[House Hearing, 116 Congress]
[From the U.S. Government Publishing Office]
ADDRESSING THE URGENT NEEDS OF OUR TRIBAL
COMMUNITIES
=======================================================================
VIRTUAL HEARING
BEFORE THE
COMMITTEE ON ENERGY AND COMMERCE
HOUSE OF REPRESENTATIVES
ONE HUNDRED SIXTEENTH CONGRESS
SECOND SESSION
__________
JULY 8, 2020
__________
Serial No. 116-118
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Printed for the use of the Committee on Energy and Commerce
govinfo.gov/committee/house-energy
energycommerce.house.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
55-505 PDF WASHINGTON : 2024
-----------------------------------------------------------------------------------
COMMITTEE ON ENERGY AND COMMERCE
FRANK PALLONE, Jr., New Jersey
Chairman
BOBBY L. RUSH, Illinois GREG WALDEN, Oregon
ANNA G. ESHOO, California Ranking Member
ELIOT L. ENGEL, New York FRED UPTON, Michigan
DIANA DeGETTE, Colorado JOHN SHIMKUS, Illinois
MIKE DOYLE, Pennsylvania MICHAEL C. BURGESS, Texas
JAN SCHAKOWSKY, Illinois STEVE SCALISE, Louisiana
G. K. BUTTERFIELD, North Carolina ROBERT E. LATTA, Ohio
DORIS O. MATSUI, California CATHY McMORRIS RODGERS, Washington
KATHY CASTOR, Florida BRETT GUTHRIE, Kentucky
JOHN P. SARBANES, Maryland PETE OLSON, Texas
JERRY McNERNEY, California DAVID B. McKINLEY, West Virginia
PETER WELCH, Vermont ADAM KINZINGER, Illinois
BEN RAY Lujan, New Mexico H. MORGAN GRIFFITH, Virginia
PAUL TONKO, New York GUS M. BILIRAKIS, Florida
YVETTE D. CLARKE, New York, Vice BILL JOHNSON, Ohio
Chair BILLY LONG, Missouri
DAVID LOEBSACK, Iowa LARRY BUCSHON, Indiana
KURT SCHRADER, Oregon BILL FLORES, Texas
JOSEPH P. KENNEDY III, SUSAN W. BROOKS, Indiana
Massachusetts MARKWAYNE MULLIN, Oklahoma
TONY CARDENAS, California RICHARD HUDSON, North Carolina
RAUL RUIZ, California TIM WALBERG, Michigan
SCOTT H. PETERS, California EARL L. ``BUDDY'' CARTER, Georgia
DEBBIE DINGELL, Michigan JEFF DUNCAN, South Carolina
MARC A. VEASEY, Texas GREG GIANFORTE, Montana
ANN M. KUSTER, New Hampshire
ROBIN L. KELLY, Illinois
NANETTE DIAZ BARRAGAN, California
A. DONALD McEACHIN, Virginia
LISA BLUNT ROCHESTER, Delaware
DARREN SOTO, Florida
TOM O'HALLERAN, Arizona
C O N T E N T S
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Page
Hon. Frank Pallone, Jr., a Representative in Congress from the
State of New Jersey, opening statement......................... 2
Prepared statement........................................... 3
Hon. Markwayne Mullin, a Representative in Congress from the
State of Oklahoma, opening statement........................... 5
Prepared statement........................................... 6
Hon. Greg Gianforte, a Representative in Congress from the State
of Montana, opening statement.................................. 6
Prepared statement........................................... 7
Hon. Eliot L. Engel, a Representative in Congress from the State
of New York, prepared statement................................ 104
Witnesses
Jonathan Nez, President, Navajo Nation........................... 9
Prepared statement \1\
Answers to submitted questions............................... 161
Christine Sage, Chairman, Southern UTE Indian Tribe.............. 10
Prepared statement........................................... 13
Answers to submitted questions............................... 177
Fawn Sharp, President, National Congress of American Indians..... 24
Prepared statement........................................... 27
Answers to submitted questions............................... 182
Charles Grim, D.D.S., M.H.S.A., Secretary, Chickasaw Nation
Department of Health........................................... 35
Prepared statement \2\
Answers to submitted questions............................... 187
Pilar M. Thomas, Partner, Quarles and Brady LLP.................. 37
Prepared statement........................................... 39
Answers to submitted questions............................... 197
Submitted Material
Statement of Alzheimer's Association and Alzheimer's Impact
Movement, July 8, 2020, submitted by Mr. Pallone............... 105
Statement of Robert Wood Johnson Foundation, July 16, 2020,
submitted by Mr. Pallone....................................... 108
Statement of Internet Society, July 7, 2020, submitted by Mr.
Pallone........................................................ 112
Statement of Rep. Deb Haaland, July 8, 2020, submitted by Mr.
Pallone........................................................ 114
Letter of July 7, 2020, to Mr. Pallone and Mr. Walden, from
Public Knowledge, submitted by Mr. Pallone..................... 123
Statement of July 8, 2020, by Katherine B. McGuire, American
Psychological Association, submitted by Mr. Pallone............ 126
Statement of ``Addressing the Urgent Needs of Our Tribal
Communities'', July 8, 2020, National Council of Urban Indian
Health, submitted by Mr. Pallone............................... 130
----------
\1\ The information has been retained in committee files and also
is available at https://docs.house.gov/meetings/IF/IF00/
20200708/110874/HHRG-116-IF00-Wstate-NezJ-20200708.pdf.
\2\ The information has been retained in committee files and also
is available at https://docs.house.gov/meetings/IF/IF00/
20200708/110874/HHRG-116-IF00-Wstate-GrimC-20200708.pdf.
Statement of National Indian Health Board, July 8, 2020,
submitted by Mr. Pallone \3\
Statement of July 8, 2020, by Jaime A. Pinkham, Columbia River
Inter-Tribal Fish Commission, submitted by Mr. Pallone......... 139
Letter of July 8, 2020, to Mr. Pallone and Mr. Walden, from Upper
Mohawk, Inc., submitted by Mr. Pallone......................... 144
Letter of June 11, 2020, to President Trump, from the Navajo
Nation, submitted by Mr. Pallone............................... 146
Statement of Confederated Tribes of the Colville Reservation,
July 8, 2020, submitted by Mr. Pallone......................... 155
Report on July 7, 2020, ``DOE Indian Energy Program Overview:
Tribal Energy Development and Deployment'', Department of
Energy Office of Indian Energy, submitted by Mr. Pallone \4\
Statement of Presidential Message on the 50th Anniversary of the
Federal Policy of Indian Self-Determination, July 8, 2020,
submitted by Mr. Pallone....................................... 159
----------
\3\ The information has been retained in committee files and also
is available at https://docs.house.gov/meetings/IF/IF00/
20200708/110874/HHRG-116-IF00-20200708-SD006.pdf.
\4\ The information has been retained in committee files and also
is available at https://docs.house.gov/meetings/IF/IF00/
20200708/110874/HHRG-116-IF00-20200708-SD012.pdf.
ADDRESSING THE URGENT NEEDS OF OUR TRIBAL COMMUNITIES
----------
WEDNESDAY, JULY 8, 2020
House of Representatives,
Committee on Energy and Commerce,
Washington, DC.
The committee met, pursuant to call, at 11:07 a.m., via
Cisco Webex online video conferencing, Hon. Frank Pallone
(chairman of the committee) presiding.
Present: Representatives Pallone, Rush, Eshoo, DeGette,
Schakowsky, Butterfield, Matsui, Castor, McNerney, Welch,
Lujan, Tonko, Clarke, Schrader, Kennedy, Cardenas, Ruiz,
Dingell, Veasey, Kuster, Kelly, Barragan, Blunt Rochester,
Soto, O'Halleran, Upton, Shimkus, Burgess, Latta, Rodgers,
Guthrie, Griffith, Bilirakis, Johnson, Long, Bucshon, Flores,
Mullin, Hudson, Walberg, Carter, and Gianforte.
Staff present: Jeffrey C. Carroll, Staff Director; Tiffany
Guarascio, Deputy Staff Director; Timothy Robinson, Chief
Counsel; Waverly Gordon, Deputy Chief Counsel; Kaitlyn Peel,
Digital Director; Joe Orlando, Executive Assistant; Kimberlee
Trzeciak, Chief Health Advisor; Alex Hoehn-Saric, Chief
Counsel, Communications and Consumer Protection; Rick Kessler,
Senior Director and Staff Director, Energy and Environment;
Meghan Mullon, Policy Analyst; Adam Fischer, Policy Analyst;
Rebecca Tomilchik, Staff Assistant; Mike Bloomquist, Minority
Staff Director; William Clutterbuck, Minority Staff Assistant;
Jerry Couri, Minority Deputy Chief Counsel, Environment and
Climate Change; Diane Cutler, Detailee, Oversight and
Investigations; Theresa Gambo, Minority Human Resources/Office
Administrator; Caleb Graff, Minority Professional Staff,
Health; Tyler Greenberg, Minority Staff Assistant; Tiffany
Haverly, Minority Communications Director; Peter Kielty,
Minority General Counsel; Ryan Long, Minority Deputy Staff
Director; Mary Martin, Minority Chief Counsel, Energy and
Environment and Climate Change; Kate O'Connor, Minority Chief
Counsel, Communications and Technology; James Paluskiewicz,
Minority Chief Counsel, Health; Brannon Rains, Minority Policy
Analyst; Kristin Seum, Minority Counsel, Health; Kristen
Shatynski, Minority Professional Staff Member, Health; Alan
Slobodin, Minority Chief Investigative Counsel, Oversight and
Investigations; Peter Spencer, Minority Senior Professional
Staff Member, Environment and Climate Change; and Evan Viau,
Minority Professional Staff, Communications and Technology.
Mr. Pallone The Committee on Energy and Commerce will now
come to order.
OPENING STATEMENT OF HON. FRANK PALLONE, Jr., A REPRESENTATIVE
IN CONGRESS FROM THE STATE OF NEW JERSEY
Today the committee is holding a hearing entitled
``Addressing the Urgent Needs of Our Tribal Communities.'' Due
to the COVID-19 public health emergency, today's hearing is
being held remotely. All members and witnesses will be
participating via video conferencing. And as part of our
hearing, microphones will be set on mute for purposes of
eliminating inadvertent background noise.
Members and witnesses, you will need to unmute your
microphone each time you wish to speak.
Documents for the record can be sent to Rebecca Tomilchik
at the email address we have provided to staff, and all
documents will be entered into the record at the conclusion of
the hearing.
I recognize myself now for 5 minutes for an opening
statement. Let me find my opening statement here, now that I
have said that.
I believe that today's hearing is long overdue. Day after
day our Nation's Tribal communities are suffering terrible
inequalities: unequal access to safe drinking water, unreliable
access to the energy grid, little or no broadband connectivity,
unreliable funding from the Federal Government, and other
systemic problems that have created unnecessary hardship and
turmoil.
Now COVID-19 is exacerbating many of these long existing
problems. More than one-third of Tribal members are at high
risk of serious COVID-19 complications due to underlying health
factors, and Navajo Nation has seen higher infection rates than
those in Wuhan, China, during the peak of the pandemic.
Despite this stark reality of the impact of COVID-19 on
Tribal communities, we have heard repeatedly about the
struggles of Tribal communities in accessing the personal
protective equipment and testing needed to protect against
COVID-19.
As this pandemic rages on and COVID-19 cases continue to
rise in many areas of the country, access to PPE and testing,
as well as access to proper sanitation and well equipped health
facilities, will be critical to flattening the curve for Tribal
communities.
Our Tribal communities deserve better. That is why we are
here to listen to representatives of Tribal governments and
organizations so we can ensure Congress meets its obligations
to Tribal governments and communities.
While I would like to believe that we have made incremental
improvements for Tribes over the years, it is clear that not
enough has been accomplished. In the area of healthcare, as I
noted, Tribal communities experience greater health disparities
compared to other groups, which increases their risk of
hospitalization due to COVID-19 and associated complications.
We have to tackle the fact that the Indian Health Service
remains chronically underfunded. It is impossible for IHS to
meet the healthcare needs of Tribal members, whether in a
pandemic or not, without sufficient and stable resources, which
has contributed to outdated infrastructure and medical
equipment.
And while Congress has provided increased resources to IHS
in recent coronavirus packages, the administration has failed
to get this money to Tribal communities swiftly, putting Tribal
members further at a disadvantage in receiving the testing,
PPE, and healthcare access they need in order to respond to
COVID-19.
The Moving Forward Act includes $5 billion for IHS and
Tribal recipients for the construction and renovation of
hospitals and outpatient care facilities.
I also look forward to hearing about what the Federal
Government can do to make sure all Tribal communities have
access to high speed internet service. As you know, the
pandemic has driven home how internet connectivity is essential
for everyone. Telehealth services are vital, especially in
remote areas, distance learning is the only option for many,
and telework and e-commerce are growing in importance.
Yet, for all its benefits, two-thirds of people living on
rural Tribal lands have no internet connectivity, which I think
is a disgrace. And, fortunately, the Moving Forward Act also
brings more connectivity to Tribal households by providing $80
billion for broadband deployment projects.
Electricity and water access on Tribal lands also continues
to be a major issue, and Tribal households are less likely to
have access to indoor plumbing and a safe water supply.
The Moving Forward Act addresses these issues by investing
$47 billion in drinking water, including the Indian Reservation
Drinking Water Program, and $50 million to improve Tribal
communities' access to affordable and reliable energy sources.
So I just want to say that we would like to bring more
renewable or other energy production to Tribes, and we have to
look forward to ways to encourage moving in that direction.
So I don't have--I wanted to give half of the time left to
both Representatives Ruiz and O'Halleran, I know there is not a
lot left. So maybe we will give like--we will start with
Representative Ruiz.
You have got, like, 30 seconds and then we will give the
other 30 to Tom.
[The prepared statement of Mr. Pallone follows:]
Prepared Statement of Hon. Frank Pallone, Jr.
Today's hearing is long overdue. Day after day, our
nation's tribal communities are suffering terrible health
inequities, unequal access to safe drinking water, unreliable
access to the energy grid, little to no broadband connectivity,
unreliable funding from the federal government and other
systemic problems that have created unnecessary hardship and
turmoil. And now COVID-19 is exacerbating many of these long-
existing problems.
More than one-third of tribal members are at high-risk of
serious COVID-19 complications due to underlying health
factors, and Navajo Nation has seen higher infections rates
than those in Wuhan, China during the peak of the pandemic.
Despite this stark reality of the impact of COVID-9 on
tribal communities, we have heard repeatedly about the
struggles of tribal communities in accessing the personal
protective equipment and testing needed to protect against
COVID-19.
As this pandemic rages on and COVID-19 cases continue to
rise in many areas of the country, access to PPE and testing,
as well as access to proper sanitation and well-equipped health
facilities, will be critical to flattening the curve for tribal
communities.
Our tribal communities deserve better. That is why we are
here to listen to representatives of tribal governments and
organizations so that we can ensure Congress meets its
obligations to tribal governments and communities.
While I would like to believe that we have made incremental
improvements for tribes over the years, it is clear that not
enough has been accomplished.
In the area of healthcare, as I noted, tribal communities
experience greater health disparities compared to other groups,
which increases their risks of hospitalization due to COVID-19
and associated complications. We must tackle the fact that the
Indian Health Service (IHS) remains chronically underfunded. It
is impossible for IHS to meet the healthcare needs of tribal
members, whether in a pandemic or not, without sufficient and
stable resources--which has contributed to outdated
infrastructure and medical equipment.
While Congress has provided increased resources to IHS in
recent coronavirus packages, this Administration has failed to
get this money to tribal communities swiftly, putting tribal
members further at a disadvantage in receiving the testing, PPE
and healthcare access they need in order to respond to COVID-
19.
The Moving Forward Act includes $5 billion for IHS and
tribal recipients for the construction and renovation of
hospitals and outpatient healthcare facilities money that can
also be used to help with public health preparedness during the
COVID-19 response.
I also look forward to hearing about what the Federal
government can do to make sure all tribal communities have
access to reliable, secure, high-speed internet service. This
pandemic has driven home how internet connectivity is essential
for everyone. Telehealth services are vital, especially in
remote areas, distance learning is the only option for many,
and telework and e-commerce are growing in importance.
Yet for all of its benefits, two-thirds of people living on
rural tribal lands have no internet connectivity. This is a
disgrace.
Fortunately, the Moving Forward Act brings more
connectivity to Tribal households by providing $80 billion for
broadband deployment projects, and includes a preference for
projects that bring broadband to rural areas and Tribal lands.
It also creates grant programs for broadband adoption and
digital inclusion, with specific tribal consultation
requirements and set asides.
Electricity and water access on tribal lands also continue
to be major issues, even in the 21st Century. Tribal households
are less likely to have access to indoor plumbing and a safe
water supply, with some communities driving weekly to get
water, rationing it for their household uses. Many households
are also left without reliable electricity or must pay
extremely high rates.
The Moving Forward Act addresses these issues by investing
$47 billion in drinking water programs, including the Indian
Reservation Drinking Water Program, and $50 million to improve
tribal communities' access to affordable and reliable energy
sources.
Tribal lands have also long suffered from development
projects that use their land without any benefit to them.
That's simply not right, and now, as some tribes explore
renewable or other energy production, they run into roadblocks
like federaland state regulations, and lack of access to
project financing and workforce training. We need to look at
ways to encourage this type of development.
I thank our witnesses for being here today, and I'd like to
yield the remainder of my time to Rep. Ruiz and Rep. O'Halleran
- both champions for the tribal communities on this Committee.
Mr. Ruiz. Thank you, Mr. Chairman, for holding this
important and historic hearing to address the needs of Indian
Country. We have been working on these Tribal issues together
for years now, including on the Indian Health Service Task
Force, along with our friend on the other side of the aisle,
Congressman Mullin. And I am pleased that we are having this
critical hearing and appreciate your leadership on Tribal
issues, which I have been working on since long before I came
to Congress.
Tribal nations have long suffered from massive underfunding
and a scarcity of resources, and the COVID-19 pandemic only
amplifies the disparities that are a result of the lack of
funding. During this Congress, reports commissioned by myself
and the chairman exposed challenges Indian Country faces,
including access to broadband inequities and failures in the
Tribal consultation process within the Superfund program. That
is not to mention the drastic health disparities in Indian
Country.
So I am looking forward to discussing all these issues
further during today's hearing and further markups and in the
coming months.
Thank you, Mr. Chairman. I yield back.
Mr. Pallone Tom, there are only a few seconds left if you
want to say something. I am sorry.
Tom?
Well, maybe he is not on?
Mr. O'Halleran. He is on.
Historically, Federal policy has unacceptably left the
needs of the Native American communities behind. President Nez
and I have been working together to address how the Navajo
Nation and people have been left behind and develop bold public
policies needed to rectify this.
I thank the chairman and all the members of the committee
for recognizing in the bills that we have put forward the needs
of Tribal lands that we can do so much more. Thank you.
Mr. Pallone Thank you, Tom.
And I am now going to now recognize Mr. Walden for 5
minutes, but if you want to give an extra 30 seconds to
Markwayne because we gave an extra 30 to Tom, Greg. It is up to
you.
Greg?
Mr. Mullin. Mr. Chairman, I thank you. He is going to
yield 2\1/2\ minutes to me and 2\1/2\ minutes to Representative
Gianforte.
Mr. Pallone Oh, OK, great. So I recognize Markwayne Mullin.
OPENING STATEMENT OF HON. MARKWAYNE MULLIN, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF OKLAHOMA
Mr. Mullin. All right. Now I am not ready. Give me just a
second because I left my notes on my phone.
Mr. Pallone Sure.
Mr. Mullin. Well, first of all, thank you, Chairman, and
thank you for all the chairs and ranking members of the full
committee and the Health Subcommittee for listening to my
concerns and having this important hearing. As was addressed
earlier, I think this is the first time in my time definitely
on the committee that we have had a full committee hearing on
Native American issues.
And Native Americans deserve quality and reliable
healthcare services as promised--as promised--by the Federal
Government. In fact, it is the only Federal obligation for
healthcare that we have out there.
As a Cherokee, I grew up going to Tribally run hospitals.
At Hastings, which is just down the road from me in Tahlequah,
was where I received my healthcare, and I understand how
important that operating these direct services and facilities
are to Tribal members.
Last Congress I was fortunate enough to co-chair the IHS
Task Force, which led up to several key areas in which we can
improve healthcare and improve care to over 2.2 million Native
Americans.
IHS is not only terribly underfunded, but it is also the
only Federal healthcare agency who doesn't receive mandatory or
advanced appropriations. We have to fix that.
IHS must also be modernized. Its IT system needs to be
brought into the 21st century.
There is so much going on in Indian Country that applies to
this committee and we need to take a deeper dive.
Again, Chairman, I want to thank you for holding this
hearing. I urge my committee to continue this process with
additional hearings in the Health and Oversight and
Investigations Subcommittees.
[The prepared statement of Mr. Mullin follows:]
Prepared Statement of Hon. Markwayne Mullin
Thank you to the Chairs and Ranking Members of the fully
committee and the Health Subcommittee for listening to my
concerns and having this important hearing. Natives deserve
quality, reliable healthcare services as promised by the
federal government. As a Cherokee, I grew up only going to
tribally ran hospitals and know just how crucial the Indian
Health Service and tribally operated direct service facilities
are.
Last Congress, I co-chaired the IHS Taskforce which came up
with several key areas in which we can improve the healthcare
provided to 2.2 million Natives. IHS is not only terribly
underfunded, but it's also the only federal healthcare agency
who doesn't receive mandatory or advanced appropriations. IHS
must also modernize its IT system and bring it into the 21st
Century.
There is so much going on in Indian Country that applies to
this Committee and we need to take a deeper dive. Again, thank
you for holding this hearing. I urge the committee to continue
this process with additional hearings in the Health and
Oversight and Investigations Subcommittees.
Mr. Mullin. And with that, I will yield the remainder of
my time to the gentleman from Montana, Representative Greg
Gianforte.
OPENING STATEMENT OF HON. GREG GIANFORTE, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF MONTANA
Mr. Gianforte. Well, I want to thank the gentleman from
Oklahoma for yielding. I appreciate his leadership on the
Indian Health Service Task Force last Congress. Well done.
I have long asked that we hear from Indian Country. And I
am glad, Mr. Chairman, we are having this hearing today. Native
Americans make up nearly seven percent of Montana's population
and more than two percent of the U.S. population.
I was proud to finally pass legislation restoring Federal
recognition to the Little Shell Tribe of the Chippewa Cree in
Montana last year. That was long overdue.
Federally recognized Tribes enjoy a nation-to-nation
relationship with the U.S. Government. This recognition allows
Tribes to access critical resources for economic development,
healthcare and education, and regulate affairs on Tribal lands.
These resources often come with complicated Federal procedures.
We need to better understand these challenges to increase
opportunity for these communities.
During the COVID-19 pandemic, Americans rely on broadband
connection for their daily activities. Broadband is essential
for business, education, and telemedicine. Many Tribal lands in
the United States are among those areas in our country that
lack adequate broadband access. Each Tribe has unique
challenges for deployment, from rough terrain to complicated
and expensive Federal permitting regimes.
Last month, I joined with Republican members to introduce
legislation that will help streamline some of those reviews,
making it easier for companies to deploy broadband
infrastructure and close the digital divide. Additionally, the
FCC offered Tribes early access to the 2.5 gigahertz band in
order to ensure that Tribes could obtain spectrum licenses.
While these are great first steps, we must do more to close
this digital divide.
Also key to Tribal nations is energy, access to it, as well
as the ability to develop, produce, and sell it. Many Tribal
nations are rich in resources that they use for energy
development and production. In my home State of Montana, the
Crow Tribe produces coal and faces challenges exporting it.
One of our witnesses today is Chairman Sage of the Southern
Ute Indian Tribe. The Southern Ute are engaged in oil and gas
production, on and off the reservation. These energy resources
are economic drivers and fund investments in other businesses
for the Tribes.
Not all Tribal lands have these types of resources and
services developed and are readily available. Still, many have
issues with access to electricity and safe drinking water. We
need to understand how to address these challenges. I look
forward to this important discussion today.
Thank you, Mr. Chairman. And with that, I yield back.
[The prepared statement of Mr. Gianforte follows:]
Prepared Statement of Hon. Greg Gianforte
I thank the gentleman from Oklahoma for yielding. I
appreciated his leadership on the Indian Health Service Task
Force last Congress.
I have long asked that we hear from Indian Country and I am
glad we are having this hearing. Native Americans make up
nearly 7 percent of Montana's population and more than
2TWOpercent of the US population.
I was proud to finally pass legislation restoring federal
recognition to the Little Shell Tribe of Chippewa Cree in
Montana last year. Federally recognized tribes enjoy a nation
to nation relationship with the US government.
This recognition allows tribes to access critical resources
for economic development, healthcare and education and regulate
affairs on tribal lands. These resources often come with
complicated federal procedures. We need to better understand
these challenges to increase opportunity in these communities.
During the COVID-19 pandemic, Americans rely on a broadband
connection for their daily activities. Broadband is essential
for business,education, and telemedicine. Many tribal lands in
the United States are among those areas in our country that
lack adequate broadband access.
Each tribe has unique challenges for deployment, from rough
terrain to complicated and expensive federal permitting
regimes.
Last month, I joined with Republican members to introduce
legislation that would help streamline some of those reviews,
making it easier for companies to deploy broadband
infrastructure and close the digital divide. Additionally, the
FCC offered tribes early access to a 2.5 gigahertz band in
order to ensure that tribes could obtain spectrum licenses.
While these are great first steps, we must do more to close the
digital divide.
Also key to Tribal nations is energy--access to it, as well
as the ability to develop, produce and sell it. Many tribal
nations are rich in resources that they use for energy
development and production.
In my home state of Montana, the Crow Tribe produces coal
and faces challenges exporting it. One of our witnesses today
is Chairman Sage of the Southern Ute Indian Tribe. The Southern
Ute are engaged in oil and gas production on and off the
reservation. These energyresources are economic drivers, and
fund investments and other businesses for the tribes.
Not all Tribal lands have these types of resources and
services developed and readily available. Many still have
issues with access to electricity and safe drinking water. We
need to understand how to address these challenges.
I look forward to these important discussions during our
hearing today.
Mr. Ruiz. Chairman, you are on mute.
Mr. Pallone OK. So I just want to remind everyone that,
pursuant to committee rules, all members' written opening
statements will be made part of the record.
And now we are going to go to our witnesses for today's
hearing. And I wanted to recognize Mr. O'Halleran to introduce
our first witness, the President of the Navajo Nation.
Tom.
Mr. O'Halleran. Thank you, Mr. Chairman.
President Jonathan Nez has served as the tireless leader of
the Navajo Nation and is now a committed public servant of the
Navajo people. He has served in all offices of the Navajo
Nation. He fully understands the scope of the challenges facing
the Navajo Nation and Indian Country.
The realities of life on the Navajo Nation is harsh. And in
many places, as you have indicated earlier, there is a lack of
water, electricity, and the basic needs of life. And join our
efforts to ensure that the Federal Government lives up to the
treaty and trust obligations that it has.
Thank you.
Mr. Pallone Thank you.
And then we are also going to hear from the Honorable
Christine Sage, who is chairman of the Southern Ute Indian
Tribe, and from Fawn Sharp, who is president of the Quinault
Indian Nation and who is testifying today as the president of
the National Congress of American Indians.
And then I would like to introduce now Markwayne Mullin to
introduce Dr. Charles Grim, if he would.
Mr. Mullin. Thank you, Chairman Pallone.
I am actually really honored to introduce this fellow
Cherokee. He is an accomplished healthcare professional, and as
I said, he is a fellow Cherokee, Dr. Charles Grim.
Dr. Grim has decades of experience at IHS, including as the
director of IHS under President George W. Bush. He has spent
years leading the health services for the Cherokee Nation and
is now the secretary of health for the Chickasaw Nation. He is
also a retired assistant surgeon general and a rear admiral in
the Commissioned Corps of the U.S. Public Health Service.
He is a Native doctor who has dedicated his life to serving
Indian Country. And I am very proud to have him here
representing the great State of Oklahoma.
Dr. Grim, thank you so much for being here today.
Mr. Pallone Thank you.
And then our last witness is Pilar Thomas, who is a partner
in Quarles & Brady.
So let's start with President Nez.
President Nez, you are now recognized for 5 minutes for
your statement. Thank you.
STATEMENTS OF CHARLES GRIM, D.D.S., M.H.S.A., SECRETARY,
CHICKASAW NATION DEPARTMENT OF HEALTH; JONATHAN NEZ, PRESIDENT,
NAVAJO NATION; THE HONORABLE CHRISTINE SAGE, CHAIRMAN, SOUTHERN
UTE INDIAN TRIBE; FAWN SHARP, PRESIDENT, NATIONAL CONGRESS OF
AMERICAN INDIANS; PILAR M. THOMAS, PARTNER, QUARLES & BRADY LLP
STATEMENT OF JONATHAN NEZ
Mr. Nez. Thank you Chairman Pallone, Ranking Member
Walden, and members of the committee on Energy and Commerce.
Thank you, my friend Tom O'Halleran, for that introduction.
My name is Jonathan Nez. I am the president of the Navajo
Nation. Vice President Myron Lizer and I greet you today. We
appreciate this opportunity to testify before the full
committee today to address urgent needs facing the Navajo
Nation. Many of these same issues are being affected by the 573
other Tribes throughout the country.
The Navajo Nation is going through some tough times right
now, as the chairman mentioned, and I appreciate the prayers
and support that we have been given by our congressional
delegation and Congress. Thank you so much.
Today I am going to be talking about water, electricity,
and broadband infrastructure. Of course this committee oversees
many other jurisdictions throughout the United States. And for
the 5 minutes I think water, electricity, and broadband will be
our focus.
But before I begin those comments, I would like to start
with a COVID-19 update on the Nation, on the Navajo Nation.
As of yesterday, July 7th, 5 p.m., I received a report from
our epidemiology team. There are a total of 7,941 confirmed
COVID-19 positive cases.
You know, we are also tracking the recovery numbers. So
5,650 have recovered. We have lost 379 of our relatives here on
the Navajo Nation. Please hold them in prayer.
We have tested over 60,000 individuals since this crisis
entered our borders. And we have been testing very
aggressively. And this shows that 29.4 percent of our total
population have been tested.
For almost two months the Navajo Nation saw the highest per
capita COVID infection rate in the U.S. But right now per
capita we are testing more of our citizens than any State or
any, matter of fact, any country, many of the countries
throughout the world.
As a result of the chronic underfunding of Indian programs,
which was mentioned earlier, Tribes were not equipped with
prompt and adequate resources to respond to COVID-19. For
example, CARES funding did not fully reach the Navajo Nation
until three months after Congress intended.
Again, I deeply appreciate the committee for convening this
hearing today to shed light on these matters and for hearing
our most urgent needs.
In terms of water, there is no greater need on the Navajo
Nation than clean drinking water, where more than 40 percent of
the Navajo Nation households do not have running water. Access
to safe drinking water and sanitation facilities are an
extension of primary healthcare delivery.
Legislation H.R. 756, introduced by Congressman O'Halleran
and Congressman Young, is a great step toward providing safe
drinking water to our Navajo people.
In addition, the House should pass the Navajo-Utah Water
Rights Settlement Act, which the Senate unanimously passed as
part of S. 886. Under this bill the Navajo Nation would receive
approximately $220 million in Federal and State funding for
desperately needed drinking water infrastructure.
Further delaying the passage of S. 886 will continue to
deny clean drinking water to the Navajo people. The Navajo
Nation has waited decades for this day to come, and this
lifesaving legislation is one House vote away from becoming a
reality. Therefore, I respectfully request the House pass S.
886, as passed by Senate, immediately.
In terms of electricity, roughly 10,000 homes lack
electricity. Red tape is as much to blame as funding. It takes
anywhere from 1 to 2 years to get the necessary approvals for
infrastructure projects. We urge Congress and Federal agencies
to review Federal laws and regulations that impede and delay
infrastructure projects.
In terms of broadband, roughly 60 percent of our resident
population lacks broadband access. This is unacceptable when
considering the opportunity our citizens and residents are
denied in our current economy.
The broadband limitations for Navajo residents is due to
the current broadband infrastructure. There are approximately
1,000 communication towers on the Navajo Nation that provide
capability for broadband and broadcast carriers. By comparison,
the State of New Jersey, which is almost one-third the size of
the Navajo Nation, boasts in excess of 1,300 communication
towers.
In conclusion, Chairman and members of the committee, the
Navajo Nation seeks to strengthen the sacred trust relationship
between our two governments. Working together in partnership
with you, we can close the digital divide, expand access to
water, health, and other needs of the Navajo people.
In my written testimony I discuss the impacts of climate
change, the closure of the Navajo Generating Station, and other
concerns such as air quality and uranium mine remediation. I
hope you are able to review those comments as well.
Thank you for the opportunity to testify before you today.
I am prepared to answer any questions members of the committee
may have. And thank you, Chairman and members of the committee.
[The prepared statement of Mr. Nez follows:]
[The information appears at the conclusion of the hearing.]
Mr. Pallone Well, thank you, President Nez. And thank you
for outlining those urgent needs, which is obviously the main
focus of our hearing today.
Next we have Chairman Sage, who is chairman of the Southern
Ute Indian Tribe. You are recognized for 5 minutes.
STATEMENT OF CHRISTINE SAGE
Ms. Sage. Good morning, Chairman Pallone, Ranking Member
Walden, and members of the committee. I am Christine Sage,
chairman of the Southern Ute Indian Tribe. Thank you for
inviting to testify. It is an honor to speak with you this
morning about the effect of the coronavirus on the Southern Ute
Indian Tribe and the needs of Indian Country.
The Southern Ute Indian Tribe story exemplifies the success
of the Federal policy of self-determination for Tribal nations.
That policy is 50 years old today.
The Tribe exercised its self-determination when confronted
with the coronavirus pandemic early this year. We acted quickly
so we could protect all of our Tribal members, in particular
our Tribal elders and others who are at risk. Because of our
diligence, today the reservation is a relative haven amid
rapidly increasing cases of the virus.
But the pandemic has highlighted weaknesses in the trust
relationship between the Tribes and the Federal Government, and
that is what I want to emphasize today.
Recent legislation was supposed to benefit Tribes during
this crisis, but it has failed to consider the unique
circumstances of Tribal government. For instance, the PPP did
not fully take Tribes into consideration. Tribes rely on
entities to raise revenue to fund governmental operations. This
means that multiple Tribal businesses may be operating under a
single EIN. The SBA processing protocol denies applications for
businesses when a loan has already been approved through the
EIN of another business, even if that other business is a
completely separate entity. This places Tribal businesses at an
unfair disadvantage as they are forced to choose only one of
their eligible businesses.
There is no reason to allow each location of a restaurant
chain to apply for a loan but not each individual Tribal
business. We need legislation allowing Tribal businesses
operating under a single EIN to each be eligible for a loan.
The CARES Act allocated $8 billion for Tribes. Congress
directed that the funds be disbursed within 30 days to address
emergency needs of Indian Country, but the full disbursement of
those funds was delayed by up to two months.
Confidential data provided to Treasury by Tribes were
leaked to the public. The guidance on the use of those funds
comes from Treasury. And once again, it is apparent that it
does not understand how Tribal government operates. That
guidance is often inconsistent, unclear, or inapplicable to
Tribes.
Tribes are not permitted to use the funds to continue to
pay employees who are unable to work due to the coronavirus.
But States may use those funds to pay those same employees
unemployment compensation if the Tribes terminate their
employment.
Additionally, the guidance is so restrictive it makes it
difficult to put funds to good use without risk of an audit.
Moving forward, prior to issuing guidance, Treasury needs
to genuinely consult with Tribal governments.
The third area of focus is around the oil, gas, and energy
industry, which has been ignored during this economic crisis.
It is vital to the economies in much of Indian Country.
We must use this opportunity to revitalize Tribal energy
programs and prepare for the future. The Energy Policy Act of
2005 authorized the Department of Energy to establish the
Tribal Energy Loan Guarantee Program, which is seriously
underfunded. Subsidy funds must be appropriated and used toward
the development or extension of power generation and
transmission projects that employ commercially proven, carbon
neutral, and/or renewable energy technologies.
The current Tribal program only provides up to 90 percent
guarantee for loans while the innovative energy programs
provide 100 percent. The Tribe requests that the percentage
guarantee be increased to 100 percent for innovative technology
projects on Tribal land to make energy development on Tribal
land equitable with development on non-Tribal land. Seed
capital and feasibility study grants would also improve the
speed and consistency of developing these projects.
Finally, the pandemic has highlighted the weaknesses in
communication and high speed internet technology in Indian
Country. Many Tribes, like Southern Ute, are in remote areas
where the broadband infrastructure is weak or nonexistent. Our
students are unable to participate in distance learning and our
elders are unable to connect with a healthcare provider
virtually.
Fifty years ago, when the Federal Government embarked on
this era of self-determination, Congress was able to look at
the mistakes of the past, learn from them, and assist Tribes in
a process of achieving self-determination. Today, we likewise
can look at the events of the past few months, identify the
weaknesses in our Federal-Tribal trust relationship that have
been revealed by this crisis, learn from them, and correct
them.
Thank you for your time. [Speaking native language.]
[The prepared statement of Ms. Sage follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. Ruiz. Chairman, you are on mute.
Mr. Pallone I am sorry. I keep forgetting that they turn it
off automatically.
So as I said, I wanted to thank Chairwoman Sage, who just
spoke. And now I want to go to President Sharp. President Sharp
is the president of the Quinault Tribe, but she is actually
testifying today on behalf of NCAI.
So, President Sharp, you are now recognized for 5 minutes.
STATEMENT OF FAWN SHARP
Ms. Sharp. [Speaking native language.] Good morning,
Chairman Pallone and Ranking Member Walden. On behalf of the
National Congress of American Indians, I thank you for
convening this hearing. My name is Fawn Sharp. I am president
of the Quinault Indian Nation and president of the National
Congress of American Indians.
Like all governments, Tribal nations strive to ensure the
well-being of our communities through the delivery of essential
government services. These services are funded by the trust
responsibility of the United States.
This obligation has been chronically and for a long time
been underfunded as was documented in the U.S. Commission on
Civil Rights report that was recently released to Congress last
year. This details and concludes not one Federal agency is
living up to its trust responsibility. On every sector
affecting our lives and our communities there is a widespread
and chronic underfunding.
These disparities have led to our vulnerability and the
disproportionate impacts of COVID-19 to our communities, both
in terms of our infection rates and the rate of death. To
address this pandemic, we urgently need an increase to the
Tribal set-aside in the Coronavirus Relief Fund.
We had heard there is a belief that Tribes don't need
additional funding, which creates a real problem. Treasury has
set a timeline of July 17 to report back the use of the funds,
and we are very concerned that this report is going to create a
distortion on the need within Indian Country because it has
been nearly three months since these dollars were appropriated
by Congress and we are just now starting to see the bulk in the
remaining balance from the fund. Sixty percent was released. We
had to go through litigation.
And so we are at the point now where we are among the most
vulnerable, we are disproportionately impacted. And it is an
outrage that at this point we still do not have the funding
that Congress appropriated three months ago. And so I want to
make it very clear that there is a need in Indian Country and
we do need additional dollars.
In addition to the pandemic, we also must respond to some
of the structural barriers within Treasury. And I want to focus
my testimony today on a few points. I would like to speak
directly to healthcare.
With regard to healthcare, we must secure stable funding.
We experience the greatest health disparities in the United
States and we are harmed by the delays in Federal
appropriations because Tribal programs are funded by the trust
responsibility.
Since 1998 only once has the Interior, Environment, and
Related Agencies Appropriations bill been enacted before the
new fiscal year. Recently, in 2019, the government shutdown a
led to the reduction of health services, endangering Tribal
health.
To address this instability, Congress must pass legislation
authorizing advance appropriations for both IHS and BIA, which
would protect essential Tribal government services from
appropriation delays.
Additionally, stable funding is needed in the Special
Diabetes Program for Indians. Presently, we have
disproportionately high rates of diabetes, which has increased
the lethality of COVID-19 to our population.
The Special Diabetes Program has reduced the prevalence of
this disease and saved Medicare $52 million per year. Despite
this success, it has been flat funded at $150 million since
2004 and short-term reauthorizations have impaired programs at
the expense of patients. To sustain this critical program,
Congress must support long-term reauthorization and stable
funding.
I would like now to shift to the topics of climate change
and clean water.
Climate change threatens the health, culture, and economies
of Tribal peoples. Due to these impacts, Tribal nations are key
partners in the national and global response to climate change.
To support this partnership, Congress should pass
legislation that includes full and meaningful consultations
with decisionmakers, co-management opportunities, and financing
climate activities, and to ensure that there is government
parity in climate action by including Tribal nations in
federally funded responses to the climate crisis.
In addition to climate change, Tribal communities
experience environmental disparities involving lack of access
to clean and safe drinking water. The EPA Safe and Clean
Drinking Water State Revolving Funds are important mechanisms
for addressing these issues.
While we appreciate H.R. 2's increases to the revolving
funds, a 5 percent Tribal set-aside is needed to address the
severe water access needs for Tribal communities.
We also encourage Congress to increase Tribal energy access
and development. Tribal nations encounter many barriers in
developing energy resources within their homelands, including
financing challenges.
The Department of Energy's Office of Indian Energy provides
funding for developing energy infrastructure on Tribal lands.
Recently, H.R. 2 increased funding for this office. We
appreciate this increase and also request elimination of
matching requirements which are an access barrier for many
Tribal nations, especially during the pandemic, which has
resulted in loss of Tribal revenues.
Furthermore, removal of statutory programmatic restrictions
is needed for other energy financing to enable Tribal access.
The Department of Energy's Tribal Energy Loan Guarantee Program
was authorized in the Energy Policy Act of 2005 and not funded
until 2017 and hasn't financed any projects. In part, this is
due to the eligibility requirements that require complex
commercial financing.
Removal of these nonstatutory restrictions would allow
applicants to access the credit necessary to develop energy
resources and sustainable businesses.
I finally would like to speak to the issue of
telecommunications accessibility. To address immediate
connectivity needs, Congress should ensure all Tribal nations
are eligible for temporary authority to unassigned spectrum on
all Tribal lands. Congress should also extend the FCC's 2.5
gigahertz Tribal Priority Window, which closes on August 3,
2020.
A spectrum license enhances broadband and mobile coverage.
Emergency access to unassigned spectrum supports immediate
broadband deployment, while the TPW aids long-term broadband
infrastructure.
Presently, Tribal nations are responding to the pandemic
and would have to devote resources to meet the August deadline.
Tribal nations and NCAI have requested an extension of the TPW
until January 2021 due to the pandemic, and to date FCC has not
responded.
Further, FCC has created classes of Tribal nations in its
spectrum and other proceedings, which is a violation of its
trust responsibility and furthers connectivity challenges by
providing checkerboard coverage.
To address these issues, we urge Congress to extend the TPW
deadline and ensure the FCC makes all Tribal nations and lands
eligible for this opportunity.
In conclusion, I thank you for the opportunity to testify
and I look forward to answering any questions. [Speaking native
language.]
[The prepared statement of Ms. Sharp follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. Pallone Thank you, President Sharp, and thanks for all
that NCAI does on a regular basis to inform us as Members of
Congress of what needs to be done and what are the priorities
for Indian Country. We really rely on you.
So now I want to turn to Dr. Grim.
You are recognized for 5 minutes.
STATEMENT OF CHARLES GRIM
Dr. Grim. Good morning. Thank you, Chairman Pallone,
Ranking Member Walden, members of the committee. We want to let
you know that Indian Country truly appreciates you holding this
important hearing on addressing the urgent needs of our Tribal
communities. I also want to thank Representative Mullin for
that kind introduction.
My name is Dr. Charles Grim and I am the secretary of
health for the Chickasaw Nation. The mission of the Chickasaw
Nation is to enhance the overall quality of life for the
Chickasaw people.
In 1994, we entered into a self-governance compact to
become a tribally operated healthcare system. Today, we
currently serve over 90,000 patients through our hospital and
three outpatient facilities with a staff of 1,700.
This committee knows that the healthcare for American
Indians and Alaska Natives often comes from a system that is
separate from that of mainstream America. The IHS is the
Federal agency with the primary responsibility in fulfilling
the trust obligation.
Today, acting under of the broad authorization of the
Snyder Act, Congress appropriates funds to IHS. However, the
amount of those funds are inadequate to fulfill the vast needs,
from the cost of care during the COVID-19 pandemics and added
financial burden to an already overwhelmed and underfunded
healthcare system.
Prior to COVID-19, the Indian health system had an average
25 percent clinician vacancy rate and a hospital system that
remains over four times older than the national hospital
system. Limited intensive care unit capacity to address the
surge of COVID-19 cases has further strained limited purchased
and referred care dollars.
And while CDC has noted that hand washing is one of the
chief preventive measures against COVID-19 infection,
approximately 6 percent of American Indian and Alaska Native
households lack access to running water.
Before COVID-19, the Indian health system faced significant
funding disparities when compared to other Federal healthcare
programs, but now COVID-19 has greatly impacted the finances of
many healthcare programs. Workload comparisons for the
Chickasaw Nation show a decrease of approximately 46 percent;
our third party revenue has decreased approximately $25
million.
While Indian Country appreciates all that has been done in
the current funding packages for COVID-19 and ensuring that
funds have been made available for Indian Country, it is
imperative that the obligation to fund Indian healthcare be met
in the face of this pandemic.
Chickasaw Nation Governor Bill Anoatubby declared a state
of emergency on March 17, 2020. Within the span of less than 2
weeks the majority of in-person visits were converted to
virtual visits. A daily employee and patient screening process
was introduced at all of our facilities. A call center was
introduced to triage patients and employees. A COVID-19 clinic
was developed to help seek persons with symptoms and testing
kits were set up throughout the Chickasaw Nation.
To date we have tested over 25,000 American Indian and
Alaska Native patients as well non-Native community members and
employees. We also stood up our Incident Command teams and
integrated with local, State, and national entities, IHS, CDC,
FEMA, and DOD emergency operations.
Because of the swift action and declaration by Governor
Anoatubby to close all nonessential businesses and offices in
the Chickasaw Nation, we currently have a very low positive
prevalence rate with approximately 400 positive cases to date.
I would ask the committee to consider the following funding
priorities which would help Indian Country address some of our
needs. $9.1 billion in fiscal year 2021 funding for IHS is
recommended by the Tribal Budget Formulation Workgroup because
the lack of a timely enacted budget will leave us all
unprepared for another wave of COVID-19 infections.
We ask for approximately $2 billion to fully fund the
remaining projects on the grandfathered healthcare facility
construction priority list.
Also, the IHS Joint Venture Construction Program is one of
most successful, expedient, and cost-effective means for
providing new and replacement facilities. On May 8, 2020, the
IHS director announced the selection of five projects for new
or expanded healthcare facilities through that program and the
Chickasaw Nation was one of those selected. However, since that
time, the economy has taken a sharp downturn, so we
respectfully ask Congress to consider funding construction of
these five critical healthcare facilities.
We ask you to consider passage of S. 3937, the Special
Diabetes Program for Indians Reauthorization Act of 2019, with
slight changes to the new delivery of funds language that would
ensure Tribes and Tribal organizations are able to receive
awards through their self-determination and self-governance
contracts and compacts.
We ask for $1 billion for water and sanitation development
across IHS and Tribal facilities, which are needed to ensure
access to safe drinking water and waste systems. The Chickasaw
Nation alone has over $70 million in such need.
We also ask for $3 billion for health information
technology to address disease surveillance and reporting,
transition to a telehealth-based delivery system, and to allow
IHS and Tribes to convert to a new electronic health record.
We ask for a direct set-aside of $50 million for new or
expanding Tribal medical residency programs, which will help
Tribes meet the challenges of the physician shortages. And we
ask for direct grants to Tribes to fully fund broadband access,
construction projects, and fixed broadband wireless solutions.
Chairman Mullin and members of the committee, I appreciate
the opportunity to testify on these important matters today.
The Chickasaw Nation is committed to ensuring the highest
quality of healthcare for our citizens, and we look forward to
working with each of you in these endeavors and do all the same
for all of Indian Country.
Thank you.
[The prepared statement of Dr. Grim follows:]
[The information appears at the conclusion of the hearing.]
Mr. Pallone Thank you, Dr. Grim, and thank you for those
important suggestions.
And then our last witness is Ms. Thomas.
You are recognized for 5 minutes.
STATEMENT OF PILAR M. THOMAS
Ms. Thomas. Thank you, Chairman Pallone. Can you hear me?
Mr. Pallone Yes.
Ms. Thomas. OK. Thank you. Sorry about that.
Good morning Chairman Pallone, Ranking Member Walden,
members of the committee. My name is Pilar Thomas. I am a
partner in the law firm of Quarles & Brady based out of Tucson,
Arizona, where I specialize in working with Tribes on Tribal
energy, natural resource, and economic development. Thank you
for the opportunity to provide my views on Indian renewable
energy, and including urgent energy, Tribal energy needs in
this very important hearing.
I am encouraged that the House and this committee recognize
the importance of renewable energy, energy efficiency, and
workforce development for Indian Tribes and the role that
Tribes can play and should play in the Nation's clean energy
future.
As we just heard from President Nez, Chairwoman Sage, and
President Sharp, access and funding for affordable and reliable
electricity is critical for community, economic, business, and
infrastructure development in Indian Country.
For many Tribes, the broken nexus between energy, water,
food, and economic development has been laid bare in the midst
of this COVID-19 crisis. Legislative and funding priorities for
Tribal energy development should seek to accomplish several
goals, including, but certainly not limited to, mitigating
economic harm from COVID-19 by reducing energy costs for Tribal
communities, jump-starting economic development through
increased capital and investment in Tribal utility and energy
development efforts, creating jobs, supporting Tribal energy,
self-sufficiency, self-determination, and reliability, and
recognizing Tribal sovereign authorities over energy
development on Indian lands.
To accomplish these goals, I would like to highlight a
handful of immediate and impactful opportunities for Tribes
that Congress can support and should incentivize.
Tribes can partner with corporations, for example, for
renewable energy procurement. This will support commercial
scale development on Tribal lands, bringing much needed revenue
and jobs, and can be leveraged to attract businesses and jobs
to locate on Tribal lands.
Mass deployment of community solar, distributed energy,
storage, energy efficiency, and microgrids will lead to energy
cost savings, job creation, energy reliability, and resiliency.
And Tribal energy utility formation gives Tribes the ability to
control their energy costs, their energy resources, create
jobs, and keep revenue within the Tribe.
Unfortunately, there are still very many major barriers to
Tribal energy development. Some of these barriers are
structural but can be overcome; others legal and can be
overturned; and still others are physical and financial, which,
given enough time and money, can be resolved.
One such barrier is State regulatory actions that hinder
Tribal energy development. For the most part, Tribal energy
development is dependent on State electricity policy and
regulatory regimes through the State's jurisdiction over and
regulation of utility companies that serve Tribal lands. If
Tribes want to develop and use their own energy resources, they
have to comply with State policies and regulations. Tribal
energy policy is cabined by State energy policy.
Another major barrier is lack of transmission and
distribution infrastructure. Grid modernization is expensive
but necessary to improve grid performance, to integrate
renewable and distributed energy and storage, and to improve
grid resiliency and reliability for Tribal communities.
Access to the bulk transmission system and wholesale
markets through the middle grid, and the capital necessary to
build it, is also necessary for Tribes to be able to access
wholesale markets for electricity purchases or to sell power
into the market.
And a third critical barrier is lack of private capital
investment. Federal funding is important, but it is simply not
enough. There has been little to no private sector investment
in Tribal renewable energy projects that directly serve Tribal
communities, and Tribes have lagged behind other governments in
attracting outside capital through public-private partnerships.
While I have more detailed legislative proposals in my
written testimony, let me just highlight two examples of
potential no-cost solutions.
For example, Congress should amend the Federal Power Act
and PURPA to treat Tribes as States under those two statutes.
This would confirm Tribal regulatory authority and jurisdiction
over retail and distribution utilities serving Tribal lands.
Plus, it has the benefit of making Tribes nonjurisdictional
entities under FERC.
A second potential no-cost solution, which was raised
previously by Chairwoman and President Sharp, is to amend the
Tribal Energy Loan Guarantee program, expanding eligibility in
terms of the types of projects that are eligible and the types
of Tribal entities that are eligible, authorize direct loans
and green bond guarantees, and reduce barriers to applying for
and qualifying for guarantees and loans.
In short, COVID has exposed some of the energy and
environmental injustices in Indian Country. It has had
devastating public health and economic impacts. But there is
hope for renewable energy and energy efficiency deployment to
lead the way out. There are considerable opportunities Tribes
can pursue as economic recovery efforts in the short and long
term. It requires, though, that major barriers are addressed by
Federal policy, law, and funding.
Thank you again, and I look forward to your questions.
[The prepared statement of Ms. Thomas follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. Pallone Thank you, Ms. Thomas, for that information on
the electricity grid and renewables. It is very, very important
for what our committee is looking into.
That concludes our opening, so we will now go to member
questions and each member will have 5 minutes to ask questions
of our witnesses. And I will start by recognizing myself.
Obviously there are so many things that I would like to
ask, but I am going to focus on the digital divide for the most
part, because it is so stark on Tribal lands.
Given what is happening with COVID, the lack of reliable
high speed internet means you are left out of healthcare
services, education, employment opportunities, civic
engagement. And it is just unacceptable, in my opinion.
So let me start with President Nez.
I am concerned, like you, that the lack of connectivity
will put disadvantaged children further behind in their
education. In the Moving Forward Act we allocated $5 billion
through the FCC's E-rate program for schools and libraries to
provide WiFi hotspots and other connected devices to families
who don't have internet access, and it has a specific guarantee
of funding for Tribal schools and libraries.
So let me ask initially, if that became law, would schools
and families in Navajo Nation benefit, if you would?
Mr. Nez. Thank you for the question, Chairman and members
of the committee.
Absolutely, the Navajo students, the Navajo people would
benefit on getting high speed internet access locally. But our
goal here on the Navajo Nation is to reach more into the rural
areas, into the house. With this COVID-19 right now, Chairman
and members of the committee, we are encouraging our Navajo
people to shelter in place. We have stay at home orders.
So if people are staying home and they don't have internet
connectivity, they will have to go to these libraries or
chapter houses to get internet access, which may get them
exposed to the virus.
So there is so much uncertainty here, we all know there is
no vaccine, there is no cure for COVID-19. And so our focus
here on the Navajo Nation is try to get high speed internet
into the homes where students could connect to their schools
and turn in their homework.
Also telehealth, as well as--we are in a closure right now,
the Navajo Nation government is closed. And so a lot of our
employees are working from home. And it all is based on how
much moneys or how much resources could be allocated to get
high speed internet closer to the home.
And lastly, I appreciate what was mentioned by Ms. Thomas.
We have been talking about funding, we have been talking about
projects, but what we really should by focusing our attention
on to get these projects done quickly is to reevaluate Federal
laws, policies, and regulations. Those are those no-cost
changes that can occur so projects can get done completely,
turn out quickly and complete.
And with the CARES Act funding, the deadline is December
31st. We didn't get the first allocation of the CARES Act
funding, Tribes throughout the country didn't get that until
three months ago. And then three weeks ago we finally got that
40 percent of the CARES Act funding.
And so I am asking the Chairman and members of this
committee to lead the charge in putting into legislation an
extension of the CARES Act funding for Tribes, maybe a full
year, to December 31st of 2021. And many of you know,
lawmakers, that projects don't move as quickly in Indian
Country and I think that would give us some time to get these
projects underway.
Thank you, Chairman and members of the committee.
Mr. Pallone Thank you.
I have a minute left. Let me ask Chairwoman Sage, again, in
the Moving Forward Act we have $80 billion to fund high speed
broadband deployment to underserved areas, preference for
Tribal lands. Do you think that that broadband deployment as
contemplated by the Moving Forward Act, would that help the Ute
Tribe? And what kind of broadband investment would help, if
not?
But I know I have only got about 30 second left here, so as
quickly as you can.
Ms. Sage. OK. Well, yes, the Tribe would support that. It
is clear that funding is sorely needed for broadband deployment
for our communities who need it most.
We are glad this issue is receiving attention and
legislative effort. For example, Senator Bennet from Colorado
recently introducing the BRIDGE Act, which would include $1
billion for Tribes for broadband deployment.
Thank you.
Mr. Pallone Thank you, Chairwoman.
I recognize the gentleman from Michigan, Mr. Upton, for 5
minutes.
Mr. Upton. Well, thank you, Mr. Chairman. I appreciate the
hearing. I have got really a couple of questions.
I want to congratulate you first on your primary win last
night. I am glad that you are resting comfortably after your
landslide victory.
I would just like to say, first, as we look at the $8
billion that was in the CARES Act, Treasury had 30 days to
disburse the money. But because of the delays in getting the
money to Tribes with all this litigation with the Alaska Native
Corporation, we have real issues trying to follow the guidance
regulations that were provided by the Treasury. Treasury is now
requesting all the recipients of CARES to submit what they have
spent the money on so far.
I know that it is somewhat unique here in terms of what is
happening. But can you expand on how you are all going to
comply with that and what we might want to do to try and help?
Maybe President Sharp first. And again, I am watching the
clock.
Ms. Sharp. Yes. Thank you so much.
You are right, there was a deadline of April 26 to get this
funding out to Tribal nations. That was not met. And I would
like to just provide a little bit of context to why this is
such an urgent need.
So Tribal nations are limited in taxing authority. So we,
instead of being able to generate revenues like any other
government through a system of taxation, we are forced to
generate profits in commercial enterprises. And so because of
the pandemic our economies have been suffering, so we
desperately need the additional dollars in the relief fund.
So not only is there a delay in the trust responsibility
necessary resources of that relief, we cannot spend money to
backfill lost revenues from our economies, from our commercial
enterprises. Treasury has explicitly said we cannot use these
funds for business losses. In other words, a loss of any sort
of revenue, through taxation or through business.
So that is crippling us. And not only are we vulnerable
because we don't have economic relief, any opportunity we have
to access resources through the National Stockpile and other
things are limited.
So like Chairman Frazier, we have no choice but to stand at
the border to try to protect our Tribal nations. We are
vulnerable, we don't have resources, we don't have access to
PPE, and we are suffering. We desperately need to have
increases and we desperately need to make sure that Treasury
appropriates and distributes these dollars the way Congress
intended.
Mr. Upton. Well, thank you.
Chairman Sage, you did mention--and thanks for submitting
your testimony in advance--you mentioned in your testimony that
the oil and gas industry has been, in your words, ignored
during the crisis.
What effect has the oil market crash had on your Tribe and
your ability to invest in the regional economy and workforce?
You mentioned that in southwest Colorado all of your employees,
mostly non-Tribal members, are receiving full pay. How
important is that fossil energy, especially natural gas, to
your economy? And what role do you see it playing in the years
ahead?
Ms. Thomas. Thank you for that question.
The price collapse for oil and gas has caused us real
problems. The virus only made them worse. Many of our producers
are shutting in and we are actively seeking relief that our
producers don't just give up and leave and abandon active
wells.
The price collapse for oil and gas has been challenging and
the virus has amplified those challenges. Many of our producers
are shutting in and we are actively seeking relief for
producers to continue production through this pandemic
sustaining the local economy and preventing orphaned well bores
on the reservation. The Tribe has not furloughed or laid off
any Tribal employees, which has supported the local economy at
the expense of the Tribal economy.
Thank you for that question.RPTR SINKFIELDEDTR
CRYSTAL[12:05 p.m.]
Mr. Upton. Well, thank you.
So, since you do have energy in your backyard, how do you
strike the right balance between the environment and be able to
conserve scarce resources like water?
Chairman Sage?
Ms. Sage. What was that again, Mr. Upton?
Mr. Upton. Since you have energy production right there in
southwest Colorado, how is it that you were able to strike the
right balance--we know all the Colorado water issues that are
there--between protecting the environment and scarce resources
like water?
Ms. Sage. Well, with the water and the economy, really we
have a lot of our water--our water is irrigation water for our
farmers and our ranchers. And this has really put a damper on
it because we have a dilapidated irrigation system. And that
was brought forth earlier.
As of during this pandemic, it has taken a lot of the
economy also away from our farmers and ranchers in this day.
Mr. Upton. OK. I know my time has expired. I yield back,
Mr. Chairman.
Mr. Pallone Next we have Bobby Rush is recognized for 5
minutes.
Mr. Rush. I want to thank you, Mr. Chairman, for holding
today's important hearing. I also want to thank our witnesses
for sharing their insights.
The coronavirus pandemic continues to shine a harsh light
on the disparities that exist in persons within our Nation's
most vulnerable communities. These disparities include the
longstanding needs of our Tribal communities, our Tribal
nations, among others, who have unlimited access to physical
infrastructure, reliable electricity, and the workforce
training needs to support these critical resources.
Ms. Thomas, you were a senior member of DOE's Indian Energy
Policy Office. How are communities best served by this office?
And what improvements should we make to the administration of
the program?
Ms. Thomas. Thank you very much, Congressman.
Yes, I formerly served as both the deputy director and
acting director of the Office of Indian Energy Policy and
Programs in the Department of Energy in the second term of the
Obama administration.
One of the biggest challenges that that office had--we
stood it up from scratch, basically--and one of the biggest
challenges that the office had was a lack of administrative
infrastructure. Our primary focus, though, was to put together
programs that would directly help Tribal governments and Tribal
enterprises, including Tribal leadership and Tribal staff, with
building capacity to help them understand and develop their
energy resources.
We had an all-of-the-above energy policy. And so our focus
was to use not only the office's resources--which were very
limited at the time, $2 million, I think, was the budget that
we had, $5 million had just been appropriated. Congress has
been kind to the office and substantially increased its
appropriation. Now, I think, the House Energy appropriation
just increased that to $22 million, and those resources are
greatly needed.
Those resources tend to be split between technical
assistance for Tribes and other capacity building efforts and
deployment grants for Tribes.
There is a bit of a challenge now, though, as Tribes get
more sophisticated and try and do more projects, with the
Department being able to keep up with them and the resources
necessary for the Department to keep up with them.
So the more funding that Congress can provide to that
office to help with technical assistance, to help with capacity
building, 575 Tribes, plus 200-plus Alaskan Native corporations
and countless other Tribal energy enterprises, which are all
covered by the office, is a lot of its constituency.
So I do think that there is a lot of benefit to continuing
to fund that office at a robust amount so that it can continue
to do some of that soft touch work, like technical assistance
and capacity building, that is necessary to keep moving energy
development forward on Tribal lands.
Mr. Rush. I want to thank you.
And, Mr. Chairman, I see my time is almost expired, so I
yield back the balance of my time.
Mr. Pallone Thank you. Thank you, Mr. Rush.
Next, we are going to go to the gentleman from Illinois,
Mr. Shimkus. You are recognized for 5 minutes.
Mr. Shimkus. Let me thank you all. Chairman, it is a great
hearing. Actually, it is too much really. We should have one on
health, we should have one on telecommunications, we should
have one on energy, because there is obviously so much in our
jurisdiction. So I am going to boil it down to three quick
questions.
One is just an observation, Chairman. We have this NDAA
bill coming up which the authorizers are trying to steal our
jurisdiction under the Ligado FCC ruling. If I have heard
anything from the testimony today, is that broadband internet
access is critical. And if we allow the HASC to interfere with
the ability of this satellite broadband, this will not provide
our Tribal entities an ability to get connected, either their
healthcare or their energy or their educational issues.
So I would hope that we would develop a bipartisan strategy
for the floor to offer an amendment to strip--I think in the
HASC bill two amendments were passed by our good friend Mike
Turner that will hurt this ability for Ligado.And as you know,
Ligado was passed by the FCC unanimously, which doesn't happen
very much.
So I put that on the table. I think everybody understands
the importance of broadband connectivity.
I would like to go back to Ms. Thomas, because also easing
the regulatory burden on energy resources is something that we
have talked about numerous times. And I am surprised that
nations don't have their ability to control their own destiny
in energy development.
Of course in rural America we have rural electrical co-ops
that are not-for-profit entities. Are you asking for something
like that in that ability to create some energy independence
for Indian nations?
Ms. Thomas. So thank you, Congressman.
So in about 16 States rural electric co-ops are not
regulated by the State utility commissions. In the rest of the
States they are.
So in Arizona, for example, our Arizona Corporation
Commission does regulate the rural electric co-ops from a rate-
making standpoint, tariffs, reliability, they are subject to
the State's renewable energy standard. But in 16 States, the
States don't exercise jurisdiction.
So the co-ops, like public power companies, like LADWP, set
their own rates. Of course, they are member-owned and member-
driven. So the idea is that the members would help kind of
control what the co-op does.
There is some friction, admittedly, between Tribes who are
trying to do especially distributed energy, rooftop solar, and
co-ops who have limits on the amount of renewable energy they
can put into the system. It is a complicated story, back story,
because the G&Ts, the big G&Ts play a role in that, like Tri-
State and Basin.
But there is a challenge. There is one Tribe, for example,
that does have a utility regulatory scheme that it imposes on
its co-op. And so if Tribes and co-ops that aren't regulated by
the State do want to do more renewable energy, do want to
interconnect community solar or rooftop solar, going through a
State regulatory scheme can be problematic if the State itself
doesn't promote that.
Mr. Shimkus. That is helpful.
Let me just get to President Nez real quick, because
reliable low-cost energy--I am from southern Illinois, and it
is a coal area, a coal basin area.
President Nez, what happens if and when your coal-fired
plant goes offline? What happens to the economy? What happens
to the employees? What happens to all the folks in that line of
work?
Mr. Nez. Thank you for the question, members of the
committee and Chairman.
We already are going through closure of a generating
station--two, actually, one on our lands, Navajo Generating
Station. The closure of that facility affected the coal mine
operation and that had to close because that is where the coal
was going, to the coal-fired power plant.
Now, between the two there, $30 to $50 million of revenue
coming into the Navajo Nation is now gone. And so we have to
supplement that. And in order for us to bring in new moneys, we
are looking at extending broadband and to have other businesses
flourish here on our Navajo Nation to bring in that $30 to $50
million loss.
Thank you.
Mr. Shimkus. Thank you.
Thank you, Mr. Chairman. I yield back.
Mr. Pallone Thank you, John.
Next we have Ms. Eshoo. You are recognized for 5 minutes.
Ms. Eshoo. Thank you, Mr. Chairman. Congratulations on
your win last night.
And I want to thank all the witnesses. You have given
superb testimony. And what I am so--is that in all of the
basics of life, whether it is clean water, electricity,
connectivity relative to broadband, healthcare, there really is
a national shame that surrounds what is taking place, and I
think really true neglect for Native Americans.
So there has to be the political will to get these things
done. These are not issues that we don't know how to address.
It is a matter of political will.
So thank you for your testimony. And there is, to me, an
enormous sadness that surrounds all of this.
Let me start by asking Dr. Grim and Jonathan Nez and
Christine Sage, have your Tribes been able to get adequate PPE,
diagnostic testing supplies, and other resources, like
ventilators and drugs to treat COVID-19 cases in your
communities?
One of the challenges is getting adequate supplies. And it
seems to me that there is confusion regarding how Indian health
programs can access the Strategic National Stockpile.
So have Tribes been able to access the Strategic National
Stockpile? Any one of you can address that.
Mr. Nez. Thank you. This is Jonathan Nez. Thank you,
Representative Eshoo.
In terms of your question, the Navajo Nation did get some
supplies from the Strategic National Stockpile, but it took
some time before that resource came to the Nation. And when
that also came to the Nation, we also noticed that some of the
items in those supplies were outdated. But we did have to use
what we were given because of the shortage throughout the
country of course. That first spike, there were just so many
governments out there in municipalities wanting to get PPEs.
And so Tribes were left bidding on this finite resource out
there.
And sometimes Tribes--most of the time, maybe all of the
time, Tribes were on the back burner. And States like New York
and other States were getting most of these supplies.
But we are hopeful that the other industries out there will
be supplying more PPEs. And maybe it is time for Tribes to
develop their own stockpile for their Nations as well.
Thank you, Representative Eshoo.
Ms. Eshoo. Yes, that is a good idea.
To Ms. Sharp, what clarification do you think is necessary
to allow Tribes to be able to access the stockpile?
Ms. Sharp. I think there needs to be clarity and direct
access. It was very clear to us early in the pandemic that that
those outside of the United States--the World Health
Organization, the IMF, the World Bank--all understand the
vulnerability to indigenous populations. And there has been a
call-out for global action to address the desperate needs among
indigenous communities, because everybody recognizes our
vulnerability.
And so to the extent there is an economic recovery plan, a
global strategy for building economies, I think there is an
appetite to work to safeguard our economies.
We also saw that the World Health Organization called for
private sector partnerships with the U.N. Foundation and the
Swiss Philanthropy Fund. So to the extent this pandemic exceeds
the scale of public resources, we know there is a global
strategy to prop up national economies, we know there is a
global strategy for public-private sector partnerships. So that
is what we need. We need the resources.
Ms. Eshoo. I appreciate your answer.
Just very quickly, in the California area of the Indian
Health Service the last his hospital closed its doors over five
decades ago. So my constituents and Tribes in my area rely on
the California Tribal Health Program, which receives very
limited annual funding from his.
So to Dr. Grim, how are areas like mine, with no his
hospitals and a reliance on Tribal health programs, treated
differently in funding allocations?
Dr. Grim. One of the things I was going to say,
Congresswoman, was that his as a whole doesn't have that much
in the way of intensive care units. There are a number of areas
across the his that have zero hospitals, and those that do have
it have a relatively small number of ICU beds. Our hospital has
six beds, six ICU beds. They happen all to be full today. And
so we are at capacity on ICU.
Early on, we tried to get resources such as testing
materials, testing machines, other things like that. And a lot
of times--and ventilators too--somebody would say yes, and they
would turn around and pull it back because it needed to go to a
higher priority.
And so what those places have to do that don't have those
resources, they have to rely on purchased and referred care
dollars. They are absolutely at the mercy of that, to send
somebody off to a hospital that has that sort of capacity.
Ms. Eshoo. Thank you, Mr. Chairman, and I yield back.
Mr. Pallone Thank you, Anna.
Next, we go to Mike Burgess. You are recognized for 5
minutes.
Mr. Burgess. Good morning. Did I successfully unmute?
Mr. Pallone You did.
Mr. Burgess. All right. I cannot see the clock, Chairman.
So I am going to trust your kind nature to let me know about
time. You generally do.
Let me just say, this is a great hearing. The landscape is
broad. And I agree with Mr. Shimkus. I hope this isn't just a
check-the-box hearing. I do hope that we can come back in the
various subcommittees where the jurisdiction is a little more
focused and drill down on some of these issues, because the
communities that are served, these issues are clearly so
critical. And it is hard to distill it all down with just one
single broad panel.
And, Mr. Chairman, just a point. You were talking at the
beginning of this, when was the last time we had a hearing on
Indian Health Service. I do recall a Subcommittee on Health
hearing, but it was so long ago that Nathan Deal was the
chairman of the subcommittee and Sherrod Brown was the ranking
member. So I think that was 2005, 2006. So, yes, we were due.
So I am glad you organized it today.
Dr. Grim, I want to thank you first off for your service,
and thank you for providing such clear and coherent testimony.
One of the things in preparation for this, reviewing the--there
was a report out by the Office of Inspector General on the
Indian Health Service, and the title was "More Monitoring
Needed to Ensure Quality Care." And one of their suggestions in
there is that the Centers for Medicare and Medicaid Services
assist the Indian Health Service with more frequent surveys.
So can I just ask you, and I apologize for not knowing
this, but in a non-his hospital--I mean, I know it is
voluntary, but hospitals have an agreement with the Joint
Commission on Accreditation of Hospitals to be surveyed at
least every three years. Is there a similar Joint Commission
survey that happens in his hospitals?
Dr. Grim. Yes, sir. And three years is the normal standard
of surveys. I have often thought, with CMS being a sister
agency of the Indian Health Service under the Department of
Health and Human Services, if they did work together closer
when there were problems like that, I thought it would be a
great service.
They have worked closely with his during this time where
some of the hospitals have had some issues that are being
rectified now. Some of them have already been rectified. But,
yes, I think more frequent surveys would help.
And then the other thing, a lot of the his regions put
together survey teams. And so they will go out and survey their
own facilities on a much more regular basis than every three
years.
Mr. Burgess. And I was on the board of a hospital,
community hospital, I am a physician as well. It was not a good
day when the Centers for Medicare and Medicaid Services came in
and surveyed your hospital. Generally, there was some sort of
problem that had occurred. So that was actually not looked upon
as a good thing. Now, I suspect, if there was a problem it
needed to be corrected.
But you did go through the standard 3-year accreditation
with the Joint Commission.
And let me ask you this. I have served for probably 20
years on our hospital's credentialing board, and I remember
having to query the National Practitioner Data Bank for anyone
who applied for hospital privileges.
Indian Health Service also has the ability to query the
National Practitioner Data Bank?
Dr. Grim. First, let me say I cringed a little bit when I
said CMS should come in more often, because I am a CEO too, and
I like it every three years.
But, yes, sir, his has criteria, as do all the Tribes, on
credentialing and privileging their staff, and one of the
requirements is to query the National Practitioner Data Bank.
Mr. Burgess. And it is also a two-way street. So those are
reported back to the National Practitioner Data Bank if a
problem is identified with the physician's practice. Is that
correct?
Dr. Grim. Yes, sir, that is true. But there is a process
within the agency that you follow to get that done. And it has
been a few years since I have been there, but basically it
rises up through the region, from the facility to the region to
his headquarters, where things are reviewed if there has been a
potential violation or a tort. And then a decision is made
whether the standard of care was met or the standard of care
was not met. So the agency has a process to do that, and Tribes
do the same as well.
Mr. Burgess. So the quality assurance is very similar to a
non-his hospital. Do I understand that correctly?
Dr. Grim. Yes, sir, you do.
Mr. Burgess. And then let me ask you this. There has been
some success in the VA system with the VA MISSION Act, and you
described your ICU with six beds. And so now if you have a
patient who requires ambulatory assistance, do you have the
ability or do you contract with another facility to transfer
that patient? How is the care for that patient handled when you
are at capacity?
Dr. Grim. Most of the facilities out there, including
ours, have I will call them preferred provider networks. They
are not always called that. But you establish relationships
with entities that you use frequently and trust. You have
contracts with them.
So most locations have a primary hospital or two or three
that they refer to whenever they cannot provide that care
locally or they are at capacity. There are some places within
the Indian Health Service, however, that it is two hours or
more to the nearest hospital. And so there are those challenges
as well. But, yes, most everyone has that.
I mentioned earlier in one of my comments the purchased and
referred care dollars. You know, those aren't unlimited either.
So if you have to refer too many things out a lot of Tribes
will run out of that before the year is out.
Mr. Pallone Dr. Burgess, you are a minute and a half over.
Mr. Burgess. Well, I told you I couldn't see the clock,
Chairman. So I was depending upon your kindness.
I have some additional questions about some energy issues.
I will submit those for the record.
Thanks, everyone, for being here this morning.
Mr. Pallone Thank you, Mike.
All right. Next is the gentlewoman from Colorado, Ms.
DeGette.
Ms. DeGette. Thank you very much, Mr. Chairman.
I want to thank all of the witnesses for attending today.
I want to give a special welcome to the Honorable Christine
Sage from the Southern Ute Indian Tribe down in my home State
of Colorado. I have worked a lot with the Southern Utes, and I
am glad to see you today. I hope you are staying cool because
we are having a really bad heat wave up here in Denver.
I would like to talk about some of the health issues that
are unique to Tribal lands. And the first thing I want to talk
about is I want to talk about the COVID-19.
Mr. Nez, you talked about--you very thankfully gave us an
update about what is going on in Navajo land with COVID. I am
the co-chair of the Diabetes Caucus in Congress, and I think
one of the reasons why Tribal issues and COVID are so extreme
is because non-Hispanic adults, in particular Native Americans,
are 2.5 times more likely to die from diabetes. And I know that
diabetes has a big impact on your community. And I am wondering
if you can talk about how you think that it has impacted the
terrible coronavirus crisis that we have had on Navajo land and
in other Tribal areas.
Mr. Nez. Chairman, members of the committee, and
Representative DeGette, thank you for that question, ma'am.
You know, we have heard the vulnerable population and the
elders. The data that I cited earlier in the testimony is that
of those 300-plus deaths here on the Navajo Nation, 379 deaths,
66 percent of those who have passed from COVID-19 are over 60
years old, and those are our elder lies.
And our elder lies are in that vulnerable population
because their immune system is not strong, but many of them, as
you are seeing, have diabetes, cardiovascular disease, and
cancers. And one out of five of Native Americans do have
diabetes.
We here on Navajo are starting to focus more on our health
and well-being, meaning that we should be bringing some of
those individuals out of that vulnerable population category so
that they have strong immune systems.
I talked earlier about being in a food desert. We need to
get more foods, healthier foods to our Native American citizens
so that their bodies can fight off any virus.
So thank you for that question.
Ms. DeGette. And that leads me--I mean, look, that is 20
percent, the type 2 diabetes rate among Native Americans. It is
stunning.
And, Ms. Sharp, you talked about--this leads me to my
question about the Special Diabetes Program, which was enacted
in 1997. Half the money goes for type 2 diabetes among Tribes.
And it has been reauthorized, but what happens is it has been
reauthorized for very short periods of time. You talked a
little bit about this, Ms. Sharp, in your testimony when you
said we need to authorize it for a long period of time. Can you
talk about why that is so important?
Ms. Sharp. Yes. We absolutely need predictability and a
stable funding source to make sure that we can develop not only
short-term immediate strategies, but there are these underlying
challenges, that we need a long-term strategy. And to
effectively work with our community to develop a community buy-
in and various strategies, we have to have stable funding.
So thank you for that question.
Ms. DeGette. I mean, originally, when we first passed it
in 1997, we had a long-term authorization. And everybody agrees
that it needs to be authorized long-term. It just doesn't seem
to happen.
I am going to give a shout-out to my colleague,
Representative O'Halleran, who is lead sponsor on the 5-year
reauthorization, and it calls for $200 million. And, frankly,
that is really what we need to have.
So I am hoping--and half of the money goes for type 1
diabetes, the other half for type 2 among Tribes. And we need
to reauthorize both of those components. We need to meld them
together and do it for five years.
So, Mr. Chairman, I hope that you can--I know you are
committed to doing that, too. We just need to make it happen.
And with that, I will yield back.
Mr. Pallone Thank you, Diana.
Next, we are going to go to Mr. Latta, is recognized for 5
minutes.
Mr. Latta. So thanks, Mr. Chairman, for holding this very
important hearing today.
I really appreciate all of our witnesses for their
testimony today and for all that you are doing.
President Nez, if I may start with you. In May, President
Trump issued an executive order directing Federal agencies to
review the regulations and modify, exempt, or rescind them in
order to help in the economic recovery from COVID-19.
On behalf of the Navajo Nation, you submitted a white paper
in response to that executive order outlining some of the
regulatory reforms needed to speed up infrastructure deployment
on the Navajo land. You wrote that currently Federal laws,
policies, and regulations stifle the completion of projects
that address the critical and basic needs of your people. Some
of these projects are more than three years old because of
these obstructions.
The Energy and Commerce Committee Republicans recently
unveiled a package of 26 bill, legislation that would achieve
many of the similar suggestions you made in your white paper,
such as streamlining reviews under the National Environmental
Policy Act and applications for co-allocations and exclude
previously disturbed land from undergoing lengthy Federal
reviews. These are real reforms that don't cost any money that
could help bring broadband to underserved Americans.
President Nez, what are some of the regulatory obstacles
you face in the Navajo Nation to deploy broadband
infrastructure?
Mr. Nez. Well, Representative Latta, Chairman, members of
the committee, great question, and thank you for reading that
white paper.
You know, we are in an emergency operation here on the
Navajo Nation, all across the country, with this pandemic. And
so the CARES Act funding was intended to aid and give relief to
U.S. citizens. And as we have been mentioning, we got those
dollars late into this year. Three months ago, 40 percent of
the CARES Act that was going to Tribes went to the Tribes. Just
three weeks ago, the remaining 40 percent came to the Tribes.
And so we have a deadline to get these projects done by
December 31st, and a little bit beyond that.
And so what we need here, and I am hoping all of the
committee members recognize that Tribal lands are characterized
as any Federal lands throughout the country, so that you have
to jump through those Federal regulations, those policies. And
this white paper that we submitted would help temporarily,
based on these dollars, get these projects developed in a
timely manner.
And that is why we are asking for an extension, 1 to 2
years, two years at the most extension to get these CARES Act
funds. Because in Tribal communities, it is hard to get
projects complete. And one of those examples is right of ways
and also environmental clearances for, like, 401 and 404
permits. And you also have business site leasing regulations
that hinder development.
And so if we can set aside certain policies and regulations
to help build a wall between Mexico and the U.S., I am sure we
can do the same here in Tribal communities throughout the
country.
And I appreciate that question, Representative Latta, and I
know that this committee could be the champion to make those
changes, not just temporary but permanently for Tribes
throughout the country. Thank you.
Mr. Latta. Thank you very much.
Chairman Sage, if I could ask in my last minute and ten
seconds here, the Southern Ute Indian Tribe has made
significant progress in connecting its citizens, despite the
challenging geography.
How were you able to overcome some of the regulatory
barriers that you face? And how are you able to bring the
connectivity to your reservation?
Ms. Sage. Thank you, Representative Latta, for that
question.
The Southern Ute Indian Tribe is unique in many ways,
including its success in energy development on the reservation,
as well as its robust environmental program. The Tribe's
sovereignty over its lands enables greater economic
development. By making the most of what we have been given, we
have been given by our Creator, we have been able to provide
for our people in a meaningful way.
Our most vulnerable, valuable resource is our people. But
there is still much to be done if we are to reach our full
potential. The current pandemic has made some of these
hardships very apparent.
Historically, Tribal lands, particularly those in rural
communities, have been the most underserved when it comes to
essential communication infrastructure. We are the largest
employer in southwest Colorado and the second largest in the
Four Corners area. We have invested millions of the Tribe's own
funds in technology.
But with employees and Tribal members working from home,
schools relying on remote education, and health providers
relying on telehealth, those investments are strained, and our
infrastructure has proven inadequate given the demands of the
modern era.
Most communities across the country are concerned about the
State of their internet and cell phone coverage. For the vast
of our reservation, we are worried about whether. We would
support any congressional measures that help enable Indian
Country to have robust internet. That would include measures to
help ease the burden of regulatory constraints on our
Development.
The CARES Act funds provided to the Tribe have fewer
restrictions on their use. A longer timeframe significantly
improve the quality and range of communication services. But as
it currently stands, we will struggle to without a necessary
audit by the Treasury.
Thank you very much.
Mr. Latta. Well, thank you very much, Mr. Chairman. My
time has expired and I yield back.
Thanks again for our witnesses for being with us today.
Mr. Pallone Thank you, Bob.
Next, we have Ms. Schakowsky.
Ms. Schakowsky. Thank you, Mr. Chairman.
It is just a fact that the United States has failed to meet
its responsibilities to provide comprehensive, high-quality
healthcare to all federally recognized Tribes and their
members. But nowhere is that failure more apparent, in my
opinion, than in reproductive healthcare.
Since 1976, the Hyde amendment has denied federally funded
abortion care to low-income, vulnerable women who get their
health insurance through Medicaid. But over the past 44 years
the Hyde amendment has expanded and expanded. And, today,
restrictions on abortion coverage also impact anyone receiving
healthcare through the Indian Health Service.
Because his facilities are often the lone source of
reproductive healthcare for Native American women, the Hyde
amendment effectively denies women their constitutionally
protected right to a safe and legal medical procedure.
A study published by the Native AmericanWomen's Health
Education Resource Center found that only 25 abortions were
performed through the his system between 1976, when the Hyde
amendment was passed, and 2002. Tragically, we have also seen
nationwide that as abortion access goes down, maternal
mortality and morbidity goes up.
The Centers for Disease Control and Prevention, CDC,
reports that today American Indian and Alaska Native women are
twice to three times more likely to die from pregnancy-related
causes than White women.
So, President Sharp, I am committed to passing timely the
EACH Woman Act that I introduced with Representative Barbara
Lee to end the Hyde amendment once and for all. But what else
do you think we need to do to improve reproductive healthcare
in Tribal communities?
Ms. Sharp. I really appreciate that question. Thank you.
And thank you for recognizing the disproportionate and high
rate of maternal mortality rates. You are right. We do suffer
at a rate of 2.3 times higher, and it is even worse in rural
communities where that rate is 4.5 times higher for our
population.
And I can say from personal experience, I have one child,
and I ended up in the intensive care unit. My child was at risk
of dying, and he was born at four pounds. And I only have one
child for that reason.
So because we do suffer these impacts, it is so very
important that we pay special attention to women's reproductive
health in appropriations for his. So thank you so much for that
question and raising attention to this very important issue.
Ms. Schakowsky. Well, thank you, and I look forward to
going ahead to work with you on specifically targeting that
community.
And let me just say, this is really a historic hearing. You
know, we have over the history of our country so badly treated
Native Americans, and we are still seeing residuals of all of
that. We have to do so much more.
But the good news is that we are expanding the number of
Native Americans in the Congress. Two women now, Deb Haaland
and Sharice Davids, are in the Congress now. And you know the
saying, if you are not at the table, you are probably on the
menu. And so we are happy to have them and now to have this
historic hearing.
I think we were talking before this, but this may be the
first real comprehensive hearing that we have had about Tribal
communities. And so I hope it is the first of many, and let's
work together on women's reproductive health.
And with that, I yield back. Thank you so much.
Mr. Pallone Thank you, Jan.
And now we go to Mrs. Rodgers for 5 minutes.
Mrs. Rodgers. Good morning. Good morning, Mr. Chairman.
And thank you, everyone on the panel, for joining us today
on this important topic.
I have the honor of representing several sovereign nation
Tribes in eastern Washington, including the Colville, the
Kalispel, and the Spokane. Like many other Tribal communities
in the country, they have been hit hard, especially during this
public health crisis, the coronavirus, and the many issues that
have been brought to the forefront.
The digital divide is especially highlighted in rural
communities and in Tribal communities, and it has underscored
the importance of us taking action to address and close the
digital divide.
I am proud that the eastern Washington Tribes are working
collaboratively with other stakeholders. We have a broadband
action team that is focused on identifying and addressing
barriers to deployment, including some unique models to lay
dark fiber and partner with the private sector to provide the
service.
Healthcare is also really important, and we must address
some of the disparities that are in healthcare. The Colville
Confederated Tribes has shared with me that they have seen an
abrupt decline in third-party billing during the pandemic that
has threatened its ability to finance and construct a new
clinic in Omak, Washington. This is one of five projects that
was selected by Indian Health Service for the Joint Venture
Facility Construction Program.
It is a competitive nationwide program, and five projects
withstood multiple levels of review. However, as Dr. Grim
discussed in his testimony, the viability of some of these
projects has been negatively impacted by COVID-19.
So, Dr. Grim, I wanted to start with asking you that if
Congress makes additional appropriations available for his
facility construction, should it also allow Tribes to use those
funds for their approved joint venture projects?
Dr. Grim. Thank you for that question.
I don't say this lightly, because that is not the way this
program normally works, but I think everyone would agree that
we are in unprecedented times. All of those projects went
through extensive review, as you pointed out, a competitive
process that meant that they were fully ready to do all these
things. And now the economy has taken a huge downturn, Tribes
have been impacted, as you have heard throughout this hearing.
And I think allowing the agency that flexibility, or asking
them to spend some portion of those funds on these projects, is
entirely appropriate under these circumstances.
Mrs. Rodgers. Thank you. I appreciate that, Dr. Grim.
I would like to ask unanimous consent to enter into the
record a statement from the Confederated Tribes of the Colville
Reservation, and it is on their joint venture project in the
Omak Clinic.
Mr. Pallone Without objection, so ordered.
[The information appears at the conclusion of the hearing.]
Mrs. Rodgers. Thank you.
I also wanted to focus on Medicaid, which is an essential
program, and Medicaid expansion has played a critical role for
Tribal health.
However, we know that problems still exist within the
Indian health system in States that have expanded, and
Washington State is one of those States that it has expanded.
As we think about how we can support the Tribes in both
expansion and nonexpansion States, we need to have a full
understanding of the needs that the Tribes are facing and the
role here in Congress that we can be playing to uphold our
obligation.
Dr. Grim, can you just detail some of the issues that we
are seeing in the Medicaid expansion space as it relates to
Indian Health Service?
Dr. Grim. Well, as you pointed out, Congresswoman, those
States that have it are doing better than those States that
don't. And some studies are coming out now that show it has
improved the healthcare of the population. But it is not the
see all and end all. And whenever you expand it that broadly,
you start running into more problems.
And so there is a group under CMS called the TTAG, Tribal
Technical Advisory Group. That group debates and talks and
discusses all of these issues with CMS.
In my written testimony, there are a number of things that
would both help the efficiency of the agency and of Tribes, but
also the funding.
I will give one example of one of the issues. It is called
the "four wall" issue. There is a law that says that it has to
be done within the four walls of a facility. That means at a
time like this with COVID when Tribes were putting tent testing
centers outdoors, or they might be using alternate care
facilities, those things weren't able to be billed adequately.
The telemedicine that immediately went into effect across
the Nation, the billings and the rules around the billing of
that has lagged behind.
Tribes also face another issue around Indian healthcare
providers providing services that are authorized by law, but
since Medicaid is a State by State program, they don't get to
necessarily bill for all of those services. [Inaudible]
Congress would fix that issue so that if it was authorized by
the Indian Health Care Improvement Act, that Medicaid would
allow those services to be billed across Indian Country.
Those are a few brief examples. I will stop there.
Mrs. Rodgers. Great. Well, that was what I was hoping you
would highlight and I appreciate that. It is certainly an issue
that the committee needs to look at.
I yield back, Mr. Chairman.
Mr. Pallone Thank you, Cathy.
Next is Mr. Butterfield recognized for 5 minutes. Is G. K.
Available? I don't know, he may not be connected, because I
think he was driving, maybe.
Jeff, I am going to move on unless you know that G. K. Is
on.
OK. Then we go to Ms. Matsui. Is Doris available?
Can you guys hear me?
Mr. Mullin. Yes, we can hear you, Chairman.
Mr. Pallone Let me see who is next here if those two are
not here. Oh, OK. So the next one, then, we will go to Kathy
Castor. The gentlewoman from Florida is recognized.
Ms. Castor. Perfect. Hi, everybody. Thanks for our
terrific witnesses. Thank you, Chairman Pallone, for calling
this very important hearing, and congratulations on your big
win last night.
I think it is very clear, we didn't even need to have a
hearing to understand that our indigenous people and our Tribal
nations have not been respected under the law.
But I would like to shift to talking about the potential to
equalize that through clean energy and climate solutions. Many
of you know that last week the Democrats on the Select
Committee on the Climate Crisis, which I chair, released a
majority staff report which laid out a climate crisis action
plan that included numerous recommendations to support Tribal
nations.
The plan calls on Congress to work with Tribal leaders to
expand clean energy solutions, to cut pollution, to advance
environmental justice, to improve public health, among other
recommendations.
We know that Tribal nations can contribute to the
deployment of climate solutions and clean energy using their
natural resources and their longstanding tenets of
environmental stewardship.
As President Sharp can attest, the National Congress of
American Indians has outlined Indian Country's priority for
addressing the climate crisis in a resolution that emphasizes
the importance of economic development and Tribal sovereignty
as part of the transition to a clean energy economy. The
offices within the Department of Interior and the Department of
Energy have provided technical assistance to Tribes on clean
energy, but the level of support for these initiatives is often
inconsistent. Broader infrastructure backlogs at the Bureau of
Indian Affairs also needs attention and funding.
So, in addition to major statutes like the Federal Power
Act, Public Utility Regulatory Policy Act, and Rural
Electrification Act, they are all silent on the jurisdiction of
Tribes over utilities. We have discussed some of that today. In
a 2015 resolution, NCAI called on Congress to clarify that
Indian Tribes have regulatory jurisdiction over utilities on
reservations or villages.
So I would like to delve into that a little bit deeper and
hear from our leaders today.
So, President Sharp, it is good to see you again. Thank you
for testifying and advising the Climate Crisis Select
Committee. Thank you for your kind words on our action plan
released last week. We recommend expanding and increasing
funding for the Office of Indian Energy Policy and Programs at
Department of Energy.
How would this investment assist Tribal to advance clean
energy infrastructure and other climate solutions?
Ms. Sharp. Yes. Thank you so much for your leadership. And
thank you for directly engaging our Tribal nations up to this
point.
I would really like to focus my remarks around the
sovereignty of Tribal nations in advancing economies. As we
pointed out in our meeting--and I cited an example. When there
was a cap-and-trade system early in my presidency, the
international rate was $5 to $8 a metric ton. Here in this
country it wasn't even close to that level. But domestic
companies couldn't access those international markets because
the U.S. was not a signatory to a Kyoto Protocol. However, a
Tribal nation could access those.
And so I think looking at global solutions in a global
economy, ways that Tribes can stand on our sovereignty
authority, we can attract foreign investment that otherwise we
would never see in the United States.
So there are many opportunities in partnership that we can
do with additional funding and support. So those are the
exciting things that we are looking at in building a new
economy.
Ms. Castor. And you all have suggested that on the
resiliency piece there are some natural solutions for
sequestering carbon and putting people to work, and our new--
the report from the majority staff really suggests bold
investments there.
Give us some examples of how we can rebuild back, we can
rebuild better at a time when we have over 40 million Americans
out of work. And I know that is a deep problem on our
reservations.
Ms. Sharp. The most effective policy that any government
can adopt in addressing climate change is pricing carbon, and
that means holding those who are directly responsible
accountable to generate revenue. Those dollars can be invested
in recovery and restoration efforts, like salmon recovery. That
will put millions of people back to work with a new economy
around natural resources, around restoration.
And so we stand with you to boldly take action to generate
revenues that can then be in turn reinvested in creating jobs
across many sectors.
Ms. Castor. Thank you very much. I yield back.
Mr. Pallone Thank you, Kathy.
Next we go to Mr. Guthrie for 5 minutes.
Mr. Guthrie. Thank you, Mr. Chairman. I appreciate the
opportunity. I appreciate all the witnesses for being here
today.
I just want to start out with this last Congress I know
Representatives Mullin and Ruiz co-chaired a bipartisan Indian
Health Service Task Force for the committee. The task force
identified numerous issues that should be examined by the
Subcommittee on Oversight and Investigations, including issues
relating to hiring, treatment of patients, and general
oversight, and the agency is in dire need of oversight.
And now during the COVID-19 pandemic we are seeing even
more issues within the Indian Health Service that Congress and
the committee must examine in more detail. And I really
appreciate the hearing today, but I hope that we won't let our
discussion end on the issues of today, and that the Oversight
and Investigations Subcommittee will hold hearings on oversight
of Indian Health Service again this year.
So for my first question, Dr. Grim, the Indian Healthcare
Improvement Act authorized billing for different medical
services from dental care, to long-term care, to mental and
behavioral healthcare. These are known as Qualified Indian
Provider Services. But because Medicaid is jointly administered
by States and the Federal Government, Tribes can't bill for
these essential services if they aren't covered in the State
Medicaid plan despite being authorized under Federal law.
So my two questions for that are, what must Congress do to
address this technical issue and how long would fixing it
improve care for Native people? And how would fixing this issue
impact third-party reimbursement at his, Tribal and urban
Indian facilities?
Thank you.
Dr. Grim. Thank you, Congressman Guthrie, for that
question. That is an issue. The Indian Healthcare Improvement
Act allows Indian healthcare providers to provide a number of
services, and we are going to do that whether a patient has a
third party of any sort or not.
But we have come to rely heavily on third-party resources
within the Indian Health Service and Tribes for our operational
budgets. What we need is an authorization from Congress to
allow Indian healthcare providers to receive Medicaid
reimbursement for all medical services that are authorized
under the Indian Healthcare Improvement Act--and those are
called Qualified Indian Provider Services--whenever we deliver
them to Medicaid-eligible American Indians or Alaskan Natives.
Currently, as you pointed out, we only receive
reimbursement if a State has made those services eligible. And
as you know, Medicaid varies from State to State in both
eligibility and services.
And, also, you all know that the States don't have to pay
any match like they do for the rest of their population for
American Indian patients seen in Indian facilities. So what we
are asking you to do would not have an impact on the States'
budgets either.
So thank you.
Mr. Guthrie. Thank you for that answer.
And then, Chairman Sage, in your testimony you mentioned
the impacts that the coronavirus has had on the Southern Ute
Indian Tribe. Specifically, you mentioned that the pandemic has
underscored the lack of access to high speed internet in Indian
Country.
In my district, the shift to remote learning and working
has highlighted the challenge of broadband access, particularly
in the rural parts of my district.
How is your Tribe bridging the gap in the short term? And
what are some of the solutions you are looking at to help
address this issue in the long term?
Thank you.
Ms. Sage. Thank you for the question. We are dealing with
the gaps here with the internet service. We do have our own
entity that I oversee, what is called the department, and they
monitor all of the internet, the WiFi that is all available for
us. So we get that going. We are accessing well with this, but
we do need the broadband.
My concern with the broadband is that if our students are
going to go to college and they are going to have to be taking
classes online is there is no way that they are going to be
able to do this because they don't have the internet, the
service that they will need to succeed themselves.
And then our telehealth. We have his that assists us with
this also, but they also say go through the State. It is just
always that we are pushed aside. Nothing is really dominant and
just in stone saying that they are going to assist here. But we
are doing well here with what we have.
Thank you.
Mr. Guthrie. Thank you very much for your answer. Good
timing.
I have 5 seconds left, and I will yield those back, Mr.
Chairman.
Thank you very much for being here today. Thank you.
Mr. Pallone Thank you, Brett.
Next we are going to go to Mr. McNerney for 5 minutes.
Mr. McNerney. Well, thank you, Mr. Chairman. And I thank
the witnesses. This is a tremendous hearing with a lot of
information. It could be done in several hearings, like Mr.
Shimkus noted.
But access to broadband infrastructure and electrification
are clearly major concerns for the Tribal communities. But even
where broadband has been deployed, people are still being left
behind because they can't afford broadband or they lack digital
literacy skills.
Now, I am the House sponsor of the Digital Equity Act,
which would help address these challenges. And I have
introduced a bill with my colleagues, Representative Clarke and
Representative Lujan, and I am very pleased that the NCAI has
endorsed it and the House passed it as part of H.R. 2 last
week.
President Sharp, would your communities benefit from
resources that would be made available, would make broadband
more affordable, equip individuals with devices, and provide
digital literacy skills, including doing tasks like applying
for jobs online? Would that be very helpful?
Ms. Sharp. Yes, that would be incredibly helpful. And we
do thank you for your leadership in recognizing the tremendous
need and meeting that need with resources.
We would also recommend that there be coordination and
communication among the various Federal agencies. Because there
are a wide range of agencies that are funded, but there is no
one lead agency to provide a very clear strategy. So those two
things would be very helpful and thank you for your leadership.
Mr. McNerney. Well, thank you. That is a good help, and
good information.
Now, President Nez, access to spectrum is also important
for connectivity needs of the Tribal communities. The Tribal
priority window for 2.5 gigahertz band closes on August 3rd.
However, the House enacted H.R. 2 to extend this period by 180
days, though the FCC could act on its own to do this today if
it wanted to do so.
President Nez, applying for FCC special licenses can be
complicated, especially for Tribal government representing a
vast territory. Can you describe the typical decision-making
process for the Navajo Nation when deciding whether to apply
for spectrum licenses, including how long each step takes?
Mr. Nez. Yes. Thank you for the question Representative
McNerney, and chairman, and members of the committee, thank you
for that question.
Navajo Nation is 27,000 square miles. We are in three
States, you know. There was mention of Medicaid expansion, we
have got to deal with three States. And in terms of broadband
and internet access for telecommunication, we have to be able
to work with the States as well. But this initiative, and I
appreciate you championing this for Tribal communities, will
allow Tribes to fit in 2.5--at least Navajo Nation, let me say
that, Navajo Nation 2.5 to be able to be used in the rural most
parts of the Navajo Nation. And that is in the Eastern part of
the Navajo Nation.
And one example in the Western part of the Navajo Nation,
we have a hospital there that doesn't have internet capability
for really connecting to the--gosh, the word--I forgot what it
is called, the connectivity there that we utilize for funding
during the American Recovery and Reinvestment Act--the fiber-
there it is fiber line to go to the hospital and right now that
the hospital in that community doesn't get that fast speed
internet.
So during a COVID-19, this pandemic, it is going to be hard
for telemedicine and also getting--and this type of spectrum
would help get some relief getting high speed internet and
connectivity to these places that don't have fiber.
Thank you, Representative McNerney.
Mr. McNerney. Sure. What else do you believe the Federal
Communications Commission should be doing to help on this
issue?
Mr. Nez. Well, the FCC if they would look at some of the
white paper, Representative McNerney, about how we can have
Federal agencies work together to, you know, either set aside,
I hate to say waive, but set aside these Federal regulations
and policies so that we can get high speed internet and also
cell service for those people that don't have it, especially
now, you know.
We have to have students go to these hotspots in order for
them to get internet availability. And here we are in a shelter
in place or a stay at home order and we are seeing students
traveling to these hotspots, and even community members going
to these hotspots.
Whereas, if we open it up, they could be able to connect
from the home, which would lessen the spread of coronavirus
here on the Navajo Nation.
Thank you.
Mr. McNerney. Thank you my time has expired. But I am
going to submit a question for the record about the uranium
tailing's effect on the Navajo Nation.
Thank you. I yield back.
Mr. Pallone Thank you, Jerry.
Next we have Mr. Griffith.
Mr. Griffith. Thank you very much. Can you hear me, Mr.
Chairman?
Mr. Pallone Yes.
Mr. Griffith. OK, excellent.
Chairman Sage, it is remarkable what the Southern Ute has
accomplished over the last several decades creating and
operating new businesses on and off the reservation that now
generate millions annually for your Tribe.
While your Tribe seems to have a very diverse portfolio of
investments in real estate, housing, and gaming, oil and gas
production appear to be particularly important.
Can you share a bit about your Tribe's experience with the
National Environmental Policy Act, also known as NEPA, and on
any other Federal regulatory barriers as you have advanced
energy development on your Tribal lands?
Ms. Sage. If I can get this to mute. Thank you for the
question.
Yes, NEPA hinders on reservation development and
construction, not just energy development, every time a major
Federal action is pending NEPA is triggered.
At a minimum agencies should use Tribal environment
analysis and where the Tribe has the kind of sophisticated
government such as the Southern Ute Indian Tribes, it should be
allowed to develop and administer its own TEPA, Tribal
Environmental Policy Act, instead of Federal NEPA.
With the part two the Tribe also faces inconsistent
requirements through the various Federal agencies on a single
project VLM, BIA and USFS, the United States Forest Service
have inconsistent requirement consistency across Federal
partners would greatly benefit Indian country.
Thank you.
Mr. Griffith. And so would you support current efforts to
modernize NEPA to help bring clarity to these various matters?
Ms. Sage. Yes, definitely.
Mr. Griffith. And are you concerned by some of the
environmental proposals, particularly those that are more
extreme that are out there that would ban fracking or phase out
fossil fuels completely?
Ms. Sage. That is a good question, you know.
Mr. Griffith. To be determined.
Ms. Sage. Yes, yes, definitely. It would have to take a
lot of review, collaboration to make sure that this is going to
benefit the Southern Ute Indian Tribe.
Mr. Griffith. Right. And of course if you ban fossil fuels
outright, then you have the same situation that President Nez
has where they are looking, as many people in my district are
looking for ways to replace the revenues from coal. And his
statement early on said $30 million to $50 million had been
lost by the Nation as a result of closing down the coal fired
power plant and the coal mine that previously was hiring and
employing members of his Nation.
Would that be the same if they suddenly shut down oil and
gas production in your area?
Ms. Sage. Yes. It is a balance there. It would definitely
be a type of a balance. But [Inaudible] So definitely. Thank
you.
Mr. Griffith. And President Nez, do you have any comments
that you might make on--how do we replace that $30 million to
$50 million that you said was lost as a result of the shutting
down of the coal fired power plant and the coal mining jobs?
How do we replace that?
And how does that effect your ability to try to get
electricity to the roughly 10,000 homes in the Navajo Nation
that currently lack electricity?
Mr. Nez. Sure. Yes well, thank you for that question,
Representative Griffith. Let me go to Representative Castor's
question about clean energy and climate change.
Yes, we are seeing closures of coal fired power plants, one
on the Navajo Nation, another outside our Nation. There is a
potential of others closing down in the future and that is
jobs, and revenue, and the local economy getting impacted
negatively. But there is a move to transition away from fossil
fuel and to renewable energy. We do have some projects that are
being planned right now, solar and wind. And it comes back to,
as was mentioned, these Federal regulations, you know, NEPA, to
be able to set some of those regulations aside could really
jump-start some of these projects quickly. And I appreciate you
all talking about that. Thank you.
Mr. Griffith. So reforming NEPA would actually help some
of the renewables as well.
One of the other things that I have been championing is
that we have research parity on both fossil fuels and clean
energy fuels. I am not trying to reduce any of that, but I
think if we had parity we could maybe figure out a way to make
that coal fired plant a little cheaper--or a little more
efficient and less costly in the sense of pollutants.
That being said, I see my time is up and I have to yield
back, but thank you to all the witnesses for your time.
Mr. Pallone Thank you, Morgan.
So next we are going to go to Mr. Lujan.
Mr. Lujan. Thank you, Mr. Chairman. I appreciate that very
much. It is an honor to be with you.
To every one of the panelists, it is an honor to be with
you as well. Thank you for being available today. And special
greetings, Mr. President, to President Nez, [Speaking native
language.] Hello, my friend from the Navajo Nation which I am
proud to represent in New Mexico. The third congressional
district of New Mexico I am proud to represent 15 Pueblos, the
Hickory Apache Nation of the Navajo Nation.
And the conversations with Tribal leaders and Pueblo
leaders have made clear that the coronavirus pandemic has
exacerbated challenges and inequities that long existed before
COVID-19. The inequities include a lack of access to broadband,
insufficient housing support, barriers to ensuring an accurate
census count, and a failure to guarantee access to the ballot
box.
Simply put, the Federal Government is not living up to its
trust responsibilities. Housing, water, healthcare, road and
broadband projects are underfunded and often wait for Federal
approval while communities suffer. These failures span many
decades and presidential administrations and it is not
acceptable. And as a Congress, we must come together in a
bipartisan way to fulfill our obligations to Tribal
communities.
Dr. Grim, your testimony is very clear on this. Will you
please state yes or no whether the Indian health services has
chronically been unfunded before COVID-19?
Dr. Grim. Yes, sir, it has.
Mr. Lujan. And I spoke about a $3 million his contract
awarded to a former Trump White House staffer whose company
delivered thousands of faulty masks that were unfit for use
which his fortunately discovered before they were distributed
to the facilities in my State.
Dr. Grim, yes or no, is it acceptable that his patients,
and physicians, and first responders should receive lower
quality supplies, lower quality facilities or lower quality
healthcare?
Dr. Grim. No, sir. None of those things are acceptable.
Mr. Lujan. I appreciate that, sir.
President Nez, in your testimony you note that the digital
divide impacts a businesses' ability to thrive, students'
ability to learn, workers' ability to telework, and patients'
ability to see their doctor. And all of this has been made
worse by the COVID-19 crisis.
According to the FCC more than 60 percent of New Mexicans
living on Tribal and Pueblo lands lack access to high speed
fixed broadband. This is unacceptable.
President Nez, yes or no, do we in the Congress and the
Federal Government need to make more robust investments in
broadband access to ensure that Tribal communities are not left
behind?
Mr. Nez. Absolutely, yes and [Speaking native language.]
My friend.
Mr. Lujan. I appreciate that, Mr. President.
Recently FCC Commissioner Rosenworcel joined me in New
Mexico to have a conversation with Tribal and public
communities about the E-rate program which is an important
program to expand broadband connectivity to educational
facilities, to libraries.
President Nez, to meet long-term needs once the stay at
home order is lifted, yes or no, do you agree that Congress
should support connectivity at Tribal anchored institutions
such as Tribal libraries, schools, and chapter houses by making
them all eligible for the E-rate program.
Mr. Nez. Yes, [Speaking native language.]
Mr. Lujan. And President Nez, in your testimony you said
that the United States must quote, "address all the health,
cultural, and environmental consequences of uranium extraction
and processing on Navajo lands. As you know, these consequences
include severe forms of cancer, kidney disease, and respiratory
illness.
Yes or no, has the COVID-19 crisis exacerbated the health
impact of our Nation's legacy of uranium mining on the Navajo
people.
Mr. Nez. Yes, absolutely. [speaking native language.]
Mr. Lujan. OK.
Mr. President, yes or no, should Congress pass the
Radiation Exposure Compensation Act amendments to extend RECA
and expand compensation to all of those impacted by uranium
mining and nuclear testing during the cold war?
Mr. Nez. Yes, sir.
Mr. Lujan. I appreciate that, Mr. President.
And that is one area where I am hoping my colleagues,
Democrats and Republicans, who are currently not cosponsors of
providing support to uranium mine workers and communities like
in New Mexico where the first bomb was tested on soil were not
included in downward communities. I hope we can all come
together and pass this legislation.
And as you heard from President Nez, it is important that
aspects of the RECA, be included in whatever the next funding
package is in response to COVID-19 because of the exposure to
so many families because of the respiratory illnesses.
And then the last question I have, Dr. Grim, what does the
lack of access to running water mean for Tribal communities and
public communities, including families risk for COVID-19 and
other health issues?
Dr. Grim. As you know, Representative Lujan, American
Indian, Alaska Natives, their homes have six percent that have
unacceptable water and sewer compared to one half of one
percent of U.S. White population. What it means specifically in
COVID-19 one of the biggest things CDC says to do is wash your
hands. They don't have the ability to do that.
If you look at the mortality and morbidity statistics
within the Indian Health Service and you take a look at how
much can be reduced by safe water and safe sewer, no matter
whether you go to [Inaudible] Or Tribal hospital or clinic, it
is remarkable. It is absolutely necessary for people's health
and it is absolutely necessary during COVID-19.
Mr. Lujan. I appreciate that. I yield back, Mr. Chairman.
I think Dr. Grim's testimony said that it was 10.83 percent
times more likely in homes without indoor plumbing that there
would be spread of COVID-19.
Thank you for this important hearing, Mr. Chairman. I yield
back.
Mr. Pallone Thank you Ben Ray.
Now we are going to move to Mr. Bilirakis. You are
recognized for 5 minutes.
Mr. Bilirakis. Thank you, Mr. Chairman. Thank you, Mr.
Chairman, I appreciate it very much. I want to thank the
witnesses for testifying today as well.
Dr. Grim, clinical trials often provide patients with the
best perhaps only treatment option for their condition.
However, without coverage or routine costs associated with
participation and clinical trials many Medicaid beneficiaries
do not have the latest technology, technological and scientific
advancements as a treatment option.
Medicaid serves many demographics, including Tribal
communities that are underrepresented in current clinical trial
enrollment. Lack of participation in clinical trials from the
Medicaid population means these patients are being excluded
from potentially lifesaving trials and are not reflected in the
outcome of the clinical research.
Congressman Lujan, my good friend, and I introduced H.R.
913, the Clinical Treatment Act which would address this issue
by providing coverage of routine care costs associated with
clinical trial participation for Medicaid enrollees.
And this is a question, does increased access to clinical
trial participation for Medicaid enrollees help ensure medical
research results more accurately, capture and it reflect the
population of the this country? And if so, why is that
important, and especially if we develop better treatment
options and a vaccine for the COVID-19?
That is a question for Dr. Grim, please.
Dr. Grim. Thank you, Congressman. You are absolutely right
that there has been underrepresentation in a lot of clinical
trials of all minority populations and Medicaid eligible
patients.
One of the reasons that it is so important is that if a new
drug or a new treatment is not tested on a specific population
group, whenever that medication or treatment comes out the
doctors ask themselves hmm, especially doctors in Indian Health
Service they will say, there really wasn't a significant or any
Indian population on this particular trial. How do we know this
drug is going to work the same on our population and that goes
across the spectrum of almost anything.
So I think it is extremely important. Although I have not
read your full bill, I support the concept and I appreciate the
question.
Mr. Bilirakis. Very good. Thank you. I appreciate the
answer.
Dr. Grim, according to the NIH, diabetes is a common risk
factor for Peripheral Arterial Disease, or PAD. A circulatory
deficiency that leads to blockages in the blood vessels that
supply the lower extremities.
Native Americans experience both diabetes and PAD at a
disproportionate rate. In certain regions of the U.S. Native
Americans are more likely to undergo a PAD related amputation
than Caucasians. Patients who undergo amputations have short
life expectancies of course and exchange independence and
functionality with chronic physical ailments, high death rates,
and costly dependency on our burdened healthcare system.
However, most of these amputations are preventable if PAD
is screened, diagnosed early and properly managed. And I have
actually witnessed a procedure that is really incredible what
we are doing today. Because Tribal communities are
disproportionately affected by PAD, what steps can be taken to
ensure that these communities, even in the midst of a pandemic
have better access to a quality of care that would prevent such
amputations?
If you could answer that question, sir, I would appreciate
it.
Dr. Grim. Thank you again, Congressman.
So amputations specifically I will talk about in Native
communities is higher, as you pointed out. And it is terrible
when the disease reaches that state where there is no other way
to treat it. Because of the isolation of many of our
communities, and the ability to get either to a specialist for
that sort of care or to recruit people to your community to
actually work, those are very difficult hurdles to overcome.
And just off of the top of my head, and I am willing to
research this further, but I feel like the agency would need
more purchased and referred care dollars, those dollars that we
use to refer the higher level specialist for care that would
help our population.
The other thing that was mentioned earlier too is the
approval of the bill that would extend a longer term to the
Special Diabetes Program for Indians and also raise the dollar
amount on that. That program has done an immense amount to
reduce the prevalence and the incidence of diabetes in Indian
country.
And as you pointed out, that is one of the primary factors
that causes a higher level of this disease in our population.
Mr. Bilirakis. Yes, it really solves--this comment I know
we could save a lot of money as well because amputations and
the care afterwards is very expensive. But it is a quality of
life issue.
Mr. Chairman, I am not sure if I have any more time. I
don't see a clock. But I have one more question if I have time.
Because I----
Mr. Pallone You have time. Yes, you do.
Mr. Bilirakis. OK. All right. Very good, I appreciate it.
Ms. Sage, your testimony talks about some of the issues
Tribes have, having accessing the Paycheck Protection Program,
the PPE funding, specifically mentioned the disparities between
Tribal businesses and large corporate chains.
Can you tell us more about this and what would you proposed
to fix the administration of PPP? Now I know we made some
tweaks to it and they have been very positive, but what else
can you add? Thank you.
And this is for Ms. Page--excuse me, Ms. Sage.
Ms. Sage. Thank you for that question, Representative.
With that we will allow multiple entities to apply under one
EIN. And that was my answer. Thank you.
Mr. Bilirakis. Thank you very much.
Mr. Chairman, I yield back. I appreciate you holding this
hearing. Thank you.
Mr. Pallone Thank you, Gus.
Now Mr. Butterfield is back so we will move to Mr.
Butterfield for 5 minutes.
Mr. Butterfield. Thank so very much, Mr. Chairman. Thank
you for your patience. You know, I am very appreciative of
technology. I first started this hearing 50 miles down the
interstate and now I am in my home office. When I was on the
interstate I was on my iPhone and now I am on my P.C. and So I
thank God for technology.
And thank you, Mr. Chairman, for this very historic
hearing. I share the views of all of you that we must pay more
attention to the needs of Indian country and I will certainly
do my part.
Thank you to the witnesses for your testimony today. I have
heard most of it and it has been very powerful. I thank you so
very much.
President Nez, and let me just start with you, if I may. In
your testimony you talk about the lack of competition among
providers, currently serving the Navajo land and the resulting
consequences for broadband access in those communities.
Last month you made know that I introduced the Expanding
Opportunities for Broadband Deployment Act, which increases
competition and we know that is so important. It just increases
competition and it promotes affordable rates by streamlining
the process for receiving universal service dollars.
I believe that doing so will not only provide high quality
service but promote competition in pricing as well. How would
providing more choices, more choices for broadband service in
undersevered and underserved communities impact the Navajo
Nation.
Mr. Nez. Well, thank you Representative Butterfield,
chairman, members of the committee. Thank you for the question.
On the Navajo Nation there is a lack of competition due to
the large vastness of our Nation, 27,000 square miles of land,
sparse population. And really the affordability of connectivity
is an issue as well, you know. Folks are going through some
hardships right now, not just here on Navajo but all across the
country and can't afford connectivity.
But with your initiative there we see that competition can
be created and at the same time Tribal governments and their
enterprises could be a part of that mix to help bring the cost
of internet accessibility down and bring affordable rates to
our citizens, which would create more choices and competition.
Right now we have a cellular service company that is offered
through the Navajo Tribal Utility Authority, our own for-profit
corporation. And with that, you know, is bringing competition
between other larger cell service providers.
Mr. Butterfield. Competition is valuable.
Mr. Nez. Yes, indeed, sir, yes.
Mr. Butterfield. All right. Let me conclude with this.
Mr. President, you written testimony begins with a very
powerful look back at the injustices that Tribal communities
have suffered down through the years. We are in the middle now
of a societal reckoning right here in our country, something
that is long overdue and it is very important. And those wrongs
suffered by other minority communities are not forgotten.
And then you go on to discuss the importance of reliable
high speed internet to the cultural preservation of the Navajo
Nation. I am very interested in ensuring that traditionally
undersevered populations can maintain their sense of community.
And I know Indian country feels very strongly about this, to
not lose touch with the culture and values rooted in their
shared history.
Can you tell us, sir, in greater detail, why the internet
is so, so important for cultural preservation.
Mr. Nez. Yes, absolutely. Thank you for that question once
again.
Mr. Butterfield. You have 45 seconds. All right.
Mr. Nez. Yes, sir. You know, during this pandemic I think
all Tribes and I think everybody has realized that in order for
information to get out to the public to help in slowing down
and stopping the spread of COVID-19, it is important, and its
crucial, and critical that we have high speed internet so that
information can get out.
And that is the same thing here that we are challenging our
Navajo citizens, sir, and members of the committee is that we
want to retain and package up a lot of the cultural knowledge
of our elders. I said earlier 66 percent of those who passed on
because of this virus were 60 and above. And our elders are in
the most vulnerable population.
So utilizing technology to get their wisdom, their
knowledge, and to save that information for our younger
generation is of up the most----
Mr. Butterfield. Thank you.
Thank you, Mr. President so much. You communicate very
effectively. Thank you very much.
I yield back, Mr. Chairman.
Mr. Pallone Thank you G.K.
Next we go to Mr. Flores for 5 minutes.
You have to unmute, Bill.
Mr. Flores. Thank you. Sorry about that.
I want to thank the panel for joining us today. And I want
to thank you for your comments regarding the needs of the
Native American community that has been made more urgent by
COVID-19. Clearly each of the issues mentioned today represent
a complicated set of challenges worthy of in-depth discussion.
Today I would like to focus on broadband access. And
President Nez, let's start with you. I appreciate your detailed
testimony. My question builds upon those by Frank Pallone and
other during this hearing.
Based on your testimony and the white paper that you
released in June, your effort to bring broadband access to the
Navajo Nation appears to be hindered not just by piecemeal
infrastructure and inconsistent connectivity, but also
obstacles created by a number of entities involved in building
out broadband service.
In fact, near the end of your discussion of broadband
challenges you specifically asked for a streamline rules and
regulation to "allow for faster and easier, but responsible
deployment of towers in communications equipment on the Nation
lands."
The white paper you mentioned several times provides a
number of recommendations regarding changing regulations. For
the discussion today can you elaborate more on the type of
challenges that you encountered as a result of multiple layers
of government agency rules and bureaucracy requirements? And
can you also provide an example or two of how your efforts have
been slowed or detailed as a result? If you could do that in
about a minute that would be--because I have one more question.
Mr. Nez. Thank you, Representative Flores, chairman, and
members of the committee.
I will use one example. One example that we have a
difficult time in trying to incorporate is an infrastructure
corridor here on the Navajo Nation. You talked about piecemeal.
We have to get a right-of-way approval for electricity to be
run throughout the communities and then another approval for
water, another approval for telephone, broadband. That is one
example of many others that are there, sir.
Mr. Flores. OK. Thank you.
Let me continue down this same line. One of my priorities
and you have reinforced it today is to cut down on unnecessary
bureaucratic red tape, especially when it creates an
inefficient duplicate process that derails innovation progress.
I recently introduced the Enhancing Administrative Reviews
for Broadband Deployment Act, which is H.R. 7349 among other
things the bill directs the Secretaries of Interior and
Agriculture to identify administrative barriers to reviewing
the communications use authorizations that are needed to grant
permits for communication facilities on Federal land.
This bill is one of 26 others in a package of bills aimed
at achieving exactly the type of streamlining you suggest is
needed. So President Nez, again based on your work to expand
broadband, do you think this approach should receive bipartisan
support?
Mr. Nez. Well, it should get broadband support,
Representative Flores, you know. I think the highlight of what
is happening the administration here trying to help, you know,
infuse economic and community development as well as this
Congress in Tribes, but more so now that all eyes are on Tribal
communities.
And this is happening right in the midst of the most
powerful Nation to where 40 to 50 percent of indigenous people
don't have running water, they don't have broadband access.
And, you know, we are also, and I will conclude by saying this,
is that we are also, here on the Navajo Nation, looking at our
own laws too because we have to reevaluate our own laws. And
based on our white paper, the white paper is there for the
COVID-19 CARES Act funding.
And so that in a way is recommending as setting aside
certain regulations and policies, but I appreciate the long-
term changes that need to occur. And with your bill I see that
some of those changes can be done permanently to help Tribal
communities throughout the country and get us up to, you know,
equal footing with the rest of this country.
Thank you, Representative Flores.
Mr. Flores. Thank you, President Nez. I want to thank all
the other witnesses for your informative testimony today. I
yield back the balance of my time.
Mr. Pallone Thank you, Bill.
Next we are going to go to Paul Tonko, recognized for 5
minutes.
Mr. Tonko. Can you hear me, Frank?
Mr. Pallone Yes.
Mr. Tonko. OK. Chairman Pallone, thank you. Ranking Member
Walden, thank you. What a great hearing and to our witnesses,
thank you for joining us for what is I think an essential
hearing.
We have heard some shocking testimony today with 13 percent
of American Indian and Alaska Native homes not having safe
water and or wastewater disposal facilities compare to.6
percent of non Native homes. Similarly, there is a high number
of violations of drinking water standards for those with
access.
Safe drinking water should be an absolute right for
everyone. And so we as Federal partners need to figure out just
how to do better and uphold our responsibilities.
So President Sharp, I believe your testimony mentions the
Drinking Water and Clean Water State Revolving Funds. Do you
believe these existing programs are able to meet the Tribe's
needs and address these longstanding water deficiencies or does
there need to be more dedicated funding or basically reforms
that are required for the programs?
Ms. Sharp. It is definitely the latter. We need more
funding. There is just simply no way around being able to build
what we need to do to provide safe water without additional
resources.
Thank you for your question.
Mr. Tonko. You are most welcome. And does anyone else want
to weigh in, any of our other witness?
Dr. Grim. Representative Tonko, this is Dr. Grim. I will
just add that I think the Indian Health Service has progressed
into the $2.67 billion of needed across Indian country for
water and sewer projects.
Mr. Tonko. Thank you sir. Anyone else?
Mr. Nez. Representative Tonko, Jonathan Nez here, chairman
and members of the committee. You know, I appreciate dollars
going through Indian Health Services for things like, you know,
sanitation facility construction programs. But there are some
Tribes that have the ability to do their own construction on
water lines. And that is self-governance. And what we noticed
about the fundings that came from the CARES Act is that there
were programs that these monies were passed through, right.
EIA, the monies came into Tribes, Treasury.
And what we liked for the future of Tribes here in the
United States is direct funding, not just direct funding for
these types of emergencies, but direct funding for the budgets
that do get approved every year.
And Tribes have the ability to govern themselves. So that
means they have the ability to take care of those Federal
dollars and to utilize it for the intent given.
Thank you, Representative Tonko.
Mr. Tonko. Oh, you are most welcome.
The recently released National Economic Transition platform
which has been developed by local, and Tribal, and labor
organizations and recommends how we can ensure a just energy
transition stated that 75 percent of the unelectrified homes in
the United States are located on Tribal lands.
So President Sharp, similar to the drinking water question
concern, do you believe that this is a case of existing
[Inaudible] Is underfunded or are there structurally deficient
to meet the needs to work effectively with the Tribes?
Ms. Sharp. I think the answer is both. As you know there
are many challenges within Indian country and it is not only
the funding and the resources, but as Chairman Nez pointed out,
many of the complexities that we face, Tribal Nations should be
able to exercise their inherent powers and authorities for that
policy. And we need to partner with Congress to also legislate
congressional responses to those challenges. So I believe it is
both.
And again, thank you for your question.
Mr. Tonko. Thank you. OK, you are most welcome.
And Ms. Thomas, your testimony mentioned the Tribal Energy
Loan Guarantee program, which I believe would be used for those
larger scale projects, but it hasn't been used yet despite the
high potential for renewable energy development on Tribal land.
My understanding is that this is a loan guarantee which
would still require a Tribe to partner with a bank or a lender.
If these commercial entities are not willing or prepared to do
business on Tribal projects, would it be helpful for the
Department of Energy to be able to make a direct loan?
Ms. Sage. Yes, Congressman. Thank you for that question.
So there is a couple of things happening in Tribal Energy
Loan Guarantee program. First, in the loan program office which
administers the program, they have created a two-step process
that has added a great deal of complexity to that loan
guarantee program. NCAI points out that we need to remove some
of the barriers that have been created by the loan program
office. And so frankly, we don't know that there aren't banks
interested in lending money to Tribes with a loan guarantee.
The application process itself is incredibly complicated
and incredibly expensive. So it has been made overcomplicated.
Having said that, a Direct Loan Program would also be a good
tool to have, just like in the 1703 program where the
Department of Energy does loan guarantees and makes direct
loans or like our U.S., where you might make a direct loan.
So those tools are all necessary. But one of the key
challenges is to reduce that regulatory and administrative
process that has been overcomplicated in that program in
general.
Mr. Flores. Thank you very much.
And with that, I yield back to the chair. And again, thank
you for a great hearing
Mr. Pallone Thank you, Paul.
Next we go to Mr. Bucshon, for 5 minutes.
Mr. Bucshon. Thank you, Mr. Chairman. And thanks to all
the witnesses.
This is really a very important hearing. I am a physician
so I am going to focus on some of the healthcare stuff. And Dr.
Grim, I will focus a little bit on maternal mortality. We had a
hearing on maternal mortality across the United States and what
can we do to decrease the disparity, and maternal mortality and
morbidity at his area hospitals?
What can Congress be doing specifically for the Indian
Health Service in this area of maternity mortality.
Dr. Grim. Well, thank you, Congressman. Maternity
mortality has improved significantly over the years in Indian
Health Service as has infant mortality. And one of the keys, as
I know you are well aware, is being prenatal care, making sure
someone gets in timely and making sure that they keep all of
their visits.
Part of the issue too with the Indian population is the
high level of diseases within that population. If you take a
look at almost any type disease, American Indians, Alaska
Natives are in that top part. So a lot of the mothers are high
risk in our population.
And I really believe that not only for this, but diabetes
and other things, prevention is the key, you know, getting them
in early. And sometimes that means there needs to be more
providers in a particular area or a bigger clinic. I mean, it
is a really complex issue. I know you appreciate that.
And so I will stop there to allow you more questions, but
really just access to care, prenatal care.
Mr. Bucshon. So I think you mentioned earlier you still
have a 25 percent shortage of providers in the system in
certain areas, do you have specialty areas that are really
short?
Dr. Grim. Yes, sir. There was a report done on Indian
Health Service a while back that looked at a number of
professions and the kind of vacancy rates that they ran.
And part of my written testimony talks about some of the
things we could do to help recruit or retain people further,
ranging from making funds available to Tribes for residency
programs, loan repayment, or scholarship funding trying to
increase those.
But yes, it is still extremely high rates across the Nation
and it varies by location. Usually the more isolated, the more
difficult that it is to recruit.
Mr. Bucshon. Yes. I mean the graduate medical education
situation is really a nationwide problem, not just in Indian
Health Service and it sounds like you have got a similar
situation there, more support for residency training.
You know, we are finding shortages particularly in primary
care of rural America and Indiana that I represent. Part of
that is the things you mentioned, the support for graduate
medical education, but also the amount of debt that students
are coming out of medical schools with, it makes it very
difficult for them to practice in underserved areas where their
income may not be at high.
So it sounds like you have got that same issue that needs
to be addressed really for the whole country, including Indian
hell service.
I want to move on to the situation with the Special
Diabetes Program for Indians. And I know we have been trying to
do a long-term reauthorization get it across the finish line.
Can you explain why short-term extensions have been disrupted
to Tribal communities and why the longer term reauthorization
for STPI is so important?
Dr. Grim. I think one of the biggest problems,
Congressman, that we have with those short terms are staff.
Whenever you get near the end of a term of a funding, everyone
in those programs across the whole country start worrying about
whether they are going to have a job come whatever date that
program ends.
Congress has been good to fund it, you know, year after
year. But every time this happens it is disruptive to those
programs and the patients too. So really something that is
longer term is much better for everyone involved, including
Congress to not have to deal with it so frequently.
The other thing that was brought up earlier in the hearing
was that funding had as been stagnant for so many years, you
know, and how medical inflation as well as general inflation
has continued to rise over the years, that $150 million does
not buy near as much as it did when Congress first passed it.
So----
Mr. Bucshon. Since 2004, right?
Dr. Grim. Yes.
Mr. Bucshon. Roughly.
Dr. Grim. Congress--asking for a very modest increase, $50
million to go up to $200 million.
Mr. Bucshon. Yes. Well, I would like to say as a
healthcare provider, the most important thing for me is quality
affordable healthcare and access. And I think we have some
substantial challenges in the Indian Health Service that we
should be able to solve together.
And I very much appreciate the committee chairman for
holding this hearing. I think it is a very important subject.
And I know you know that you have substantial support on both
sides of the aisle to try to address some of these long-
standing problems, which we really should be able to address.
Again, for me, it is about access to quality healthcare.
And we need to make that happen for everyone.
So with that, Mr. Chairman, I yield back.
Mr. Pallone Thank you, Larry.
Next we are going to go to our vice chair, Yvette Clarke
for 5 minutes.
Ms. Clarke. Thank you very much, Mr. Chairman. And I thank
our Ranking Member Walden for holding this important and timely
hearing on the wide range of pressing issues that our Tribal
communities face. And thank you to our five witnesses for
offering your testimony today.
Whether you look at the disparate impacts of the COVID-19
pandemic or the recent civil unrest marked by police brutality
across our Nation, the past few months have made one simple
fact clear, minority communities in America face countless
inequities from all segments of society.
This is why I, along with my dear friend and colleague, a
member of the Energy and Commerce Committee, the gentle lady
from Illinois, Congresswoman Robin Kelly, are cochairing the
Energy and Commerce working group for racial disparities to
examine these manifestations of racial inequity and develop
legislative solutions that will improve outcomes among people
of color all across our Nation.
And so in my limited time today I would like to focus my
line of questioning on the disparities that we have seen in our
Nation's Tribal lands around healthcare, broadband, and energy
development. According to the Indian Health Service, Native
Americans have life expectancy that is 5-1/2 times lower than
the average American. We also know that had the Indian Health
Service on a per capita basis spends only one-third of what is
spent nationally on patient care due to severe underfunding.
Now with the COVID-19 pandemic, we see similar disparities
playing out once again as the virus exacerbates preexisting
inequities in healthcare access and quality. My first question
is for President Sharp. Could you please elaborate on these
broader health disparities that you mentioned in your
testimony? What steps do you think Congress must make to
address the systemic inequalities that lead to such disparate
outcomes?
Ms. Sharp. Thank you. I so appreciate not only your
question, but I must say just during the course of this hearing
the questions that have been raised, I clearly there are a lot
of people championing our issues and thinking about these. So I
want to thank everyone that has been here this morning, it is
quite an honor.
And directly to your question, Ms. Clarke, I really
appreciate that, because Tribal Nations have a very clear
vision for getting to the place we now in that classless future
that we with all see. And part of it is holding the United
States accountable to fulfill its trust responsibility. Those
recommendations that are detailed in the report for the U.S.
Commission on Civil Rights.
I think there is also another strategy supporting Tribal
sovereignty to advance our economies the way we envision,
building our private sector economy within our borders,
engaging in international trade. There is a big gap between
where we are today and that prosperous future and part of it
[Inaudible] Holding the [Inaudible] Responsibility and
supporting Tribal sovereignty, but both of those strategies and
a Marshall Plan would be very effective and we look forward to
partnering with Congress to see that through the end.
Ms. Clarke. Wonderful. Thank you so much for your
response.
I am going to move on to the issue of broadband
affordability. According to the FCC, less than half of all
households on Tribal lands have access to reliable broadband
services. This lack of access represents nearly a 27 point gap
between non Tribal rural areas and an even greater gap when you
compare it with countrywide coverage.
President Nez, why are so many Tribal households not
connected to broadband, even in many instances when broadband
service is available? And how can Congress ensure that all
Tribal households are able to afford broadband access and
devices needed to connect?
Mr. Nez. Well, thank you Madam Vice Chair Clarke,
chairman, members of the committee. Thank you for that
question.
You know, we have--and I hate to say this and I am sure you
all know that we have high rate of unemployment here on Tribal
lands. And we are doing our very best to create economic
development, community development, job opportunities here on
the Navajo Nation. But as the white paper that has been
mentioned many times that we sent to secretaries, to cabinet
members of this administration, as well as congressional
leaders is that there are certain regulations that hinder--and
policies, and laws that hinder development on Tribal lands.
And so, you know, even by bringing--I will give you an
example, even by bringing one new healthcare facility into an
Tribal community could be that anchor tenant. That can bring
economic development, it could bring in shops, and restaurants,
and eat--and other type of businesses around the new facility,
as well as bringing in broadband connectivity for not just for
the hospital, but for that region and for that community.
And I also wanted to mention too that, you know, specialty
care--see, a lot of doctors and nurses have a hard time getting
used--in Navajo getting used to being way out in the rural
area.
They like to get doctors and nurses that are out there,
want to have the shops, the businesses to go to. But here in
Tribal Nations, the salaries are not up to par. As you have
heard earlier his has not been fully funded.
And in term of specialty care, a lot of those specialty
professionals are off our Nation. So we have to send our
patients off the Navajo Nation. And during this pandemic, some
of the COVID-19 positive patients we had to send off our Navajo
Nation, towards like Phoenix and Albuquerque. As you all know
and have seen the news, there has been a big spike in patients
off the Nation around us, like in Phoenix and in Albuquerque.
So we are fearful that some of our COVID positive patients
may be denied to go to these facilities. And so the need to
better our healthcare system here through the his is very
important to us.
Thank you.
Ms. Clarke. Very well. I am yielding back, Mr. Chairman,
but look forward to doing a deeper dive with the working group
that we have established in committee.
I yield back.
Mr. Pallone Thank you, Yvette.
Next we move to Tim Walberg, 5 minutes. Tim?
Mr. Walberg. Thank you, Mr. Chairman.
Can you hear me now.
Mr. Pallone Yes.
Mr. Walberg. I will get the screen up so I know the 5
minutes that are here.
I appreciate the panel here today, it has been very
interesting, but it only would have been better if we had the
opportunity to have a hearing on the Tribal lands themselves,
the beauty of those places.
President Nez, in your recent white paper you state that
land previously disturbed for any infrastructure construction
should have a categorical exemption from NEPA for future
infrastructure projects.
I have a bill H.R. 7378 that would provide a categorical
exception for the deployment of broadband wholly within
brownfields, et cetera, those type of sites that are heavily
contaminated with former industrial activities.
So you have the picture of what site I am talking about,
would you support this concept as we consider future packages
or are there challenges that we need to consider that you
address today?
Mr. Nez. Thank you, Representative Walberg, chairman,
members of the committee. Absolutely, the intent of what you
are doing is something that we have been advocating for some
time on Tribal lands, but not just for broadband. I talked
about an infrastructure corridor earlier where electrical
lines, water lines, telephone lines, you know, everything to be
approved with one approval process.
And what we are encouraging others to keep in mind,
including yourself, Representative Walberg, is with the
categorical exclusion, we also would that like that cover
building of roads within Tribal communities. Much of the work
in category exclusions have to be done by local communities and
it only has a certain timeline before you have to restart that
again.
And so we put a lot of money and effort into a lot of these
requirements, but yet the law could be changed and that is what
you are looking at with other Members and I appreciate that.
And I am willing to be a part of that discussion.
Thank you, Representative Walberg.
Mr. Walberg. I hope we can move that forward and use land
appropriately and also provide the amazing economic impact that
it could possibly be.
Let me ask you President Nez again, I understand the Navajo
Technical University has a wireless tower site maintenance
program to help develop power technicians to deploy and
maintain communications infrastructure, and that the NTU can be
authorized to engage in partnerships with providers to build
these towers.
What role can workforce needed for communications
infrastructure deployment and the local economy aside from
connecting members of the Nation?
Mr. Nez. A great question, Representative Walberg. And
Navajo Technical University is right in the middle of one of
the largest communities in the eastern part of Navajo Nation.
And because of internet access, it is hard to get resources and
monies to supplement salaries for, as I mentioned earlier, for
doctors and nurses in healthcare.
There is a hotel going up in that community of Crownpoint,
New Mexico, and Ship Rock, New Mexico, where NTU is. And I
think with what is being proposed, you know, we could really
make a hub community to where goods and services could be
delivered there, rather than having our folks----
During this COVID-19 having our folks leave the Navajo
Nation to go to the big box stores and possibly go into some
type of discrimination, those that live off the Nation saying,
well, you are bringing the virus off the Nation and then same
thing for our citizens saying, hey, those visitors may be
bringing the virus on.
And I think if we can really strengthen our economy here on
the Navajo Nation, you know, these types of pandemics in the
future we could really enhance our economy here on the Navajo
Nation and in Tribal communities throughout the country.
Thank you.
Mr. Walberg. Thank you. Thank you. I yield back my time.
Mr. Pallone Thank you, Tim.
Next, we are going to move to Kurt Schrader for 5 minutes.
Mr. Schrader. Thank you very much, Mr. Chairman, I
appreciate it. And thanks for all the participants on the
panel.
President Nez, thank you for your leadership. It is tough,
tough times. My heart goes out to Navajo Nation right now. And
I actually represent several Tribes myself, but for the purpose
of my question to you, I want to point out that we have a
Chemawa Indian School in my district, and several younger
members of the Navajo Nation are participants and students at
the school. And I am very worried--and you talked about a
little bit about the digital divide.
I mean, it is bad to begin with. And with this pandemic, I
am very concerned about different school districts around the
country and in my State and worried about Chemawa about going
to online education. To me, I am very concerned that would only
make the educational disparities that much bigger and have
unequal education.
If you are a wealthy Portland suburbanite, you get a great
education. Because you have access to the internet, you have
access to devices. Maybe not so much for some of our kids in
other locations.
So if you can describe a little bit your experience working
with BIE to expand the broadband access to Navajo students and
during the epidemic in particular, and actually prior to that.
Could you just talk about a little bit. And you are
concerned about the difference in educational attainment given
the fact that a lot of Tribal folks don't have access to the
internet.
Mr. Nez. All right. Thank you, Representative Schrader,
chairman, and members of the committee. Thank you for that
question.
By the way, my mom and dad graduated from Chemawa Indian
school. So----
Mr. Schrader. Very good.
Mr. Nez [continue]. So there is some history here.
With the work that we are doing here on the Navajo Nation,
early on in this pandemic, as we saw the numbers start peaking
all around the Navajo Nation, we got all of the schools and
resources together, including the State schools. Remember, we
have three States within the Navajo Nation--Arizona, New Mexico
and Utah. So that was a really a difficult thing to do is to
bring State school departments to the table as well as the
Bureau of Indian Education.
But we did begin to strategize on putting up hotspots, use
hotspots for our students out there, and for also our citizens.
Because, you know, early on, we had a public health order in
place to mandate everybody to stay at home, and it was
difficult because we are telling people to stay home, but they
needed internet access.
And so with the Bureau of Indian Education, you know, they
are looking at ways to bring online schooling to the forefront
as well as the State schools. Some of the States in Arizona
right now are looking at giving options to their parents. Three
options. One, you want to be in the classroom. Two, at home or
a little blend of both.
But here on Navajo Nation, we--with the CARES Act funding
that we recently got from you all with approval, we have put
$60 million or $50 million aside to help out with connectivity
to our schools and then to communities throughout the Navajo
Nation.
Thank you.
Mr. Schrader. Very good. Very good.
Dr. Grim, I will switch to you here. I am pretty pleased
that the Affordable Care Act actually is in now place. It is my
understanding it has been a huge boom for Indian country as
well as millions of Americans across the Nation. We permanently
reauthorized the Indian Healthcare Improvement Act.
We expanded Medicaid, key determinant. And, yet, there are
folks here in the United States Congress that want to get rid
of the ACA, and some people in the White House perhaps. And I
wish you would just comment a little bit what that would do to
Indian healthcare right now.
Dr. Grim. Well, that is a good question, and I appreciate
it, Congressman. The Indian Healthcare Improvement Act, and I
am sure this committee is well aware of that, is attached and a
part of the Affordable Care Act.
So every time there are challenges to that act, there are
concerns that ripple across Indian country about whether that
bill would be severable or not, you know, and saved, or whether
we would go through having to try to reauthorize that bill
again.
When I was director of the Indian Health Service, we had
been trying for several years. I thought this is something I
will be able to do when I am up there. Five years, we couldn't
get it reauthorized while I was there. So, I finally got
attached to that bill, and we were glad to see it, but we knew
it was a risky move, but it worked.
And there are also things within the Affordable Care Act
that are specific to Indian country. And I won't go through
what those are. But to lose those too would be, you know,
devastating to the Tribes. So thank you for the question.
Mr. Schrader. Well, thank you for being here. Thanks for
the responses.
And I yield back, Mr. Chairman.
Mr. Pallone Thank you, Kurt.
Next, we go to Billy Carter. You are recognized for 5
minutes.
Mr. Carter. Billy Carter, Mr. Chairman?
Mr. Pallone Did I say "Billy"? I am sorry. I am losing it.
It is has been a long day, Buddy. I apologize.
Mr. Carter. It has been a long day, indeed.
Mr. Pallone [continue]. I am going to Savannah.
Mr. Carter. Well, I thank all of the panelists. I really
appreciate this. This has been a very good hearing.
And I agree with my colleagues in saying that we need to
expound upon this and expand this into, in more than just one
hearing. All of this information has been very, very good.
Dr. Grim, I want to start with you, it has been said that
during this pandemic that we have experienced ten years worth
of growth in telehealth, in telemedicine in one week. In fact,
we have had--we went from roughly 11,000 telehealth visits a
week to almost over a million a week.
And I just wanted to ask you, I think that telehealth
provides a tremendous opportunity for the Tribal areas, and
what has been your experience--what has been your experience
during this pandemic with telehealth?
Dr. Grim. Well, you are absolutely right that this is one
of the good things that has come out of this effort is that we
have expanded telehealth tremendously across the entire health
sector, not just in Indian country.
Our health visits in two weeks that were telehealth prior
to two weeks later, 300 percent increase, and they have
continued to increase to specialties we didn't think may be
interested in doing it, providers that were on our staff that
said, I never want to do telehealth, they are doing telehealth,
and they actually like it now. Patients are liking it now.
Some of the problems, though, we have talked about the
broadband issue, the access. Certain of the telehealth visits,
you need to have connectivity, you know. Certain
reimbursements, you know, you can get it if you have this, but
if it is just over a phone, maybe you can't get it.
CMS was good to rapidly waive a lot of items during this
emergency. And what the healthcare sector is hoping is that a
lot of the things that have been waived to make telehealth
easier, you know, gets approved long-term. And Seema Verma has
said they are looking at that, they are going to do it. But the
other thing is that the reimbursement for telehealth visits
lags behind is significantly too.
It was because it wasn't used that much. And so we need
those both for Medicare, in particular, Medicaid, and also
private insurance to be updated if we, after this is over, have
some long-lasting effect that telehealth continues. And I hope
we do.
Mr. Carter. Good. Good.
And, you know, you mentioned private insurance, and I
appreciate you mentioning that because we need to focus on
that. Obviously, we are going to focus on it at the federal
level. We get it now. In fact, this committee has been pushing
for telehealth for years. And I don't think there is any other
Members of Congress that are members of this committee who are
happy to see what has happened with telehealth because we,
particularly, in the Health Subcommittee have been push pushing
for that for years.
I will ask you, Chairman Sage, the broadband high speed
internet, obviously, that is very much needed in the areas and
on the reservations. Have the Tribes been able to utilize the
two-and-a-half gigahertz spectrum for Tribal lands?
Ms. Sage. Yes, we have.
Mr. Carter. Have you had any difficulties with it, or has
it worked OK?
Ms. Sage. We are still working on, you know, [Inaudible]
That is about it. Everything [Inaudible]--there is always
something that has happened. But we are still working on
different issues and [Inaudible] Have like the short-term
things is using like WiFi hotspots. The long-term is building
out networks using the [Inaudible] 65 gigahertz. The big issue
is that FCC [Inaudible] Mapping needs to be funded. Mostly
needs make access [Inaudible].
Thank you for the question.
Mr. Carter. OK. Good. And one final question, and I will
open it up to the panel. What are some of the challenges that
you have experienced in, in encouraging the private sector,
particularly private sector construction on your reservations?
Have you had any particular challenges with that and really
encouraging private sector to--in particularly private sector
construction?
Ms. Thomas. Congressman Carter, this is Pilar Thomas. From
an internet perspective, one of the biggest challenges the
Tribes have with attracting private developers and private
companies to build projects on Indian lands is a combination of
the issue I brought up earlier with State regulatory systems
that control the utility regulations.
But also a challenge across all of energy development--and
Chairwoman Sage, I am sure, can talk about this as well, is the
dual taxation problem that we have. Because, as you know with
renewable energy projects, investment tax credits are one of
the critical, economic incentives.
And so since Tribes are nontaxable, they can't take
advantage of those tax credits. They have to bring in a taxable
entity to do those projects. While then the State can tax that
taxable entity. So the Tribe, it pushes out the Tribe's ability
to tax or have other tax incentives to attract private
enterprises because of a State taxation scheme that can
interfere with that economic feasibility of that project.
Mr. Carter. In other words, it is a tangled web, I
understand.
Ms. Thomas. It is.
Mr. Carter. My time is up, and I will yield back, Mr.
Chairman. Thank you.
Mr. Pallone Thank you, Buddy.
Next is Dr. Ruiz recognized for 5 minutes.
Mr. Ruiz. Thank you, Mr. Chairman. This is a good day. It
is a good day to finally have an Energy and Commerce hearing
solely on Tribal policy issues.
After many years of requesting one, I am glad that now
under your leadership, Mr. Chairman, that it happened. I am
looking forward to many more, including markups, and will
continue to advocate strongly for further hearings in this
committee and other committees.
There are many important ways that this committee should
advance Tribal priorities and improve lives. But today I want
to focus primarily on healthcare. One issue that is incredibly
important to me is a shortage of doctors and providers in
Indian country. Without adequate providers, including doctors,
nurses, and specialists, Native Americans are unable to access
the care they deserve, and that the United States Government
has a trust responsibility to provide.
According to the GAO in 2017, four out of eight his regions
with his hospitals had nurse vacancy rates above 22 percent,
including as high as 36 percent. Three out of those eight
regions had physician vacancy rates above 30 percent, including
two over 45 percent.
Last Congress, Congressman Mullin and I examined this and
several other issues as chairs of the Indian Health Service
Task Force. That investigation showed that the his had a
variety of challenges to filling these vacancies, including the
following: Many his facilities are rural, surrounded by
insufficient housing and have other infrastructure deficiencies
that make it challenging for providers and their families to
relocate.
Lower rates of pay make it harder for his facilities to
compete for medical school graduates who just invested many
years and often hundreds of thousands of dollars in their
education and are weighed down by student debt.
Finally, there is a shockingly low number of American
Indian and Alaskan Native students who pursue medical careers.
Out of the almost 20,000 medical graduate students in 2017,
only 30 were Native youth. That is 0.15 percent of all students
who have graduated. While Native doctors are by no means
guaranteed to serve Tribal communities, they are more likely to
do so than their peers.
We know that the two biggest factors for where a doctor
will practice medicine is where they are from and the last
place that they trained. I did this when I returned to the
Coachella Valley to serve my own community in terms of creating
pipelines with students from underserved areas and creating
residency trainings in medical education in those areas as
well.
As a physician, I know the problem that the healthcare
workforce shortage create. It means that Native Americans have
to wait longer and drive further to get care. It means that
many of the underlying social determinants of health are
exacerbated by the lack of access to preventative care and
early treatment of disease.
We must improve the educational pipeline by increasing the
awareness and interest in pursuing careers in medicine among
Native youth.
Dr. Grim, my first question is to you. Do you agree that
helping and inspiring more Tribal youth to pursue medical
education is an important step to solving the long-term
provider shortage?
Dr. Grim. Yes, sir, I do. I think it starts early. And,
you know, a lot of studies have shown the earlier in the
pipeline you can do that, the better.
Having medical schools that are close to Tribal lands also
helps, and having residencies on Tribal lands. Oklahoma State
University Center for Health Sciences is opening up a medical
school this year at the Cherokee Nation in partnership with
them.
There are three Tribes in Oklahoma, and the Chickasaw are
one of them, that have their own family practice residencies.
And we are--our own. We have not been able to get a grant for
teaching health centers through HRSA.
Mr. Ruiz. Great. Well, we definitely need more of that.
That is why Chairman Pallone and I introduced a package of
bills that included H.R. 4534, The Native Health and Wellness
Act which would create a grant program for Tribes to recruit
and mentor Native youth for medical professions. This bill
would lead to more doctors who can serve their communities.
Dr. Grim, other than increasing pay, what are your top
recommendations to shrink the provider shortage in Indian
country in the near term?
Dr. Grim. Well, two of the things that you mentioned in
your opening comments, which I thought were great, are loan
repayment programs and scholarship programs.
If we could make more funding available for both of those
things, to Native youth, but to any doctors that are coming to
Indian country, I think that would be a great, great help.
Mr. Ruiz. Thank you.
And then the final question, can you speak to how proactive
investments like investing in Indian Health Service, making
sure that we have more public health outreach programs like the
special diabetes program, perhaps even creating more funding
for grants for mental health, public health within Indian
Health Service is beneficial to Indian country?
Dr. Grim. Yes, sir. If somebody doesn't have access to
care or doesn't have access to preventative services, they just
flat out aren't going to go. And the longer they wait to get
care, the worse their condition gets.
There are certain conditions that get better over time, you
know, if you do nothing at all. But there are others that
continue to get worse. And we are sorely underfunded in all of
those areas you talked about, especially mental health too.
Huge needs in Indian country for behavioral health issues.
Mental health, alcohol, and substance abuse, great, great
needs. And part of the problem to fix it is making more dollars
available in that particular line item of the budget.
Mr. Ruiz. Thank you very much. I yield back my time.
Mr. Pallone Thank you, Raul.
Next, we go to Ann Kuster recognized for 5 minutes.
Ms. Kuster. Thank you very much.
Thank you, Mr. Chair. Delighted to be with you all. Thank
you so much to our witnesses for being with us. This is an
incredibly important conversation, and it is long past time for
Congress to address all of these challenges.
Healthcare, telecommunications, energy and water, even
before COVID-19 but now we have seen that they have further
exacerbated the inequities faced by our Tribal community.
I would like to address an issue that we haven't discussed
that ties into the rates of sexual and domestic violence in
Indian country and the alarming rate of missing and murdered
Native women, which is truly a national tragedy.
It is a stain on our country that these incidents have
persisted for too long and all too often without justice being
served. And I will just say this as a deeply personal issue for
me. I am a survivor of sexual assault, and now the co-chair of
the Bipartisan Task Force to End Sexual Violence.
Last fall, our task force held a very emotional round table
on this topic. And I want to thank Congresswoman Deb Haaland
and Members from both sides of the aisle that joined us to hear
from Tribes as far away as Alaska and across this great
country. We heard heartbreaking stories and staggering
statistics. The scope of this crisis is truly disturbing.
So I am proud now to support legislation to enable Tribes
to arrest and prosecute non-Native perpetrators to expand
protection orders and to establish new law enforcement
protocols and resources. But it is clear to me that Congress
has a long way to go. And I want to ask about what more this
committee can be doing to help.
My first question is to Dr. Grim. Year by year, we continue
to learn about how survivors process trauma and what kind of
treatment they need for their own mental health. In some cases,
this pain compounds upon historical trauma that people in
Indian country can feel from their people having been
systematically oppressed for generations.
So over your years with the Indian Health Service, have you
noticed that the system is being more responsive to the
emerging science, like trauma and informed care for survivors,
and is there anything that you could add how we could help
implement these strategies?
Dr. Grim. That is a great question, Congresswoman, and I
appreciate your leadership on this issue. Yes, over the years
as the science has evolved, you know the his has adopted it.
One of the great things about Indian Health Service, I think,
and Tribal Health Service Programs, is whenever research starts
showing things, we can really spread it across our system very
quickly.
I am sure many of you have heard the adage that when
something gets proven in research, it may take up to 13 years
to end up in practice. But especially for problems like this,
when new research and new treatments come out, you know, the
agency has been doing a lot of trauma-informed care training
with their staff.
And I hate to keep saying that it goes back to money, but,
you know, having the availability of these services in areas,
the vacancy rate issue that we talked about, all of these
compound the already difficult nature of dealing with some of
these problems, you know.
So I appreciate what you are doing, and I appreciate, you
know, you say staying on top of this. And we will do anything
we can to work with you on it, and it is a big problem in
Indian country.
Ms. Kuster. Thank you.
Just before I close off, do you see in your near term an
opportunity for Congress through the CONNECT Act to leverage
telehealth solutions, to help survivors, particularly in those
remote areas that we have talked about, and are there any other
healthcare barriers that need to be addressed such as access to
telehealth?
Dr. Grim. Yes. To all of that. There are barriers to
telehealth. Some of them are the broadband issues, we have been
discussing. And I am not an expert on the area, but I support
everything that has been said, and our Tribe is doing a lot on
that front to try to help.
But telehealth for behavioral health issues actually
sometimes is more acceptable to the patients than, you know,
coming in and talking to people face to face.
This rapid change to telehealth during this time, we have
had so many patients and/or providers tell us, especially for
behavior health services, that people are more accepting of it,
they like it. In fact, they want to continue to do it when, you
know, the crisis, the pandemic is over.
So anything that we can do to make that number available,
part of that is getting this broadband network out, part of it
is the equipment. Sometimes there are special equipment.
Sometimes it is just a phone. But anything we can do to enhance
telehealth, I think it goes particularly well in psychiatric
and behavioral health service.
Ms. Kuster. Great. Well, thank you so much for being with
us. My time is up. I yield back.
Dr. Grim. Thank you.
Mr. Pallone Thank you, Ann.
The next member is Lisa, Lisa Blunt Rochester is recognized
for 5 minutes.
Ms. Blunt Rochester. Thank you, Mr. Chairman. And thank
you so much to the witnesses. This is a very important hearing,
as many of my colleagues have stated.
In Delaware, I represent our two State recognized Tribes,
the Nanticoke Tribe and the Lenape Tribes. And, you know, just
being able for people to have a voice and to be heard is
important. And, particularly when they are the people on which
this country is your country.
I think all of us take a moment in this hearing because it
is a--it is a pivotal one. We know that COVID-19, the pandemic,
has shined a light on systemic, ethnic, and racial inequities
that course through our country. And these disparities have
caused communities of color to really be disproportionately
affected, and particularly in Tribal Nations.
And I have always believed that there is an inextricable
link between the environment in which people live and their
health.
This pandemic has underscored that reality. And one example
is our country's clean water infrastructure. In Delaware, from
2000 to 2014, we saw an increase in communities lacking access
to clean water and sanitation services. It is no wonder then
that these same communities are having higher infection and
death rates from COVID-19, where one of the best ways to guard
ourselves against this disease is by washing our hands with
clean water.
The same trend is happening throughout the country's Tribal
Nations, and it underscores a larger problem where these
communities lack access to a basic human right, water.
My first question is for President Nez, you mentioned in
your testimony that some members of the Navajo Nation haul
water from more than 50 miles away. And I read another article
that talked about donations of bottled water being distributed
by volunteers in coordination for the response for COVID-19.
Can you discuss the sustainability of these practices and
the continued impacts on health--human health and the
environment to communities that lack sustainable water
infrastructure?
Mr. Nez. Thank you, Representative Rochester, chairman,
and members of the committee, thank you for that question.
You know, we do appreciate the friends of the Navajo Nation
that have stepped up and helped during this public health
emergency here on the Navajo Nation, this pandemic.
And you know, we waited three months for the CARES Act
funding to come to Tribes, and three weeks ago we finally got
the last allocation of that. And so we had to rely on the
friends to bring bottled water. And we are in a drought as well
here on the Navajo Nation. We just got a report from a forest
fire here Wood Springs two forest fire that just ravaged our
lands and over 12,000 acres burned, and 76 percent contained.
So there is a drought here, and then on top of that you got
this public health emergency. And CDC guidelines saying to wash
your hands with soap and water. And people just can't do it.
They haul water from various places. And even the water that we
drill for right now could be contaminated with or arsenic and
uranium.
As many of you know that are on the committee, you know we
have over 500 uranium mines still opened here on the Navajo
Nation that are still being cleaned up and those were during
the Cold War era. And so during the Cold War era, the Navajo
Nation helped out in two ways. The natural--the resources here
by gathering uranium and putting them into weapons. The second
is also our language, our Navajo Code Talkers. I am sure many
of you know about the history of our code talkers.
But in terms of water, it is very important that we, you
know, get Navajo Utah Water Rights Settlement Act approved.
Arizona Water Rights approved so that we can get clean drinking
water to those 30 to 40 percent of our Navajo people that don't
have running water.
Thank you.
Ms. Blunt Rochester. Thank you, Mr. President.
I have so many questions for so many of you, and my time is
out in 20 seconds.
But one of the areas that hasn't been touched upon that I
did want to ask about is people with disabilities. I served as
Secretary of Labor in Delaware and also in another job got to
work with CANAR which is the Consortium of Administrators for
Native American Rehabilitation.
And as we talk about health disparities and issues related
to mental health and physical health and jobs, rehabilitation
services are going to be important as well.
So, hopefully, we will have an opportunity to talk about
people with disabilities who come from Indian country as well.
Thank you, and I yield back.
Mr. Pallone Thank you, Lisa.
Let me just mention because I have been given some emails.
What I have now is since there is no Republicans, I have the
order as Kennedy, Cardenas, Kelly, Nanette Barragan,
O'Halleran, and Veasey. Now that is assuming that none of the
Republicans come back.
So next is Mr. Kennedy for 5 minutes.
Mr. Kennedy. Thank you, Mr. Chairman.
And thank you to your witnesses for being here for a
critically important hearing.
As some of my colleagues have mentioned, this pandemic has
become a diagnostic dye tracing through our system, exposing
deep inequities and injustice across our society. Indian
country and Tribal lands have, obviously, been no exception.
What we knew long before COVID-19 first entered our
communities, that systemic underfunding of healthcare on these
reservations was having a devastating consequence to the health
of Native Americans across our Nation. We can't be surprised
that after centuries of mistreatment of Tribes--in this
Government's name.
But now, as cases of COVID-19 reaches historic highs on a
daily basis, we need to act quickly and to learn from our
mistakes and protect the people that we serve.
So President Sharp, I wanted to start with you, can you
describe whether his was able to, in your opinion, disburse
CARES Act funding in a timely manner while respecting the
consultation process?
Ms. Sharp. With all of the delays and barriers and
appropriations, we could not gain access quickly enough, and
nor did we gain access to the resources. But working through
his to try to gain access to the National Strategic Stockpile
was also a barrier. So, in terms providing resources and
equipment, there were many delays that cost lives.
Mr. Kennedy. Did you report, just to flesh that out a bit,
did your report end up receiving supplies of PPE and other
critical devices or no?
Ms. Sharp. No. Here in the State of Washington, when we
sought to seek PPE, we were told that a good part of that was
going to be deployed to the Seattle King County area where the
first nursing home was impacted.
So not only our Tribal Nations by virtue of being Tribal
Nations have barriers, but because we are in a remote
communities, we still have additional barriers in accessing
PPE.
Mr. Kennedy. So, it is clear that there are those barriers
and so many changes that are affecting Native Americans and
ultimately the health outcomes and quality of life.
One particular issue is the availability of healthcare
workers, which shortage of physicians and nurses impacting the
State. What has been your perspective on the shortage, Madam
President, and what actions need to take place in order to
address this in the short-term.
Ms. Sharp. The shortage within my own Nation, and I could
speak from personal experience as a Tribal leader dealing with
a pandemic, we actually had to reach out to the Washington
State National Guard to deploy the necessary resources and
partnerships to conduct the testing.
In other words, a thousand, 30 percent of our population,
like the number of staff and personnel that we had, it was
simply just inefficient and insufficient to meet the needs.
Mr. Kennedy. Thank you, Madam President.
Dr. Grim, I wanted to turn to you. Telehealth obviously has
been critical [Inaudible] during the pandemic [Inaudible]
including during normal times, [Inaudible] the cost for
providers and individuals. In one program, telehealth created a
$12 return for every dollar [Inaudible] spent on providing
basic services to underserved regions.
However, inadequate broadband infrastructure means
teleconferencing opportunity has been limited for those who
needs it most, including on tribal reservations where under
half of Tribal residents have access to fixed broadband.
Doctor, if you could share how telehealth would improve
healthcare to Tribal residents. What are the main barriers of
access to telehealth through Indian country?
Dr. Grim. Thank you for that question, Representative
Kennedy. I think one of the biggest barriers we have talked
about along on this hearing is broadband access. You know, for
everyone to have access to that, it has just been exacerbated,
you know, with COVID when you can't go into your doctor's
office or you can't go into the office unless you are really
sick.
You know, we converted things rapidly all across the
Nation, and people have done the best they can. And I think
this just pointed out some of these needs, you know, where that
last mile of, you know, coverage to get to places or in
President Nez's case, sometimes it is a lot more than the last
mile.
But the other thing too is the funding, you know, the
reimbursement for telehealth services. For some services, it is
OK, it is good. And for others, it is way behind what it should
be today.
And I think that was, you know, because as one of the
former Representatives said, you know, we weren't using
telehealth that much no matter how much we tried to push it for
years. And now that people are seeing how useful it is, how
good it is for so many services, I think it will continue
beyond this.
And so we are going to have to fix some of these things we
have discussed in the hearing today.
Mr. Kennedy. Sir, thank you very, very much.
President Nez, just very briefly. The cost of access to
broadband far outweighs the cost that most residents in Tribal
communities can afford to pay. H.R. 2 provided a $75 subsidy
for Tribal residents for broadband.
Briefly, can you talk a little bit about what those
subsidies would be for?
Dr. Grim. Well, thank you Representative Kennedy, and
chairman, and members of the committee there. You know, that
subsidy would help to get fast high speed internet capability
to our students, to our workers, as well as those most
vulnerable populations so that they can have telehealth at
their homes.
Mr. Kennedy. Thank you. I yield back.
Thank you, chairman.
Mr. Pallone Thank you, Joe.
And next is Tony Cardenas for 5 minutes.
I think you are OK Tony.
Mr. Cardenas. Let me move it over so I can see the clock.
OK. There you go.
Thank you very much, and I appreciate this opportunity for
our committee to have this hearing and meet with the leaders of
Nations. Thank you so much for coming forth and representing
all the people of Indian country and all the needs that persist
out there.
I have the right and I believe the responsibility to take
this opportunity to apologize on behalf of the United States
Congress and for the past opportunities that we passed up to
have this hearing.
And I personally believe--and I don't want anybody to
assume that I am speaking for other Members of Congress, they
can concur with me if they choose--but I personally believe
that the efforts of genocide on the first Americans has never
ended in the sense that for us as a country to chronically
ignore that in Indian country you have the worst conditions on
your Tribal lands of any other people in the United States of
America. And for that to be ignored and that not to be attended
to by Presidents of different parties, it is not a partisan
statement I am making, I believe it is a fact.
And I want to make something very, very clear. I say this
from my heart, and I say it as an honored Member of the United
States Congress, that I do not say this out of pity, or I would
not believe for one second that any of you came here today for
anybody to feel sorry for you.
I believe that I say what I say because it is only right
that we State that in public record. And that I believe that
you are here to represent, as you have been elected, duly
elected to represent your Nation.
So with that, I would like to open it up for an opportunity
for you to share, if you will, how you feel about being the
most ignored and disrespected communities in our land.
And the numbers prove out that when you look at the
disparities of healthcare, when you look at the morbidity
rates, when you look at the rates of death by babies who are
Native American, et cetera, you are, if not at the top of the
list, in every category, that no one wants to be at the top of
the list of, you are.
And United States Congress has power of the purse. And,
yes, whoever is the President at any moment has the
responsibility of administering everything of this relationship
between the United States of America and your Nations.
So if you would please, take this opportunity to express
how you feel about this relationship and what it is lacking in
this very important relationship that determines life and death
with your people.
Thank you.
Mr. Nez. Representative Cardenas, thank you for those
words. And thank you chairman and members of the committee.
And, you know, on behalf of the Navajo people, your
heartfelt apology, I as an individual, as a President accept
that. But we need the whole entirety of Congress to do the
same.
You know, where to start right, there are just so many
places, but if you look at the Broken Promises Report, you know
these were sacred promises that were given or been made by one
sovereign to another. And treaties or that foundation of our
relationship. I mean we were here since the time of memorial.
But that relationship, you know, should improve because of this
committee hearing today.
You know, on the Navajo Nation, there are nine emergency
rooms, 27,000 square miles of land equivalent to the size of
West Virginia, and yet we have only nine emergency rooms. And
our Indian Health Services need to be fully funded. We need to
be able to support the Tribes in taking over their healthcare
facilities. And that is just based on what we have gone through
through this pandemic. And there is just this long list of
other items that we could say.
So thank you so much for your heartfelt apology, sir.
Ms. Sharp. Thank you, Congressman, and with 10 seconds,
how do I feel? I feel that Tribal Nations have an effective
death sentence. If the scale of this pandemic continues to
climb, and looking at the images coming out of Italy and Spain
when I saw people just left to die in their homes, left to die
on a gurney, I saw Indian country.
We don't have the resources, we don't have access to PPE.
So how I feel? We have an effective death sentence right now
facing this pandemic.
Mr. Pallone Tony are you?
Mr. Cardenas. Thank you, Mr. Chairman. I appreciate this
opportunity, and I look forward to working with all of my
colleagues on both sides of the aisle to rectify these wrongs
that have been so chronic and so persistent for hundreds of
years and for generations.
I yield back. Thank you.
Mr. Pallone Thank you, Tony.
Next we go to Robin Kelly and recognized for 5 minutes.
Ms. Kelly. Thank you, Mr. Chairman. And I thank the
committee for bringing us together to discuss this critical
issue that everyone agrees we should have been discussing a
long time ago. So thank you for bringing us together.
COVID-19 has laid bear longstanding issues related to
Tribal data collection and sharing. Federal agencies claim that
Tribes do not fully report demographic information, and that
certain privacy restrictions prohibit data sharing.
Meanwhile Tribes note legitimate sovereignty concern.
Without access to standardized data, it can be difficult to
understand the impact of COVID-19 on Tribal populations. Some
organizations and local health departments may even collect
data without listing American Indian or indigenous as an
option. Tribal data could be lost in a very expansive "other"
category.
Dr. Grim, what recommendations would you have for his or
CDC on how they can work together to improve the quality and
quantity of Tribal and public health data both during and after
COVID-19?
And I am the chair of the Congressional Black Caucus Health
Brain Trust, and we have been very active on getting racial
data numbers included in the last bill. But still, when the
report came out, it was not good at all, and had very little
meat to it.
So how can we make sure that the data from the Tribal
Nations is included because data informs policy in resources
and programs?
Dr. Grim. Thank you, Representative Kelly, for your
leadership and for that question.
You know, one of the things that you mentioned has been a
big problem over the years is the lack of American Indian or
Alaskan Native being included in sufficient numbers and surveys
across the country so that we can use that data.
And a lot of times, this was when I was with Indian Health
Service, I don't know if it has changed, but a lot times the
agency or individual Tribes will pay a company who is doing,
you know, those big surveys to oversample, they call it
oversampling the Native population so we have enough data to be
comparable to what they are using those surveys for.
So I think ensuring that that is always happening, you
know, for the population, not that it has to be an
afterthought, that it has to be paid for separately by some
Indian specific agency, but whenever things are being done, you
know, that it be done in just a matter of course.
The other thing with the Indian Health Service, it is a
huge issue right now for all of the Tribes and all of the
Federal sites is our aging electronic health record. A lot of
the data that comes to the Congress from Indian Health Service
comes from that electronic health record, both clinical data
and statistics as well as public health data.
And so right now, you know, the DOD and VA are making a big
change in electronic health record. The Indian Health Service
is the third, you know, Federal entity that has a big health
service. And the agency is working on a plan, but it is going
to be an extensive expense.
And my testimony, I said $3 billion. That is what the
estimate is right now to get a new electronic health record. I
would say between those two things, that would go a long ways
in making things right in the way of data.
Ms. Kelly. And the other question I have for whoever wants
to answer is about vaccines and clinical trials. I know in the
African-American community, they were left out of clinical
trials for months, but now don't have the trust because of
different things that have happened.
And I don't know if President Nez, if you want to answer
the question, how do we get Tribal communities involved with
clinical trials?
Mr. Nez. I appreciate the question, Representative Kelly,
chairman, and members of the committee.
Yes, you hit it on the nail in regards to trust, you know.
I mean, folks have taken advantage of Tribal communities,
including the Federal Government. And you know, just look at
what happened with the information that we forwarded to U.S.
Department of Treasury. There was a breach of information
there. And now it is all over the world. And you know that is
not helping in restoring trust here.
And, you know, I think I also heard from Chairman Pallone
that some of our--I have heard a lot about bipartisan earlier,
but I don't--I didn't hear anyone from the Republican side
being on this committee today. And that just shows that there
is a lack of attention coming from the other party, and the
seriousness in reconciling the relationship between the Federal
Government and others.
So thank you so much.
Ms. Kelly. Thank you.
Mr. Griffith. Mr. Chairman, a point of parliamentary
inquiry.
Mr. Pallone Mr. Griffith, yes I hear you.
Mr. Griffith. Mr. Chairman, I just want to have the
chairman acknowledge that there are Republicans that have been
on the--in the committee most of the time, and for a big period
of time, I see Tim Walberg has turned on his camera.
Some are listening to it, but many of us have participated,
and I just want to set the record straight.
Mr. Pallone Thank you. Now, where were we? Whose time was
it? Robin?
Ms. Kelly. Yes, my time is up.
Mr. Pallone You are done. All right. Thanks a lot.
Next is Ms. Barragan. Nanette is recognized for 5 minutes.
Ms. Barragan. Thank you, Chairman Pallone, for holding
this hearing on addressing the urgent needs of Tribal
communities, whether it is broadband access, energy, and water
security, environmental injustice for public health
disparities, the United States has a long way to go to address
the challenges facing Tribal communities.
We have unfortunately seen during COVID-19 how harmful
longstanding inequities are. It will take bold investments and
policy solutions developed in partnership with Tribal
governments and Native communities to make progress. So I
appreciate the opportunity for us to talk about this today.
Ms. Sharp, my first question is going to be for you, there
are over 500 super fund sites across Indian country, making up
more than a quarter of all super fund sites in the United
States.
Over 80 are on the National Priorities List. This
environmental injustice causes serious harm to the health of
Tribal communities from the ongoing air and water pollution
caused by these toxic sites.
Ms. Sharp, how can we do a better job of empowering Tribes
and engaging in consultation with Tribal governments in the
super fund cleanup process so their needs and views are
prioritized?
Ms. Sharp. Thank you. I can simply answer that question by
suggesting the United States take bold action to implement
international standards set forth in the U.N. declaration on
the rights of indigenous peoples with respect to pre, prior,
and informed consent.
Throughout the years and facing many of these super funds
sites, we engage in consultation. And up to this point, it
seems as though it is an administrative exercise to check the
box and proceed with unilateral predetermined action.
But if there is to be any meaningful relationship between
the United States and Tribal Nations that comes to super fund
sites, sacred sites, they must take into consideration not only
our views, but those views must be decisive and determinative
in the outcome that directly impacts our lives, our lands, and
our people and resources.
Ms. Barragan. Well, thank you, Ms. Sharp.
We have also heard from advocates on the EPA action that
the super fund cleanup is slow. However, when the EPA does take
action, they often take the lowest cost option, such as
covering up toxic substances instead of removing them from a
location. These toxins then persist in the environment and
still cause harm to our Tribal communities.
Do you have any advice on how Congress can improve the
super fund policy to ensure a cleanup actually removes the harm
from the community?
Ms. Sharp. Yes. I could answer that very broadly. Courts
are now starting to consider climate-related impacts to
regulatory and permitting decisions. Up until this point,
climate-related impacts are not on regulatory checklists.
Although, scientists are now finding that those impacts should
be taken into consideration and factored.
And so we need to look at our environment holistically and
look at new and emerging science, best science, and make sure
that we are in line with the court decisions. Because if it is
up to judges to force public policy to be responsive to climate
change, that means there is still work to do in Congress to
address those very critical needs.
Ms. Barragan. Thank you.
Mr. Nez, when it comes to the climate crisis, we know
environmental justice communities are hit first and worst by
drought, flooding, and other impacts. Can you speak to some of
the impacts the Navajo Nation is experiencing from climate
change, and what investments Congress can make to help with
adaptation?
Mr. Nez. Thank you again Representative Barragan for your
question, the chair, and members of the committee.
Let me go to your comment on the super fund funding that is
available there. You know, we as Tribes have to apply for these
fundings in a competitive way. And we have recently tried to
apply for some super fund dollars, and we were--we weren't
successful. And so we have to wait until the next available
grant cycle in order to get funds that, you know, can clean up
some of these sites here on the Navajo Nation.
And so what I am saying here is we need to be able to get
direct funding to Tribes to help--and I am using the example of
the 500 or so uranium sites that are still open here on the
Navajo Nation. I mean, those need be to cleaned up.
And as you all know, and the assistant speaker mentioned
earlier that the downwinder bill, you know. Some of these
uranium mines are still open, and we get a lot of wind here.
And the uranium particles do go into the atmosphere, and we
wonder why we have high rates of cancers in our area. And that
could be one of many reasons why people get cancer here in the
Southwest.
Thank you, Representative.
Ms. Barragan. Thank you, sir.
And with that I yield back, Mr. Chairman.
Mr. Pallone Thank you, Nanette.
Next we have Tom O'Halleran. You are recognized for 5
minutes.
You are good.
Mr. O'Halleran. I am good. OK. Thank you, Mr. Chairman,
and ranking member. I first want to thank the chairman for
keeping his promise and making sure that this hearing was done.
You made that promise publicly a number of months ago, and I
really appreciate it.
Secondly, to clear up a couple of things we have a bill
that we will drop tomorrow, on the extension deadline for the
COVID money that was given out to the Tribes.
We also have a bill--I want to thank the chairman and the
ranking member also for leading a bipartisan GAO letter to
identify his needs on Tribal Nations for different types of
facilities. I am going to request and have been working with
staff to do that also for the COVID conditions that are out
there and to see how his has worked on those.
Additionally, we have a bill out there already on graduate
medical education for Tribal in rural areas in the United
States. So I am looking forward to that.
Now, I had a whole list of things, but the treaty and trust
obligations of the United States of America. I just want to
point out a couple of things we talked a lot about healthcare
and others, and that is extremely important.
But the Navajo Nation 40 years ago had the Bennett Land
Freeze where a large section of the reservation could not be
changed. No new businesses, no changing of your house, nothing.
And that is not resolved yet. It is resolved not as far as
funding to get that resolved.
The uranium mining, the President brought that up, we are--
I have talked to EPA, there is not one of those 500 and some
sites that are safe, and we have known that for 70 years since
this is going on.
Unemployment, I represent 12 tracts. Unemployment rate
ranges from 40 percent to over 80 percent. That is before
COVID. Just imagine what it is today.
Police on Navajo, there is probably about 205 or 4 of the
police officers on the street, around the clock, in an area of
the State the size of West Virginia.
You get the sense here that I could go on and on, but I
wanted to ask a couple of questions of President Nez, [Speaking
native language.] President Nez.
In your testimony, you mentioned H.R. 7056 legislation that
Congressman Don Young and I introduced to authorize much needed
funding for the Indian Health Service Facilities Construction
Program.
Can you explain how this would improve the lives of the
elders in remote communities, like hard rock chapter, or do you
think that adequate funding for the program will reduce the
spread of COVID-19 by allowing elders to follow CDC guidelines
and wash their hands with soap in clean water?
The second one is, is there a piece of legislation
currently before the House that would immediately help the
Navajo people if passed?
Mr. Nez. Thank you, my good friend, Tom, O'Halleran,
Representative, and chairman, members of the committee for
those questions.
I have spoke about earlier in terms of getting needed water
infrastructure to our citizens. And again 40 to 50 percent of
our Navajo citizens don't have running water. And so it is
critical that we get water. Water to our Navajo people and
through this drought, in our way of life, in our culture, and
many of you may be ranchers, you know that our animals are
important to us for providing for our well-being as well. You
know, we sell our livestock to make, to--you know, pay for
things.
And here being in a drought, you know, with what
Representative O'Halleran is pointing out is to give monies to
the his for watering points, not just for drinking water but
also for our livestock here. Because a lot of times we have to
go 50-plus miles to haul water.
And so it is critical at this point. Again, no vaccine. No
cure for COVID. We don't know how long this is going to last.
And we need to get running water to our Navajo citizens,
especially those in the rural parts of the Navajo Nation.
And thank you so much for being a champion, Representative
O'Halleran on the Special Diabetes Program, SDBI, and you know
that funding has lessened the rate of diabetes throughout the
Tribal communities.
Thank you.
Mr. O'Halleran. And, Mr. Chairman, I think my time is
probably up. So I will yield.
Mr. Pallone Thank you, Tom.
And next, I see Marc Veasey. You are recognized for 5
minutes.
I cannot hear you yet, Marc. I think you are on mute.
Mr. Veasey. Thank you, chairman. Can you hear me? I
appreciate you holding this hearing today. And I want to thank
all the witnesses for taking time to be here as well.
It has really been amazing to me to just watch the news
over the last really month or so, because we are learning more
and more about how our Tribal communities in this country are
being affected. At the very beginning, we didn't hear much
about them at all. But as COVID continued to wreak havoc on the
country, we finally started to recognize just how worse it has
even been in our Tribal communities.
And we really have to be able to provide some sort of
relief to these communities. We have talked a lot about
healthcare and energy and education and environmental issues.
But, in my opinion, and you have heard this term a lot, we
have to get to the root of the problem and start talking about
some of the systematic inequalities that have held Indian
country back and really put them in the space that they are in
right now, which is obviously very dire.
And so I just want to ask the panel. In 2013, President
Obama established the White House Council on Native American
Affairs through an executive order to ensure that the Federal
Government engages in a true and lasting government-to-
government relationship with federally recognized Tribes in a
more coordinated and effective manner, including better
carrying out its trust responsibility.
Under the Trump administration, this council has been
ignored and was only reestablished in April after COVID-19 had
already started wreaking havoc and devastating Indian country.
And my question to the panel is are you aware of whether
the White House counsel has held a principal level meeting yet,
and if representatives from your Tribes have been invited?
Anyone on the panel? From Indian country, please.
Ms. Sharp. I am not aware of any engagement nor have I
received any invite to participate.
Mr. Veasey. Thank you. Any other panelists?
Mr. Nez. I am sorry. Go ahead, Christine.
Ms. Sage. Thank you for this question and for the comment.
For Southern Ute we have not been aware of this also. There
needs to be attention drawn to this and hopefully you can do
that. Thank you.
Mr. Veasey. Thank you. Mr. Nez.
Mr. Nez. Yes Representative, thank you, and chairman, and
members of the committee. The 2013 White House Council of
Native American Affairs was very critical in getting all the
information from the Tribes to the White House, because those
members on that council were secretaries of various
departments.
And so when we are talking about the white paper, about
seeing how these secretaries would be able to waive or set
aside certain regulations, this could have happened if that
council was established.
And I understand now it was reestablished in April, but to
this date, I haven't heard any invitation other than what was
brought up earlier about the missing and murdered indigenous
relatives of ours being in the forefront. But when it comes to
policy and regulations that deal with community and economic
development, I haven't heard nothing.
Thank you.
Mr. Veasey. Do you think that if the White House, if
President Trump were to fully revive this committee, do you
think that the council could provide more inclusion and
transparency for Tribal communities and better insure they have
a seat up at the table when opportunities are made available
for State and local government?
Mr. Nez. Absolutely, Representative. We as Tribal leaders
throughout the United States have advocated that there should
be a Tribal leader on this council. And I know that towards the
end of the term it didn't happen for the previous
administration, but, you know, that request is also being
forwarded over to the White House.
We need Tribal leadership to be at the table on a lot of
these discussions. And I bet if they were to do that, a lot of
coordination can happen. Communication would be a lot easier
for them, because these would be secretaries of each of the
departments to make decisions on behalf of the Navajo or Native
American citizens. Thank you.
Mr. Veasey. Thank you very much.
Mr. Chairman, I yield back.
Mr. Pallone Thank you, Marc.
I think that concludes the questions, unless I missed
somebody. I don't think so.
So look, I want to thank all of our witnesses. I thought
this was really worthwhile today. You know, we don't have too
many full committee hearings. And the reason we did this was
because the issues basically go across all of our subcommittees
of jurisdiction. And so that is why we wanted to do a full
committee hearing today.
Certainly you all gave us some very good ideas, as did the
members about where we need to go from here legislatively,
investigatory, and otherwise and we are certainly going to
follow up.
So I want to thank you all sincerely and thank all the
members. We had almost every member of the committee
participate today.
I do want to request unanimous consent before we conclude
to enter into the record the following documents, a statement
from the Alzheimer's Association and Alzheimer's Impact
Movement, a statement from the Robert Wood Johnson Foundation,
a statement from the Internet Society, a statement from
Representative Deb Haaland, a statement from Public Knowledge,
a statement from the National Indian Health Board, a statement
from the American Psychological Association, a statement from
the National Council of Urban Indian Health, a statement from
the Columbia River inter -Tribal Fish Commission, a July 2011
letter from Upper Mohawk Inc. to myself and Ranking Member
Walden, a 2020 letter from the Navajo Nation to the President,
to President Trump.
A statement from the Confederated Tribes of the Colville
Reservation, a July 2020 report from the Department of Energy,
Office of Indian Energy entitled DOE Indian Energy Program
Overview, Tribal Energy Development and Deployment. And finally
a July 2020 Presidential message on the 50th anniversary of the
Federal policy of Indian self-determination. Without objection
so ordered.
[The information appears at the conclusion of the hearing.]
Mr. Pallone I do want to also remind members that pursuant
to committee rules they have ten business days to submit
additional questions for the record to be answered by the
witnesses who have appeared and I would ask each witness to
respond promptly to any such questions that you may receive.
So unless anyone has any other business, at this time the
committee is adjourned.
Thank you all.
[Whereupon, at 3:12 p.m., the committee was adjourned.]
Prepared Statement of Hon. Eliot Engel
Thank you Chairman Pallone for holding today's important
hearing on the challenges faced by Tribal communities across
the United States.
There are currently eight federally recognized Indian
tribes in my home state of New York.
Like many New York communities, they have been greatly
affected by the coronavirus pandemic.
This public health crisis has brought to light the systemic
inequities and barriers that Tribal communities face in
accessing high-quality healthcare, from chronically underfunded
health systems to the absence of robust public health
infrastructure.
The Federal Government needs to immediately address these
shortcomings as required by the Indian Health Care Improvement
Act, which this committee helped enact as part of the
Affordable Care Act.
As this committee examines proactive steps to improve
healthcare for Native Americans, we should consider how can
advance transformative legislation that addresses the social
determinants of health, including access to safe, affordable
housing and proper sanitation systems.
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