what was promised to the Northern Marianas. The
diversion occurred before the Northern Marianas was represented
in Congress. Now I think it is time to re-evaluate where that
money is going and for Congress to have a role in deciding.
So, Nik, Mr. Pula, the criteria OIA uses to divide up the
Marianas covenant funds all have to do with financial
management and grant reporting. And I appreciate very much the
importance of fiscal responsibility. But, according to EPA, the
main island in the Marianas, Saipan, is the only U.S.
municipality without 24-hour running water available to
residents. To me, that is a serious public health concern.
Don't you think--with a yes-or-no answer--that it is time
for us to develop new criteria so that public health and safety
needs are prioritized, or at least considered when funds are
distributed?
Mr. Pula. [No response.]
Mr. Sablan. Please. I don't have too much time, Nik. Yes or
no?
Mr. Pula. As I mentioned, every 5 years we do that. But
based on your question, the Office of Insular Affairs will take
that into consideration.
Mr. Sablan. I appreciate that. That is a yes? OK.
Mr. Pula. Not really, but----
Mr. Sablan. How about the amount of money, Mr. Pula? The
$27.72 million Marianas covenant grant was set up in 1978,
nearly 40 years ago. Do you think this annual money is adequate
to address the infrastructure needs of today?
Mr. Pula. Well, as I mentioned before, Congressman, the
needs are a lot more than the money that----
Mr. Sablan. So that is a no. Thank you. What would that
$27.72 million be today, if we adjusted for inflation?
Mr. Pula. If we adjusted for inflation, that would be
approximately around $42 million.
Mr. Sablan. Thank you. And again, Mr. Pula, every
Thanksgiving I write to each Member of Congress, thanking them
and the American people for their generosity to the Northern
Marianas.
Electricity in the Insular Areas costs about three times
the national average. And I am going to a set of questions, but
I want to say this one thing to our Native Indian tribes and
Native Americans. In another committee I served on, we had a
hearing on Bureau of Indian Education schools, and I will tell
you this much--I was appalled at the conditions that students
in BIA schools were, the conditions their schools were. It was
embarrassing. Schools where snow goes to 8 feet, and the
heaters do not work. You have schools with not enough desks for
students. It is appalling, at the very least. And I am with
you. I am with you, sir.
Do we have second round? OK, I will yield for now. Can I
take my second round right now?
[Laughter.]
Mr. Sablan. I am in the groove.
Mr. LaMalfa. You are on a roll, but we will come back to
you.
Mr. Sablan. All right. No, no, thank you.
Mr. LaMalfa. Thank you. I appreciate that, Mr. Sablan.
Mr. Sablan. Thank you.
Mr. LaMalfa. It is my honor, as the new Chairman of this
Subcommittee, to recognize our Chairman of the entire Natural
Resources Committee, Mr. Bishop, for 5 minutes.
Mr. Bishop. Thank you. And you will notice he did not make
me go first. There is protocol, right? Inside joke, I am sorry.
Let me ask--let me see how many of these things I can get,
a whole bunch of questions. As we now go forward from this
hearing in trying to come up with priorities that we are going
to submit to the overall approach to things, let me ask a
couple of questions.
Let me start with Ms. Kitcheyan, if I can, first. As we are
looking at these priorities, would you give equal weight or
preference either to replacing facilities or maintenance and
repair of facilities? If we have to prioritize, where do we go
with that?
Ms. Kitcheyan. If we had to prioritize, I think we could do
more with maintaining what we have at this point.
Mr. Bishop. Maintenance would take precedence.
Ms. Kitcheyan. Maintenance. Not with IT, though. IT, we
need a complete new infrastructure for IT and telehealth. But
in other terms of infrastructure, we need to maintain what we
have.
Mr. Bishop. All right.
Ms. Kitcheyan. If that is----
Mr. Bishop. I appreciate that. I realize that there is a
priority list with I think 13 projects that have been
grandfathered. It is based on--it has been there for decades on
data that was decades old, as well.
Maybe, Mr. Joseph, if I could ask you. At one time, it
seems to me that Congress has provided at least one creative
idea to approach construction. But IHS has never implemented
it. From the outside looking in, it seems like there is a
culture that they don't really want to be interested in new,
creative approaches.
So, beyond funding, should priorities be tailored to each
of the different regions to update the requests of tribes in
those different regions?
Mr. Joseph. Well, using my tribe as an example, I have been
on my Council for 14 years. When I first came on Council, I
wanted to have a hospital built to replace the old building
that used to be a hospital, was built by the Department of War
back in the 1920s. When they put us on a historical site, then
we kind of got knocked off that priority list. So, it is almost
100 years of waiting.
Our tribe built our own clinic in that area with our
dollars, and we never got any kind of staffing change from back
in those years when IHS first became the provider.
Mr. Bishop. So the historic site was one of the problems
you had faced, then.
As you look at the 13 remaining projects, do you think they
really represent the greatest need?
Mr. Joseph. I would say they do. An area facility
distribution plan would give every area a pot of money so that
we could work on the list. Right now, the Portland area, at the
rate that IHS's facilities are funded, would never see a
facility in over 30 years. And you know, that causes a really
big problem.
Mr. Bishop. All right. I am going to come back to you on
some creative ways we can leverage construction funds. But let
me ask a couple other questions.
First of all, I want to follow up on what Miss Gonzalez was
talking about to Mr. Secretary. That fort, San whatever-it-is
in the Virgin Islands?
Mr. Pula. In St. Thomas, yes.
Mr. Bishop. Why are we using CIP funds to do that? That is
a Park Service project. Why isn't the Park Service paying for
it?
I mean, to me, CIP is not for restoration of Park Service
property. That is Park Service property. Why isn't the Park
Service funding that restoration?
Mr. Pula. Mr. Chairman, I think it is not a Park Service
project. It was a request from the Government of the Virgin
Islands----
Mr. Bishop. Is----
Mr. Pula [continuing]. To use their CIP----
Mr. Bishop. The fort is not federally owned?
Mr. Pula. I don't----
Mr. Bishop. And not part of the Park Service? It is part of
the Park Service? It is not part of the Park Service.
Mr. Pula. It is not--the one in St. Thomas is not part of
the Park Service.
Mr. Bishop. Who owns it?
Mr. Pula. The local Government of Virgin Islands.
Mr. Bishop. All right. Then that is a different question,
then, again.
Look, I will do this very quickly. Mr. Honanie, are there
other barriers to infrastructure development? Specifically,
does NEPA pose a problem? Is it an asset to getting those
development projects going forward, or are there problems with
it in this old law that has never been updated in my lifetime?
Mr. Honanie. Could you repeat? I didn't quite catch
everything, I am sorry.
Mr. Bishop. Actually, I have 18 seconds. I will come back
to you in the next round. But I am asking specifically about
how NEPA--does that process provide an asset to you in getting
this development, or is it a hindrance. I will let you think
about that, because I don't have enough time to do it in this
round. I will yield back.
Mr. LaMalfa. All right. Thank you, Mr. Chairman. That
concludes our first round of questions for our panel. I am
going to go ahead and recognize you, Mr. Chairman, for the
first question of the second round.
Mr. Bishop. All right. Mr. Honanie, how does NEPA help you?
Is NEPA a help or a hindrance?
Mr. Honanie. I think, with regard to rules and regulations,
things of that sort, when it comes to health issues and so
forth, they are both a hindrance and a help. Hindrance, in
terms that it is very demanding, these are very stressful
violations that are being imposed upon us; in terms of fines,
for example, with regard to our arsenic, that is a hindrance.
It forces us to move, it forces us to act.
As far as helping us, it is a way to be able to bring this
type of situation to the attention of the Federal Government--
for example, to this Committee--in hopes of garnering support,
in hopes of being able to raise and bring the capital to the
reservation, so that we can resolve such a pressing issue at
this time, as well as other matters that may be facing us.
So, it just depends on the situation, the timing, and how
long we may have had a situation before us that we have been
trying to resolve so many challenges on the reservation.
Mr. Bishop. All right. I thank you with that.
Mr. Joseph, are there any ideas or ways that the tribes can
leverage these construction funds?
Mr. Joseph. There is the joint venture project. There are
38 of them that were applied last go-around. Our tribe applied
for them, and the price of construction will go up every year.
The joint venture is where the tribes build the facility and
then the government staffs them.
And, using new market tax credits and working with that,
and also utilizing our third-party billing that we are able to
generate some of those dollars could also help in funding the
projects.
Mr. Bishop. That would be helpful. Are there other things
that the Colville Tribes or tribes in the Northwest have done
that are creative to address shortages of construction funding?
Mr. Joseph. Well, the joint ventures is one where the
tribes would invest their dollars. And looking at how tribes
could bill third party, it would generate a lot of added
funding with the new market tax credits. The area facility
distribution that I talked about would be another way where
every area, their tribes would get a pot of that funding.
We are looking at the dental aid therapy program and
generating more funding and providing dental services to our
area. Our state finally authorized us to do dental aid therapy.
And, to me, that will really help a lot.
Mr. Bishop. All right. I appreciate that. I appreciate the
panel being here. Thank you for allowing me to go this time.
Mr. Chairman, I will yield back.
Mr. LaMalfa. I will now recognize Ms. Bordallo for a second
round of questions.
Ms. Bordallo. Thank you, Mr. Chairman. And I am very happy
that we are recognizing protocol.
[Laughter.]
Ms. Bordallo. I want to start out by saying, although I and
Mr. Sablan here are representing the territories, I do support
the needs of all our witnesses today. And I understand your
shortcomings in your areas and the needs you have.
As I stated previously, I hope that we do move forward with
more investments in our infrastructure, and that the
territories will be fully included in these plans, Mr. Pula.
Specifically, I hope that any infrastructure bill would also
include funding to address access to broadband, and for
expanding the IT and telecommunications economies in the
territories, which bring enormous socio-economic potential to
our islands. And this is critical to Guam, especially since I
believe that we should leverage our position in the Asia-
Pacific region to be the hub between the United States and
Asian countries.
Mr. Pula, has OIA given serious consideration to funding
broadband infrastructure needs in the territories? For
example--and I am sure you are well aware of this--several
years ago, the CNMI was cut off from the internet, which
severely and negatively impacted their economy. A potential
redundant system is in the works, and that type of project
should seem appropriate to be funded out of CIP funds.
So, my question. Will you give serious consideration to
funding broadband infrastructure needs to the territories?
Mr. Pula. Thank you, Congresswoman, for the question. I
would like you to know that the CIP funding that the Office of
Insular Affairs has, we have funded laying of cables and that
kind of thing in the past--again, based on the request from the
governors. If that is their priority, then it is something that
is allowable, or has been done through the CIP funding.
Ms. Bordallo. So sometimes request and funding do not
always----
Mr. Pula. You got it right.
Ms. Bordallo. So you will do everything you can.
Mr. Pula. Yes, ma'am.
Ms. Bordallo. Thank you. And I yield back, Mr. Chairman.
Miss Gonzalez-Colon [presiding]. Thank you, Ms. Bordallo.
At this time we recognize the lady from American Samoa, Mrs.
Radewagen.
Mrs. Radewagen. I want to thank you, Chairman Gonzalez, for
holding this hearing today. And I want to thank the panel for
being here, especially Acting Assistant Secretary Pula, who has
worked closely with my office in the past, to ensure that our
island infrastructure needs are being met.
I also want to humbly thank Chairman Bishop for the recent
congressional delegation to the territories, where Members and
staff were able to witness firsthand some of the unique
challenges our islands face in maintaining our infrastructure.
American Samoa, in particular, is engaged in a never-ending
fight to make sure that our islands are on equal footing as the
states and other territories.
A primary example is the LBJ Tropical Medical Center in
American Samoa, which remains under-equipped and under-staffed,
forcing many of our island's residents, especially our
veterans, to seek off-island care. That said, the CIP program
does help alleviate some of our funding issues, going not only
toward healthcare projects, but also education, transportation,
and other infrastructure projects. And I would love to see the
grant program not only continue, but possibly be expanded.
I am also looking forward to a continuation of the well-
executed oversight practices regarding the program. And I am
thankful to have colleagues on this Committee, the Department
of the Interior, and the local American Samoa government work
closely with me and each other to ensure that the CIP grants
are utilized to their fullest.
I have a couple of questions for you, Assistant Secretary
Pula. Since being designated as high risk by OIA, as
recommended by the General Accounting Office and the Office of
Inspector General, how has the American Samoa government
managed to improve accountability for Federal funds? And can
you tell me whether the American Samoa government has completed
any of the requirements necessary for compliance in order to
remove the high risk designation by OIA?
Mr. Pula. Thank you for the question, Congresswoman. There
are a variety of, I guess, high risk. I think the U.S.
Department of Education has designated the American Samoa
government with the education as high risk.
But your particular question regarding the Office of
Insular Affairs, I have to say a lot of the categories, or the
things that needed to be done, have been done by the American
Samoa government, so there has been improvement there. But
there are still some final things that needed to be done, and
we have to kind of circle back and work with the government so
that we can lift the high risk. At this point we have not
completed everything.
Mrs. Radewagen. Thank you. And would you care to comment on
what can be done to ensure that American Samoa continues to
receive increased CIP funding in the future?
Mr. Pula. Well, as you have heard, the allocation of the
CIP funding is made on the basis of competitive criteria, and
measured a demonstrated ability of the government to exercise
prudent financial management practices, as well as the Federal
grants requirements.
The best things for American Samoa that can maximize on the
share of the CIP--because this is mandatory funding, so we will
continue the program--is to have clean audits, and submitted on
time, as well as timely executions of the conditions of the
grants, the terms of the grants.
Mrs. Radewagen. Thank you, Mr. Chairman. I yield back.
Mr. LaMalfa [presiding]. Thank you, Mrs. Radewagen.
Continuing our first round of questions, I recognize Mr. Soto
for 5 minutes.
Mr. Soto. Thank you, Mr. Chairman. I have the honor of
representing Florida up here. And we are home to several major
tribes, including the Seminole Tribe, Miccosukee, and others,
so we deeply care about these issues. And I just wanted to get
a sort of overall view from all the panelists about how should
we in Congress decide how and where to fund infrastructure
development in Indian Country.
I realize there is a 1992 high-priority list, but it would
be great to know if there is a more updated list, and if there
is consensus among high-priority infrastructure projects among
our various prominent tribes here in the United States.
And it is for the entire panel. We could start from left to
right. How does that sound?
Mr. Honanie. I think one way to address such questions and
points is--I wholeheartedly believe that committees such as
yourself really consider the idea of coming to the respective
reservations and literally seeing who we are, what we have, and
what we are facing, the challenges as far as bringing in
infrastructure.
Again, I relate to the point that, as far as Hopi is
concerned, we are landlocked, surrounded by Navajo, and it is a
challenge to bring in any kind of infrastructure onto
reservation, because we have to pass through Navajo. It is not
an easy task. We have to go practically to court to be able to
try this concept of access by necessity.
These are the kind of challenges. And many of the
infrastructures that exist currently on the reservation are
old, they probably do need replacement. While we do replace
them, it is a continual challenge. And the funding, as far as
these projects are concerned, are nil, as far as the tribal
reserves are concerned. We are very, very isolated, and so we
depend on outside funding, we depend on the Federal Government
to be able to come to our assistance, and so forth.
But sometimes many of these issues occur naturally, such as
the arsenic situation here in the water. That is a very serious
issue. That is an issue that is impacting our health care, our
health of the people. And I want to remind you that we have
five schools that are affected, one high school, and scores and
scores of elderly. And again, young people----
Mr. Soto. Thank you, Chairman Honanie. I want to make sure
we get everybody to be able to----
Mr. Honanie. All right.
Mr. Soto [continuing]. Speak a little bit on it.
Chairman Joseph, is there consensus on a list that we could
draw from? What would your thought be?
Mr. Joseph. What I would recommend is that you look at the
current needs that exist. Basic healthcare needs should be
projects that should be, I would say, funded first, so that we
are able to at least get basic healthcare needs. I would rather
have my people getting the basic healthcare needs taken care
of, so that we are not being admitted to the hospital later on
when it becomes a chronic issue, where we are in emergency
care, and it costs the government a whole lot more.
So, if we had the basic medical needs, and had the adequate
amount of providers to provide services to our people, we would
be able to keep us out of the hospitals. And to me, that is
more important. It would save more lives, it would be more
preventative-type medicine, but----
Mr. Soto. Thank you. Thank you, Chairman Joseph.
Representative Kitcheyan, what would you say about
consensus and priority?
Ms. Kitcheyan. From the National Indian Health Board's
perspective, the main priority would be meaningful consultation
with the over 500 federally-recognized tribes, and to have
current data to drive and facilitate that conversation.
Mr. Soto. And Secretary Payment?
Mr. Payment. OK. So this report, we have taken a stab at it
through the National Congress of American Indians, and it is
ongoing. I would say be careful not to throw the baby out with
the bath, because the existing priority lists were built on
criteria based on consultation. So, the only problem is that
they are underfunded, and so there is a backlog.
But I would also say to look--be creative, to create match
incentives for states. We would like at least $20 billion of
that $1 trillion that might be coming. But I would also say
look creatively to seed financing, because you are not going to
fund everything. And if you can create a way to provide seed
financing, so that tribes can go out in a self-determined way
to be able to help fulfill their needs, I think that would be
something that would be different than what we have done in the
past.
Mr. Soto. Thank you. President Teuber?
Mr. Teuber. Thank you for your question. I think, with
respect to health care, which is much of the area that I have
covered, consensus is difficult to achieve in a local
community, much more so across the United States with 500-plus
tribes. But the area distribution fund that was referred to
earlier is an opportunity for us to ensure that there is some
level of equitable distribution of funds for those priorities
that exist within each of the regions, or each of the areas.
Also, the sanitation deficiency list that has been created
for sanitation projects, I would refer to that, but I would
allow tribes to continue to update that as a process for
distribution of resources.
Mr. Soto. Mr. Chairman, at your discretion, would it be OK
for the Secretary to comment?
Mr. LaMalfa. Second round, OK? I have to maintain some type
of discipline here a little bit, right? Thank you.
All right. Recognizing myself on a second round here, I
will back up with Ms. Kitcheyan. Well, first, let me go to Mr.
Joseph.
Again, we are talking about, Chairman Joseph, a 30-year-old
list that maybe does not necessarily match the needs of today's
needs. Should IHS be more active in ensuring that the list is
more up to date, especially for you in the Oregon-Portland
area?
Mr. Joseph. I also serve on the National Facilities
Advisory Committee that IHS has, and there we are looking at
working on doing that. About 17 years ago, they worked on a
master plan for each of the tribes in the United States. So,
they have a master plan that showed the needs that would be
good for up to 15 years.
To me, I think that if the work group was to work on
looking at that, that is where the area facility distribution
plan came out of that work group, and it also came up with a
fair way to score tribes on facility needs. Before that, there
were tribes that had 20-year-old projects that were getting
brand-new facilities built by earmarks. That is why they
established that work group, to do that type of work.
Mr. LaMalfa. OK, thank you. Updating is needed.
Let me come back to, again, Ms. Kitcheyan--when we were
talking about the need for update and more current technology,
let's come back to that information system once again we talked
about. As you mentioned, I think also, that there is no
updating what you have. You need a new system. Tell us about
that a little bit, on what that might take. What will it be,
cost-wise? What will implementing it look like? How far and
wide, if you can.
Ms. Kitcheyan. It would be $3.5 billion to entirely
overhaul the whole system, and it would take time to implement
that update across Indian Country, and right now, some of the
tribal facilities have gone outside and sought private-sector
products. We have huge bargaining power in Indian Country, and
if we leverage our resources and our bargaining power, we can
really come up with something that would serve all of Indian
Country and be of a consistent system that is manageable and
would operate in this 21st century healthcare environment.
Mr. LaMalfa. All right, thank you.
Chairman Honanie, coming back to your situation there, when
I asked you earlier about your ability to, your main economic
core with coal, and the transportation issues you have with
that, that is primarily a railroad problem, again, that you
need infrastructure upgrades on? Or develop that a little more,
please.
Mr. Honanie. Well, the ideal would be to construct a
railroad line to be able to transport the coal once we identify
buyers or a market for it. But again, let me bring up the point
that we would have to work with Navajo to cross their
reservation onto Hopi. And we are already hearing a little bit
of grumbling as that goes. So, this is really going to be a
challenge. And if we can be able to sit down and negotiate with
them, fine and great. That rail line would certainly add to our
ability to create that economic viability, as far as coal is
concerned.
Mr. LaMalfa. Are they interested in being a partner on that
at all, or is it strictly a right-of-way that you are seeking?
Mr. Honanie. It would be a right-of-way, and we would need
to just market, so that we do achieve the goal of establishing
this railroad.
Mr. LaMalfa. OK. A couple of times in the testimony the
arsenic issue has come up here. I don't think I heard you
recognize what is the source of the arsenic problem in the
water?
Mr. Honanie. We have been told that it is a naturally
occurring phenomenon. Because of the groundwater tables, the
amount of water that has been pumped, but Mother Nature, in its
own way, presents arsenic into the water as time goes. So----
Mr. LaMalfa. Let me follow up on that, then, because,
indeed, they changed the arsenic action level a few years ago,
federally. The number was a little higher, what was allowable.
Then that number was----
Mr. Honanie. Right.
Mr. LaMalfa [continuing]. Lowered. Was it OK at the higher
number, or was it outside of it at either action level?
Mr. Honanie. Yes, you could say that because the higher
number allowed us to be able to move forward and to plan, and
so forth. But now that it has been lowered, it really presents
a challenge, it really presents this pressing situation that we
have to deal with to essentially try to resolve this arsenic
issue as soon as possible.
The EPA is certainly keeping a watchful eye on us and, in
fact, threatening with daily fines upon a certain point that we
reach and do not resolve this matter. So it----
Mr. LaMalfa. Were you in compliance at the old number but
not the new number? Do I have that correct?
Mr. Honanie. The lower numbers are what we are trying to
achieve and work with.
Mr. LaMalfa. OK, thank you. I will yield to Mr. Sablan,
waiting patiently for that second round.
Mr. Sablan. Thank you, again, Mr. Chairman.
Mr. Pula, I meant to mention earlier--I wanted to let you
know and thank you, that your field representative in the
Northern Marianas, the retired Colonel Blanco is free again to
come and visit the congressional office, and to discuss issues
of mutual benefits to the constituencies of OIA and the
congressional office. Apparently, before you, he was put on a
leash. But he is again free, and I want to thank you for that.
Electricity in the Insular Areas costs about three times
the national average. And in 2014, in Public Law 113-235,
Congress directed the Interior Department to establish teams of
technical policy and financial experts to develop energy action
plans for the Insular Areas. The plans were to include
recommendations on how to lower the cost of electricity. Can
you please give me a short update on the status of these plans
required by law?
Mr. Pula. Thank you, yes. The office and, of course, the
NREL folks have joined together and helped each of the
territories come up with their action plans, and--so that has
been going forward. And already we have utilized some of the
funding for energy projects to be used in the territories
already. So, I just wanted to give you that update.
Mr. Sablan. Well, thank you. And one of the witnesses
mentioned earmarks. The last time I read the United States
Constitution it says that Congress has the power to control the
purse. And yet, here we are discussing--Ms. Bordallo brought up
the issue of who decides which capital improvement project gets
funded, and it is based on recommendations by the governors.
Now, it should be appropriate that it is Congress that decides
that, I think.
And, Mr. Pula, in the past--and I was one of the special
representatives--we negotiated with the special representative
of the President a 7-year capital improvement project plan. And
we came to an agreement of $128 million for 7 years. But with
the full faith and credit of the United States, we were able to
raise $144 million. The timing was just right for the markets.
And that investment was--we were able to do projects up front,
front-loaded.
And actually, that investment up to today, the Commonwealth
Development Authority, who managed some of the funds, are
receiving benefits, are receiving the payments for projects
that are revenue-generating projects that--and that is a good
way. If we could, again, explore a possibility of doing it that
way, it probably will be beneficial.
But I want to go back to one more thing. I mention this
because the Bureau of Indian Education schools--your office,
Mr. Pula, and the Army Corps of Engineers assessed every public
school building in the Insular Areas in 2013. I was actually
joining them in one of the schools on Saipan. And they were
looking for immediate hazards to student safety: the potential
for falling concrete, electrocution, and fire system problems.
They identified a priority need for $16.7 million to provide a
safe environment for students, and a total of $177 million
overall for deferred maintenance to schools.
Now, your office, the Office of Insular Affairs, is
providing $1 million annually for each Insular Area. At this
rate, could you tell us how long it will take to make all the
necessary repairs at all island schools? And this is for the
Virgin Islands, the Northern Marianas, Guam, and American
Samoa. How long, at $1 million a year?
Mr. Pula. Seven hundred years--I am just kidding, sir. I
will have to look at that and come back and provide it to the
Committee.
Mr. Sablan. Yes. Mr. Pula, I want to thank you, sir, for
the many years of service you have provided the Northern
Marianas and, of course, the Insular Areas in your position as
Director of OIA. We do not always see eye to eye, but your
service, sir, has not gone unnoticed, as well.
We turn to you for so many things, and we appreciate your--
please know that I, for one, appreciate your service, and I
want to thank you.
And, Mr. Chairman, I yield back.
Mr. LaMalfa. Thank you----
Mr. Pula. Thank you, Congressman. Just to respond to your
question about the $1 million a year, based on the program that
we participated with the Army Corps, it will take about 44
years, based on this.
Mr. Sablan. If you give us the $44 million at one time----
Mr. Pula. That would be nice, if we had that.
Mr. Sablan. But that is for all the territories, not just
for us.
Mr. Pula. OK, thank you.
Mr. LaMalfa. Thank you again. Our Vice Chair has no further
questions? OK.
Then Mr. Soto, bring it home, if you have any more.
Mr. Soto. Very briefly, Mr. Chairman, and thank you for
your indulgence.
I would strongly encourage you all to update the list, and
consensus is the key word. It is already going to be
precarious, whether or not we have a large infrastructure bill
or not. I believe that consensus gives you all the best shot to
really have a chance to get the kind of funding that you are
requesting. And, obviously, you all made the case today that
the need is there.
I just wanted to ask one question. Are there any legal
changes that we would need to make to allow you all to combine
your buying power for infrastructure needs such as health care,
roads, sewers, et cetera? Or does that legal authority already
exist? That is to anybody who feels like they can respond to
it.
Mr. Joseph. I would recommend that the Congress ask that
the IHS Director, I guess, enact what has been asked for in the
Indian Health Care Improvement Act to authorize them to move
forward with the area facility distribution plan, and also to
have the existing tribes that are on the joint venture list, to
have that revolve until that list is complete, because that
would allow tribes to move forward with building their
facilities that are ready. They are shovel-ready, a lot of
them.
And, to me, they would be able to move forward if they--out
of the 38, only 7 were authorized to move forward. So, the rest
of them are just waiting; and the longer we wait, the more it
is going to cost. Thank you.
Mr. Soto. Anybody else? Any legal changes we need to make
to allow you all to harness united buying power?
Ms. Kitcheyan. I would encourage the Committee to empower,
and the congressional people to empower our agency, the IHS.
They have the relationships with the tribes, the direct
service, and self-governance tribes, and it makes sense that we
empower IHS to make some of these moves and negotiations on
behalf of the patients that they serve.
Mr. Payment. I would say tax-exempt bond financing,
qualifying tribes to participate in that; providing seed
funding through the agencies, so that they can work with tribes
to identify the joint needs; and just to reinforce RPMS. That
is something that we are obligated, through the system, to
utilize. Right now, with electronic records, it causes crashes,
it is antiquated.
But that is an example of a joint effort and joint buying
power that, if we had some incentive to be able to finance
through that, we could help participate in finding the solution
for that by participating with other tribes.
Mr. Honanie. I would also like to respond that the Indian
Health Care Improvement Act is in existence, and I would like
to think that it will move forward. But I think even the
question and some of the issues being raised here, that that be
taken a look at and embellished or be enhanced, so that issues
like this can be addressed accordingly through a legislation
appropriately.
So that is why I would like to say. Thank you.
Mr. Teuber. We have recently enjoyed some successes, both
legislatively and judicially, around contract support costs.
And we would be remiss if we did not mention that, where
support costs are not associated with direct program dollars,
those direct program dollars oftentimes are diluted. So,
ensuring that legislation and--robust legislation around the
contract support cost appropriations is there is important, but
also to ensure that our agencies and departments are not
returning funds to Treasury that could and should be used for
the purposes that they were appropriated.
Mr. Soto. I yield back, Mr. Chairman.
Mr. LaMalfa. All right. Thank you, Mr. Soto.
With that, we are at the end here. So I, again, wish to
thank our witnesses for their valuable testimony and your
travel in order to be part of today's Committee hearing. And
the Members, for their questions.
If members of the Committee have additional questions for
the witnesses, we would ask for you to respond to these in
writing. Under Committee Rule 3(o), members of the Committee
must submit witness questions within 3 business days following
the hearing, and the hearing record will be held open for 10
business days for these responses.
So, if there is no further business, without objection, our
Committee stands adjourned.
[Whereupon, at 12:04 p.m., the Subcommittee was adjourned.]
[ADDITIONAL MATERIALS SUBMITTED FOR THE RECORD]
Prepared Statement of Ralph Deleon Guerrero Torres, Governor of the
Commonwealth of the Northern Mariana Islands
Mr. Chairman and members of the Subcommittee on Indian, Insular,
and Alaskan Native Affairs, thank you for allowing me to submit
testimony for the record on the infrastructure needs and priorities of
the Commonwealth of the Northern Mariana Islands (CNMI).
As the Subcommittee of Jurisdiction on the affairs of the Insular
Areas, you are well aware of the challenges of creating and sustaining
a viable economy in our islands due to geographical isolation and
limited economic resources.
Despite these challenges, the Insular Areas, like the CNMI continue
to pursue measures to build an economy that can provide for increased
standards of living for our people. At the forefront of these efforts
continues to be the development and the improvement of our
infrastructure.
The CNMI has benefited greatly from the work of the U.S. Department
of the Interior's Office of Insular Affairs and the funding provided
under the Capital Infrastructure Project (CIP) Program. Most recently,
the CNMI has completed the transformation of the former Puerto Rico
dump site into a community park that has added a benefit to the CNMI
residents and an added attraction to our growing tourism industry. This
project, along with the $4.9 million allocated to replace the HVAC
equipment of the Commonwealth Health Care Corporation's hospital on
Saipan and the Garapan Water Quality Restoration Project, are notable
examples of CIP projects that have greatly contributed to building an
infrastructure that can support and sustain a growing population and
economy.
In December 2016, I received a message from the National Governor's
Association (NGA), who at the behest of then President-Elect Donald
Trump's Transition Team requested a listing of the top infrastructure
priorities for each of the states and territories for consideration
into a national infrastructure investment plan.
Following receipt of that request, I took an earnest look into the
immediate needs of the CNMI people and the economy to delineate the
most urgent infrastructure demands of our community. The list I
provided to the NGA and the Transition Team included five major
infrastructure development projects that would allow for economic
growth and enhanced public well-being and the resulting list was as
follows:
1. Saipan Waterline Modernization Project
2. Saipan Wastewater Facility Modernization Project
3. Power plant Rehabilitation and Modernization Project
4. Saipan International Airport expansion and improvement Project
5. Marpi Landfill Completion Project
The priorities were assembled through conversations with the CNMI
Capital Improvement Program Office, the Commonwealth Utilities
Corporation, various departments within the CNMI central government and
the Commonwealth Ports Authority. Each of these projects is essentially
the redevelopment of existing components of the CNMI infrastructure
network, which following decades of use, demand large-scale
rehabilitation or expansion to keep pace with a growing island
community.
I am thankful that the President's Transition Team offered the
Territories and Commonwealths of the United States the to opportunity
provide input into this important conversation about the state of our
Nation's infrastructure. Despite much appreciated Federal assistance
throughout the history of the Northern Mariana Islands' relationship
with the U.S. Government, we are still a developing economy that
requires larger capital investments into our vital, yet aged public
infrastructure.
In addition to the development priorities provided to the
President's Transition Team, we have other serious concerns, which I
believe merits mention. For example, our roads, hospitals, schools and
the CNMI's healthcare physical facilities are all in need of attention
and improvement in order to continue to provide basic services and
improve the quality of life for the citizens and residents living in
our islands. Likewise, inter-island transportation is also a tremendous
problem and compounds the issues associated with trying to bring growth
and economic opportunity to the lesser populated islands in the
Northern Marianas.
While we are in the process of developing a comprehensive proposal
for consideration on the listed priorities, I respectfully request that
we continue to advance the needs and priorities of the U.S. Insular
Areas in any future legislation on investments to our Nation's
infrastructure.
Geographically isolated populations such as ours are heavily
dependent on a stable and reliable infrastructure system. The
unfortunate reality is that the CNMI has only just begun to grow from
years of deep and persistent economic decline. While in the midst
severely reduced economic activity, difficult choices were made in the
allocation of very scarce resources. In this environment, maintenance
and investment into our islands' infrastructure was deferred, only
adding to the need for repair and the costs for doing so today.
However, as Congress may endeavor to move forward with a national
infrastructure investment package, I firmly believe, for a relatively
small investment compared to the needs of others, together we can build
a modern and stable infrastructure network in the CNMI that will usher
in possibilities for a diverse and stable economy and will allow us to
make dramatic strides toward improving the quality of life for the many
American citizens living on our shores.
I thank you for the time you have provided for this important
dialogue and for allowing the inclusion of this testimony.
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