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Statement by
Robert  G.  McSwain
Deputy Director
Indian Health Services
U.S. Department of Health and Human Services

FY 2009 Budget Hearing 

Committee on the Interior, Environment, and Related Agencies
Appropriations Subcommittee
U.S. House of Representatives

Wednesday April 2, 2008

Mr. Chairman and Members of the Committee:

Good Morning.  I am Robert McSwain, Acting Director of the Indian Health Service.  Today I am accompanied by Dr. Richard Olson, Acting Director of the Office of Clinical and Preventive Services, Mr. Gary Hartz, Director, Environmental Health and Engineering, and Mr. Richard Turman, Deputy Assistant Secretary for Budget, Department of Health and Human Services.  We are pleased to have the opportunity to testify on the President's FY 2009 budget request for the Indian Health Service.

The IHS provides health services to nearly 1.9 million American Indians and Alaska Natives.  In carrying out this responsibility, the IHS maintains a unique relationship with more than 560 sovereign Tribal governments that represent this service population in some of the most remote and harsh environments within the United States as well as in modern metropolitan locations such as Anchorage and Phoenix.  These relationships and the geographic diversity offer extraordinary opportunities and challenges to managing and delivering health services.

The IHS and Tribal programs provide a comprehensive scope of individual and public health services, including preventive, clinical, and environmental health services.  In addition, medical care and urgent health services are purchased through the Contract Health Services program when the care is otherwise not available at IHS and Tribal facilities.  For all of the American Indians and Alaska Natives served by these programs, the IHS is committed to its mission to raise their physical, mental, social, and spiritual health to the highest level.

This mission is supported by the Department of Health and Human Services (HHS), as reflected in the many partnerships we have established with other HHS operating divisions and the Department’s commitment to its Intradepartmental Council on Native American Affairs (ICNAA).  The role of ICNAA is to assure coordination across HHS in support of American Indian, Alaska Native, and Native American health and human services issues.  The Administration takes seriously its commitment to honor the unique legal relationship with, and responsibility to, eligible American Indians and Alaska Natives by providing effective health care services.

Through the government’s longstanding support of Indian health care, the IHS, in partnership with the people we serve, has demonstrated the ability to effectively utilize available resources to improve the health status of American Indians and Alaska Natives.  From 1997 to 2007, American Indian and Alaska Native communities have used Special Diabetes Program for Indians funding to make evidence-based, quality diabetes practices commonplace in local Indian health care facilities according to locally-defined objectives and priorities for diabetes treatment and prevention.  During this time period, key clinical outcome measures among American Indians and Alaska Natives with diabetes have improved, such as:

  • Blood sugar control improved 13%
  • Blood lipid levels improved 14%
  • Kidney function improved 18%

These types of improvements have been shown in the scientific literature to significantly reduce the incidence of diabetic complications.  In addition, the IHS has consistently met 80 percent or more of its annual Government Performance and Results Act measures since FY 2005.

Although we are very pleased with these achievements, we recognize that there is still progress to be made.  American Indian and Alaska Native mortality rates for alcoholism, cervical cancer, motor vehicle crashes, diabetes, unintentional injuries, homicide, and suicide continue to be higher than the mortality rates for other Americans.  Many of the health problems contributing to these higher mortality rates are behavioral.  For example, the rate of violence for American Indian and Alaska Native youth aged 12-17 is 65 percent greater than the national rate for youth.  And while diabetes is a major focus of prevention and treatment efforts across Indian country, the prevalence is still growing and occurring in an increasingly younger population.

The IHS and our stakeholders remain resolved and deeply committed to addressing these disparities.  We are joined in the implementation of three health initiatives, launched in FY 2005, with the specific intent of achieving positive improvements in these areas of preventable health problems.  The Health Promotion/Disease Prevention, Behavioral Health, and Chronic Care Initiatives target underlying risk factors for morbidity and mortality as well as the reengineering of the IHS and Tribal health delivery system to incorporate best practices documented in the scientific literature.  Collaborations with other Federal agencies, States, and foundations are also integral components of each Initiative. 

This budget request allows the IHS to continue these efforts and address needs expressed by Tribes.  As partners with the IHS in delivering needed health care to American Indians and Alaska Natives, Tribal leaders and health program representativesparticipate in an extensive consultation process on the IHS budget.  In addition, the Department holds annual budget consultation sessions, both regionally and nationally, to give Indian Tribes opportunities to present their budget priorities and recommendations to the Department.  

The FY 2009 President's Budget request in budget authority for the IHS totals $3.3 billion, a net decrease of $21 million, or .06 percent, below the final enacted FY 2008 Consolidated Appropriations funding level.  In comparison, the overall budget request for all HHS discretionary programs is a decrease of $2.2 billion, or 3 percent, below the enacted FY 2008 Consolidated Appropriations funding level. 

The FY 2009 Budget for IHS includes increases that prioritize the provision of clinical and preventive care, including primary care services, mental health, dental care, and public health nursing and education.  Some of these increases include $25 million for staffing and operating costs for newly constructed or expanded health facilities.  These facilities are the Lawton Outpatient Expansion in Oklahoma and the Phoenix Indian Medical Center SW Ambulatory Center in Arizona.  The other is for a Joint Venture project that will be ready for funding during FY 2009.  The FY 2009 President’s Budget also includes $10 million for the Indian Health Care Improvement Fund, to be allocated to IHS and Tribal service sites with the greatest deficiencies as measured by the Federal Disparities Index.  This funding will allow highly deficient sites to expand health care services and reduce backlogs for primary care. Also included, is an increase of $9 million over the FY 2008 Enacted level for Contract Health Services, specifically for catastrophic and high-cost cases, and an increase of $4 million for Contract Support Costs to support Tribes that assume the administrative role for programs previously carried out by the Federal government.

There are also decreases for the following activities, which primarily fund non-clinical functions, to focus IHS resources on provision of health care services on or near reservations.  The FY 2009 President’s Budget proposes $162 million for the Alcohol and Substance Abuse program, a reduction of $11.3 million.  The Indian Health Professions program budget of $21.9 million reflects a reduction of $14.4 million.  The program will prioritize existing scholarship awards and extension of loan repayment contracts to meet immediate staffing needs and fill provider vacancies.  The Health Care Facilities Construction budget of $15.8 million (a reduction of $20.8 million) will continue the construction of the replacement hospital at Barrow, Alaska.  The Budget also continues to propose elimination of the Urban Indian Health program (which was funded at $34.5 million in FY 2008), as the beneficiaries of this program have access to other health care in urban areas where they reside.

The focus of the President’s Budget request for IHS is on provision of health care services and ensuring that the basic needs of all IHS and Tribal health programs are met. Therefore, the budget request targets additional funding for the provision of health care on or near Indian reservations in order to serve a population who cannot readily access health care from outside the IHS or Tribal system.

The proposed budget reflects a continued Federal commitment to basic primary and preventive health care for American Indians and Alaska Natives.

Thank you for this opportunity to present the President’s FY 2009 budget request for the IHS.  We are pleased to answer any questions that you may have.

Last revised: June 18, 2013