National Congress of American Indians

By:  Kathleen Sebelius
Date: March 5, 2013
Location: Washington, DC

Thank you, Jefferson, for that kind introduction, and for your leadership of the National Congress of American Indians. I could not be more proud of our work together to strengthen our nation-to-nation bonds and improve the health and well-being of all tribal people.

This is the third year I've had the honor of addressing this council. I always look forward to it because it's a chance to look back at the progress we've made, and look forward at how we can build on that progress in the future.

In the immediate future, we face the challenge of dealing with the harsh, arbitrary budget cuts Congress allowed to go into effect with sequestration.

I share your concerns about what these cuts would mean for Indian Country. They could mean 3,000 fewer inpatient admissions and 804,000 fewer outpatient visits for IHS patients. They could lead to understaffing of IHS facilities that tribes have built with their own resources. They could mean children kicked off Head Start and lower payments for seniors' doctors.

As our economy improves, businesses, families, and tribes need certainty, not thoughtless cuts to programs middle-class families rely on. That's why the President has proposed a balanced approach to reducing the deficit that meets Republicans more than halfway at the negotiating table. Unfortunately, as of now congressional Republicans have refused to consider shifting any of the burden off of middle-class families.

In the weeks to come, we'll do everything we can to minimize the devastating impact these cuts will have on your communities. But I want to be clear that it's Congress that has tied our hands and the President's hands. We simply do not have the authority to decide where to cut and where not to cut. So ultimately, it's going to be up to Congress to meet the President in the middle and fix this. And the President will continue to reach out to partners in Congress who are willing to do that.

With that said, we can't let sequestration bring the other important work we're doing to a halt. And that's especially true when it comes to building on the important progress we've made to improve health and opportunity in Indian Country.

Think about where we were four years ago. Our economy was in freefall. Hundreds of thousands of jobs were being lost. Budgets were being stretched thin. In the past, a crisis like that might have led to cuts in tribal investments.

But together, we decided we weren't going to travel down that road. Despite the tough times and budget challenges, we forged a new path and continued to invest in Indian Country. We kept lines of communication open.

And because we did, we can proudly say that we did more to advance health in Indian Country in the President's first term than has been done in years.

After a decade of hanging in congressional limbo, the Indian Health Care Improvement Act has been permanently reauthorized under the Affordable Care Act. Many of you worked tirelessly to make that happen. Thank you for helping to get the job done.

We also increased the Indian Health Service budget, boosting funding by 29 percent, even as other programs were seeing their budgets frozen or cut.

And we improved benefits and protections for American Indians and Alaska Natives who have insurance, whether they receive care inside or outside the IHS. Because of the health care law, families with private insurance are now protected from the worst insurance company abuses, young people can stay on their parents' plan, and seniors with the highest prescription drug costs are getting savings.

We should be proud of the progress we made in the President's first term. But we have more work to do in his second.

Tomorrow you will hear from Dr. Roubideaux who will outline our second-term agenda to keep strengthening IHS. This includes continuing to make IHS a budget priority and carrying out additional reforms. It also means implementing the VA-IHS national reimbursement agreement signed in December, and reaffirming our commitment to address contract support costs claims -- consistent with the recent US Supreme Court decision.

And we also need your help to make sure the benefits of the Affordable Care Act reach as many people in your communities as possible. As tribal leaders, there are three things you can do to help make sure your nations reap the full benefits of the law.

First, you can educate people about the benefits that are already available.

We know there are women in your communities who are putting off their mammograms because they don't know their co-pay has been eliminated for these and other preventive services. There are parents who haven't gotten coverage for their kids because they don't know they can no longer be denied coverage for a pre-existing condition. You can help spread the word to make sure the people of your nations are taking advantage of these and other new benefits.

The second thing you can do is help educate people about the benefits of the law's Medicaid expansion.

Under the new law, states may expand their Medicaid programs to cover uninsured adults with incomes at or below 133 percent of the Federal Poverty Level. That's about $15,000 a year for an individual and $31,000 for a family of four.

The potential benefits of this expansion for tribes are huge: it means more security for working families, healthier students, more productive workers, and stronger communities.

And the best part from the states' perspective is that the federal government will pick up 100 percent of the bill for the first three years, and at least 90 percent of the bill after that.

As a former governor, I know this is a deal that can't be beat. And I'm so heartened to see governors across the country and across the political spectrum deciding to expand their Medicaid programs. But in states that haven't made up their mind, we need your help to make sure people understand exactly what is at stake for Indian Country.

Finally, the third thing you can do is help make sure the new coverage options created by the law reach people in your nations.

Starting on October 1 new Health Insurance Marketplaces opening in every state will provide many American Indians and Alaska Natives the option to purchase quality, affordable health coverage. That means more security for those who had gone without insurance in the past. And as more IHS patients get private insurance, it also means more resources and services for all patients in your local community.

But here's the key point. Just because these great benefits are available doesn't mean people automatically know about them. People are busy taking care of their families, paying their bills, and enjoying their few hours of free time. Too often, they don't think about health insurance until something goes wrong and it's too late.

And that's where you can help. As tribal leaders, people trust and listen to you. So beginning in October, we'll need your help to identify everyone who is eligible -- and then help them enroll. We need your help to get Indian Country covered.

Already, the IHS has started us down this path with the creation of the National Indian Health Outreach and Education Initiative. In partnership with your organization and the National Indian Health Board, we're working to educate American Indians and Alaska Natives across the country about the new coverage options that are coming. But together, we can do more.

Along with health care, another key area where we can build on our success in the first term is on consultation.

Four years ago, HHS had an outdated consultation policy. Today, we're proud to be a leader across the federal government -- with seven agencies within the Department having new or updated consultation policies.

And I encourage all of you to attend our Annual Tribal Budget Consultation this week, where you can work with our leadership team on the priorities of your nations.

As you know, I've also created a Secretary's Tribal Advisory Committee (STAC) to ensure that our Department's leadership receives regular updates and feedback about our work in Indian Country.

I would like to give a special thanks to Ken Lucero, who served as the chair of that committee for two years, and to Gary Hayes, who was recently elected the new chair. Will all the members of STAC please stand and be recognized? Thank you for your service.

Together, we strengthened these channels of communication in the first term because we've seen that our policies are most effective when they are most strongly shaped by tribal leaders. And in the second term, we're going to work to make our nation-to-nation relationship even stronger.

One area where we can do this is by making sure your voices are heard in state-level decision-making.

I'm happy to report that as of this year, all 37 states required to develop a Medicaid and Children's Health Insurance Program consultation plan have done so. And those that fell short -- like Kansas and New Mexico -- are resubmitting their proposals following appropriate tribal consultation.

We're also making progress with states to better support Indian health programs that interact with Medicaid. For example, in Arizona, and possibly in California, the states will provide uncompensated care payments to Indian Health Service and tribal facilities.

And because of your input, today I can announce that we're finalizing an agreement with New Mexico that will achieve two things. First, it will reflect our department's decision not to grant a waiver for Medicaid retroactive eligibility to the state, which would've negatively impacted American Indians and tribal health programs. Second, it will ensure that no American Indians are automatically enrolled in managed care.

And moving forward, we are committed to ensuring that states take into account your voices and your needs as they make policy decisions that affect your nations.

We still face challenges. There's still much more work to be done to ensure better health and greater opportunity throughout Indian Country.

But we've come a long way in the last four years. And because of what we've accomplished, we're poised to make even greater strides in the next four years.

And I look forward to working with you each step of the way into that bright and more prosperous future.

Thank you.