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National Congress of American Indians

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March 2, 2010

Good Afternoon.

I want to thank President Jefferson Keel, Jackie Johnson-Pata, and Ahniwake Rose and the membership of NCAI for the invitation to be here with you today. I also want to thank the tribal leaders who met with me earlier today to discuss the government-to-government relationship we have with individual tribes across the country. This is an opportunity—and I’m looking forward to many—for the Department of Health and Human Services to strengthen its partnership with the National Congress of American Indians.

This is a good time to introduce some of the top people here at HHS advising me on tribal issues.

Unfortunately, my Chief of Staff, Laura Petrou, couldn’t be here today. Many of you know of Laura’s work on Indian health and deep interest in tribal issues from her years with Senator Tom Daschle and work with South Dakota tribes.

Paul Dioguardi, my Director of Intergovernmental Affairs, is here, and he is your first point of contact at the Department and the lead on the HHS Tribal Consultation Policy.

Stacey Ecoffey—whom I know you know well—is the Department’s Principal Advisor for Tribal Affairs. We are lucky to have her.

And, of course, you know Dr. Yvette Roubideaux, who’s doing an extraordinary job as Director of the Indian Health Service. I’m so proud to have the first female American Indian to serve in this critical role.

As the Nation’s oldest and largest tribal organization, you’ve seen too many policies created inside the Washington beltway that fail in Indian Country. Washington thought it knew best, and didn’t bother to ask you first.

As President Obama said at the Tribal Summit last November, Washington can't—and shouldn't—dictate a policy agenda for Indian Country. Working with the tribes is a priority for President Obama, as it is for the Department of Health and Human Services and every other cabinet agency. The only way tribal nations can serve people’s needs is for you to set the vision. Then we can work with you to achieve it.

That's why we're all here today.

HHS takes its communication and consultation responsibilities very seriously. So seriously, in fact, that we’re already working on establishing a Secretary’s Tribal Advisory Committee for the Department. This is a first for a cabinet-level agency.

As you know, last November President Obama asked each of the federal departments to provide the Office of Management and Budget a detailed plan to meet our responsibility to strengthen relationships with Indian tribes.

I’m proud to say HHS has been a leader in this area—we’ve had a Departmental plan on tribal consultation and coordination since 1997. I want to thank all of the tribal leaders and organizations who have worked with us over the years to review and revise it—it’s a true partnership between Indian Country and our department that we can all be very proud of.

Consultation with tribal governments is important, not just because the President told us to do it, but because we genuinely want to improve life in Indian communities, and because we know that improving our communication and partnership with tribes is essential to that effort.

There are so many examples of how tribal consultation leads to successful federal programs. Dr. Roubideaux recently shared one of these success stories with me, from the Special Diabetes Program for Indians, a program built on the lessons learned from consultation with tribal leaders.

It concerns a gentleman in his 50s named Rude Dog “Rudy” Clark who, when he first showed up at the Hualapai Healthy Heart Project in Peach Springs, Arizona, had diabetes, high blood pressure, and weighed 306 pounds.

Mr. Clark says that when he first came to the project, he didn’t know anything about diabetes, other than that it was a disease. But when the professionals at the Healthy Heart Project began working with him, Mr. Clark made a commitment to control his diabetes. He lost weight and lowered his blood sugar, blood pressure, and bad cholesterol. Now he no longer needs insulin injections.

Mr. Clark has changed his life. He walks, jogs and goes to the fitness center. He eats fewer eggs, went from fry bread to tortillas, and quit drinking Coke. He also switched from beef to buffalo meat, venison, and elk meat—he says it’s “more natural protein.”

He also says his children think he’s the most boring dad in the world. But that doesn’t stop him—he’s setting a great example and helping family members and coworkers manage their diabetes, too. And he’s smart. We know if one parent is obese, there’s a 40 percent chance that the children will also be obese. With two obese parents, there’s an 80 percent chance.

This is the kind of difference we can make when we have a strong consultation process that can translate your wisdom and experience into effective policies.

We want to continue to do better.

Last December I wrote to tribal leaders, asking them how we can improve our consultation process. I was delighted to have so many positive and constructive replies.

In the upcoming regional consultation sessions, we’d like to start with some of these recommendations—such as improving follow-up, making clearer distinctions between Indian tribes and corporate or non-profit Indian organizations, and allowing tribes to initiate consultation. Paul Dioguardi and Stacey Ecoffey are going to lead these sessions—I strongly encourage you to contact them before the first session in Seattle on March 23 with any additional input you have.

At the conclusion of the regional consultation sessions, we’re going convene a Tribal-Federal Work Group that will ultimately create the roadmap to a more timely, transparent, and productive HHS consultation policy. I look forward to working with you on these efforts, and sharing the results with you in the fall.

Later this week, we’re going to discuss health and human services funding priorities for 2012. I want to thank the people here who have assisted in planning this session, as well as those of you who are planning to join. But I want to say a few words about the FY 2011 budget.

I actually attended last year’s HHS budget consultation—it was my first day in office last spring. You may see the imprint of that session on the 2011 budget the President released a few weeks ago.

For example, the President’s budget proposes an additional $354 million for the Indian Health Service—a 9 percent increase for IHS, which continues the President’s commitment to Indian Country.

He first showed that commitment when he made a record $500 million investment in the IHS as part of the Recovery Act. That investment funded new clinics, repairs for hospitals, and health information technology that will allow doctors to deliver better care.

Now, in a year when difficult economic times meant we could make very few budget increases, he’s showing it again by proposing an increase for IHS—the largest percentage-wise of any agency within HHS—for the second year in a row.

And this budget is based on tribal priorities:

Reducing chronic disease by supporting programs that prevent childhood obesity and help people quit smoking,

Improving access to care from private providers, and

Increasing catastrophic coverage.

This budget increase is about more than adjusting for population growth and medical inflation – it includes funding for staffing and operating costs for new facilities, which will allow IHS to improve care and services.

The 2011 budget reflects my commitment to improve Indian health, and the President’s commitment to honor our treaty obligations. But my department’s efforts to improve the lives of Native people go beyond the Indian Health Service.

For instance, the budget provides an additional $6 million for the Substance Abuse and Mental Health Services Administration for suicide prevention programs. With this level of increase, SAMHSA will be able to fund twice as many tribes as it does today.

Under the President’s budget plan, more parents could pay for child care, and Head Start could serve more young children. At the other end of the lifespan, new support for caregivers and home- and community-based supportive services would help Native American families care for elders who live at home with them.

The budget also increases funding for public health emergencies, like fighting the H1N1 flu pandemic. HHS worked very hard to keep all Americans—including American Indians and Alaska Natives—safe this flu season.

HHS was concerned from the start that the H1N1 flu was likely to have a more severe impact on American Indians and Alaska Native people. From the beginning, we hoped for the best, but prepared for the worst, communicating regularly with tribal officials.

While H1N1 activity has declined over the past couple of months, H1N1 flu is still circulating, and there are still lives to be saved. Vaccination is still the best protection against the flu, so I would encourage you to continue to vaccinate anyone who hasn’t yet been vaccinated, particularly those with high-risk conditions, and, as you know, that’s a lot of people in Indian Country.

We got good news from our scientists recently—the H1N1 vaccine will be part of the seasonal flu vaccine next flu season. People won’t have to get a separate shot to be protected. But it is not part of the 2010 seasonal flu vaccine, so it’s still important for your leadership to reach out to high priority tribal members.

Your input and partnership have been incredibly important at every step of the H1N1 response. There’s always the possibility of a new public health challenge on the horizon, and we will need to continue to work together.

Finally, I want to talk about the continued effort at the Department of Health and Human Services – and throughout the Administration – to make comprehensive health insurance reform a reality. As you all know, lack of coverage, high health care costs, and problems with quality and access to care impact American Indians and Alaska Natives, whether they use IHS or other providers.

The Indian Health Care Improvement Act is a vital part of comprehensive health reform, and the Administration strongly supports this measure, including in the President’s recent health reform proposal.

This legislation is another success story that’s been achieved through consultation, one that we’d like to extend to people who are not part of the Native community. Last week, as you know, the President convened a bipartisan meeting to discuss health reform. That meeting was an important step in the effort to bring parties back to the table to work through outstanding differences and achieve health insurance reform.

We are closer than ever before to passing health reform. And when we’re successful, we will finally have insurance that’s affordable for all Americans who don't have coverage, and that offers stability and security to Americans who do—and that includes the First Americans.

While American Indians and Alaska Natives would be exempt from the mandate to purchase coverage, lives will be enhanced with an improved healthcare system. It’s another important principle of health reform – regardless of race, ethnicity, gender, disability, or geography, every American deserves high-quality, affordable care.

As a former Governor, I understand the unique relationship that we have with tribal governments, on health care and every other issue we face. I know that, without real communication and consultation, government to government, we risk policies that don't work for you or for any American. That’s why I will be joining my team at several consultations later this spring.

This Administration is working hard to change lives for the better in Indian Country. We know the only way to achieve real progress in that effort is to work side by side with you.

Again, thank you for inviting me here today. I’m looking forward to our partnership over the coming months and years as we work to improve the health of tribal communities.