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National Congress of American Indians Executive Council Winter Session

March 1, 2011
Washington, DC

Remarks as prepared for delivery

Thank you Mathew, I am delighted to be here.

I also want to thank President Keel, the Board, and everyone with the National Congress of American Indians for your leadership and partnership.

At the Department of Health and Human Services, we are committed to considering tribal issues in a way that promotes healthy people and healthy communities while honoring every tribe’s sovereign rights.

And before I begin, I want to reintroduce you to a few members of our HHS leadership who are leaders in that work.

  • Paul Dioguardi, our Director of Intergovernmental Affairs who is your first point of contact at the Department and the lead on the HHS Tribal Consultation Policy.
  • Stacey Ecoffey, the Department’s Principal Advisor for Tribal Affairs, whom I know you know well.
  • Lillian Sparks, our Commissioner of the Administration for Native Americans in the Administration for Children and Families, who is a former staff attorney with the National Congress of American Indians.
  • Dr. Yvette Roubideaux, our extraordinary Director of the Indian Health Service, who is meeting with members of Congress as we speak to update them on how we are changing and improving the IHS.

They are just a few members of the incredibly committed team at HHS who – along with many talented people across this administration – are committed to working hand-in-hand with tribes across the country.

We believe deeply in the federal government’s obligation to help improve the health of American Indians and Alaska Natives everywhere.

And over the last two years, along with you, we have taken important steps toward that goal, starting with the Recovery Act, which was one of the biggest investments in Indian Country in our history.

For example, the law provides 500 million dollars for the Indian Health Service, including funds for the construction of priority health care facilities, building maintenance and improvement, water and wastewater sanitation projects, purchasing critical medical equipment, and health information technology.

And this investment has already begun to make a real and measurable impact.

You can see it places like Eagle Butte, South Dakota where IHS Recovery Funds are being used to complete the construction of a new Health Center that will serve 10,000 American Indians living on the Cheyenne River Reservation. When it’s completed this summer, it will replace an old facility one-third the size that has struggled to meet community needs.

This kind of project is protecting current jobs and creating new ones. But it also represents an investment in greater access, better care, and a healthier community for years to come.

And the Recovery investment in Indian country has reached well beyond the Indian Health Services and HHS – from economic development to water projects, from housing to road repair, from workforce training to broadband deployment.

Altogether the Recovery Act targeted $3 billion specifically to the needs of tribal communities, a historic investment in the future of American Indians and Alaska Natives.

The Recovery Act has made an enormous difference. But there is still work left to be done. First Americans continue to feel the weight of the economic downturn in the form of high unemployment and poverty, substandard housing, and failing infrastructure. And they continue to suffer from persistent health disparities.

That’s why the health law, the Affordable Care Act, is so crucial. As you know, the law contains important benefits for First Americans, starting with the permanent reauthorization of the Indian Health Care Improvement Act.

The law was first approved by Congress in 1976 and last reauthorized in 2000. Now in 2011, we are taking critical steps forward to modernize and update the Indian Health Service. But more than that, we have made a lasting and permanent commitment to the health of American Indians and Alaska Natives.

Let me tell you what’s new, thanks to permanent Reauthorization:

First, the Indian Health Service now has authority to expand access to care, including new authorities for long term care and mental and behavioral health services, addressing needs that too often go unmet in the community.

Second, we have significantly improved the tools and flexibility we have to recruit and retain doctors and nurses for Indian health programs, especially in rural and remote areas that are typically underserved by primary care providers.

Third, the law allows tribes and urban Indian organizations carrying out programs under federal law to purchase health care coverage for their employees as part of the Federal Employees Health Benefits Program.

We also know that almost half of all American Indian and Alaska Natives don’t live close to Indian Health Service facilities and providers.

And the Affordable Care Act is just as important for them.

Thanks to the law, starting in 2014, American Indians and Alaska Natives will have access to quality, affordable health insurance through state-based competitive health insurance marketplaces called Exchanges.

The health coverage offered under these new Exchanges will be forbidden from discriminating against anyone based on their health status.

This means that more American Indian families can afford to get care when they need it instead of waiting for an illness to get worse before they get help.

When you put all these changes together, the Affordable Care Act is one of the most important Indian health laws in the last few decades

That’s why it’s so disturbing that some in Congress want to refight the political battles of the past two years and repeal these new protections and benefits, including the Indian Health Care Improvement Act.

That would be a terrible blow to the health of American-Indians and Alaska Natives.

We need to move forward not backward.

So we’re working hard at the highest levels of our Department and with partners across the country to make sure First Americans can benefit from all that the law has to offer. And to do that, we need to hear from you. That’s why we’ve held frequent meetings, and listening sessions with Tribes to make sure your voices are heard.

For example, we heard concerns from many of you that as states began to implement the health reform law, some states had not done a great job of consulting with Tribes.

So we made sure that the latest funding opportunity announcement for state Exchange grants included a requirement that states develop a detailed plan to consult with tribes. This important requirement was included because of your input during consultation sessions.

As we implement this law, Dr. Roubideaux always has a seat at the table to make sure we consider Tribal input. She also has a great blog on the IHS website, which is a terrific way for you to stay up-to-date on what’s happening.

At the same time, Paul and his team at Intergovernmental Affairs are providing you with regular updates as they coordinate Tribal consultation activities. And they continue to take comments on upcoming regulations and nominations for key advisory boards. Their doors are always open.

At the heart of efforts like these is a fundamental belief that tribal consultation is essential to any sound and productive federal-tribal relationship. Over the last two years, we have worked hard at HHS to hone and strengthen that consultation process.

When I spoke here last year, we had just begun the work to establish the Secretary’s Tribal Advisory Committee -- or STAC -- the first of its kind for a cabinet-level agency.

Last spring, we held seven regional tribal consultation meetings from Anchorage to Albuquerque to discuss steps we can take to strengthen our consultation policy, from improving follow-up, to making clearer distinctions between Indian tribes and corporate or non-profit Indian organizations, to allowing tribes to initiate consultation.

The input you provided during those meetings created the framework for the official consultation policy that I signed last month.

Regional consultations will continue again this year through the end of April and guide our work together in the years ahead.

The common thread running through this approach is the idea that Washington can't—and shouldn't—set the agenda for Indian Country. The only way tribal nations can serve their people’s needs is for you to set the vision. Then we at HHS and other agencies, led by President Obama, can and will work with you to achieve it.

I believe we share a vision of the future where our nation is strong and where every individual and every community has the opportunity to reach their full potential.

First Americans are a central part of that picture.

That’s why President Obama proposed an increase of 14 percent to the Indian Health Service Budget in FY 2012. That is on top of a 13 percent increase enacted in FY 2010. This will give IHS the tools it needs to focus on reducing health disparities, support tribal efforts, fund health facility and medical equipment upgrades.

But my department’s efforts to improve the lives of Native people will go beyond the Indian Health Service. The President also proposed adding $50 million in the SAMHSA budget for new Behavioral Health Tribal Prevention Grants to be awarded to each of the 565 federally-recognized tribes for alcohol abuse prevention and suicide prevention.

And the Administration on Children and Families’ tribal programs also see increases under the President’s budget, including $36 million more for Foster Care, $16 million more for the Childcare and Development Block Grant, and $6 million more for Tribal Child Support.

Overall, the President’s FY2012 budget makes a $19 billion investment in Tribal programs throughout the federal government.

It doesn’t include everything we wish we could include. It makes tough choices, but it also makes smart, targeted investments today that we know will pay off tomorrow. And it recognizes that when we invest in our nation’s American Indians and Alaska Natives, we’re investing in a shared future.

Sitting Bull said it better than I ever could: “Let us put our minds together and see what life we can make for our children.”

I want to thank you again for inviting me to be here today. This Administration is working hard to help change lives for the better in Indian Country.

The Recovery Act laid a strong foundation. The Affordable Care Act and the Indian Health Care Improvement Act are giving our nation a powerful new set of tools. The President’s budget provides a blueprint. And our consultation policy ensures that we’re working side-by-side.

Tomorrow holds great promise. We can strengthen our partnership and improve health and opportunity for all American Indians and Alaska Natives. Together, we have the opportunity to build something great.

Thank you.