resources and order committee is meeting today to conduct a hearing on h r two thousand and seven zero eight the indian health care improvement act amendments of zero nine sponsored by the gentleman from new jersey frank clown and myself as a congressman gives an historic debate over the launch a new effort to improve health care for american indians secretary sebelius stated that she would challenge the congress to make the issue a priority i'm here this morning to say we will rise to the challenge the fact of the matter is that united states has an is in desperate need of this legislation it is a sad testimony that in today's america the infant death rate among american indians is forty percent higher than the rate of most of the rest of us american indians are twice as likely that from diabetes sixty percent more low pay in remote locations make it difficult for indian health facilities to retain needed professionals provide needed resources for recruitment and retention of health professionals including scholarships for continuing education  retention bonuses but they also contains important lying which require the health secretary of health and human services to expand available cancer screenings to ensure that mammogram mammogram and other cancer screenings are consistent with updated national standards board was my margraf sorry in addition the bill would create a new behavioral health initiative which would oversee a range of substance abuse mental health and social health programs as well as incorporate important traditional healing practices that have proven to be successful within a native community and finally h r twenty seven zero eight would elevate the current position the director of and in health service to have assistant secretary a patient within indian health service i would also like to take a moment to share my appreciation for the hard work the national steering committee this group of health care workers and tribal health policy experts has worked for over ten years on national regional and local levels to obtain we move this bill h r two seven zero eight the indian health care improvement act the members of two thousand and nine many in the room know how long we've been working to pass this crucial piece of legislation the indian health care improvement act actually expired nine years ago in two thousand and while there have been several attempts to reauthorize the legislation in previous congresses unfortunately none have been successful yet but i'm hopeful is out now that with a new president and a new congress will be more successful this year and we're already off to a better start in his first few weeks in office the president signed into law the children's health insurance program reauthorization and within that bill we were able to include key provisions from the indian health care improvement act we included provisions that allow states to use more of their medicaid and chip money to enroll indian children who are eligible for these programs provisions that encourage states to take steps to provide for enroll them in of indians residing on or near reservation and medicaid and s chip and also provisions that allow members of federally recognized tribes to use their travel documents to enroll in medicaid rather than having to go through the burdensome citizen document requirements in the in the regular medicaid program i also work to pull out some more provisions of the indian health care improvement and include them in the economic recovery bill that was signed into law shortly after chip these provisions included the medicaid premium and core sharing protections for indian beneficiaries as well as new protections for indian so they are not denied medicaid certain property or assets they hold like trust land in addition to those provisions there were other provisions in the economic recovery package that are important in the country we added new monies to i just the syllabus which is crucially important to improving the delivery of health care services and we included grants and laws to help providers including indian providers use and adopt health information technology does so many american indians live in remote locations improving their ability to use a and connect with other providers will dramatically improve health care services in indian country and finally i wanted to mention the health reform bill that we're currently working on as we speak the energy and commerce health subcommittee is holding hearings on the draft proposal and i'm going to have to go back to that after i speak here that was released last week and yesterday we had the opportunity to hear from the tribes on our proposal we included several provisions in that traffic bill that will benefit indian country and as we move forward with this bill i intend to continue conversations with the tribes and try to get their input on the on the larger health care reform piece of legislation but aside from all this we i know we must turn our attention to moving the indian health care improvement act before say it's critical that we act that we act quickly the unmet health needs of american indians are alarmingly severe and the longer we wait the worse we're going to get i mentioned the beginning that i'm optimistic this legislation could be passed this congress i know it's going to be hard but i think there's a big difference now with president obama and i look forward to working with everyone to ensure that our efforts are successful this time around thank you mr chairman of this is very important piece of legislation you know we talk a lot about gaming we talk a lot about recognition bills we talk about a lot of other things there's nothing more important i think than than any and health care right now in indian country i can tell you in my congressional district which we have larger tribes smaller tribes everywhere you go this issue is brought up we have an alarming rate of diabetes in indian country and it's something that i'm as long as i'm in congress hopefully a little while longer to focus on this issue and so i applaud the chairman for having this hearing and i agree with mr plow and i hope that we get this through we've had some problems in the past some hot button issues like abortion and everything else have been brought into this i hope those sorts of issues can be debated separately and that we just focus on any and health care and that's what this is all about so  support the chairman and his efforts and i thank you and  nation in fulfillment of a special responsibilities and legal obligations to the american indian people to ensure the highest possible health status for indians and urban indians and to provide all resources necessary to effect th reauthorization that the reference to urban india has taken out and as somebody who represents a district that has a very high proportion of native americans but  where that they are not living on their home reservations but in an urban setting i find this concerning i hope it's not an indication that the congress intends to exclude urban indians from the services provided as part of our nation's seven for all americans at this hearing is timely in the larger context of the current health reform debate and i think chairman revolve i thank you very much for convening this meeting the comprehensive high quality and culturally acceptable health care services in indian country and for alaska native is an important responsibility for this committee and i know this committee has worked hard in several consecutive congresses to reauthorize the indian health care improvement act to best meet the present day needs of indian country and i am an original co sponsor of this legislation and i look forward to reviewing the testimony from today's witnesses and working with the chairman to advance toward inec meant as the chairman of the health taskforce of the congressional asian pacific american caucus i recognize the importance of linguistic and cultural competence in health care and the need for us to overcome barriers to a quality care i am a representative of the u s territory of guam we share some of the same concerns i was listening to about the dialog about suicide we also had one of the highest suicide rates per provisions the recruitment and training of health professionals to work for the indian health service program and i'm equally interested in the provision to address upgrades and construction but i just wanted the statement to be placed in diabetes and a number of preventable and we're also going to a national health care debate which will affect the entire u s community i would just ask both of you for what you believe to single most important things we can understand not only generally what we're facing in indian country but in south dakota in particular a two thousand and six harvard study found that native american men in south dakota have the lowest average life expectancy of any group in the united states t study estimates that south dakota indian men will live to years old or nearly twenty years less than the average american and researchers noted that their life expectancy of only fifty eight years and comparable to that of here in africa of the other challenges we face with urban india there's the issue of recruiting and retaining qualified health care professionals and i know you address some items that could assist in that  we appreciate your work and ongoing support for improving the delivery of health care to indian people i also want to acknowledge the content of the contributions of so many tribal leaders who have served on the national steering committee for the consequently became very busy but feel strongly about the passages of health care legislation and does stay engaged during our participation we have consistently advocated opt of principles to be observed that the legislation allow no regression from current law and that the care system be modernized and strengthen i particularly want to thank you both co sponsors population the heartbreaking aspect of this is the knowledge that the majority of illnesses and deaths are preventable if additional funding and modern programatic approaches to health care were made committee to amend this bill to remove the sunset date and permanently authorize the appropriation of funds to carry out the programs in the act our request for permanent authorization is not congress authorized other living program and health services and home community based all such delivery methods are commonplace and mainstream america but rare in indian country these approaches are more efficient and responsibility to provide healthcare to the people i would be neglecting my duty as an elected tribal leader to not remind us of this responsibility tribal leaders really want every family we're no different than other families and that we want our children and our family members we want them to be happy and we want to live in a community but because of our political status because of where we live and some of the health and three things really work together to ensure that the indian health system really is a public health system that addresses the needs of individual american native communities as well as the funding and because folks don't have to travel or get early treatment lessening the cost and we really appreciate the leadership provided by congressman young were able to allow us to be able to reach agreement with the american dental association with regard to the settlement agreement and the compromise that was twenty one and we're also equally thrilled with the opportunity that the community health program allows to be able to provide some behavioral health i know that there was a comment that was made earlier about behavioral health suicide rate that's one of the things that we know because many communities don't have to be able to provide a behavior act eighty five million dollars that was designated to the indian health service for health information technology we thought that some of those resources would be available to self government to be able to address our health information technology and that did not happen rather they were distributed by the indian health service and most of those funds will stay within the indian health indian health service and weren't available to self  person on earth which i think probably makes me eligible for some of those behavioral health programs we were talking about earlier but i really appreciate you being able to get those things done i did want to clarify a statement that was made earlier with regard to appropriations and whether those are included and the answer is yes when the budget is submitted to congress approximately seven hundred million dollars third party from both medicare medicaid and private insurance is actually included in that three point two billion dollars amount so the amount that's available is actually less than you would believe i think someone answered the question earlier that no it didn't states and every other federally operated health program has protection for peer review and what that means is when our providers get together and say ok here's didn't go as well as we thought it should have how can we make sure that we can make improvements for quality assurance to make sure that our patients are getting the best care they can those kinds of information are normally in a regular facility private facility are considered exempt from discovery and all that we would be in health facilities be treated the same as every other facility in the united states and i noticed that i am way over time i apologize there was a comment that was made earlier about contracts and i believe that the answer was really  health information health information systems to make sure that we're able to provide patient data to be able to be able to third party reimbursement and i want to thank the committee for your commitment and exciting activities that i've been over the years is working with the national committee because we are so diverse and yet we've been able to maintain and develop consensus around the provisions in the bill this area an area distribution is an area where we have not been able to reach consensus and if personal respond as a california representative i do know that  adequately funded area distribution would help our area but i personally believe that current law under section one does provide for  serve as a member of the budget formulation and we are recommending as a consensus recommendation from the representatives across the country that for two thousand and eleven and regardless of whatever resources are available with what we have i think a part of it comes from living in a very traditional community when you're living in isolated three hundred fifty people and the closest available hospital as a four hundred airline ticket away you don't have any other opportunities available the community health program is actually a forty year old program that began with people who are volunteers who travelled up and down the line up and the dentist was there often just pulling teeth and if you were lucky you were at the front of the line if you were not you were toward the middle of the back of the line where the dentist came out at that time literally with a butcher's apron that was covered with blood voice and she said how are you without even thinking i began to put back the things that i probably shouldn't necessarily have gotten but it's those kinds of prevention  early childhood activities that really have the opportunity to make a difference and we know that the expansion of the community health program to tribes in the lower forty eight is really going to have that kind of an impact because somebody who   for your testimony and with that if there's no further questions or comments the committee stands adjourned thank you