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2011 White House Tribal Nations Conference

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December 2, 2011
Washington, DC

Thank you for that kind introduction, I am delighted to be here. I want to thank all of the tribal leaders for participating today, but more importantly for your leadership in your communities every day.

Before I begin, I want to reintroduce you to a few members of our leadership team at the Department of Health and Human Services.

  • 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.
  • Dr. Yvette Roubideaux, our extraordinary Director of the Indian Health Service, who updates me regularly about our work to change and improve the Indian Health Service, and
  • Lillian Sparks, our Commissioner of the Administration for Native Americans in the Administration for Children and Families.

We are lucky to have them leading our efforts. But as you know, the list of people at HHS who come to work every day thinking about tribal issues is much longer. And it includes people at the highest levels of our Department from George Sheldon at the Administration for Children and Families to Pam Hyde leading the Substance Abuse and Mental Health Services Administration to Mary Wakefield at the Health Resources and Services Administration.

From my perspective, when it comes to the health and well-being of the American Indian and Alaska Native people, our responsibility at HHS extends beyond the Indian Health Service and our Office of Intergovernmental and External Affairs. It is a critical part of our work in every operating division and program office across the Department.

Over the last two and a half years, I have had the opportunity to see those efforts first hand from the Cherokee Nation in Oklahoma to the Muckleshoot tribe in Washington to Isleta and Jemez Pueblo in New Mexico.

This summer I visited a number of villages in Alaska, including a health center in Anatuvuk Pass, a small village with no outside road access and less than 300 people. This facility was staffed by a single, trained community health worker – one incredible woman who diagnoses her neighbors, answers their questions and helps them manage their chronic illnesses.

She is basically the health professional in residence 24-7 and she has been doing it for 20 years. I suppose that’s one way to achieve an integrated health system! To say she knows her patients well would be an understatement.

For more serious issues, a doctor visits 4 times a year. For more urgent issues, doctors can be reached by phone and internet in Fairbanks. Or patients can pay hundreds of dollars to travel to Fairbanks to see a doctor.

This health center was an inspiring place and the people there are amazing. But it was also clear that many obstacles have put them at a disadvantage when it comes to health.

From great distances to great costs, from a limited workforce to rising chronic disease, there is so much that can come between the residents of Anatuvek Pass and the good health they deserve in their lives.

What is tragic is that while Anatuvuk Pass is incredibly unique, the health challenges they face are not.

Together, we have made enormous progress across Indian country promoting healthy people and healthy communities while honoring every tribe’s sovereign rights. And yet too many First Americans continue to live sicker and die younger than their peers.

They’re more likely to suffer from a serious illness like diabetes or heart disease. They’re less likely to get the preventive care they need to stay healthy. And when they do get sick, they have less access to the treatments they need to get better.

The imperative to close these terrible disparities in access to care has never been more urgent. But we also know that any solution is not going to be dictated from Washington. The best policies for Indian country must come from Indian country.

As you know, the President issued an executive memorandum at the first White House Tribal Nations Conference in November 2009 directing every federal agency to strengthen ties with Indian country.

Over the last two years at HHS, we have worked hard to build on that strong foundation.

Every year we hold a series of regional tribal consultation sessions across the country led by Paul and Stacey. And we continued to explore new ways to improve the lines of communication, create a mechanism for tribes to initiate consultation, ensure all tribes have a seat at the table regardless of their size or affiliation and provide a better mechanism for follow-up.

We also took a big step by establishing the Secretary’s Tribal Advisory Council, the first-cabinet level group of its kind.

The STAC as it is called, has been active for about a year, reviewing many of the comments we have heard at consultations, and putting the HHS Intradepartmental Council on Native American Affairs to work, tackling some of the great challenges facing Indian Country today.

For example we’ve begun looking at the funding we send to States and how we can make sure tribes benefit. As a governor I know that there is a wide range in the relationship that states have with tribes, some are great, some are not so great. So we’re looking at all the tools we have to bring all the states to the table.

Requiring states to consult with tribes on the Affordable Insurance Exchanges was an important first step.

In September, I wrote to Governors reiterating my full commitment to strong government-to-government relationships with Tribes. And I made it clear that states must consider Tribes full partners during the design and implementation of any programs that use HHS funds.

We’re also looking at grants from the perspective of tribal nations. The first step has been to make sure we have an accessible, accurate, and comprehensive list of every grant offered by HHS for which tribes are eligible. It is my goal to be able to make changes to those grant opportunities where I have authority.

And we are also exploring new resources like workshops, webinars, and databases to let tribes know about those opportunities, and to help them prepare competitive applications.

Next week we are hosting an internal training for own grant reviewers across HHS to give them the tools to better review tribal applications. It is already booked to capacity and we’re looking to host another soon.

But perhaps the most fundamental sign of progress under our new consultation policy has been that it is spurring agencies within our department to revise and improve their own consultation policies.

The Indian Health Service has had the most extensive process in the department for years, and they continue to implement improvements.

Now, last summer the Administration for Children and Families signed a policy and the Centers for Medicare and Medicaid Services signed theirs last week. Neither had a consultation policy prior to this administration, but today they do -- and I want to thank all of the Tribal leaders who helped make it happen.

Each is part of a broader approach which says that consultation is an ongoing process. It not only strengthens our federal-tribal ties, it also makes us a better team.

Fortunately, we’re also developing a better set of tools for the job beginning with the Affordable Care Act which Congress passed and the President signed last year.

As you know, the law contains important benefits for First Americans, starting of course, with the long-overdue permanent reauthorization of the Indian Health Care Improvement Act. This gives IHS, more opportunities to address needs that too often go unmet in the community, such as expanding access to mental and behavioral health services.

It also gives IHS better tools to recruit health care professionals to tribal communities, and allows tribal employees to purchase health care coverage as part of the Federal Employees Health Benefits Program.

And the rest of the health care law – not just the Indian Health Care Improvement Act – is just as important for First Americans, especially those who don’t have regular or easy access to IHS facilities.

Already, the Patient’s Bill of Rights provides protection from the worst abuses of the health insurance industry like imposing arbitrary lifetime limits or cancelling your coverage when you get sick.

And in 2014, American Indians and Alaska Natives will have access to quality, affordable health insurance through new, competitive health insurance Exchanges run by the states. Plans offered through these exchanges will be forbidden from discriminating against you based on your health.

So we’re working hard to make sure American Indians and Alaska Natives can benefit from all that the law has to offer.

And, even at a time when resources have been stretched thin, President Obama’s 2012 budget makes a $19 billion investment in Tribal programs throughout the federal government including a 14 percent increase to the Indian Health Service budget. That is on top of a 13 percent increase enacted in FY 2010.

This budget doesn’t include everything we wish we could include. It makes tough choices. But at a time of an overall budget freeze, they show this administration’s continued commitment. And it recognizes that when we invest in our nation’s American Indians and Alaska Natives, we’re investing in a shared future.

I have been proud to see the relationship between our nations grow stronger and stronger. In the face of immense challenges ahead, we will need one another more than ever. That’s why this conference and our consultation is so important. This Administration is committed to shaping a future where every American Indian and Alaska Native has access to the care and support to achieve their highest aspirations.

We understand and abide by the true meaning of the government to government relationship. And we believe in true partnership with you. We have made great progress and I know that through our partnership we will continue to move forward, in support of strong healthy Tribal communities.