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Letter to Barack Obama, President-Elect of the United States - Funding Indian Country Health Programs

U.S. Senator Tim Johnson (D-SD) has asked President-Elect Barack Obama to fully fund Indian Country programs enacted as part of the President's Emergency Plan for AIDS Relief (PEPFAR) reauthorization bill, which passed Congress earlier this year. Johnson cosponsored an amendment to PEPFAR that directed money back home to fund health care, water projects and law enforcement programs on reservations.

The amendment supplemented the Indian Health Service and created an "Emergency Fund for Indian Safety and Health" within the Treasury Department. The amendment called for $1 billion for water projects, $750 million for safety and justice programs, and $250 million to address health care needs in Indian Country.

"The Senate came together months ago to increase the amount of available funding for the most critical needs currently facing Indian Country," Johnson said. "I hope the new administration shows a renewed sense of purpose in addressing the needs of our tribes and provides these resources as part of the budget request for the upcoming year. I understand the President-Elect has a lot on his plate, but it is important this does not get lost in the shuffle."

A Copy of the Letter is Included Below:

The Honorable Barack Obama
Washington, DC 20270

Dear Mr. President-Elect:

We are writing to request that the FY 2010 Budget Request include the funding authorized in Title VI of the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 (P.L. 110-293) (the "Act"). The funding would be used for desperately needed law enforcement, health care, and water projects benefitting American Indians and Alaska Natives.

Based on the U.S. Constitution, treaties with Indian tribes, and federal statutes, the United States has assumed a trust responsibility for the provision of public safety and health care to Indian people. The Native American population, however, is facing a public safety and health crisis due, in large part, to a lack of federal funding. Recognizing this fact, in July 2008, Congress authorized (1) $750,000,000 for law enforcement in Indian Country, (2) $250,000,000 for Indian health care, including contract health services, Indian health facilities, and domestic and community sanitation facilities, and (3) $1,000,000,000 for water supply projects that are part of Indian water settlements approved by Congress. See Sec. 601, P.L. 110-293. These amounts are in addition to any amounts made available under any other provision of law.
The funds authorized for public safety would begin to address the lack of staff and resources to arrest, prosecute, and detain criminals in Indian Country. According to a Justice Department study, American Indians experience violent crime at a rate more than twice the national average, yet funding for law enforcement in Indian Country is seriously deficient, contributing to serious public safety risks. For example, a 2004 Inspector General report showed that Indian detention facilitates are neither safe nor secure. The report states that "it became abundantly clear that some facilities we visited were egregiously unsafe, unsanitary, and a hazard to both inmates and staff alike. BIA's detention program is riddled with problems . . . and is a national disgrace."
A 2008 Department of the Interior-contracted report (the Shubnum Report) confirms that tribal jails are still grossly insufficient:

[o]nly half of the offenders are being incarcerated who should be incarcerated, the remaining are released through a variety of informal practices due to severe overcrowding in existing detention facilities. . . and life and safety of officers and inmates are at risk for lack of adequate Justice Facilities and programs in Indian Country.

The Shubnum Report recommends that the United States construct or rehabilitate 263 detention facilities throughout Indian Country at an estimated cost of $8.4 billion over the next ten years. Significant funding is also needed for the operation and maintenance of these facilities as well as tribal law enforcement and tribal judicial systems.

The health care funds authorized by the Act would help strengthen access to health care in Indian Country. Historically, Indians suffer from a greater incidence of illness and higher mortality rates than the general U.S. population. Indians are six and one-half times more likely to die from alcoholism, six times more likely to die from tuberculosis, and three times more likely to die from diabetes. Nevertheless, Indian health care funding remains inadequate. For example, the Indian Health Service (IHS) estimates that the unfunded total cost in FY 2008 to meet the need for IHS health care facilities was approximately $3.5 billion.

A drinking water crisis also is plaguing Indian Country. According to IHS, safe and adequate water supply and waste disposal facilities are lacking in approximately 11 percent of American Indian and Alaska Native homes, compared to one percent for the U.S. general population. In some areas of Indian Country, this figure is as high as 35 percent.

The lack of a reliable potable water supply in Indian Country results in a high incidence of disease and infection attributable to waterborne contaminants. IHS estimates that for every dollar it spends on safe drinking water and sewage systems, it achieves at least a twentyfold return in health benefits. The agency estimates that the cost to provide all American Indians and Alaska Natives with safe drinking water and adequate sewage systems in their homes is estimated to be over $2.3 billion.

In addition to inadequate safe drinking water and sewage systems throughout Indian Country, many tribes are facing water supply shortages. The cost of constructing the water supply infrastructure necessary to deliver water to these tribes would be an additional several billion dollars.

In order to begin to address the public safety and health care needs in Indian Country, Congress authorized $2,000,000,000 in appropriations for these priorities over a five-year period beginning October 1, 2008. See Sec. 601, P.L. 110-293. Accordingly, we request that the Budget include the total $2,000,000,000 for fiscal years 2010 through 2014. Of that amount, we are requesting that $400,000,000 be allocated in FY 2010. Pursuant to Title VI of the Act, the amounts requested in this letter are over and above any amounts already assumed in the baseline budget for American Indian and Alaska Native law enforcement, health programs, and water settlements.

Thank you for your consideration of this important matter.


Tim Johnson Daniel Akaka
United States Senator United States Senator

Max Baucus Jeff Bingaman
United States Senator United States Senator

Maria Cantwell Mike Crapo
United States Senator United States Senator

Pete Domenici Byron Dorgan
United States Senator United States Senator

Mike Enzi Russ Feingold
United States Senator United States Senator

Jon Kyl Herb Kohl
United States Senator United States Senator

Joe Lieberman Lisa Murkowski
United States Senator United States Senator

Patty Murray Ben Nelson
United States Senator United States Senator

Ken Salazar Charles Schumer
United States Senator United States Senator

Jon Tester John Thune
United States Senator United States Senator

Ron Wyden
United States Senator

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