National Indian Health Board

Washington Report, May 9, 2008

Sat, 10 May 2008 12:35:23 -0400

IN THIS ISSUE:

NIHB Public Health Summit: May 21-22, 2008 in Green Bay, WI
Update: H.R. 1328 Indian Health Care Improvement Act (IHCIA)
Update: Special Diabetes Program for Indians Reauthorization
FY 09 Appropriations
New Staff Member: Caitlin Wesaw
NIHB has a new address in the District of Columbia!

Full Washington Report (Adobe Acrobat PDF)

HR 1328 Call to Action

Thu, 08 May 2008 16:31:00 -0400

INDIAN COUNTRY HAS ALWAYS HAD A VOICE IN CONGRESS

WITH PASSAGE OF THE INDIAN HEALTH CARE IMPROVEMENT ACT IN THE SENATE, WE ARE HALFWAY THERE . . . . . WE'VE COME THIS FAR

Let's Keep the Indian Health Care Improvement Act (IHCIA) Moving!

In February 2008, when the IHCIA (S. 1200) was stalled in the Senate -- Indian Country and friends of Indian health jammed the phones of key Senate offices - the bill passed by an overwhelming vote of 83-10. We need the same passion to move the bill in the House!

Tribal leaders, tribal members, and friends of Indian health, you can serve an important role in ensuring passage of the IHCIA. By taking only a few minutes of your time, you can make a difference and influence the Speaker's decision to move HR 1328 to the House Floor! We need you to call Speaker Pelosi. Please make your calls by May 14^th. Here's how you can help!

Call the Capitol Switchboard at (800) 828-0498 and ask to be connected to the Speaker's Office. Then, ask to speak to the Chief of Staff or the Health Policy Advisor.
Give the staff your name and tribal affiliation.
Ask them to convey the following message to the Speaker:
- Thank her for supporting HR 1328
- Thank her for imposing a June 6^th deadline for House committees to consider the bill, but please do not extend the deadline.
- Don't let the bill die in the House because of possible codification of the Hyde Amendment – this is not an Indian issue.
- Please commit to moving HR 1328 to the House Floor in June.
Thank the staff for speaking with you and tell them why reauthorization of the IHCIA is important to you, your family and your community.

If you are transferred to voicemail, please leave this same message and ask the staff person to call you back to make sure your message to the Speaker will be conveyed.

Call to Action - HR 1328

Thu, 01 May 2008 19:35:19 -0400

House Speaker Nancy Pelosi and Minority Leader John Boehner need to hear Indian Country supports HR 1328, the reauthorization of the Indian Health Care Improvement Act (IHCIA). Calls made to Senate offices in support of S 1200 jammed phones lines and ensured passage of the IHCIA on the Senate side. We need Tribal leaders, Tribal members and friends of the IHCIA to show the same support for the House bill.

We need Indian Country to inundate Speaker Pelosi and Minority Leader Boehner’s office with faxes of a letter of support of HR 1328. The National Indian Health Board (NIHB) has crafted a generic letter for you to use. Please feel free to tailor the letter to the health issues of your tribal community and let the Speaker know why reauthorization of the IHCIA is important to your community.

Faxing letters to the Speaker Pelosi and Minority Leader Boehner is the easiest way to express your opinions. Please fax the letter to each of the offices beginning May 5^th and if possible, fax subsequent letters at least once a week. The House will be on recess beginning May 23^rd – we need these letters faxed before then.

The Speaker’s fax number is 202-225-4188 and Minority Leader’s fax number is 202-225-5117. Please fax a copy of the letter to your Representative as well.

Please remember to call the offices of Speaker Pelosi and Minority Leader Boehner to make sure your fax was received. Please call the Capitol switchboard main number:

1-800-828-0498 and ask to be connected to the Office of the Speaker or the Office of the Minority Leader. Confirm that your fax was received and that the House leadership will move HR 1328 to the House Floor immediately after June 6^th.

In order to track the number of letters sent to the Hill, please fax or email a copy to the NIHB, c/o Kraynal Alfred, Legislative Assistant, at kalfred@nihb.org or 202-507-4071 (fax number).

H.R.1328 is being held up in the House Committee on Energy & Commerce because of a Hyde-like amendment

Mon, 28 Apr 2008 18:18:00 -0400

NIHB Chairman Sally Smith in her letter to Chairman Dingell and Ranking Member Barton, wrote:

“the Hyde-like amendment is an unnecessary provision which co-opts an important debate about health care for AI/ANs. Indeed it injects an inflammatory, polarizing issue into a debate about comprehensive health care for AI/ANs. The amendment should not be allowed to distract from the important issues before the House; such as, the reauthorization of the IHCIA. Indian Country has been working for almost ten years to reauthorize the IHCIA. The NIHB implores all Members of the Energy & Commerce Committee to not allow this issue to derail our bill.”

Click the following links to read Chairman Smith’s letter to House leadership and obtain a copy of other Federal laws with the codified Hyde Amendment.

One Year Anniversary of House Inaction on Native American Health Care Bill

Fri, 25 Apr 2008 18:44:17 -0400

FOR IMMEDIATE RELEASE
Contact: Adam McMullin at 202-466-7767 or amcmullin@ncai.org
Darren Thompson at 202-466-7767 or dthompson@ncai.org

House Energy & Commerce Committee Continues to Sit on Desperately Needed Bill

WASHINGTON—April 25, 2008— Today marks the one year anniversary that the Indian Health Care Improvement Act (IHCIA) has been sitting in the Energy & Commerce Committee of the U.S. House of Representatives. Several months ago, the U.S. Senate passed the reauthorization of the IHCIA sending optimism to Indian Country that health care will finally be brought into the 21st Century, but today Native Americans are still waiting on the House.

“The United States has a longstanding trust and treaty responsibility to provide adequate healthcare to our people and it’s about time that Indian Country has its health care modernized,” said National Congress of American Indians (NCAI) President Joe A. Garcia. “With the U.S. Senate’s overwhelming support of the reauthorization of the IHCIA, Indian Country is surprised the bill is still lingering in Speaker Pelosi’s House of Representatives.”

Native Americans continue to rank on the bottom of nearly every single indicator of good health. The life expectancy for males in the U.S. is 75 years. On the Pine Ridge Reservation in South Dakota it is 56 years, lower than Haiti where it is 58 years. Natives also face dramatically higher diagnosis and death rates from chronic illnesses such diabetes, heart disease, and cancer.

The IHCIA will modernize and improve Indian health care services and delivery; provide the basic tools to address the overall health of our communities; help us address problems of teen suicide and methamphetamine abuse; and allow for in-home care for our elders.

“This one year anniversary is not a day to celebrate. Tribal leaders, tribal members, and friends of Indian Country continue to do all we can to move this legislation forward. NCAI and NIHB reach out to Speaker Pelosi for her help to break this gridlock in the Energy & Commerce Committee and hold the Committee to their new June 6, 2008 deadline.”
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Founded in 1944, the National Congress of American Indians is the oldest, largest and most representative American Indian and Alaska Native organization in the country. NCAI advocates on behalf of tribal governments, promoting strong tribal-federal government-to-government policies, and promoting a better understanding among the general public regarding American Indian and Alaska Native governments, people and rights.

The National Indian Health Board (NIHB), established in 1972, serves all Federally Recognized American Indian and Alaska Native (AI/AN) Tribal governments by advocating for the improvement of health care delivery to AI/ANs, as well as for upholding the Federal government’s trust responsibility to AI/AN Tribal governments. We strive to advance the level and quality of health care and the adequacy of funding for health services that are operated by the Indian Health Service (IHS), health programs operated directly by Tribal governments, and other programs. Our Board Members represent each of the twelve Areas of IHS and are elected at-large by the respective Tribal Governmental Officials within their Area. For more information, visit the NIHB website at www.nihb.org.

Expansion of Indian Health Service�s the Chronic Care Initiative Collaborative

Fri, 25 Apr 2008 00:18:10 -0400

Request for Participation - Deadline: June 19, 2008

Indian Health System Partners

I am pleased to announce an opportunity for participation in the expanded Innovations in Planned Care for the Indian Health System Collaborative (IPC II). Please review these materials carefully and consider participating in this groundbreaking work.

The Aim of the Chronic Care Initiative and the IPC-II collaborative is to support community and individual wellness and strength and reduce the prevalence and impact of chronic conditions. I am proud of what the original 14 IPC sites have accomplished in the past year, adapting the Care Model and using rapid cycle improvement methodology to chart a new course in care.

Now we have an opportunity for additional sites to join the IPC collaborative, refining the work of the past year and building the foundation for an Indian Health System with a focus on the patient, family, and community at the center of care and the improvement skills and tools to make this vision a reality.

I recognize that not all sites will be prepared at this point in time for participation in IPC II. This work requires IHS, Tribal, and Urban Indian sites with a high degree of readiness and the will to drive fundamental change in their health program. Programs that do not participate in IPC II will have the opportunity to join the Chronic Care Initiative readiness learning community launching this spring.

I encourage IHS, Tribal, and urban Indian health programs to consider participation in IPC II. This work, part of the integrated initiatives in Health Promotion and Disease Prevention, Behavioral Health, and Chronic Care, is critical to the health and wellness of American Indian and Alaska Native people. I look forward to the innovative work you will do together over the next year.

Robert G. McSwain
Acting Director
Indian Health Service

SAMSHA, US Army Medical Research Acquisition Activity, and Harry and Jeanette Weinberg Foundation Grants

Thu, 24 Apr 2008 13:28:29 -0400

The four grants reviewed in this Alert are from two Federal Agencies and one private organization.

Up to $14.5 million in public funds will be made available in up to 36 awards, with the maximum amount ranging from $300,000 to $2.000,000 per award. Up to $9 million will be awarded by the Harry and Jeanette Weinberg Foundation in up to 20 awards, with amounts ranging from $300,000 to $900,000 per award.

Funds will be utilized to:

1) facilitate collaboration and the exchange of information related to substance abuse and mental health within the network of Historically Black Colleges and Universities;

2) expand and strengthen substance abuse and mental health services to homeless individuals;

3) promote holistic studies of trauma spectrum disorders in servicemembers; and

4) increase support for family and informal caregivers who assist older adults living in the community.

Public founding is available thru the Department of Health and Human Services (Substance Abuse and Mental Health Services Administration), and the U.S. Army Medical Research Acquisition Activity’s Defense Center of Excellence (DCoE) for Psychological Health (PH) and Traumatic Brain Injury (TBI). These grants may provide opportunities to develop and enhance your strategies for program sustainability. Decide if they are compatible with your TBI program, and share them with your partners working to improve outcomes for individuals with TBI.

Scroll down to find further details on the grants summarized (and numbered) above.

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PUBLIC FUNDING

1) Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Mental Health Services Cooperative Agreement for the Historically Black Colleges and Universities Center for Excellence in Substance Abuse and Mental Health (Short Title: HBCU – Center for Excellence) CFDA No.: 93.243. Grants.gov Funding Opportunity Number: TI-08-011. Application Deadline: May 22, 2008.

Purpose: To create a Center for Excellence that will continue the effort to network the 103 HBCUs throughout the United States and promote workforce development through expanding knowledge of best practices, leadership development and encouraging community partnerships that enhance the participation of African-Americans in the substance abuse treatment and mental health professions. The comprehensive focus of the HBCU – Center for Excellence will simultaneously expand service capacity on campuses and in other treatment venues.

Eligible Applicants: Any of the 103 nationally recognized HBCUs, or a consortium of HBCUs with a lead college/university as the applicant. Estimated Available Funds: $500,000. Maximum Award Size: $500,000. Estimated Number of Awards: 1. Project Period: Up to 3 years. For more information, contact: Shannon Taitt Center for Substance Abuse Treatment Substance Abuse and Mental Health Services Administration 1 Choke Cherry Road, Room 5-1037 Rockville, MD 20857 Telephone: 240-276-1691. Email: Shannon.Taitt@samhsa.hhs.gov or Roslyn Holliday Moore Center for Mental Health Services Substance Abuse and Mental Health Services Administration 1 Choke Cherry Road, Room 6-1077 Rockville, MD 20857 Telephone: 240-276-1825 Email: RoslynHolliday.Moore@samhsa.hhs.gov Or go to: http://www.samhsa.gov/Grants/2008/ti_08_011.aspx

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2) Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Mental Health Services Development of Comprehensive Drug/Alcohol and Mental Health Treatment Systems for Persons Who are Homeless (Short Title: Treatment for Homeless) CFDA No.: 93.243. Grants.gov Funding Opportunity Number: TI-08-013. Application Deadline: May 29, 2008.

Purpose: To expand and strengthen treatment services for persons who are homeless, who also have substance use disorders, mental disorders, or co- occurring substance use and mental disorders. SAMHSA will give preference to applicants that:

- Provide integrated primary health, substance abuse, and mental health services to homeless individuals;

- Demonstrate effectiveness in serving runaway, homeless, and street youth;

- Have experience in providing substance abuse and mental health services to homeless individuals;

- Demonstrate experience in providing housing for individuals in treatment for or in recovery from mental illness or substance abuse; and/or

- Demonstrate effectiveness in serving homeless veterans.

Eligible Applicants: Public and private nonprofit entities, including local governments, Federally recognized American Indian/Alaska Native tribes and tribal organizations, urban Indian organizations, public or private universities and colleges; and community- and faith-based organizations. Estimated Available Funds: Up to $10 million.

Maximum Award Size: $400,000 per year.

Estimated Number of Awards: Treatment for Homeless - General: Up to 13 Treatment for Homeless - Services: Up to 12.

Project Period: Up to five years. For more information, contact: Joanne Gampel, M.A. Center for Substance Abuse Treatment Substance Abuse and Mental Health Services Administration 1 Choke Cherry Road Room 5-1058 Rockville, MD 20857 Telephone: 240-276-2895 Email: joanne.gampel@samhsa.hhs.gov Or go to: http://www.samhsa.gov/Grants/2008/ti_08_013.aspx

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3) U.S. Army Medical Research Acquisition Activity (USAMRAA) The Defense Center of Excellence (DCoE) for Psychological Health (PH) and Traumatic Brain Injury (TBI) Call for Proposals: Military Psychological Health Research – Complementary and Alternative Strategies (CAM) CFDA No.: 12.420. Grants.gov Funding Opportunity Number: W81XWH-08-PH-TBI. Deadline for required Letter of Intent: April 15, 2008, 5:00 p.m. EDT. Application Deadline: May 15, 2008, 11:59 p.m. EDT. Purpose: To instigate studies that will lead to a better understanding of the current use of CAM therapies by service-members, and to explore approaches that may be particularly effective in both protecting and treating the injured service-member. The Department of Defense is dedicated to supporting evidence-based approaches to medical treatment and wants to support the use of alternative therapies if they are proven efficacious.

Specific aims of this call for proposals focus on a holistic approach for trauma spectrum disorders, including patients with TBI and/or post traumatic stress disorder (PTSD), depression, anxiety, and/or substance dependence/abuse. Eligible Applicants: Any organization with the ability to carry out scientific investigations, and is capable of addressing the unique focus and goals of the program. Funding: Two types of proposals will be considered. Individual research proposals containing preliminary data are expected to average $200,000 per year for up to four years of support; no proposal award will exceed $1 million in total funding (including indirect costs). Seedling grants proposing innovative but testable hypotheses without preliminary data, will be considered for $300,000 in total funding (including indirect costs), with research to be completed within 18 months. A total of approximately $4,000,000 is available for the portfolio of projects to be funded. For more information, contact: Russell Shilling Telephone: 703-696-9460 Fax: 703696-9478 Email: Russell.shilling@tma.osd.mil Or go to: http://tinyurl.com/4ufdoa to download the full announcement.

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PRIVATE FUNDING

4) The Harry and Jeanette Weinberg Foundation Family and Informal Caregiver Support Program The Foundation believes that the best solutions for improving long-term care and supportive services for older adults living in the community must include their family and informal caregivers, as well as the active engagement of older adults and other community members and assets. This Program provides support to innovative and/or evidence-based community initiatives or projects that help family and informal caregivers assist low and moderate income, community dwelling older adults in maintaining their independence and quality of life. Deadline for required Letter of Inquiry (LOI): June 12, 2008, 5 PM EST. Successful LOI applicants will be notified by August 1, 2008, and will have until October 7 to submit a Full Proposal. Grants will be announced in early February 2009. Estimated Available Funds: Up to $9 million over three years will support from 12 to 20 community-based Projects with grants ranging from $100,000 to $300,000 per year (for a total of $300,000 to $900,000 for each grant recipient from March 2009 through February 2012). Eligible Applicants: Non-profit 501(c)(3) organizations, including aging and human service agencies, faith-based and other community-based organizations, tribal organizations, and units of local government. NOTE: Two free Informational Phone Conferences will take place – the first on Wednesday, April 30, 2008, between 3 PM and 3:25 PM EST, the second on Thursday, May 8, 2008, between 1 PM and 1:25 PM EST.

FOR FURTHER INFORMATION

For more information, contact: The Harry and Jeanette Weinberg Foundation 7 Park Center Court Owings Mills, MD 21117 Phone: 410-654-8500 Fax: 410-654-4900 Email: CaregivingRFP@theweinbergfoundation.org Or go to: http://www.hjweinbergfoundation.org/subPages/grantmaking/rfp.htm

2006 National Youth Tobacco Survey and Key Prevalence Indicators

Thu, 24 Apr 2008 13:18:15 -0400

Information from the 2006 National Youth Tobacco Survey (NYTS) and estimates of key prevalence indicators are now available online at http://www.cdc.gov/tobacco/data_statistics/surveys/NYTS/index.htm#NYTS2006. This summary and the accompanying tables provide a full description of data from the 2006 NYTS and changes in current tobacco use since 2004, followed by a discussion of findings and programmatic implications.

2006 National Youth Tobacco Survey and Key Prevalence Indicators
From 2004-2006, middle school students reported significant declines overall in current use of any tobacco product, cigarettes, cigars, and bidis, but not in current use of smokeless tobacco, pipes, or kreteks. No significant changes overall in either the use of specific tobacco products or in the use of any tobacco product were observed among high school students during this same period. While there is not a ready explanation at this time for the recent significant declines in tobacco use seen among middle school students, these younger students’ significantly lower level of exposure to pro-tobacco advertising and promotion may, at least in part, explain this decline. When taken together, these patterns suggest that enhanced and sustained comprehensive tobacco control efforts are needed to further reduce tobacco use prevalence. Likewise, ongoing and effective surveillance and evaluation of tobacco use among youth are essential for monitoring whether declines noted among middle school students continue as they age into high school.

For questions specific to the NYTS survey please contact Heather Ryan at hryan@cdc.gov.

For media-related inquiries please contact the OSH Press Line at 770-488-5493.

NIHB Vice-Chairman Buford Rolin Testifies before House Committee on Natural Resources

Thu, 10 Apr 2008 18:38:12 -0400

On April 9th, Buford Rolin, Chairman of the Poarch Band of Creek Indians and Vice-Chairman of the National Indian Health Board (NIHB), testified as a witness before the House Committee on Natural Resources regarding H.R. 5608, a bill to establish a meaningful consultation and collaboration with tribal officials in the development of Federal policies by the Department of Interior (DOI), Indian Health Service (IHS) and the National Indian Gaming Commission (NIGC).

In the photo (left to right): President Shirley, Chairman Rolin,
and Chairman Danforth. Photo is courtesy of the Navajo Nation Washington Office.

There were two panels testifying on H.R. 5608. The first panel consisted of government witnesses and the second panel consisted of tribal witnesses. Government witnesses included James Carson, Associate Deputy Secretary of DOI, Philip N. Hogen, Chairman of NIGC and Robert McSwain, Acting Director of IHS. In addition to Chairman Rolin, the Committee heard testimony from tribal witnesses: Dr. Joe Shirley, Jr., President of the Navajo Nation, and Gerald Danforth, Chairman of the Oneida Nation of Wisconsin. Due to many other House hearings being held, Chairman Rahall was the only Committee member present during the majority of the testimony on H.R. 5608, but was later accompanied by Reps. Ron Kind (D-WI-3) and Raúl M. Grijalva (D-AZ-7) who made remarks and asked questions of the tribal witnesses.

Chairman Rahall in his opening remarks quoted a maxim from ancient Roman law: What touches all must be approved by all. He expressed concerns that everyone, except for the Administration, understands that “Indian tribes are governments and as such, should be consulted with not dictated to.” He explained that H.R. 5608 is modeled after Executive Order 13175 and would impose tribal consultation requirements on the DOI, IHS and NIGC. Acknowledging that the Committee will most likely hear opposition to the bill from the Administration as “too costly, unworkable, unnecessary, too difficult to implement”, he expressed concerns that Indian tribes have mandates imposed on them without their input and these mandates are “costly, unworkable, unnecessary, and difficult to implement.”

True to form, all three government witnesses testified that they strongly opposed the bill. Associate Deputy Secretary Carson testified that the legislation could “halt nearly all the actions in the DOI.” Chairman Hogen testified that NIGC, as independent federal regulatory agency, is exempt from Executive Orders but as a matter of policy, the NIGC consults with tribes, “Whether or not it applies, we consult with tribes.” Acting Director Bob McSwain testified that codification of the tribal consultation policy would hamper the agency’s ability to modify tribal consultation policies in the future,
“It is important for the IHS policy to be dynamic and to address the particular needs of tribes.” At the heart of the all of the administration’s objections to H.R. 5608, the government witnesses agreed that the legislation was unnecessary, would create undue administrative burden and additional costs, and would result in increased litigation.

Chairman Rolin testified in support of the bill providing examples of how tribal consultation results in implementation of successful programs for the benefit of the Federal government and Tribal communities. Chairman Rolin explained how the Special Diabetes Program for Indians was successfully implemented: “Through consultation, the IHS, tribal and urban diabetes programs have developed an implemented a variety of community and education programs that reflect the specific needs of their local communities.” However, Chairman Rolin expressed concern that the current draft of H.R. 5608 only targets DOI, IHS and NIGC, and does not include Department of Health and Human Services and other Federal agencies that implement policies impacting Tribal communities. When Chairman Rahall questioned Chairman Rolin on suggested changes to the bill, Chairman Rolin recommended the Committee amend H.R. 5608 to include all Federal agencies so that all Federal agencies would be required by statute to participate in meaningful tribal consultation. Chairman Rahall asked Chairman Rolin if he would support the bill if the bill was not amended to codify tribal consultation policies for all the agencies. Because of the complex nature of the tribal consultation, Chairman Rolin responded, “If all the federal agencies are not included, it is hard to say right now.”

Both President Shirley and Chairman Danforth supported the bill. President Shirley said, “Decisions are routinely made in Washington that effect the daily lives of Native Americans with little meaningful consultation with tribal governments.” Chairman Danforth testified that “We believe that H.R. 5608 takes the next logical step by clarifying and codifying the true intergovernmental nature of our relationship consistent with treaty, federal policy, and the intent of Executive Orders issued by Presidents representing both parties.” However, Chairman Danforth recognized the significant challenge in implementing a tribal consultation policy and its varying effectiveness, “Consultation depends on the person who is there to consult.”

The House Natural Resources also heard testimony on other legislation such as H.R. 3522, to ratify a conveyance of a portion of the Jicarilla Apache reservation to Rio Arriba County, New Mexico, H.R. 3490, to transfer administrative jurisdiction of certain Federal lands from Bureau of Land Management to the Bureau of Indian Affairs, S. 2457, a bill to provide for extensions of leases of certain land by Mashantucket Pequot Tribe and H.R. 5680, to amend certain laws relating Native Americans.

For more information on the hearing or to read the testimony submitted as part of the record, please visit the Natural Resources Committee website at:

http://resourcescommittee.house.gov/index.php?option=com_jcalpro&Itemid=27&extmode=view&extid=158

Bob McSwain, Acting Director of the Indian Health Service, Testifies before House Appropriations Subcommittee

Fri, 04 Apr 2008 18:18:05 -0400

On April 2, 2008, Robert “Bob” McSwain, Acting Director of the Indian Health Service (IHS), testified before the House Interior, Environment and Related Agencies Appropriations Subcommittee. Mr. McSwain was accompanied by four of his advisors: Dr. Richard D. Olson, Acting Director of the Office of Clinical and Preventive Services, Gary J. Hartz, Director of the Office of Environmental Health and Engineering, and Richard J. Turman, Deputy Assistant Secretary for Budget, Department of Health and Human Services. Rep. Norman Dicks (D-WA-6), Chairman of the Subcommittee, and Rep. Todd Tiahrt (R-KS-4), Ranking Member of the Subcommittee, were joined by Rep. James “Jim” Moran (D-VA-8).

In the photo: back row (left to right) Rep. Todd Tiahrt, Chairman Norm Dicks, Rep. James Moran
front row: Richard Turman, Bob McSwain, Gary Hartz and Richard Olson

In his opening remarks, Chairman Dicks recognized the 30 Tribal representatives who expressed anguish over the President’s FY 09 budget proposal during the Subcommittee’s Native American Public Witness Day held on March 12, 2008. Chairman Dicks quoted the Governor of the Pueblo of Acoma, Chandler Sanchez, “The Indian Health Service is dying a slow death from a 1,000 budget cuts.” Though Chairman Dicks acknowledged that IHS has never been funded adequately, Chairman Dicks stated emphatically that the FY 09 proposed budget is a very negative budget with negative impacts. In almost a rehearse fashion, Chairman Dicks asked Mr. McSwain, “Will the budget cuts result in 218,000 fewer outpatient visits? Will 9,000 fewer patients receive services from diabetes programs? Will 465 fewer patients receive dental services? Will 1,500 fewer patients receive mammogram screenings? Will 3,000 fewer patients receive cancer screenings?” Without disagreement or additional statements, Mr. McSwain answered, “Yes,” to each of the Chairman’s questions. Chairman Dicks said that the Subcommittee’s budget was cut by $1 billion. Chairman Dicks went on to say that the Subcommittee is placed in a difficult position when the President submits a negative budget. For a moment, Chairman Dicks acknowledged, “I understand the Secretary did his best to get this reversed, but when the President signs this, his people have to be held responsible.”

Rep. Tiahrt took the lead in examining Mr. McSwain on the proposed budget cuts, including the elimination of funding for the $14 million Meth initiative, which received funding during the FY08 Appropriations. Mr. McSwain responded that the IHS has not spent the funding but plans to set up a Behavioral Health Tribal Advisory Group to obtain tribal input on how the $14 million for the Meth initiative should be spent.

Leading into another topic on funding, the conversation turned to health professional vacancy rates and loan repayment programs. Chairman Dicks asked Mr. McSwain, that in light of the IHS’ core mission to provide primary care, “If you don’t have health professionals, how is IHS going to provide primary services?” Dr. Olson explained that recruitment is difficult due to remoteness of locations, condition of facilities and competition with the private sector. For instance, Dr. Olson explained, “We go to almost every dental school in the country but America faces a huge supply issue and we have to compete with the private sector. More dentists are retiring than coming out of dental school.” In clarifying the definition for vacancy rates, Rear Admiral Richard Church, Director of the Office of Public Health Support for the IHS, explained from the audience, “All those vacancy rates represent fundable vacancies. We have money for those positions but we cannot fill them. IHS has to contract or hire locum tenans at costs 2-3 times higher.”

Rep. Moran raised concerns regarding high rape statistics among American Indian and Alaska Native (AI/AN) women. He asked the witness panel about the availability of rape kits and trained nurses. IHS officials testified that IHS has difficulty retaining specially trained Sexual Assault Nurse Examiners (SANE). Thus, IHS doctors refer AI/AN women to other hospitals who have SANE staff to ensure the rape kits are properly performed. However, the Congressmen questioned the viability of referring patients to other hospitals because of the time sensitive nature of the evidence. Mr. McSwain mentioned the Department of Justice and the Bureau of Indian Affairs should be involved in the discussion because of the implications for criminal prosecution. Chairman Dicks suggested that a hearing be held on the issue.

In changing topics, Rep. Tiahrt showed concern for the negative impact of the budget cuts to the health care facilities construction line item. Chairman Dicks asked Mr. McSwain whether the budget cuts that cause construction to halt result in higher construction costs in the long run. In response, Hartz explained that the IHS is able to limit additional incurred costs by identifying major “stop points” in construction where construction can be restarted when funding becomes available.

In closing, Rep. Tiahrt encouraged other Congressmen to be aware of the work of United National Indian Tribal Youth organization (UNITY), which is based in Oklahoma City, Okla. He mentioned the organization’s good work in drug abuse prevention activities for youth.