National Congress of American Indians Executive Council Winter Session

Thank you for that kind introduction.

I am delighted to be here today. This is the third year I've had the opportunity to join the National Congress of American Indians and I've been proud to see the relationship between our governments grow stronger and stronger.

As you know, the list of people at the Department of Health and Human Services who come to work every day thinking about tribal issues is long and reaches the highest levels of our Department. The health and well-being of the American Indian and Alaska Native people is a top priority in every operating division and program office at HHS. And that work is driven by this Administration's belief that everyone should have the opportunity to achieve their full potential, no matter who they are or where they live.

Fulfilling that promise in Indian Country has been incredibly difficult, especially with so many persistent challenges: federal resources stretched thin, high unemployment, energy costs, suicide, and chronic disease. Essential services promised under treaties are among your sovereign rights, yet you have had to fight for support.

Over the years we have tackled some of these obstacles together and we have seen real progress. There are great success stories in programs like the Special Diabetes Program for Indians which, in its first decade, saw a 13 percent reduction in blood sugar levels across American Indians and Alaska Natives.

But when President Obama took office, he recognized that we need more than isolated victories and pilot programs. We need a comprehensive approach.

And to succeed, we had to confront three major challenges at the heart of our work: limited resources; limited access to care and services; and the need to improve consultation throughout HHS.

So over the last three years, we partnered with you to tackle these problems.

First, we've started to target resources where they have been lacking. That began with the Recovery Act which was one of the biggest investments in Indian Country in our history. It included $500 million for the Indian Health Service -- vital funds that are going toward the construction of priority health care facilities, building maintenance, water projects, medical equipment, and health information technology.

But this wasn't just a one-time boost either. Since 2008, IHS has seen its total budget increase 29 percent. And we intend to build on this progress with the 2013 budget that President Obama released last month, including another $116 million for the Indian Health Service. At a time of an overall budget freeze, these increases show this administration's continued commitment to greater access, better care, and healthier communities for years to come.

And nowhere is that more clear than in the impact these funds have had on contract health services.

As you know, in the past, only the highest priority life and limb cases have been paid for by Contract Health Service funding. With limited funds and rising costs, a lot of people were forced to wait or put off care that they needed. But more often than not, putting it off meant they only got sicker. And, in the long run, they needed even more costly care.

Now, more patients are getting the referrals they need before their cases become dire. Dr. Roubideaux shared a story from one tribal leader who had struggled with persistent knee pain for a long time. Without an MRI to diagnose the problem, there wasn't much he could do. Recently though, with the increases in contract health services funding, he finally got the MRI that he needed to start getting better.

Since 2008, we have increased the budget for Contract Health Services by 46 Percent. There is still a significant need. There is still care denied and still care deferred, but we are finally beginning to stem the tide.
I also want to make clear that my Department's commitment to improve the lives of Tribal Communities is a commitment shared by the entire department.

The Substance Abuse and Mental Health Service Administration's 2013 budget request proposes to invest more than $40 million for tribes to implement substance abuse and suicide prevention strategies.

And the Administration for Children and Families proposes to increase funding to support more children in Head Start and child care while also raising the bar on quality to ensure that these programs provide a pathway to success in school and in life.

But we also know that resources alone are not enough.

So the second broad step we took was to look at how we can increase access to care and services.

As you know, two years ago, we passed the Affordable Care Act, which contains important benefits for First Americans, starting of course, with the long-overdue permanent reauthorization of the Indian Health Care Improvement Act.

It 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. Already more than 50 tribes have signed up for the opportunity to offer coverage this way. With better access to health insurance coverage, we also hope to see more contract health dollars available for those in most need.

And the rest of the health care law -- not just the Indian Health Care Improvement Act -- is just as important, especially for the nearly 50 percent of American Indians who don't have access to an IHS facility. Many have already begun to see the difference -- from the Patient's Bill of Rights, which provides protection from the worst insurance company abuses -- to new savings in Medicare.

And in 2014, Affordable Insurance Exchanges will ensure every American Indian and Alaska Native access to quality, affordable health coverage.

Under the law we're also working hard to make sure that when you visit an Indian Health Facility, it is fully staffed with the finest doctors and nurses.

We know the power of bringing even one more qualified provider to a facility. And that's why one of the best tools we have to address workforce shortages anywhere is the National Health Service Corps -- a program that says to doctors, nurses, and dentists: "If you go practice in an underserved community, we'll give you a scholarship or help pay your loans."

But in the past, each facility had to fill out a ton of paperwork to make that happen. And that had become an obstacle to people getting better care. So we made a decision. We said that every single Indian Health Facility is approved and qualified to receive National Health Service Corps providers right now. And today, an additional 221 providers are serving across Indian Country as a result.

Now, our Department's third key goal was actually the cornerstone of everything we've been working toward over the last three years.

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.

Since then, at HHS, we have worked hard to build on that strong foundation. This week we will host our annual budget consultation and this spring we will also convene for our annual regional consultations across the country. Paul Dioguardi and Stacey Ecoffey lead these sessions for me and our department and they have helped HHS develop a stronger partnership with all of you.

We continue to explore new ways to improve the lines of communication, create a process 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.

I heard from you on the day I was sworn it that the best policies for Indian country must come from Indian country and I have followed that advice from day one.

This is why I created the Secretary's Tribal Advisory committee (STAC). I wanted Tribal Leaders to provide me and my staff firsthand advice on how we can make decisions that benefit you.

The STAC has been active for more than 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. Many members of the STAC are here today and I want to thank them for their guidance and support.

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. 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 a letter 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.

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.

Agencies like the Indian Health Service and the SAMHSA, took the lead in these efforts. And now several others have followed suit: Last summer the Administration for Children and Families signed a consultation policy and the Centers for Medicare and Medicaid Services signed theirs in November. Neither had a consultation policy prior to this administration, but today they do -- and I want to thank everyone here today who had a part in that success.

What we've learned is that consultation has to be an ongoing process. And we intend to apply that approach to Tribal self-governance.

Last month, a Federal-Tribal working group met for the first time to consider expanding self-governance for tribes in HHS-funded programs. The group started to identify existing legal barriers to self-governance, and began discussing potential strategies to move forward and overcome them.

At the heart of this effort and all of our work together is an agenda driven by, and for, Tribal Governments and your members.

Challenges remain, but together we are making progress. Resources are reaching programs that had once been stretched to the limit. Patients are beginning to get the care they need. Families are starting to get support as they look for work or job training. And our serious commitment to consultation is building a true partnership.

This Administration is working hard to change lives for the better in Indian Country.

While we have made progress, there is more to do. And we know the only way to build a bright and healthy future for everyone is to keep working side by side with you.

Thank you.

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