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Testimony on the President's FY 2000 Budget Request for IHS by The Honorable Donna E. Shalala
Secretary
U.S. Department of Health and Human Services

Although I was unable to appear before the Subcommittee in person today, I would like to express my strong support for the Indian Health Service (IHS) Fiscal Year 2000 budget request. I also want to thank the Subcommittee, particularly you, Chairman Regula and Representative Dicks, for your strong support of the Indian health programs, especially in the treatment and prevention of diabetes among American Indians and Alaska Natives.

As you know, Mr. Chairman, the IHS is a most important component of the Department's effort to meet the federal government's obligations to the American Indian and Alaska Native population of this country. Other components also play a role by providing funds directly to Indian tribes under programs such as Head Start, Child Care and TANF. A total of $400 million is requested for these non-IHS programs. The Health Care Financing Administration continues to work with IHS to ensure that IHS hospitals and clinics receive Medicare and Medicaid on the same basis as other providers. IHS Medicaid inpatient rates will rise by 40 percent between 1997 and 1999 while Medicaid outpatient rates will increase by 13 percent. With this rate increase, IHS expects to collect an additional $82 million in third party reimbursements over three years.

The unique government-to-government relationship that exists between the Federal government and Tribal governments is nowhere more demanding than in the area of public health. The IHS has a mission to elevate the health of American Indians and Alaska Natives to the highest possible level and to increase opportunities for Tribal governments to design and manage health services for their people. The IHS has carried out this mission with great care for the health of the population it serves. It has fostered an effective partnership with local Tribal governments that has borne fruit in greater life expectancy, declining infant mortality, fewer accident related deaths, and improvements in other health indicators. Unfortunately, there still exist significant disparities in the health of this population when compared to the general U.S. population.

The rates of suicides and homicides in this population continue to exceed the general population rates significantly. Diabetes remains a devastating scourge in Indian country. Accident related deaths are still significantly elevated in the most productive (25-44 year old) age group in this population. Even tuberculosis is significantly elevated in this population. Youth in Indian country are engaging in gang activity in unprecedented numbers.

The President's budget request for FY 2000 was developed in consultation with the tribes and urban Indians and begins a fundamental rebuilding process to restore greater access to primary services and it provides some investments in especially vulnerable portions of the population. We are requesting an 8-percent increase over the FY 1999 appropriations to achieve substantial progress in meeting these health needs. Let me highlight a few:

• While the number of clinical services provided has increased steadily over the last few years, preventive primary care services such as well child care and well woman care have declined. Our budget proposes to reverse this trend.

• The agency has experienced a 40-percent increase in the number of denials issued for needed secondary and tertiary medical services. This budget proposes a significant increase to the contract health service program to address this reduction in access.

• Women are unable to fully access basic screening services for breast and cervical cancer. Funds are requested to improve access to these vital services. The proposed FY 2000 budget will enable IHS to provide greatly needed additional breast cancer mammography screenings for women between the ages of 50-69.

• Victims of domestic violence and other forms of community violence are currently unable to fully access treatment services. The budget proposal includes a significant investment for mental health.

• Community based health services such as pre-maternal evaluation and education, support and assistance to elders and those with chronic diseases, and school-based health programs are all in need of assistance. Accordingly, funds are proposed for these special needs activities.

• Lastly, to assure the greatest participation of tribes in managing the health systems, we are proposing increases in the funds needed to support tribal governmental infrastructure as it assumes many of the operational activities formerly accomplished through federal employees. The FY 2000 budget proposes substantial increases for facility maintenance and improvement, sanitation facilities, and environmental health services. This is a critical investment in assuring that local solutions, which are, in my view, often the best solutions, can be adequately planned and implemented to continue to improve the health of the First Americans.

These investments will substantially improve our ability to assure access to primary care in all Indian communities and expand tribal management of these programs. I take pride in the fact that this request reflects the priorities developed by the tribes, urban Indian programs, the IHS, and the Department through a valued partnership. This budget will allow communities to reduce disparities on their way to total elimination of these unnecessary differences in health. I urge you to support our budget request so that we will have the tools we need to achieve our most important mission for this very special population and to continue this country's commitment to uphold the government to government relationship with American Indians and Alaska Natives.