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White House Annual Tribal Nations Conference

Washington, DC
November 13, 2013
As Prepared for Delivery.

It’s great to be here with all of you.  I always look forward to joining you here at this conference, but this year in particular.  You see, in July I had the opportunity to visit the Navajo Nation and to attend a Special Session of the Navajo Nation Council.

I was able to hear directly from delegates about the challenges they face day after day . 

  • They spoke about their efforts on diabetes, cancer, and HIV/AIDS prevention and treatment.
  • And they shared some of their concerns, as well as their hopes for how to improve health and wellness throughout the Navajo Nation. 

I wanted to take this opportunity to offer some thoughts on a few of the priorities we share: building on our government-to-government relationship and obligations to closing health disparities, and reinvigorating health and wellness in Tribal Communities.

Challenges

The research tells us that nearly one out of every three American Indians and Alaska Natives do not have health insurance.

While 62% of all non-elderly Americans are covered with private insurance, in AI/AN communities, only 36% are covered.  So the challenges we face are very real. 

By the same note, so too are the opportunities to expand services and access to coverage.

If, for example, every state were to expand Medicaid, 94% of uninsured American Indians and Alaska Natives would qualify for some sort of assistance with getting covered – whether it’s financial assistance through the new Health Insurance Marketplace, Medicaid or CHIP. 

A Priority from Day 1

Closing disparities and promoting health and wellness in tribal communities have been a priority for this Administration for as long as there has been an Obama Administration. 

Even as the President inherited the worst economic crisis in a generation, he insisted on forging a new path, opening lines of communication, and investing in Indian Country.

As a result, we’ve been able to make more progress for Indian Country than we’ve made in a generation.

Before President Obama took the oath of office, there was a steady decline in the number of children in Head Start who spoke a tribal language at home. Today, we’re using Head Start’s new performance standards to integrate tribal language and culture into their classrooms and curricula.

Before the Affordable Care Act, only 60 IHS and Tribal facilities were eligible for National Health Service Corps members –doctors, nurses, dentists, and mental and behavioral health specialists who receive a scholarship or loan repayment in exchange for practicing in under-served communities.  Today, every IHS and tribal facility is eligible, more than 600 in all.

What’s more, as many of us remember all too well, it wasn’t very long ago that reauthorization of the Indian Health Care Improvement Act was hopelessly stuck in Congress.  Today, because of the Affordable Care Act, the Indian Health Service is here to stay – after a permanent reauthorization.

Many of you worked tirelessly to make this happen, and were it not for your work, we would be having a very different conversation today. 

Sequestration

As encouraging as the progress we’ve made together has been, all of us recognize that Washington politics have put much of this progress at risk, due to the so-called “sequestration” cuts.

For Indian Country, these cuts could mean 3,000 fewer inpatient admissions and an unconscionable 804,000 fewer outpatient visits for IHS patients.

But that’s not the only human toll these cuts could take.  They could also mean children kicked off Head Start.  IHS facilities that are understaffed.  Tribes without the ability to staff facilities they used their own resources to build.

The President is committed to doing everything he can to minimize the impact of these cuts on Indian Country.  But ultimately, it’s up to Congress to prevent these arbitrary cuts from having this potentially devastating impact.    

Department Initiatives

Last year at this conference, I announced the signing for the VA IHS Reimbursement Agreement. So far, IHS and Tribal sites have received nearly $1 million in reimbursements, because of this agreement.

And we’ve been working on a number of fronts to make sure your voices are heard in both state-level and federal decision-making. 

At HHS, I created a department-wide Secretary’s Tribal Advisory Committee – and in fact, I’m meeting with them tomorrow. 

One of the areas I’ve asked them to work on is reducing barriers to eligibility access to HHS grants. We recently completed a two-year study in order to better understand some of the obstacles– so that we can remove them. 

These grants can be especially significant for behavioral health and substance abuse services.

It used to be that Tribal nations were largely on their own in the ceaseless fight against alcohol and substance abuse. Today, our department has a dedicated office working with Tribes as they develop detailed action plans and coordinate resources from across the federal government.

These efforts are getting a very big boost from the Parity Rule, which we released on Friday. It puts behavioral health and substance use services on equal footing with physical health – and, in tandem with the Affordable Care Act – it will expand and protect behavioral health benefits for more than 62 million Americans.

Let’s Move Announcement

Another important area we’re working on is childhood obesity – and these efforts have a great leader and champion in First Lady Michelle Obama.

As you know, the First Lady launched an initiative called Lets Move! to ensure all kids have the opportunity to grow up healthy and pursue their dreams.

Lets Move! in Indian County focuses specifically on First American children.

I have some news to share with you on these efforts:  the Administration is entering a new partnership with the Notah Begay Foundation to identify best practices and areas for collaboration with Tribal communities on reducing childhood obesity in Indian Country. 

Notah Begay is here with us today.  Notah, can you stand up?  Thank you for all that you are doing to reduce childhood obesity and type 2 diabetes in Tribal communities.

I hope that all of you who are with us today will join us in these efforts.

Affordable Care Act

Ultimately, one of the most important things we can do – and are doing – to decrease disparities is to increase access to affordable health coverage. 

The Affordable Care Act targets and reduces those disparities by lowering health care costs and making quality health care accessible.

For those who currently have health insurance, the new law is making it better.  The Health Insurance Marketplace is an opportunity for those without insurance – or those purchase insurance on their own – to get covered. 

If you’re a member of a federally-recognized Tribe and you buy a private health insurance plan through the Marketplace, you may not have to pay any out-of-pocket costs like co-pays or deductibles.

And if you’re eligible for services through IHS, an urban Indian health program, or a Tribal program, you not only can enroll through coverage through the Marketplace, you may be eligible for special exemptions that make it easier to qualify for Medicaid or CHIP coverage. 

There are four ways to enroll: on paper, over the phone, in-person and online – where the experience is getting better every day.

IHS has trained staff to help its American Indian and Alaska Native patients enroll to get covered.

Conclusion

As we observe Native American History Month, we remain committed to building on this work, to ensure all American Indians and Alaska Natives have access to quality, affordable health insurance—whether they’re living on a reservation or on Tribal land or in an urban area.

Many of the people who wrote the Constitution were inspired by the Iroquois Great Law of Peace and its three principles of righteousness, justice, and health.

In many ways, these principles have new meaning today.  There is no righteousness without justice, and there is no social justice, so long as there are unacceptable disparities in health. 

And therefore we are committed to working with you to move forward.  Thank you all very much.