[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                    
          
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                    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

                              ----------                              
                                                                   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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