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S. HRG. 113–327 

THE PRESIDENT’S FISCAL YEAR 2015 BUDGET 

FOR TRIBAL PROGRAMS 

HEARING 

BEFORE THE

COMMITTEE ON INDIAN AFFAIRS 

UNITED STATES SENATE 

ONE HUNDRED THIRTEENTH CONGRESS 

SECOND SESSION 

MARCH 26, 2014 

Printed for the use of the Committee on Indian Affairs 

( 

(II) 

COMMITTEE ON INDIAN AFFAIRS 

JON TESTER, Montana, Chairman 

JOHN BARRASSO, Wyoming, Vice Chairman 

TIM JOHNSON, South Dakota 

MARIA CANTWELL, Washington 

TOM UDALL, New Mexico 

AL FRANKEN, Minnesota 

MARK BEGICH, Alaska 

BRIAN SCHATZ, Hawaii 

HEIDI HEITKAMP, North Dakota 

JOHN MCCAIN, Arizona 

LISA MURKOWSKI, Alaska 

JOHN HOEVEN, North Dakota 

MIKE CRAPO, Idaho 

DEB FISCHER, Nebraska 

MARY J. PAVEL, Majority Staff Director and Chief Counsel 

RHONDA HARJO, Minority Deputy Chief Counsel 

(III) 

C O N T E N T S 

Page 

Hearing held on March 26, 2014 ............................................................................ 1 

Statement of Senator Barrasso ............................................................................... 22 

Statement of Senator Begich .................................................................................. 19 

Statement of Senator Johnson ................................................................................ 14 

Statement of Senator Murkowski ........................................................................... 24 

Statement of Senator Tester ................................................................................... 1 

Statement of Senator Udall .................................................................................... 16 

Prepared statement .......................................................................................... 17 

WITNESSES

Joseph, Jr., Hon. Andrew, Member-At-Large/Portland Area Representative, 

National Indian Health Board; Chair, Northwest Portland Area Indian 

Health Board ........................................................................................................ 64 

Prepared statement .......................................................................................... 65 

Payment, Aaron, Midwest Area Vice President, National Congress of American Indians; Chairman, Sault Ste. Marie Tribe of Chippewa Indians ........... 32 

Prepared statement .......................................................................................... 35 

Roubideaux, Hon. Yvette, M.D., M.P.H., Acting Director, Indian Health Service, U.S. Department of Health and Human Services ...................................... 8 

Prepared statement .......................................................................................... 9 

Washburn, Hon. Kevin, Assistant Secretary—Indian Affairs, U.S. Department 

of the Interior ....................................................................................................... 2 

Prepared statement .......................................................................................... 4 

APPENDIX

National Indian Child Welfare Association (NICWA), prepared statement ....... 87 

National Indian Education Association (NIEA), prepared statement ................. 92 

Native Hawaiian Education Council, prepared statement ................................... 85 

Patterson, Hon. Brian, President, United South and Eastern Tribes, Inc., 

prepared statement .............................................................................................. 78 

Yazzie, Albert A., President, Crystal Boarding School Board of Education, 

prepared statement .............................................................................................. 77 

(1) 

THE PRESIDENT’S FISCAL YEAR 2015 BUDGET 

FOR TRIBAL PROGRAMS 

WEDNESDAY, MARCH 26, 2014 

U.S. SENATE, COMMITTEE ON INDIAN AFFAIRS, Washington, DC. 

The Committee met, pursuant to notice, at 3:56 p.m. in room 

628, Dirksen Senate Office Building, Hon. Jon Tester, 

Chairman of the Committee, presiding. 

OPENING STATEMENT OF HON. JON TESTER, 

U.S. SENATOR FROM MONTANA 

The CHAIRMAN. We will call this hearing to order on the President’s Fiscal Year 2015 Budget for Tribal Programs. 

I want to welcome the two witnesses for this panel and also the 

witnesses for the next panel. 

We will be holding this Oversight Committee while there are 

votes happening on the Floor right now. I honestly do not know 

how that will impact the membership attending this hearing but 

we will have questions as we move forward. 

The President’s request for Indian Affairs and the Department of Interior is $2.6 billion, an increase of $33.6 million over fiscal year 

2014. The Indian Health Service budget was increased by $199 million to $4.6 billion. 

Although these proposed increases are encouraging, we must also 

acknowledge that these are harsh financial times. Tribes have not 

recovered from sequestration which resulted in across the board 

cuts to all Federal programs, including those affecting tribes and 

nowhere was this more devastating than the Indian Health Service 

where due to sequestration, continuing resolutions and a 16-day 

government shutdown, health care to Indian people was jeopardized. 

That is why today and next week, the Committee is going to talk 

about securing advanced appropriations for the Indian Health 

Service. The delivery of health care to Indian people should not be 

threatened because those of us who serve in Washington cannot get 

our act together, prepare, and pass a budget. 

There is a bill now pending in Committee, S. 1570, that would 

provide advance funding for the Indian Health Service. This bill is 

tailored after a bill Congress enacted to advance funding for the 

Veterans Administration system in 2009. I look forward to working 

with my colleagues on both sides of the aisle and the Administration on making this initiative a reality. 

2 

Despite the budgetary constraints that we face, there are some 

positive highlights in the President’s fiscal year 2015 budget request. The Committee is pleased that the Administration finally 

understands the legal obligation to fully fund contract support costs 

for both the Indian Health Service and the Bureau of Indian Affairs. 

I am particularly encouraged by the $11 million increase for social services and job training to support an initiative to provide a 

comprehensive and integrated approach to address violence, poverty and substance abuse in Indian Country. 

As we learned from Dr. Costello, who testified at our early childhood development hearing last month, we can either pay now or we 

pay later, but we are going to pay. I think it is much wiser to invest in preventive services today than pay for a lifetime of treatment and remedial assistance later. 

However, there are some areas that may not be receiving the attention they deserve. For tribal communities to thrive now and into 

the future, there must be economic development opportunities and 

an educated workforce. 

My colleagues and I have heard in numerous Committee meetings of the poor conditions at many of the BIA schools. Yet again, 

the BIA has only requested enough funding to do the site development to construct one of three schools that remain on the 2004 

school construction list. In addition to that list, there are another 

60 schools considered in poor condition. 

Finally, I am very concerned with the Administration’s request 

for drinking water and sanitation construction. There is more than 

a $3 billion backlog in drinking water and sanitation construction 

needs in Indian Country. However, across all Federal agencies, including the EPA, the Administration is only requesting $173 million to address drinking water and sanitation needs in Indian 

Country. 

Senator Barrasso obviously is not here. When he gets here, opening statements will certainly be open to him. I am going to move 

with the panel. 

On our first panel is the Honorable Kevin Washburn, Assistant 

Secretary, Indians Affairs, U.S. Department of the Interior and the 

Honorable Yvette Roubideaux, Acting Director, Indian Health Service, U.S. Department of Health and Human Services. 

Your entire written testimony will be made a part of the record. 

I would ask that you be as close to five minutes as you possibly 

can. That way, there will be enough time for me to ask questions. 

With that, we will start with you, Secretary Washburn. 

STATEMENT OF HON. KEVIN WASHBURN, ASSISTANT 

SECRETARY—INDIAN AFFAIRS, U.S. DEPARTMENT OF THE 

INTERIOR 

Mr. WASHBURN. Thank you, Chairman Tester. 

Let me say the Secretary very much enjoyed her recent visit to 

Montana. I heard wonderful stories about it. 

The CHAIRMAN. Don’t believe them. 

[Laughter.] 

Mr. WASHBURN. It is really important for her to get firsthand experience and she really enjoyed it. 

3 

The CHAIRMAN. It was a great trip and we appreciate the time 

she spent in Montana visiting Indian Country, water projects, conservation projects and energy projects around the State of Montana. Thank you. 

Mr. WASHBURN. Larry Roberts is with me, the Deputy Assistant 

Secretary who was on that trip and Pam Hayes, another Deputy 

Assistant Secretary. Two Deputy Assistant Secretaries are useless 

unless you have three so we have Tommy Thompson here as well. 

They come in threes, so we are well staffed. 

The CHAIRMAN. We appreciate them. 

Mr. WASHBURN. The budget that we propose for Indian Affairs 

this year is best characterized as a responsible budget. We understand there is not dancing in the streets, but we also understand 

there are serious budget caps here on the Hill with the MurrayRyan budget cap. We have promised to live within that so the 

budget we propose fits within the Murray-Ryan cap. It includes the $33 million increase, new money, for Indian Af- fairs and also $42 million, new money, for fire in the Department’s 

overall budget. There is a nice increase for tribes in this budget 

even though it is a very flat budget year and a very strict fiscal 

environment. 

We do propose to fully fund contract support costs. We know that 

contract support costs are necessary for tribes to be able to really 

perform under their self governance compacts and their self determination contracts, so we have fully funded them for fiscal year 

2014 and propose full funding for fiscal year 2015. We are grateful 

for the leadership of this Committee on that issue. 

We also propose a new approach to social services which you recognized in your opening statement. The Tiwahe Initiative which is 

sort of a double entendre, the idea is that we need to be serving 

families. 

Tiwahe is the Lakota word for family. The idea is we need to be 

bringing our services together more around serving families rather 

than leaving them in silos serving individuals. That program will 

help with social services. 

We have social workers running from crisis to crisis in Indian 

Country. In part through people on this Committee, Senators 

Hoeven and Heitkamp, we have seen some of the serious problems 

that these social workers face when they are under staffed and 

overworked. 

That money will basically go in large measure to provide more 

money for social workers to help get ahead of problems instead of 

being reactive all the time and just going from crisis to crisis. 

That is one of our initiatives we really think can improve things. 

We can all work together within the BIA and function more like 

a family ourselves. We think that will be an improvement. 

As part of that initiative, we have asked for funding for a housing improvement program, something we have talked about zeroing 

out in the past but we heard from tribes that is a real important 

part of their social services. We heard loud and clear they want us 

to keep the funding for the housing improvement program so we 

have asked for funding for that for fiscal year 2015. 

We have several other programs. One of them is somewhat involved with the Tiwahe Initiative is we have embarked on a proVerDate Mar 15 2010 12:43 Jul 18, 2014 Jkt 088726 PO 00000 Frm 00007 Fmt 6633 Sfmt 6633 S:\DOCS\88726.TXT JACK
4 

gram that would continue into 2015 that will reduce recidivism in 

Indian Country. 

Our chief law enforcement officer with the BIA tells me that we 

have several people in Indian Country who are serving life sentences a couple of days at a time because they committed some 

very minor offense and they get locked up for a couple of days and 

get out only to commit another offense soon thereafter. 

We are going to work on trying to reduce recidivism in Indian 

Country and especially try to provide services to people suffering 

those kinds of issues. 

Those are two of the biggest things, contract support costs and 

the Tiwahe Initiative. We have some modest increases in other 

areas. It is a fairly flat budget though. We are trying to improve 

but we are also trying to stay within the Murray-Ryan cap. 

The Obama Administration has worked very hard to improve the 

Nation’s commitment to Indian Country and we do think this budget continues that commitment. We thank you, Senator Tester, and 

this Committee for being such an important ally in that mission. 

Thank you very much. 

[The prepared statement of Mr. Washburn follows:] 

PREPARED STATEMENT OF HON. KEVIN WASHBURN, ASSISTANT SECRETARY—INDIAN

AFFAIRS, U.S. DEPARTMENT OF THE INTERIOR

Good afternoon, Chairman Tester, Vice Chairman Barrasso, and members of the 

Committee. Thank you for the opportunity to provide a statement on behalf of the 

Department of the Interior (Department) on the President’s Budget Request for Fiscal Year (FY) 2015 that was presented to Congress on March 4, 2014. The FY 2015 

budget request for Indian Affairs programs within the Department totals $2.6 billion, which is $33.6 million more than the FY 2014 enacted level. 

As the Assistant Secretary for Indian Affairs, I have the responsibility to oversee 

the numerous programs within the Bureau of Indian Affairs (BIA) and the Bureau 

of Indian Education (BIE), along with other programs within the immediate Office 

of the Assistant Secretary for Indian Affairs. The Office of the Assistant Secretary 

for Indian Affairs, BIA, and BIE programs expend over 90 percent of appropriated 

funds at the local level. Of this amount, over 62 percent of the appropriations are 

provided directly to Tribes and tribal organizations through grants, contracts, and 

compacts for Tribes to operate government programs and schools. In sum, tribal 

self-determination and self-governance programs have eclipsed direct service by the 

BIA and BIE to Indian people. Indian Affairs’ programs serve the more than 2.0 

million American Indian and Alaska Natives living on or near Indian reservations. 

The FY 2015 President’s Request supports continuing efforts to advance self-governance and self-determination, promote efficient and effective governance, prudently manage tribal natural resources, build stronger economies and self-sufficiency and maintain safer Indian communities. In November 2013, President 

Obama hosted the fifth annual White House Tribal Nations Conference. The event 

included thirteen Cabinet members and dozens of senior Administration officials 

who met with representatives from the 566 federally recognized Tribes on a wide 

range of issues including advancing the Nation to Nation relationship, economic development, housing, excellence in education, energy, infrastructure, law enforcement, cultural protection, natural resources, and Native American youth. 

Our funding priorities are guided, in part, by careful coordination with Tribes 

through a regional-to-national planning process through the Tribal Interior Budget 

Council. In addition, input from tribal leaders gained since the first White House 

Tribal Nations Conference has helped guide the Administration’s priorities and decisionmaking processes. These and other sources of tribal input have informed legislative and programmatic initiatives and funding priorities in the 2015 budget, including full funding for contract support costs. 

To insure the continued success of tribal self-determination and self-governance, 

the 2015 President’s budget request proposes to continue full funding for contract 

support costs. It includes a request for $251.0 million, an increase of $4.0 million 

above the 2014 enacted level. Based on the most recent analysis, the requested 

amount will fully fund the estimated 2015 contract support need. The availability 

5 

of contract support cost funding is a key factor in tribal decisions to assume responsibility for operating Federal programs, furthering tribal self-determination and selfgovernance. The Interior Department fully funded estimated contract support costs 

in 2014. The Bureau of Indian Affairs will continue to consult with Tribes to develop 

streamlined mechanisms and a long-term approach to advancing these shared goals. 

To further enhance the Nation-to-Nation relationship, Indian Affairs is continuing 

its comprehensive look at the regulations addressing how Indian groups apply for 

and receive Federal recognition as an Indian Tribe. The Department is reviewing 

comments recently received and plans to proceed with a proposed rule for publication in the Federal Register. After another round of consultations and a formal comment period, Indian Affairs plans to publish the final rule in 2014 or early 2015. 

In addition, the 2015 budget proposes language to clarify the Department’s authority to take Indian land into trust and amend the Indian Reorganization Act of 1934, 

thereby reducing significant delays in processing land into trust applications 

Supporting Indian Families and Protecting Indian Country 

Supporting Indian families and ensuring public safety are top priorities for the 

President and tribal leaders. As part of the President’s commitment to protect and 

promote the development of prosperous tribal communities, BIA proposes the 

Tiwahe Initiative, a new effort to support community and cultural awareness in Indian Country. Child abuse and neglect are serious and persistent problems among 

Indian populations in the United States. The impact of child maltreatment in many 

Indian communities has been devastating. It has disrupted extended family support 

networks and broken up families through placements outside the community. 

Children living in poverty are far more likely to be exposed to violence and psychological trauma, both at home and in the surrounding community. Indian communities are plagued by high rates of poverty, substance abuse, suicide, and violent 

crime. The U.S. Census Bureau recently reported that between the years 2007 and 

2011, 23.9 percent of the American Indian and Alaska Native population lived in 

poverty; a figure that exceeded the national poverty rate of 14.3 percent. 

The 2015 budget includes a comprehensive and integrated approach to the interrelated problems of poverty, violence, and substance abuse faced by Indian communities. The proposed increase of $11.6 million for social services, child welfare and 

job training programs will support the initiative by providing culturally appropriate 

services with the goal of empowering individuals and families through health promotion, family stability, and strengthening tribal communities as a whole. In its initial phase, the Tiwahe Initiative will expand BIA’s capacity in current programs 

that address Indian children and family issues and job training needs. 

To promote public safety and community resilience in Indian communities, the 

2015 budget maintains resources to build on recent successes in reducing violent 

crime and implements a new goal to lower repeat incarceration in Indian Country. 

The goal of the pilot program is to lower rates of repeat incarceration at the three 

targeted reservations of Red Lake, Ute Mountain, and Duck Valley by a total of 

three percent by September 30, 2015. To achieve this goal, BIA will implement a 

comprehensive ‘‘alternatives to incarceration’’ strategy, that seeks to address underlying causes of repeat offenses, including substance abuse and social services needs, 

by utilizing alternative courts, increased treatment opportunities, probation programs, and interagency and intergovernmental partnerships with tribal, Federal, 

and State stakeholders. 

Supporting Sustainable Stewardship of Trust Resources 

The BIA’s trust programs assist Tribes in the management, development, and protection of Indian trust land and natural resources on 55 million surface acres and 

57 million acres of subsurface mineral estates. These programs assist tribal landowners in optimizing the sustainable stewardship and use of resources, providing 

many benefits such as revenue, jobs, and the protection of cultural, spiritual, and 

traditional resources. 

Taking land into trust is one of the most important functions Interior undertakes 

on behalf of Indian Tribes. Homelands are essential to the health, safety, social, cultural, and economic welfare of tribal governments. In 2013, Interior acquired 32,148 

acres of land in trust on behalf of Indian Tribes and individuals and approved 438 

fee-to-trust applications. The Administration has set an ambitious goal of placing 

more than 500,000 acres of land into trust by the end of the Obama Administration. 

To that end, BIA has processed more than 1,500 land-into-trust applications, accepting more than 240,500 acres in trust on behalf of Tribes since 2009. To put that 

in context, that figure equals more than 375 square miles. The BIA intends to build 

on this progress to meet or exceed the 500,000 acre goal. 

6 

The BIA is striving to increase the economic utilization of Indian lands. In addition to implementing the Helping Expedite Responsible Tribal Homeownership Act 

provisions for tribal leasing approval, Indian Affairs continues to implement other 

new Federal leasing regulations finalized in early 2013. The updated regulations encourage and accelerate economic development in Indian Country. The revised regulations reformed the former antiquated, one-size-fits-all Federal surface leasing regulations for Tribes and individual Indians. The rule defines specific processes, with 

enforceable timelines, through which BIA must review leases and permits. The regulation establishes separate, simplified processes for residential, business, and renewable energy development, so that, for example, a lease for a single family home 

is distinguished from a large solar energy project. 

The 2015 budget will continue funding resource stewardship with expanded 

science and technical support started in 2014, including research, analysis, and 

technical support activities for the development of alternative and conventional energy sources, sustainable management of natural resources such as land, water, 

oceans, endangered and invasive species, and climate adaptation and resilience. In 

addition, the Indian Affairs budget proposes $35.7 million for Indian land and water 

settlements in the 2015 budget, which is equal to the 2014 enacted level. 

Advancing Indian Education 

Native American youth are the most precious resource of any Tribe, and educating our youth is vital to the well-being of Indian Country. The 2015 budget request for the Bureau of Indian Education is $794.4 million, $5.6 million above the 

2014 enacted level. Included within this funding request are programs that will advance the Department’s continuing commitment to American Indian education. 

A thriving educational system for American Indian students is essential for the 

long-term health and vitality of Native American communities and is a critical component of the broader initiative to strengthen tribal communities. In 2013, Secretary 

Jewell and Secretary of Education Arne Duncan convened an American Indian Education Study Group to address needed reforms to American Indian elementary and 

secondary education and seek higher levels of academic achievement. 

The Study Group is overseen by myself, as Assistant Secretary for Indian Affairs, 

and includes representatives from BIE, Department of Education, leading academics, and Department of Defense educational system. Foundational issues the 

group is evaluating include: the creation of a relevant curriculum; the need for retention and recruitment of effective teachers; the application of appropriate teaching 

practices; and addressing the student achievement gap. The work will be done in 

concert with President Obama’s initiative to support tribal self-determination. The 

group has traveled the Country to listen to BIE and tribal school employees, parents, and students directly impacted by the BIE system. They will conduct tribal 

consultations to gather tribal views and input on recommendations for improving 

educational outcomes in schools. The President’s budget proposes to include Indian 

education in the Opportunity, Growth and Security Fund. The Fund would support 

incentives to promote improvements in educational outcomes at schools funded 

through the Bureau of Indian Education. 

Land Buy-Back Program for Tribal Nations 

Throughout 2013, the Land Buy-Back Program continued to implement the land 

consolidation portion of the Cobell Settlement Agreement. In the Settlement, $1.9 

billion was set aside to consolidate fractionated ownership of land interests held in 

trust or restricted status across Indian Country. Under the terms of the Settlement, 

the Department of the Interior has until November 2022 to expend the funding to 

acquire fractional interests at fair market value from willing sellers. Fractionation 

has been identified as a key impediment to economic development and is a significant factor in the complexity and cost of managing the Indian Trust. Lands acquired 

through the program will remain in trust or restricted status and are immediately 

consolidated for beneficial use by the tribal nation with jurisdiction. Some of the 

beneficial uses of consolidated land include energy development, farming, cultural 

preservation, and timbering. 

In December 2013, the Department made initial purchase offers for fractional interests at three locations: Pine Ridge Reservation, Makah Indian Reservation, and 

Rosebud Reservation. In 2014, the Land Buy-Back Program has extended offers to 

additional individual owners with fractional interests at these locations and will 

send offers to owners at other locations. Purchasing interests at fair market value 

from willing sellers ultimately strengthens tribal sovereignty by increasing tribal 

land bases. As a result of Buy-Back offers, tens of thousands of acres have been consolidated and millions of dollars in payments have gone to willing sellers. The program is focusing on the most fractionated locations and using a detailed mass apVerDate Mar 15 2010 12:43 Jul 18, 2014 Jkt 088726 PO 00000 Frm 00010 Fmt 6633 Sfmt 6621 S:\DOCS\88726.TXT JACK
7 

praisal method where feasible to achieve the most cost-effective acquisition of fractional interests. 

Other Bureau funding in the Department 

As this Committee is aware, all the departments within the Executive Branch of 

our Federal Government potentially have at least one or more bureaus or programs 

that provide funding in support of Native Americans and Tribes. The Department 

of the Interior (Department) is no different. The Department’s FY 2015 budget includes $612 million for programs in other bureaus, not in Indian Affairs, in support 

of Native Americans and Tribes. This reflects an increase of $42 million or 7.4 percent from 2014 enacted levels. When added together with the Indian Affairs budget, 

the total request for Indian programs is $3.2 billion. This is an increase of $76 million or 2.5 percent over 2014 enacted levels. 

Listed below are a few highlights of the programs outside the Indian Affairs budget that support Tribes and American Indians and Alaska natives, these include: 

• Wildland Fire: The Wildland Fire budget includes $200.1 million for emergency 

and non-emergency Fire Programs. The Tribal initiative includes additional 

$52. 3 million in funds for Fire Preparedness, Fuel Management, and the Resilient landscapes program.. Funds will support contract support costs, workforce 

development, firefighter and support personnel, and to maintain veteran 

crews0. 

• The Bureau of Land Management (BLM) budget includes $16.9 million for programs such as Alaska conveyance, oil and gas, and coal and other minerals to 

support Native Americans. 

• The Fish and Wildlife Service (FWS) budget includes $10.7 million for a widerange of activities including fish hatchery maintenance and Tribal Wildlife 

Grants. 

• The National Park Service (NPS) budget includes $13.5 million for Native 

American programs including grants for Historic Preservation Fund and the 

Native American Grave Protection programs. 

• The United States Geological Service (USGS) budget includes $7.6 million for 

Tribal Science Partnerships which includes an increase of $2.8 million for Tribal 

Science Partnerships. 

• The Office of Surface Mining (OSM) budget includes $2.1 million for programs 

with Crow, Hopi, and Navajo tribes. 

• The Office of the Special Trustee (OST) includes $139.0 million for programs 

that manage Indian funds held in trust by the Federal Government. 

• The Office of Natural Resources Revenue (ONRR) budget includes $35.0 million 

for the management of royalty assets from Indian trust properties, an increase 

of $1.0 million. 

• The Bureau of Reclamation (BOR) budget includes $186.5 million for Native 

American programs including $112.0 million for Indian Water Rights Settlements. 

Conclusion 

This FY 2015 budget supports the Administration’s objectives to strengthen tribal 

nations through economic development, protect Indian communities through public 

safety and justice programs and social services, improve Indian education to secure 

the long-term health and vitality of Indian Country, and improve the governmentto-government relationship between tribal nations and the United States. The 2015 

budget request maintains the President’s commitment to meet our obligations to 

tribal nations while exercising fiscal responsibility and improving government operations and efficiency. 

Chairman Tester and Members of the Committee, thank you for the opportunity 

to appear before you today. I am happy to answer any questions you may have. 

The CHAIRMAN. Thank you for your testimony, Secretary 

Washburn. 

Dr. Roubideaux, you are up. 

8 

STATEMENT OF HON. YVETTE ROUBIDEAUX, M.D., 

M.P.H., ACTING DIRECTOR, INDIAN HEALTH SERVICE, U.S. 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Dr. ROUBIDEAUX. Thank you and good afternoon, Chairman Tester. 

I am Dr. Yvette Roubideaux, the Acting Director of the Indian 

Health Service. I am pleased to provide testimony today on the 

President’s fiscal year 2015 budget request for the Indian Health 

Service. 

The President’s fiscal year 2015 budget request in discretionary budget authority for the IHS is $4.6 billion, an increase of $200 

million or a 4.5 percent increase. 

The request includes priority increases for medical inflation, 

staffing and operation of four newly constructed facilities, an increase for the Purchased/Referred Care Program, formerly the Contract Health Services Program, pay costs, funding for five new 

tribes, funding to restore reductions made in 2014 to fund priorities 

and full funding for the estimated need for contract support costs 

in fiscal year 2015. 

We are very happy about this proposal and the outcome in 2014. 

We thank you for your partnership on this issue and I am glad we 

were all able to work together to make sure we could advocate and 

get the tribal priorities enacted. 

The budget proposal also includes health care facilities construction funding to complete construction on the Kayenta, Ft. Yuma 

and Northern California Youth Regional Treatment Center and 

funds to continue construction on the Gila River Southeast Arizona 

facility. 

The President’s fiscal year 2015 budget request also includes an 

Opportunity, Growth, and Security government-wide initiative that 

proposes an additional $200 million for IHS health care facilities 

construction. 

The fiscal year 2015 budget also includes legislative proposals to 

reauthorize the Special Diabetes Program for Indians for an additional three years, to establish authority for Medicare-like rates for 

non-hospital and physician/non-physician services and to provide a 

tax exemption for the Indian Health Service Health Professions 

Scholarship and Health Profession Loan Repayment Programs. 

The IHS budget is critical to our progress in accomplishing our 

agency priorities, reforms and improvements. If this proposed 

budget is enacted, the IHS appropriations will have increased 38 

percent since 2008, so thank you for your partnership. 

Appropriations increases received in the past six fiscal years are 

making a substantial difference in the quality and quantity of 

health care we are able to provide American Indians and Alaska 

Natives. We are grateful that IHS remains a top budget priority. 

The budget request was developed after formal tribal budget formulation process and incorporates tribal budget priorities. Tribal 

consultation is a priority of President Obama who has expressed a 

commitment to honoring treaty rights and making tribal consultation a priority. 

In order to continue our commitment to tribal consultation, I 

plan to personally conduct listening sessions in all IHS areas this 

year to hear views from tribes on how we can continue to make 

9 

progress in agency reforms. I do believe I am holding a listening 

session next week in Montana. 

IHS has made improvements in a number of areas detailed in my 

written testimony. One of those areas is contract support costs. In 

addition to working with tribes on a long term solution for contract 

support costs or CSC appropriations, we have also made substantial progress on settling past CSC claims. 

We heard input from Congress and tribes to accelerate the settlement process and our recent dedicated increase in resources and 

staff is making a difference. IHS has analyzers in the process of 

analyzing over 550 claims and since Ramah, IHS has made settlement offers on over 200 claims from 31 tribes. The total settlement 

amount to date for 104 claims that have been formally settled or 

are in the process of settlement totals over $133 million. 

IHS is committed to fair, consistent, and speedy resolution of 

claims through settlement wherever possible. 

In summary, we are working hard and in partnership with Congress and tribes to change and improve the Indian Health Service 

through our reform efforts. We really thank you for your support 

and partnership. 

The increases IHS has received in the budget over the past few 

years are making a difference but we know we still have much 

more to do. We look forward to working with you on the President’s 

fiscal year 2015 budget request to help continue or progress in 

changing and improving the Indian Health Service. 

Thank you and I am happy to answer questions. 

[The prepared statement of Dr. Roubideaux follows:] 

PREPARED STATEMENT OF HON. YVETTE ROUBIDEAUX, M.D., M.P.H., ACTING

DIRECTOR, INDIAN HEALTH SERVICE, U.S. DEPARTMENT OF HEALTH AND HUMAN

SERVICES

Good morning Chairman Tester, Vice Chairman Barrasso, and Members of the 

Committee. I am Dr. Yvette Roubideaux, Acting Director of the Indian Health Service. I am pleased to provide testimony on the President’s Fiscal Year (FY) 2015 

Budget request for the Indian Health Service (IHS), and to update you on our 

progress in addressing our agency mission to raise the physical, mental, social, and 

spiritual health of American Indians and Alaska Natives (AI/ANs) to the highest 

level. 

Indian Health System 

IHS is an agency within the Department of Health and Human Services (HHS) 

that provides a comprehensive health service delivery system for approximately 2.1 

million American Indians and Alaska Natives (AI/ANs) from 566 federally recognized Tribes in 35 states. The IHS system consists of 12 Area offices, which are further divided into 168 Service Units that provide care at the local level. Health services are provided directly by the IHS, through tribally contracted and operated 

health programs, through services purchased from private providers, and through 

urban Indian health programs. 

President’s FY 2015 Budget Request 

The President’s FY 2015 Budget request in discretionary budget authority for the 

IHS is $4.6 billion; an increase of $200 million, or 4.5 percent, over the FY 2014 

enacted funding level. 

The request includes priority increases: $63 million for medical inflation, $70.8 

million to staff and operate four newly constructed health facilities, $15.4 million 

for a general program increase for the Purchased/Referred Care (PRC) program (formerly known as Contract Health Services) that results in a total increase of $50.5 

million when added to the $32.5 million for medical inflation for PRC and a program 

increase of $2.6 million for New Tribes, $2.5 million for pay increases for federal 

and Tribal health program staff, $8 million for five new Tribes, $10 million to reVerDate Mar 15 2010 12:43 Jul 18, 2014 Jkt 088726 PO 00000 Frm 00013 Fmt 6633 Sfmt 6621 S:\DOCS\88726.TXT JACK
10 

store funding reductions made in FY 2014 to fund priorities, and $29.8 million for 

contract support costs (CSC), primarily for the estimated need for new and expanded contracts. The budget proposal also includes $85 million for health care facility construction to complete construction and the staff quarters for the Kayenta, 

AZ facility, begin and complete construction of the Fort Yuma, AZ facility, continue 

construction of the Gila River Southeast, AZ facility, and complete construction of 

the Northern California Youth Regional Treatment Center. 

The President’s FY 2015 Budget request also includes an Opportunity, Growth 

and Security government-wide initiative to grow the economy and create opportunities. For IHS, the initiative includes an additional $200 million to continue progress 

in constructing facilities on the IHS Health Care Facilities Construction priority list. At the Program Level, the budget also estimates $1.2 billion in third party collections in FY 2015 that includes an estimated increase in Medicaid reimbursements 

of $22 million compared to FY 2014, which is anticipated to result from additional 

enrollees as the Affordable Care Act continues to be implemented. The Program 

Level funding also includes $39 million in estimated reimbursements from the Department of Veterans Affairs. 

The FY 2015 President’s budget also includes legislative proposals to reauthorize 

the Special Diabetes Program for Indians for an additional three years, to establish 

authority for Medicare-Like Rates for non-hospital and physician/non-physician 

services for Indian Health Service, Tribal and Urban Indian Health Programs, and 

to provide a tax exemption for the Indian Health Service Health Professions Scholarship and Health Profession Loan Repayment Programs similar to the National 

Health Service Corps programs. 

IHS—Continued Progress 

Over the past few years, we have been working to change and improve the IHS. 

The IHS budget is critical to our progress in accomplishing our agency priorities and 

improvements. If this proposed budget is enacted, IHS appropriations will have increased by 38 percent since FY 2008. The appropriations increases received in the 

past six fiscal years are making a substantial difference in the quantity and quality 

of healthcare we are able to provide to AI/ANs. IHS remains a top Administration 

priority. In the President’s FY 2015 Budget request the HHS discretionary budget 

overall decreased while IHS’ budget increased. 

IHS has made considerable progress in addressing our Agency priorities and reforms and the budget increases have been critical to this progress. Tribal consultation is fundamental to our Agency reform activities. This budget request was developed after a formal Tribal budget formulation process and incorporates Tribal budget priorities. Tribal consultation is a priority of President Obama, who has expressed a commitment to honoring treaty rights and making tribal consultation a 

priority. In order to continue our commitment to Tribal consultation, I plan to personally conduct listening sessions in all IHS Areas this year to hear views from 

Tribes on how we can continue to make progress on Agency reforms. 

Tribal consultation helps us focus on budget priorities. For example, funding for 

the Purchased/Referred Care (PRC) program, formerly called the Contract Health 

Service program, is a top budget priority of IHS and Tribes and has increased by 

60 percent since 2008. This increased funding is making a difference. Four years 

ago, most programs were funding only Medical Priority 1, or ‘‘life or limb’’ referrals. 

In FY 2013, 15 out of 66 Federal PRC programs were able to fund referrals beyond 

Medical Priority 1. This means these programs are paying for more than just life 

or limb care and more patients are accessing the health services they need, including preventive services such as mammograms and colonoscopies. The increased PRC 

funding also means that the IHS Catastrophic Health Emergency Fund (CHEF), 

which used to run out of funding for high cost cases in June, now is able to fund 

cases through August. 

In this budget request, the Administration demonstrates its commitment to selfdetermination by continuing its FY 2014 commitment to fully fund the estimated 

amount of CSC for FY 2015. Of particular importance for the FY 2015 budget is 

Tribal consultation on a long term solution for funding CSC, as requested in the Explanatory Statement accompanying the Consolidated Appropriations Act of 2014. 

The Explanatory Statement requested the Department of the Interior and IHS consult with Tribes and work with Congress and the Office of Management and Budget 

on long term accounting, budget, and legislative strategies. IHS will be engaging 

Tribes in multiple forums over the next several months to develop strategies for the 

long term CSC solution. A workplan on the plan for consultation is under development and will be submitted to Congress as requested. 

Related to this is IHS’ work to resolve all past claims for underpayment of CSC. 

IHS has heard the request from Tribes and Congress to accelerate the rate at which 

11 

the Agency is resolving past claims. As a result, IHS has devoted additional resources and staff to resolving claims for unpaid CSC with a primary focus on speedy 

resolution through settlement whenever possible. IHS must analyze each claim individually and comply with the multi-step process required by the Contract Disputes 

Act. IHS is working to resolve the claims expeditiously and also believes that the 

Agency and Tribes working together to resolve the claims will have the most benefit 

for our ongoing relationship. IHS is also improving internal business practices related to the CSC claims settlement process. IHS is also consistently reviewing methods to enhance collaboration and streamline the process, and has offered an alternative claim resolution process that is less burdensome for Tribes but still is fair 

and consistent for all Tribes. 

This work is showing results. As of March 18, 2014, IHS has analyzed, or is in 

the process of analyzing, over 550 claims. Since Ramah and as of March 18, 2014, 

IHS has made settlement offers on over 200 claims for 31 Tribes. Of those claims, 

34 claims have been formally settled with five Tribes, and an additional 68 offers 

have been accepted by eight Tribes and are in the process of settlement. This is a 

considerable increase from the three settled claims reported as of November 2013. 

The total settlement amount for claims that have been formally settled, or are in 

the process of settlement, totals over $133 million. Our goal is to resolve the majority of currently pending claims with Tribes that are amenable to settlement and to 

extend settlement offers to all Tribes by the end of calendar year 2014. I personally 

have experienced the recent increased pace of our settlement process since I now 

receive emails almost every day from Agency attorneys requesting approval of settlement offers. 

IHS is also continuing its work to reform the IHS. We are now focused on implementation and outreach activities to ensure that our patients benefit from the Affordable Care Act. We want every patient who visits our facilities to get education 

and assistance primarily from the business office, which is a place where every patient spends some time in our facilities. All of our sites have been working hard to 

educate our patients on the Affordable Care Act provisions. 

We have also been working with national and regional Tribal organizations to 

conduct outreach and education on the benefits of the Affordable Care Act. Our 

partners include the National Congress of American Indians, the National Indian 

Health Board, the National Council of Urban Indian Health, and the Self-Governance Communication and Education organization. 

Our internal reform efforts are focused on improving the way we do business and 

how we lead and manage our staff. Overall, we have implemented many improvements. To improve the way we do business, we are working with HHS and our Area 

Directors to improve how we manage and plan our budgets and improve our financial management. We are working to make our business practices more consistent 

and effective throughout the system. We are also working on program integrity and 

responding to recommendations from oversight agencies to ensure we are effective 

and using federal resources wisely. 

We are also working on strategies to improve recruitment and retention, which 

are big issues at all of our sites. This includes working on specific activities to make 

the hiring process more efficient and proactive, and less time-consuming. We need 

to make sure the way we do business is not causing us to lose the opportunity to 

hire and keep quality staff. 

We are also continuing work on our priority of improving the quality of and access 

to care for our patients. We have emphasized the importance of customer service, 

and we are also working on a number of initiatives to help improve the quality of 

care and promote healthy Indian communities. 

One of the most important of these is our Improving Patient Care, or IPC, program. The IPC is our patient-centered medical home initiative that is designed to 

improve the coordination of care for patients. This is about making changes that 

will result in measurable improvements in patient-centered care, including reduced 

waiting times, more access to appointments, and improvements in the quality of 

care. The patient-centered medical home is a big focus of the changing health care 

system in the United States. 

We plan to expand this initiative throughout the entire IHS system—currently we 

have 127 sites. Many of these sites are doing really outstanding work, including reducing waiting times, improving no-show rates, and arranging the system so that 

patients can see the same providers each time they come to the clinic, which results 

in better coordination of care. 

A few other initiatives are also helping us improve the quality of care. The Special 

Diabetes Program for Indians (SDPI) is continuing its successful activities. In partnership with our communities, we can prevent and treat diabetes in Indian country 

with innovative and culturally appropriate activities. Our 2011 SDPI Report to ConVerDate Mar 15 2010 12:43 Jul 18, 2014 Jkt 088726 PO 00000 Frm 00015 Fmt 6633 Sfmt 6621 S:\DOCS\88726.TXT JACK
12 

gress clearly shows that the SDPI programs have done an incredible job of implementing activities to prevent and treat diabetes in the communities we serve. The 

data in the congressional report shows that the SDPI programs have dramatically 

increased access to diabetes treatment and prevention services. For example, access 

to diabetes clinics has increased from 31 percent to 71 percent of grant programs 

from the 1997 baseline before SDPI funding to 2010. Based on local needs and priorities, the SDPI grant programs have implemented proven interventions to address 

the diabetes epidemic, often where few resources existed before. 

The most important impact of these combined and sustained clinical improvements is seen in the dramatic drop in the rate of end stage renal disease (ESRD) 

in American Indian and Alaska Native people with diabetes when compared with 

other racial and ethnic groups in the U.S. 

Between 1995 and 2011, the incident rate of ESRD in American Indian and Alaska Native people with diabetes fell by nearly 39 percent—a greater decline than for 

any other racial or ethnic group. Given that the Medicare cost per year for one patient on hemodialysis was $82,285 in 2009, this reduction in the rate of new cases 

of ESRD means a decrease in the number of patients who would have required dialysis—translating into millions of dollars in cost savings for Medicare, IHS, and 

other third-party payers, as well as improved quality of life for patients who do not 

need dialysis. 

Diabetes health outcomes have also improved significantly in American Indian 

and Alaska Native communities since the inception of the SDPI. One of the most 

important improvements has been a 10 percent reduction in the average Hemoglobin A1C levels of American Indians and Alaska Natives with diagnosed diabetes. 

Improved blood sugar control contributes to reductions in complications from diabetes. This FY 2015 President’s Budget request includes a proposal to reauthorize the 

SDPI for another 3 years to maintain and build upon this important progress. 

We are also focusing on behavioral health issues, which Tribes have identified as 

a top priority. IHS is making progress on implementing its recently released National Behavioral Health Strategic Plan and its National Suicide Prevention Plan. 

And the evaluation data from our Methamphetamine and Suicide Prevention and 

Domestic Violence Prevention initiatives show very promising results as the programs are implementing evidence-based strategies. 

IHS has a lead role in the First Lady’s Let’s Move! in Indian Country initiative, 

which includes our IHS Baby-Friendly Hospital initiative and a collaboration with 

the Notah Begay III Foundation involving activities to prevent childhood obesity. 

We are promoting breastfeeding in all IHS hospitals because it has been shown that 

breastfeeding can reduce childhood obesity. We are also encouraging all triballymanaged hospitals to join us in this effort. 

We have also established a new hospital consortium to work on improving quality 

and maintaining accreditation requirements in our hospitals. We plan to establish 

a system-wide business approach to accreditation. 

We are meeting regularly with the Department of Veterans Affairs (VA) to implement activities to better coordinate care for American Indian and Alaska Native veterans who are eligible for both VA and IHS care. We have also implemented the 

VA–IHS national reimbursement agreement at all federal facilities and are billing 

and receiving reimbursements from the VA for direct care provided to American Indian and Alaska Native veterans. 

We have accomplished a great deal as we work to meet our priorities, and this 

is reflected in our Government Performance and Results Act (GPRA) measures. In 

FY 2011, for the first time ever, we met all of our clinical GPRA measurement goals. 

In FY 2012, we did great again. And the results are now in for 2013, and once 

again, we met all of our clinical targets. We are very proud of all the IHS and tribal 

sites that worked so hard to make improvements in the quality of the health care 

that we deliver. Our focus on improving the quality of care, along with more accountability system-wide, is making a difference. But we know that we still have 

much more to do. 

In summary, we are working hard and in partnership with Tribes to change and 

improve the IHS through our reform efforts, and we thank you for your support and 

partnership. The increases IHS has received in its budget over the past few years 

are making a difference, and we look forward to working with you on the President’s 

FY 2015 Budget request to help continue progress. Although we are in a challenging 

fiscal environment, the work of the past few years has clearly established that by 

working together, our efforts can change and improve the IHS to ensure that our 

AI/AN patients and communities receive the quality health care that they need and 

deserve. 

Thank you and I am happy to answer questions. 

13 

The CHAIRMAN. Thank you both for your testimony. We very 

much appreciate it. Thank you for the work that you do. 

I will start with you, Kevin. If I’m the only one here, we will 

probably ask questions for a while. Then you can take a break and 

we will go to Dr. Roubideaux. 

This year’s budget, as already pointed out, has a 1.2 percent increase over last year’s enacted levels. There is a chart up there 

that you can see of the Interior allocations. I am not saying the National Park Service should not get 22.2 percent, because our national parks are in disrepair. I am not saying that the BLM should 

not get 6.1 percent because the BLM needs resources to be able to 

do their job. 

What I am saying and what you know much better than I is the 

challenges out there in Indian Country across this country. Their 

increase is almost at the bottom, yet we have so many challenges 

out there. 

I don’t know how your life works. I don’t know if you come in 

and say we need a 5, 10, or 20 percent increase over last year and 

they just whittle you down and keep whittling you down until you 

get to 1.2 percent or if you come in at zero and hope they give you 

1.2 percent. The chart is not right, it says 1.5 percent. It is 1.2 percent, lower than that. 

How do we get budgets that will work? I know you have to shed 

the best light you can on this budget but this needs some work. 

Give me an idea of what you are up against? Who do we need to 

talk to? Who do I need to get Senator Udall or Senator Johnson 

to talk to so we can get some of these figures up so the people and 

the agencies can do the job? It will help morale and help folks on 

the ground. 

Mr. WASHBURN. You put these charts up and they look pretty 

bad. I feel there are some apples and oranges going on in these 

charts. 

I won’t quibble with it too much except to say I think we would 

provide different data and it would look a bit different the way we 

would present it. For example, over the last five years, in the 

Obama Administration you would find the President’s budget request for Indian Affairs has been higher than for any other agency 

at the department. 

If you pick out one year, you can cherry pick figures and make 

it look bad. You are also comparing tiny budgets to big budgets. 

Our overall budget is about $11 billion at the Department of Interior. Ours is $2.6 billion, so it is a big chunk of that. Some of these 

offices are tiny offices that $1 million can make a 10 percent swing 

in the office if it is a $10 million office. 

I guess we would quibble with this but the question is how do 

we come up with these budgets. We work really hard and the Secretary made a real commitment this year and really went to bat 

for the Indian Affairs budget. Compared to the really big budgets 

at the Department of Interior, we did okay. 

If you compared apples to apples, I think you would find we 

didn’t get the request the National Park Service got for their centennial year. There is a special occasion this year for them next 

year and there is also this Opportunity Growth and Security Initiative built into these numbers that you have presented. 

14 

We didn’t quantify our request for that initiative. It is in there. 

We have a request for Indian education in that initiative but we 

didn’t put a number figure. We kind of got shellacked here because 

we didn’t attach a number to the Opportunity Growth and Security 

Initiative which is the President’s way of saying if we do get more 

money than the Murray-Ryan caps provide, we are going to put a 

significant amount into Indian education. 

I am not sure this graph is entirely fair. 

The CHAIRMAN. That is a fair statement but here is what we will 

argue. When you talk about this Administration putting in record 

amounts of money, especially compared to previous administrations, that is apples and oranges too because the previous administrations haven’t exactly been stellar when it comes to Indian Country. 

I would just say this. It comes down to things within these programs and we can go down the list and you can pick any line item 

and say it is deficient. Honestly, you might be able to do that with 

the other budgets also but in this case because of the trust responsibility we have and treaty responsibilities we have, it is different. 

I know where your heart is. I just think we need to figure out 

how we can work together to make this happen. 

The only other question I have is I know OMB plays a role in 

all this budgetary stuff. Sometimes they are the hammer that 

pares back things. I would like your honest assessment. Does OMB 

know about the trust responsibilities and treaty rights that this 

country has for Indian Country? 

Mr. WASHBURN. Mr. Chairman, they have actually learned a lot. 

I have to say they have really been much more engaged with tribes 

over the last few years. I think they really have gotten onboard and 

gotten much more engaged with tribes. 

I think it might be fair to say they are sort of the adults in the 

room who say hold on a second, we have to meet these MurrayRyan budget caps so we cannot give you everything you dream of; 

we have to pare it back a little bit, but they do have sense of the 

trust responsibility and have been learning a lot. 

The CHAIRMAN. I appreciate that. 

We are going to do something a little different. I am going to go 

down the line. I want seven minutes on the clock for questioning 

because I think there are two people here who are pretty important 

to everyone on this Committee. 

I will start with you, Senator Johnson. You can do it with an 

opening statement or go right into questions, whatever you prefer. 

Senator JOHNSON. I will give my opening statement for the 

record. 

STATEMENT OF HON. TIM JOHNSON, 

U.S. SENATOR FROM SOUTH DAKOTA 

Senator JOHNSON. Mr. Washburn, I appreciate the BIA is focusing on reducing repeat incarceration in Native communities. However, tribes are still struggling with the lack of infrastructure. 

Tribal law enforcement and agencies need detention centers that 

are not falling apart and tribal courts need integrated courts for 

drug and mental health issues. How is the Department planning 

on addressing this infrastructure issue? 

15 

Mr. WASHBURN. Thank you, Senator Johnson. We have increased 

our funding request for detention facilities in Indian Country. We 

have 96 existing detention facilities. As Chairman Tester said in 

the beginning we have about 180 schools. I don’t like those numbers. I wish we had a lot more schools than detention centers. The 

fact is we don’t take care of either one of them enough. In the fiscal year 2014 budget, we had a $14 million increase for 

detention facilities and because we just got our operating plan finalized about a month ago, that money is just now to a place where 

we can use it. That money is continued into the fiscal year 2015 

budget request so there will be more money available. 

We fund the detention programs at about 55 percent of need. 

That is not enough. Many of the poorest tribes cannot afford to 

come up with the other 45 percent. This is going to be an ongoing 

challenge for us but we are working hard to meet it. 

Senator JOHNSON. Too often I hear from South Dakota BIA funded tribal schools that they much continually use ISEP funds to pay 

the heating and electrical bills. Can you please explain why the 

President’s budget does little to alleviate the burden of administrative costs, facilities operations, and maintenance costs? 

Mr. WASHBURN. You are asking that question at a very stressful 

time for tribes and for the Administration. The cost of propane this 

winter was a serious problem in your State and that really ate into 

those funds. 

We pay for our maintenance program out of the same funds, we 

pay for our electric bills and the propane bills. If you use up all 

your money on propane, it doesn’t leave a lot for maintenance and 

repairs and that sort of thing. That has been a real challenge to 

all of us. 

We hope that is a one year problem and that the costs will not 

repeat themselves. We have also worked on other strategies of trying to pay in advance for propane so that we are paying a more 

flat rate rather than dealing with the ups and downs in the market. We are exploring ways to deal with those problems. 

It is a tough fiscal environment. We are trying to do a lot with 

a little amount of money. 

Senator JOHNSON. The expense of propane exacerbates things. 

This issue has long been in existence, the use of ISEP funds for 

overhead. 

Dr. Roubideaux, you noted the dramatic increase in funding for 

the Purchased Referred Care Program. However, in a recent GAO 

study, this program was given poor marks on the handling of medical claims. Recently a South Dakota dialysis clinic reported to me 

that the business has thousands of dollars of unpaid claims and a 

number of patients were left to foot the bill because their life-sustaining dialysis treatments were not a high medical priority. 

Can you please address how IHS will improve both the claims 

process and approval of referred patient services? 

Dr. ROUBIDEAUX. Thank you for that question. We will have our 

staff connect with yours about that particular provider and that 

particular issue. 

The Purchase and Referred Care Program, how we pay for referrals, we have been working very hard to try to improve our ability 

to process and pay for those referrals and have been working on 

16 

education with outside providers on eligibility, looking at our billing process and the GAO report you mentioned looked at how we 

are measuring our progress. We are implementing recommendations from that report. 

We want to do everything we can to make sure we can pay or 

authorize referrals in the quickest time possible. We definitely 

want to work with you on this issue. 

Senator JOHNSON. The Sanitation Facilities Construction Program provides critical water supply and disposal for individual 

homeowners and projects. 

As Chairman of the Banking, Housing, and Urban Affairs Committee, it is important to me to find solutions to our critical housing needs. With a tremendous need for water systems in Indian 

Country, how will IHS continue to work with tribes and other 

agencies to address the need for this critical infrastructure without 

a budgetary increase? 

Dr. ROUBIDEAUX. We are very interested in finding solutions in 

this area because you are correct, there is an incredible need. 

One of the things we have done in the past year is signed an 

interagency memorandum of understanding with other Federal 

agencies to try to leverage other resources and look at what legal 

or regulatory things might be getting in our way. That MOU is 

with EPA, HUD, DOI and the Department of Agriculture. 

That will help us make sure we can look for some creative solutions to this very significant challenge. 

Senator JOHNSON. I yield back. 

The CHAIRMAN. Senator Udall? 

STATEMENT OF HON. TOM UDALL, 

U.S. SENATOR FROM NEW MEXICO 

Senator UDALL. Thank you very much, Chairman Tester. I really 

appreciate being here with you as our new Chairman. 

I want to completely identify with the frustration of the Chair 

and the passion he spoke of in terms of the budgets and looking 

at these charts. He has outlined something and I would adopt his 

comments. 

In addition, I would point out it has been absolutely devastating, 

the long terms effects sequestration has had on Indian Country. 

Dr. Roubideaux, the IHS was the only direct medical service agency that was subject to full sequestration cuts. Medicare, Medicaid, 

children’s health insurance, veterans affairs, all were either exempt 

or received a smaller cut of 2 percent. 

According to your testimony in April 2013, you estimated that 

the reduction would include 3,000 in-patient admissions, 804 outpatient visits and this was a painful, unnecessary, arbitrary cut to 

communities that can ill afford them. 

I am not going to go on and on. I will put the statement in the 

record because I want to ask you questions on BIE. 

It is important we get the figures out there. BIE schools lost 

$42.2 million as a result of sequestration. This had to be absorbed 

by 183 already underfunded schools. 

Tribal Head Start programs lost $11.9 million as a result of sequestration, impacting 25,000 children in 26 States. 

17 

The Bureau of Indian Affairs, Office of Public Safety had an 

$18.3 million sequestration cut and I could go on and on. I know 

you both know and understand this very well. I would be interested 

as we proceed with the hearing how these cuts are going to affect 

us in terms of moving forward. 

[The prepared statement of Senator Udall follows: 

PREPARED STATEMENT OF HON. TOM UDALL, U.S. SENATOR FROM NEW MEXICO

I would first like to thank Chairman Tester and Vice Chairman Barrasso for holding this important hearing. I am glad to see my friend Assistant Secretary for Indian Affairs, Kevin Washburn, here today. I look forward to hearing from him, as 

I do the rest of this distinguished panel, as we discuss the President’s FY 2015 

budget and the impact on Indian communities. 

I’d like to begin by addressing the devastating and long-term effects sequestration 

have had on Indian Country. The IHS was the only direct medical service agency 

that was subject to full sequestration cuts. Medicare, Medicaid, Children’s Health 

Insurance Program, and Veteran’s Affairs were all either exempt, or received a 

smaller cut of 2 percent. According to her testimony in April 2013, Dr. Roubideaux 

estimated that reduction would include 3,000 inpatient admissions and 804,000 outpatient visits. This was a painful, unnecessary, arbitrary cut to communities that 

can ill-afford them. 

The BIE schools lost $42.2 m as a result of sequestration. This had to be absorbed 

by the 183 already underfunded schools. Tribal Head Start programs lost $11.9 million as a result of sequestration, impacting 25,000 children in 26 states. The Bureau 

of Indian Affairs Office of Public Safety had a $18.3 sequestration cut. The Indian 

Housing Block grant program was cut $34.5m by sequestration. And the cuts continued. I will be interested in hearing how these cuts affect programs moving forward. 

Contract support costs are a vital part of tribal self-determination and self-governance. I think everyone here can confidently acknowledge the positive outcomes that 

have resulted from tribes having the option to contract and carry out their own services. Unfortunately, funding for contract support costs has consistently fallen short, 

and I look forward to addressing with Dr. Roubideaux the steps being taken to address the underpayments, in addition to hearing from Mr. Washburn how the budget will try to anticipate these costs. 

I look forward to working with my colleagues on this Committee to help address 

the long-standing issues facing Indian country. I am encouraged by the administration steps to take seriously our responsibilities to Tribes, and look forward to hearing how the President’s budget reflects that commitment. 

Senator UDALL. Let me ask a couple questions. Dr. Roubideaux, 

I appreciated your testimony about the work the Indian Health 

Service is doing to address outstanding claims for contract support 

costs. As you noted, these have real impacts on tribes, including 

tribes in New Mexico. However, while you have reported considerable progress overall, your agency has stated that of the 93 claims, 

zero have been settled and 81 are still pending. 

What will you do to work with me and the Committee to ensure 

that tribes receive the settlements they are entitled? 

Dr. ROUBIDEAUX. We are absolutely committed to working with 

you to try to resolve these past claims for contract support costs as 

quickly as possible. 

If you look at the claims in New Mexico, I think since we sent 

you information, I think in my in-box a settlement offer to one of 

the tribes popped up and I approved it. We will see how that negotiation goes. We have also completed four analyses and have 15 

claims on the priority list for New Mexico. 

We are working very hard and know that tribes need this funding, they know it is owed to them and we want to work very hard 

to resolve these claims. We are working hard. The numbers are 

18 

changing on a daily basis, so I am glad to be able to give you a 

little update. 

Senator UDALL. I hope you will update us and keep us apprized 

because as you have said, these contract support costs are absolutely crucial for self determination and for the tribes to be able to 

move forward with the things they believe are important to them. 

We have an Indian center in Gallup called the Gallup Indian 

Medical Center. It has long been on the list. It is a facility that 

needs to be renovated, if not replaced. At this time, how is the IHS 

creatively thinking to advance the management of facilities and 

construction to update or improve or replace these outdated facilities and what other sources of funding, what greater use of Telehealth or emerging models of care are you contemplating to address this concern now and in the future? 

Dr. ROUBIDEAUX. We are absolutely trying to do everything we 

can to address the health facility construction needs in Indian 

Country and they are enormous. The current priority list, which 

Gallup Indian Medical Center is on, has $2.1 billion of construction 

left on it. 

In addition to our President’s budget, the Opportunity Security 

and Growth Initiative has the $200 million increase for health facilities construction. We do hope that gets good consideration. 

We do a lot of creative things. The average age of our facilities 

is 20–30 years, so we do things like save our third party collections. 

Gallup Indian Medical Center was very innovative and was able to 

build an entire outpatient center doing that. 

We look at leasing sites, we look at other innovative things like 

modular construction, and we look at what kinds of repairs we can 

make. Tele-health is an area that really does help us expand services without having to do construction. New Mexico leads in that 

with several programs that are happening and help get services to 

rural areas. 

In terms of delivery models, I think there is a lot of change with 

the changing health care delivery system. We are working on our 

Improving Patient Care Initiative which looks at reorganizing the 

clinic to make sure patients waiting times go down and there is 

more availability of appointments, with more of a team approach 

to care. In some cases, that involves reorganizing the actual space 

in the clinic to be more efficient. 

We are working on some of those things, but we know funding 

is the quicker answer and we are working on that as well. 

Senator UDALL. Thank you. 

Assistant Secretary Washburn, you heard me talk a bit about the 

impacts of sequestration. Moving forward and coming up with your 

budget, what are you trying to do, as best you can, to fill the holes 

and make a difference in terms of the cuts that have happened and 

how we are going to move forward to deal with what has happened 

in the past? 

Mr. WASHBURN. You are right, a lot of the tribes are still feeling 

the sequestration because we did not backfill the five percent that 

got cut. First of all, we paid full contract support costs in the 2014 

year when we did get funding, so we couldn’t backfill the five percent because we had other purposes for that money suddenly. 

19 

We did a few other things we felt were important in the law enforcement area and a little bit in education. We are doing the best 

we can and tribes are frustrated and struggling. We are in tight 

fiscal times. As long as we are in tight fiscal times, it is going to 

be hard to get out of this. 

Hopefully with the economy improving, we won’t get another sequestration, we will get past the Murray-Ryan budget caps and go 

back to regular order where we can ask for what we need rather 

than trying to live and fit into really tight caps. We are working 

hard on that. I just came from two days of budget meetings with 

tribes and they are really feeling the pinch. 

Senator UDALL. Thank you very much. I know you are both 

working very hard to try to remedy some of this. 

Thank you and I yield back. 

The CHAIRMAN. Senator Begich. 

STATEMENT OF HON. MARK BEGICH, 

U.S. SENATOR FROM ALASKA 

Senator BEGICH. Thank you, Mr. Chairman. 

Thank you both for being here today and thanks for the work 

that you do for Indian Country and Alaska Native communities 

throughout my State. 

As you know, we have the most remote parts of the country and 

some of the most difficult challenges be they from health care to 

education to infrastructure and many other things. Thank you all 

very much for being here. 

Dr. Roubideaux, thank you for your work at the Indian Health 

Service. I know at times we have pushed back quite a bit here and 

I am trying to get some resolution. Let me follow up quickly on the 

data point you were sharing with Senator Udall. 

I would love to see you submit something to the Committee with 

regards to how many cases are still pending overall, how many are 

being actively pursued for resolution and how many are still kind 

of out there getting scheduled and what those time schedules 

would be. 

If you could answer that now, it would be great. If you can submit something, that would be even better. If you can answer that, 

I also have some additional questions in regards to the past claims 

issues. 

Dr. ROUBIDEAUX. For contract support past claims, we have 

heard from Congress and tribes that they wanted us to accelerate 

the claims process, so we committed additional resources and staff. 

Currently, there are 1,200 claims pending but we have about 550 

of those in analysis or the analysis is done. We have actually made 

offers on over 200 claims from 31 tribes. The total amount of claims 

that either there have been offers formally settled or accepted and 

in the process of settlement is about $133 million worth. 

Our progress definitely over the past couple of months has increased and we are working hard to continue that increase because 

we know it is important that we settle those as quickly as possible. 

Senator BEGICH. Do you think you would be able to give to the 

Committee, with the numbers remaining in the process, what that 

schedule would look like timewise? It doesn’t have to be specific but 

you expect another x amount of cases settled in x amount of time. 

20 

Is that something you could tell me now or submit to the Committee so that we have a good sense of how that progress will 

move? 

Dr. ROUBIDEAUX. We would like to work with you and give you 

frequent updates on that. It is hard to estimate because some of 

the cases are in Federal court. 

Senator BEGICH. Yes, and some are more complicated. 

Dr. ROUBIDEAUX. Some are more complicated and the negotiations are in process. The one thing we can control is getting settlement offers out to the tribes. That is our primary goal right now, 

as soon as possible to get settlement offers out to the tribes. 

Senator BEGICH. That is the 550 where you have done an analysis. From that 550, 200 of those are in motion or have been resolved and the remaining amount are ones you could make offers 

to at some point because now you have an understanding of where 

the parameters are. Is that a fair statement? 

Dr. ROUBIDEAUX. Yes. We have worked collaboratively with the 

tribal lawyers on this and have negotiated. I am really seeing 

progress in my email inbox every day or offers that I approved. I 

approved one while I was waiting for the hearing. 

Senator BEGICH. Let’s stop the hearing and you continue to approve a few more. 

Dr. ROUBIDEAUX. We are seeing the numbers go up like that, so 

I am pretty confident we can make significant progress this year. 

Senator BEGICH. That is very good. 

As you know, I have had regrets about this initiative and sometimes I know you felt too aggressive from me maybe, but this is important. It is contract provided services and we need to settle them 

so we can move forward. 

The next question I have, which I think is a great statement, 

2014 and 2015, and now the 2015 budget has full funding of contract support services. We greatly appreciate that. I want to make 

sure that at some point you will put together a more detailed plan 

of how you can maintain that. 

One of the big concerns people have is maintaining that may 

mean other services get squeezed within the overall Interior budget 

and/or within budgets like BIA and others. I don’t know if you are 

planning to submit something to the Congress or the Administration, but this is something I would be very interested in. 

Now you have two years under your belt, one year and moving 

to two years, hopefully, and that piece of the puzzle, it is very important that it’s sustainable, long-term and full funding. Is that 

something you could provide at some point, your plan of action? 

Dr. ROUBIDEAUX. Yes, sir. The Consolidated Appropriations Act 

of 2014 required a work plan to be submitted within 120 days. 

That is due in May. We are very interested in working with all of 

you on the long term solution for contract support costs, to be able 

to determine the more predictable amounts and that would work 

in the overall budget formulation with other priorities. 

Senator BEGICH. In May when you submit that, is that to us and 

the Administration or is it the Administration first and then to us? 

Dr. ROUBIDEAUX. Yes. It goes through our clearance and then 

goes to Congress. We are happy to discuss it with you before we 

21 

develop the plan. It is a plan for consultation on the issue because 

we want to develop this in consultation with the tribes. 

Senator BEGICH. Perfect. May is 30 some days away. 

Dr. ROUBIDEAUX. Yes. 

Senator BEGICH. Also, as you know, I am a lead sponsor on the 

advance appropriations bill for Indian Health Services which I 

know about a year ago we asked for the position you would have 

on that. Do you have any new information you can share? Do you 

support that legislation or does the Administration have a position? 

Can you give me your thoughts on that? 

Dr. ROUBIDEAUX. We are very happy to work with this Committee on this issue. We know it is a top tribal priority. It would 

be so good to have more predictable and stable funding levels. 

Senator BEGICH. Can I take that as you are supportive of the 

concept in the legislation and we could talk about the details? 

Dr. ROUBIDEAUX. We just saw the legislation and are now reviewing it. We are talking with the VA to see their experiences. We 

are hoping to have more definitive information for you. 

Senator BEGICH. I would love that soon. I know we have done it 

with the VA very successfully. I actually have a bill for the VA also 

to finish out their discretionary advanced funding. Between VA and 

Indian Health Service, it would make a huge difference long term. 

I know we have done it on the medical side of VA. I supported 

that when I first came in. Now I have the bill for VA on discretionary and also now Indian Health Services. I would love your 

thoughts on that. 

I have some other things I will submit for the record. If I could 

jump very quickly to Mr. Washburn, we have talked about public 

safety issues. Based on conversations we have had publicly and privately, there is always great stress on your budget but tell me your 

thoughts on how we are going to go after the issue based on the 

report. 

We had a hearing here in regards to the report done on the 

needs not only in Alaska but across the country in public safety 

and how we can get these more unified and also how and what you 

need to be successful. 

I can tell you in Alaska, the incarceration rate with the Alaska 

Native population is double the population percent which is unacceptable. As you know, I have a bill which I think in a week along 

with other bills, we will be doing a hearing on. I would love to hear 

your thoughts on what you think we need to be doing. Obviously 

we are not doing enough. I don’t mean that in a negative way but 

we just are not. 

Mr. WASHBURN. Senator Begich, thank you for your leadership 

on the contract support cost issue. You have made a difference 

there and it has been helpful. 

The law enforcement issues are important. I think we have increased funding over the Obama Administration. That is the area 

where we probably have already increased funding the most in our 

budget or it is close to it. It is one of the highest priorities. I just 

came out of two days of budget meetings with tribes, including the 

Alaska region, where law enforcement, once again, was one of the 

highest priorities. 

22 

It is no small challenge to try to start funding 229 Native villages and 109 tribes in California in addition to the ones we are 

already under funding. During really tight fiscal times like we are 

in, I am not sure if we can make a big impact on that. 

Senator BEGICH. It is a resource issue. 

Mr. WASHBURN. It is a resource issue and requires changing our 

paradigm about how we do this stuff because in Public Law 280, 

States like yours, we just don’t fund very much law enforcement. 

That is a problem. Those tribes have public safety issues as well. 

Senator BEGICH. Serious issues. 

Mr. WASHBURN. Absolutely. 

Senator BEGICH. I know I am out of time, Mr. Chairman, but I 

will submit other questions for the record if that is okay. 

The CHAIRMAN. Absolutely. Thank you. 

Senator Barrasso, we appreciate your being here. We appreciate 

your courtesy for the previous ones. 

STATEMENT OF HON. JOHN BARRASSO, 

U.S. SENATOR FROM WYOMING 

Senator BARRASSO. Thank you, Mr. Chairman, for holding this 

hearing on the President’s Fiscal Year 2015 budget request for tribal programs. 

We all recognize the Federal Government has important responsibilities in Indian Country. Public safety, education and health 

care are just a few. Carrying out the responsibilities requires 

money and as I have stated before, priorities and spending will receive increasing scrutiny, especially with the enormous Federal deficit. 

Agencies are called upon to find a more efficient manner of operating and promoting economic development, especially and particularly for Indian communities. Earlier this month, I introduced S. 

2132, the Indian Tribal Energy Development and Self Determination Act Amendments for 2014. 

This bill is going to streamline the bureaucracy of Indian energy 

resource development and in turn facilitate long term job development and economic growth. 

Secretary Washburn, I have a couple of things. 

In reading the testimony from both you as well as from Dr. 

Roubideaux, you highlight several behavioral health initiatives as 

top priorities, appropriately. The Bureau of Indian Affairs proposes 

a new family initiative to address violence and substance abuse 

within Indian communities related to what Senator Begich talked 

about in terms of crime. 

How is your agency coordinating with tribes and the Indian 

Health Service to effectively implement these interrelated initiatives? 

Mr. WASHBURN. Our Tiwahe Initiative, our family initiative, is a 

request for the fiscal year 2015 budget which we do not have yet. 

Let me say we have already started planning in the hope we will 

have it funded and it will require coordination. 

So far it is an initiative in concept. We have not had lengthy conversations with our partners in IHS and elsewhere about that but 

that is certainly something we need to do. We need to take a much 

more holistic attitude towards these problems. 

23 

Senator BARRASSO. I appreciate your efforts and direction. 

I mentioned the energy bill I introduced again this session. Your 

written testimony notes that the Bureau of Land Management is 

requesting $16.9 million for programs such as oil and gas to support Native Americans. 

The Bureau of Land Management also requested a $6,500 fee for 

submitting an application for a permit to drill for energy. The Bureau of Land Management has stated in recent budget justifications that this fee is to offset the application processing costs. 

I am looking for an explanation in detail of what makes up those 

processing costs for the applications for a permit to drill? 

Mr. WASHBURN. Thank you for your leadership on Indian energy 

issues. We know you are concerned about those and have been a 

constructive partner on those issues. 

I can’t tell you what all the specific costs are. We probably need 

to get someone from BLM to do that better. I will tell you there 

has always been frustration about how slow we are to issue our 

APDs at BLM. The good news about those costs is they go to offset 

the costs so that BLM can process more of those. That is a good 

thing because it requires the people who want to drill to bear the 

cost of the drilling, the processing costs and the government. 

I am not sure exactly what each of those costs is but we work 

very closely with BLM on processing these APDs. We have a part 

to play and they have a role to play as well. That is one reason 

why, Mr. Chairman, those figures you put up on the board where 

you say BLM is funded higher than BIA, some of the BLM money 

actually benefits Indian tribes also. That happens and that is why 

some of those figures aren’t so obvious. 

We would be happy to get back to you with a clearer answer exactly accounting for those figures. 

Senator BARRASSO. I’d appreciate it. 

Dr. Roubideaux, we talked a little bit in the past about the cost 

to construct all facilities on the current Indian Health Care Facility 

Priority List. It is over a billion dollars. I think in your testimony 

was it was $1.2 billion. I’m sorry, over $2 billion, I can’t read my 

own writing. 

I have also emphasized to you a number of times that the primary health care facility on the Wind River Reservation in Wyoming is nearly 140 years old. We have only been a State in Wyoming for 124 years. It was there before we became a State. 

It would astonish everyone in this room, I would imagine, to 

know that the facility is not even on the priority list. We are talking about a priority list of $2.1 billion and it has not even made 

it to the priority list yet. 

The last time I asked, you said you would be happy to work with 

us. I just what to know what has happened since we last visited? 

Have you personally worked with the Wyoming tribes to develop a 

plan and a timeline for addressing their facility needs? 

Dr. ROUBIDEAUX. We address the facility needs in a number of 

ways. The first is the list which by law we have to address all of 

those facilities but we do have other ways to address health care 

facilities construction. I know Wind River has been interested in 

the joint venture program. 

24 

The good news I have to share today is that we are approving 

the last three agreements from the last round of applicants. Wind 

River is one of them. We can move forward with that joint venture 

agreement. 

We also plan to open a new round of applications for joint venture later this year. We are trying to look at other innovative ideas 

in addition to trying to fund the Health Care Facilities Construction List and trying to move forward on some of these other programs. 

Senator BARRASSO. Hopefully we can continue to work together 

on this because it continues to be an issue of concern for many. 

Thank you, Mr. Chairman. 

The CHAIRMAN. Senator Murkowski. 

STATEMENT OF HON. LISA MURKOWSKI, 

U.S. SENATOR FROM ALASKA 

Senator MURKOWSKI. Thank you, Mr. Chairman. 

Welcome to you both, Mr. Washburn and Dr. Roubideaux. Thank 

you for all that you do. 

From a budgetary perspective today, I am going to focus my 

questions on some of the programs that really have impact on our 

tribal governments and our village clinics. These are the small and 

needy tribes account at BIA and the Village Built Clinic Lease Program at IHS. 

We have clearly seen the benefit of these programs but considering these programs keep the village governments, and the village 

clinics open, it is important we pay attention to them as priorities. 

Oftentimes they get kind of swept under with all of the other big 

things we are dealing with. I appreciate the discussion you have 

had with Chairman Tester as well as Senator Begich on contract 

support costs and the advances we have made which were long and 

hard fought but I think we are on the right track. I agree with Senator Begich, we need to make sure that it continues on that track. 

I am also very curious, Dr. Roubideaux, to hear greater clarity 

from the Administration in terms of our request on the advance appropriations. That is an area where I look at the trust responsibility we have to our Native people which is akin to our obligation 

to our veterans. 

If we can provide greater certainty to our veterans, if we can assure that during times of furloughs and cutbacks that they don’t 

see that reduction, I would certainly like to think that we can afford the same to our Native people as well. I would be curious to 

hear your response to that. 

Mr. Washburn, on the small and needy tribes issue, the BIA 

budget justification describes the background behind the small and 

needy tribes account, the initiative that was advanced in the early 

1990s. It was the 1994 Joint Tribal Advisory Task Force on BIA 

Reorganization that made the recommendation to provide the small 

tribes with a base of $160,000 and in that, the recommendation for 

Alaska tribes was $200,000 as a base. Of course we know that this 

has never been met. 

You always feel you have to make a special case but we know, 

you know, both of you, that the costs in rural Alaska are tremendously high. Utility bills are eight to nine times higher than they 

25 

are in the lower 48. In Noatak, in the northwest Arctic area, they 

are looking at energy costs of 87 cents a kilowatt hour as compared 

to about 11–11.5 cents in other parts of the lower 48. 

The cost to keep the lights on and the cost to heat a building is 

extraordinarily expensive for our tribes. Given the minimum 

amount of funding they receive, it is not penciling. Our tribal populations are growing. We have seen a 19 percent increase in the Bering Strait region in the past ten years. 

Population has gone up, costs are going up and yet, the assistance for our small and needy tribes has not moved. I guess the 

question to you, Mr. Washburn, is given what we have seen within 

BIA necessary budget increases for public safety and school operations, and I am not complaining about it, we know these programs 

are not eligible for our Alaska tribes. 

Can you give me any kind of commitment or assurance that we 

might see a base funding level to Alaska tribal governments of the 

$200,000 that was recommended in that report? What is the future 

of this? 

Mr. WASHBURN. I am relatively new to this issue, so I guess I 

would like to take it back and respond to you in writing. 

We do have a Small and Needy Tribes Program. It sounds like 

you are saying we have a shortfall that we don’t provide $200,000 

to each of the Native villages in Alaska. My understanding is we 

only have about five tribes in the lower 48 still involved in the 

Small and Needy Program because the base of $160,000 has been 

eclipsed by the regular funding. 

The idea behind the Small and Needy Program was it sort of provided a base funding in case your ordinary funding didn’t rise to 

$200,000 or $160,000 in the lower 48. We can look at that. We can 

look to see what the shortfall is and talk to you more about that 

and try to figure out what is the shortfall and what is needed to 

solve that. With 229 Alaska Native villages and $200,000 for each, 

we are talking real money. 

Senator MURKOWSKI. We are talking real money. I clearly understand and appreciate this. I also appreciate your willingness to 

take a look at it if you are not familiar with it. Again, some of the 

programs available for our tribes in the lower 48 through BIA are 

simply not available to the Alaska tribes. 

If we are going to treat all of our Native people on some level 

of funding parody, I think this is an area we need to be looking at. 

If you are willing to explore it with your staff and mine sitting 

down, I would certainly welcome that. 

Mr. WASHBURN. We would be happy to. 

Senator MURKOWSKI. Dr. Roubideaux, we have had good opportunity to talk about the success we have seen with our dental 

health aid therapy program in our tribal communities. I think it 

is something we point to as a source of pride, an innovative way 

to be able to provide for oral health care needs of our Native people 

in areas where we are not going to see dentists out there on a regular basis. 

I have been pleased with how we have built that forward. It is 

important that we continue to see the support of the DHAT program in the budget process in order to see these improvements in 

access to the care. 

26 

The other program that we follow closely, on which you and I 

have had a conversation, that is essential to delivering basic health 

services in our remote Native communities is the Village Built 

Clinic Lease Program. The Indian Health Care Improvement Act 

mandates that IHS develop and operate the community health aid 

program of which the funding for the VBCs, these leases are essential. The Village Built Clinic Program that really helps keep our 

health clinic doors open. 

Going back to the rising costs that we see directly related to energy that impacts our utilities, VBCs only cover 55 percent of clinic 

operating costs. IHS has not increased the lease rental since 1989. 

I know we have had a chance to talk about it before. In previous 

conversations, you indicated this was something you would like to 

look into to gain a better understanding. 

I really think we are in a situation and I hear from so many of 

our tribes that they just don’t know where to turn. It would appear 

that some of our more remote communities are just kind of forgotten. I cannot forget them, will not forget them. 

My question to you with both these programs is, the Dental 

Health Aid Therapy Program and the Village Built Clinic, what are 

you doing to address both of them within the context of this budget 

we have before us? 

Dr. ROUBIDEAUX. We definitely see the success of the Dental 

Health Aid Program in Alaska. We actually posted on my director’s 

blog a very positive position paper showing our support for that 

program. In terms of the budget formulation process, we definitely 

want to continue to work with you on that and also on the Village 

Built Program. 

As I think about all the programs in Alaska are 638 and there 

is the ability to rebudget their programs. We are proposing an increase in medical inflation in 2015. I wonder if maybe that kind of 

increase gives tribes the flexibility to put funds into different areas 

they might have a need. 

We are interested in talking with you more and working with 

you. I know a work group has been formed in Alaska and I believe 

there is some new information they want to share on the needs related to village built clinics. We are definitely willing to continue 

to work on this issue with you. 

Senator MURKOWSKI. My time has expired so I will be very quick. 

Are you saying that contained within your fiscal year 2015 budget, 

you think you have funding flexibility with this inflation factor or 

not? 

Dr. ROUBIDEAUX. Because the tribes manage the programs under 

the ISDA contracts and compacts, they can rebudget and reprogram however they want. As we look at the increases in the budget, we are proposing a $63 million increase in medical inflation. It 

is really up to the tribes how they use those funds. That might be 

a way to address some of these needs. 

Senator MURKOWSKI. It is not necessarily taking it from another 

budget category where we are arm wrestling with somebody else? 

Dr. ROUBIDEAUX. This is on top of. In particular, we have talked 

about the hospitals and clinics line item and the medical inflation 

increase does include increased funding for the hospitals and clinVerDate Mar 15 2010 12:43 Jul 18, 2014 Jkt 088726 PO 00000 Frm 00030 Fmt 6633 Sfmt 6601 S:\DOCS\88726.TXT JACK
27 

ics line item. Under the ISDA, tribes are able to rebudget funds 

however they want. 

Senator MURKOWSKI. Is there anything separate for VBCs, for 

the village built clinics? 

Dr. ROUBIDEAUX. There hasn’t ever been a separate line item for 

village built clinics in the budget. There was conference language 

that mentioned it many years ago, but it really can be in the hospital and clinic line item and any funds could be used towards 

leases in that particular line item. That is part of the great thing 

about tribal management, the flexibility with ISDA. 

The challenge, of course, is there are many other priorities and 

each tribe makes decisions about what they need to fund. We are 

hoping that this increase in medical inflation, once it gets to the 

local level, each tribe can make choices about how they allocate 

those funds. 

Senator MURKOWSKI. I would be interested in learning a bit more 

about that. I recognize we can have very successful, innovative programs like the DHAT Program and have these programs like VBC 

that have been critical in maintaining these clinics but we have to 

make sure that we have the funds in the budget to allow for that 

going forward. 

As you gain more information from some of our tribes on this 

and we can better understand what is going on within the medical 

inflation account, perhaps we can build on that. 

Thank you, Mr. Chairman. Thank you for the additional time. 

The CHAIRMAN. Absolutely. Thank you, Senator Murkowski. I appreciate your line of questioning. 

Secretary Washburn, over the last month and a half I have 

toured most of the reservations, some of them twice. I will tell you 

they have some great new facilities I can think of across Highline 

3, as a matter of fact, that have facilities that are brand new that 

aren’t open and they are done. They are not open because they 

don’t have staffing. 

I was wondering how your department works with other Federal 

partners, DOJ, the Indian Health Service, the Department of Education, to ensure that operations and maintenance expenses are 

being fully funded for these new facilities because it is really frustrating that we have literally state of the art facilities that are either partially open or not open at all. 

Mr. WASHBURN. To the extent those are detention facilities, we 

fund our existing detention facilities at 55 percent of need, which 

is not adequate. Tribes are frustrated by that. We increased our 

funding in the operating plan we just finished for fiscal year 2014. 

We increased the fund by $14.3 million for new facilities that have 

come on line. 

If we used all of that $14 million for the new facilities, including 

one at Ft. Peck, we would be funding those facilities at 88 percent 

of need but meanwhile, our existing facilities would be at 55 percent of need. 

We are trying to figure out a more fair way to allocate that 

money. We may very well be spreading around that money a little 

bit more to not just include the six newest facilities but some of the 

other relatively new ones like the ones you are talking about that 

have come online in the last few years. 

28 

That will not be 100 percent of need for staffing but it will be 

much closer to what the tribes need. 

The CHAIRMAN. The bottom line in almost every other question 

I have asked, you understand this and I know you get it, right now 

there just aren’t the resources there to open these facilities. I am 

not going to say it is almost criminal because it is criminal because 

in a lot of these cases, we have criminals walking the streets because they don’t have a facility to put them in. 

Ft. Peck’s water system and the O&M associated with this is a 

BIA obligation. You know the BIA and the tribe negotiated the 

amount of money that is required to operate this project and that 

the tribes executed the Indian Self Determination Act contract 

based on those negotiations. The BIA only requested $750,000 for the operation, maintenance 

and repair of the water project that provides water to frankly most 

of the folks on the Ft. Peck Reservation. Why is BIA having so 

much trouble determining the cost of operation, the cost of repair 

and maintenance of this project? 

Mr. WASHBURN. Chairman Tester, I am not sure why that is. 

Last year I think we over funded the project for operation and 

maintenance. Because of that, this year we lessened that amount. 

We are committed to funding it at the proper amount going forward, but we were trying to average out for the last two years basically so we get to the right amount. 

We do want to see that project with the right amount now that 

it is finished so it can continue going forward. We will certainly 

work with you when it comes to the fiscal year 2016 budget formulation to get it right. We hope it averages out for fiscal years 2014 

and 2015. 

The CHAIRMAN. Which brings up another issue, an issue we tend 

to create around here, not you, and that deals with government 

shutdowns and reserve accounts. What is your perspective on reserve accounts as they apply to government shutdowns? 

Mr. WASHBURN. The government shutdown is the best reason I 

see to having tribes running these programs because they can keep 

operating even if the Federal Government is shutdown but they 

have to have the money to do so. We need to create flexibility in 

the system to ensure they can do so. 

The CHAIRMAN. I would hope we can figure out what the amount 

is supposed to be and get it there. Quite frankly, if I was running 

the water system right now, seeing what I saw last fall, I wouldn’t 

deplete my reserve account either. 

I want to talk a little bit about education and I will move on to 

Dr. Roubideaux because I know she doesn’t want to get left out of 

this conversation. 

Secretary Jewel testified before this Committee that Indian education is an embarrassment. We have looked at the budget and I 

am curious to know, Secretary Washburn, what you think is in this 

budget that would change that perception? 

Mr. WASHBURN. Thank you for asking the question. I do have the 

BIA Director, a new permanent BIA Director, Monty Roessel, here 

with me today. 

We are studying Indian education really hard right now. Secretary Arne Duncan is very interested in this and of course SecVerDate Mar 15 2010 12:43 Jul 18, 2014 Jkt 088726 PO 00000 Frm 00032 Fmt 6633 Sfmt 6601 S:\DOCS\88726.TXT JACK
29 

retary Jewel. She knew when she made that statement, she needed 

to do something about it, so I have clear marching orders. 

We have a study group working on this. I notice you put up some 

charts about the Department of Defense education. 

The CHAIRMAN. It’s right there. 

Mr. WASHBURN. It’s right there. 

The CHAIRMAN. That is not apples and oranges. 

Mr. WASHBURN. No, that is not apples and oranges. That makes 

we think maybe we should move the BIA back into the War Department because they are funding their schools well in the Department of Defense. 

One of the things I mentioned early on was the President has 

proposed we are going to live within the Murray-Ryan budget caps, 

but if there are new revenues, we have already projected how we 

would spend those new revenues. One of the areas is for Indian 

education. 

We have a study group. I know study group doesn’t sound like 

a big deal. You can certainly put together a study group at any 

time but we are really committed to doing something with Indian 

education once the study group comes up with recommendations. 

The White House has been engaged in this and two Cabinet Secretaries and Mr. Roessel, the Director. I am confident we are going 

to be moving forward with some real improvements in Indian education. 

The CHAIRMAN. I appreciate that. Do you agree that Indian education is a trust responsibility? 

Mr. WASHBURN. It certainly is. It is in some of the treaties. Some 

of the treaties include words about education. 

The CHAIRMAN. You answered that correctly. Thank you. 

Do you think the OMB understands that education is a trust responsibility? 

Mr. WASHBURN. Yes. I know in theory they think it is a trust responsibility. 

The CHAIRMAN. I think it is really important. Secretary Jewel 

thinks it is important, the Secretary of Education thinks it is important, and I would dare say I absolutely do and I think a vast 

majority of people on this Committee agree when it comes to getting people out of poverty, this is the best way to get it done. There 

is a lot of poverty in Indian Country. 

Thank you very much. I appreciate your testimony. I have some 

other questions for the record. 

Dr. Roubideaux, correct me if I am wrong, there are about 1,500 

claims out there for contract services, correct? 

Dr. ROUBIDEAUX. It depends on who you ask, but the running 

tally of total claims is over 1,300, probably over 1,400. The pending 

ones now are about 1,200 and some. 

The CHAIRMAN. Let’s use the smaller number, let’s say it is 

1,200. There have been about 200 claim offers to tribes of that 

1,200, correct? 

Dr. ROUBIDEAUX. Yes. 

The CHAIRMAN. How long have we been working on this? 

Dr. ROUBIDEAUX. We have been working on this since the Ramah 

decision came down which was in June 2013. 

The CHAIRMAN. June 2013, so we are about nine months in? 

30 

Dr. ROUBIDEAUX. Yes. 

The CHAIRMAN. How many of those 200 claims that have been 

offered, not counting the ones on your blackberry today, have been 

settled? 

Dr. ROUBIDEAUX. Of the 200 claims, we have 41 claims formally 

settled with tribes, 68 offers accepted by tribes but they are in 

process, so it is about 104 settled. That is $133 million worth. 

The CHAIRMAN. How many settled out of the 200? 

Dr. ROUBIDEAUX. 104. 

The CHAIRMAN. 104 have been settled out of the 200. Did you say 

the process started in June 2013 or June 2012? 

Dr. ROUBIDEAUX. I’m blanking right now, so I will get back to 

you but we have been working very hard on it for so long, I can’t 

remember. 

The CHAIRMAN. I will just tell you this. We had this conversation 

in my office before and I know you guys are working hard to get 

it done, but in the overall scheme of things, with 1,200 claims, potentially more than that, 104 have been settled, 200 have been offered, the reason I am hearing from tribes and the reason many 

people on this Committee are hearing from tribes is because they 

are frustrated that it is not moving faster. 

I would tell you that we have to figure out how to move the ball 

forward. We just have to figure it out because it is not going to get 

easier for me or for you if this doesn’t move quicker. 

I want to talk about Indian health care and sanitation facilities. 

I think the Ranking Member talked about it from an Indian health 

care facility standpoint. I want to talk about it from both because 

this Administration has reported that there is a $10 billion backlog 

for health care facility and sanitation facility construction, yet the 

request is $150 million. I know those are all big numbers but $150 

million of $10 billion is 1.5 percent. 

Talk to me. We are it even keeping up with inflation and inflation is pretty low. 

Dr. ROUBIDEAUX. I hear your frustration on this. We are frustrated as well. These are difficult budget times and with available 

funds, we are not able to fund all tribal priorities but we do believe 

these are extremely important priorities. 

That is why trying to use the Opportunities Growth and Security 

Initiative to get more construction funds for health facilities could 

help us. That is why we are collaborating with other agencies to 

leverage other funds to try to see if we can make some progress. 

It is an enormous need and we are very much interested in working with you on this. 

The CHAIRMAN. I could go down the same list of questions I did 

with Secretary Washburn but I won’t. I will tell you if you look at 

this backlog, we are talking about backlogs in health care facilities 

construction and talking about sanitation facilities construction. 

There is no way we are going to get our arms around the health 

impacts of these two deficiencies. I dare say that we are running way, way more than $150 million 

in additional expenses because we are this far behind on these two 

arenas. 

When we talk to OMB in all these things, I just think it is very, 

very important that we talk about what is happening on the 

31 

ground because it is really important. This quality of life, this is 

health care, this is the ability to go to school, this is the ability to 

get educated. We need to fix it. 

Eighteen million dollars for health care education in this budget 

request, as I alluded in my opening comments, we can invest now 

in a lot of these things or we can invest later. I can tell you on a 

lot of the reservations in Montana, and I am learning more about 

it since I have gotten this position around the country, we are seeing unemployment rates through the roof and we are seeing a 

shortage of nurses and an incredible shortage of doctors. 

It would seem to me that this is just an incredible opportunity, 

with the challenges that are out there, to make some investments, 

whether it is through tribal college, which would be my first choice, 

or some other arena to help push Native American people into 

health care to take care of their own. 

They are good paying jobs, there is a huge need out there. The 

question is, when you go to OMB, the President, Sally Jewel, or 

whoever it may be, what are we talking about when it comes to investment in health care education? Have we talked about it? It is 

a priority but it doesn’t seem to be a priority when it comes to 

money. 

Dr. ROUBIDEAUX. It is definitely a priority to our agency because 

we know there is a great need. Our fiscal year 2015 budget proposal includes the medical inflation which could be used to hire 

more providers. We also have the proposal to exempt our scholarship and loan repayment programs from taxation which would 

allow us to give more awards which would allow us to be able to 

improve the pipeline. 

We are definitely interested in working with you on this in the 

budget formulation process. 

The CHAIRMAN. I will make a statement and we will get to the 

next panel. I appreciate your patience, I appreciate your testimony 

and I appreciate your willingness to sit here and answer questions 

over a budget. 

When Byron Dorgan was Chairman of this Committee, we had 

the same conversation with different people sitting in your chairs. 

I would just say that when we look at budgets for Indian Country, 

we need to look at it from the standpoint of what challenges are 

out there and what needs are out there and if we are doing anything to close the gap. 

I will be honest. If you just took health care, if you just took the 

facilities budget, or if you just took loan forgiveness or this $18 million for health education or whatever it might be, my daughter 

happens to be a nurse. It is a good job. There is a lot of opportunity 

out there to take care of folks. 

I also live in a small town in rural America, frontier America, 

and I know how hard it is to get people off reservations to come 

and work there. We have a tremendous opportunity. Whether it is 

your department, your agency, Health and Human Services and 

Secretary Sebelius or OMB, we need to try to get across this message. 

All you have to do is step into Indian Country. Some of them who 

have the resources are doing a great job but those who don’t have 

the resources, it is not good. It is just not good. 

32 

We have some other questions for the record that we will put in 

for you, Dr. Roubideaux, as well as Secretary Washburn. Once 

again, I want to thank you for your testimony and we will be visiting as we move forward on budget issues and everything else. 

Thank you for your service to the country. 

We will start with the next panel. The next panel consists of the 

Honorable Aaron Payment, Midwest Area Vice President, National 

Congress of American Indians and Chairman, Sault Ste. Marie 

Tribe of Chippewa Indians of Sault Ste. Marie, Michigan. 

Mr. Payment was elected October 16, 2013 to serve a two year 

term as Midwest Area Vice President of the National Congress of 

American Indians. His resume is good and impressive. It is good 

to have you here and look forward to your testimony. 

Then we have the Honorable Andrew Joseph, Jr., Member-atLarge and Portland Area Representative, National Indian Health 

Board here in Washington and Chair, Northwest Portland Area Indian Health Board in Portland, Oregon. 

Andrew Joseph, Jr. was elected in March 2013 as Member-atLarge and Portland Area Representative of the National Indian 

Health Board. Andrew also has a very impressive resume which I 

could go through but their testimony is more important than the 

accolades at this point in time. 

I would say thank you very much for being here. Before you give 

your testimony, I very much value it and I appreciate you taking 

the time to tell us what is going on from your perspective. 

As with the previous presenters, we are going to give you five 

minutes but your entire written testimony will be made a part of 

the record. It might just be you and I on question and answer but 

maybe someone will show up again. 

At any rate, we will start with you, Mr. Payment, and then go 

to Mr. Joseph. 

STATEMENT OF HON. AARON PAYMENT, MIDWEST AREA VICE 

PRESIDENT, NATIONAL CONGRESS OF AMERICAN INDIANS; 

CHAIRMAN, SAULT STE. MARIE TRIBE OF CHIPPEWA 

INDIANS 

Mr. PAYMENT. Good day. My name is Aaron Payment. I am 

Chairperson of the Sioux Tribe. 

As Congress considers the fiscal year 2015 budget and beyond, 

tribal leaders call on Congress to ensure that the promises made 

to Indian Country are honored in the Federal budget. Please remember just as we do not have the discretion to renege on our millions of acres of land cessation, we ask that you no longer exercise 

your trust obligation as discretionary. 

With accumulated impacts of level funding, budget cuts and sequestration in some cases amounting to up to 30 percent cuts since 

the Clinton era, the continued trust obligation of the Federal Government is threatened. These cuts feel very much like an abrogation of the treaty and trust obligations. 

NCAI’s President Cladoosby would remind you this is your duty, 

you are our trustee. Please serve with honor and put the trust in 

trustee. When people ask why honor such antiquated documents 

like Indian treaties, I remind them that they are pursuant to the 

33 

U.S. Constitution and judicial decisions and remember the Constitution is older. 

My written testimony calls for the equitable funding for tribal 

governments across the board and then addresses specific proposals 

in the Administration’s fiscal year 2015 budget, including the Bureau of Indian Affairs, Indian Health Services, Natural Resources 

and Environment, Education and Public Safety and Justice. 

NCAI, in collaboration with national, regional and issue specific 

tribal organizations has developed comprehensive recommendations 

included in the fiscal year 2015 Indian Country budget request. We 

request for the document to be entered into the record. 

For the remainder of my time, I would like to hit a few highlights to sound the clarion call for equitable funding for tribes. 

Even with the inroads and understanding of trust obligation, Indian Country continues to experience what the U.S. Commission on 

Civil Rights in 2002 called the ‘‘quiet crisis of Federal funding and 

unmet needs.’’ 

The Indian Health Service is currently funded to meet only about 

56 percent of the need despite being the primary provider of health 

care for many tribal communities. In 2002, IHS per capita expenditures for patient health services were just $2,896 compared to 

$7,535 per person for health care spending nationally. This is a disparity of nearly the magnitude of three times. 

For my tribe, for 66 percent of the citizens not residing near our 

health care delivery system, their health needs remain unmet. The 

response, intended or not, to access Medicaid fails to recognize the 

trust obligation, besides hundreds of thousands of tribal citizens 

across the country live in States where Medicaid expansion simply 

did not occur. 

Please restore leftover 2013 IHS budget cuts due to sequestration. We lost ground. The rural nature of our health care system, 

so far my tribe lost six providers just since last fall due to the shutdown and sequestration. I fear this will be even more devastating 

if special diabetes is not renewed and one year is the least of what 

we are looking for. 

Due to these losses, we desperately ask Congress to move our 

funding from discretionary to non-discretionary and support advance funding to further avoid losing ground. 

We ask that Congress fully fund contract support and reinstate 

sequestration losses. Again, fully funding contract support is mandated by the Supreme Court in the Ramah case. However, fully 

funding contract support but cutting other areas appears like a 

sleight of hand or punishment. 

We support the President’s request for $251 million to fully fund 

contract support but please don’t cut services to IHS or infrastructure to do so. Otherwise, we will experience a net loss. 

To give you the importance of health care in our community, life 

expectancy for American Indians and Alaska Natives is 4.1 years 

less than it is for the general population. In my family, our life expectancy is 60 years, with one exception. How many years would 

you have left? I have 12 if we live the expectancy. 

We support the BIA’s increase of at least $33.8 million or 1.4 percent above the fiscal year 2014 enacted level. However, with congressional mandate to fully fund contract support, this will mean 

34 

inevitable cuts to Indian programs and essential BIA infrastructure. After a year of sequester cuts, now making do with sequestration is an impossible burden to place on the BIA. 

With Interior budgets, some budgets are projected to increase up 

to 22 percent. Ours is really the least of it. Ours is the very least. 

A joke was made the other day, maybe Indians should move to the 

national parks. However, that is to a good idea either because the 

Navajo haven’t been able to move forward some of their housing 

development because they are located in national parks, so that is 

really not the solution. 

We have the highest dropout rate of any racial ethnic population 

in this country. This has not increased in the last ten years. We 

need greater effort in Indian education. Impact aid is critically important because 90 percent of our kids go to public schools and depend on the funding that comes from impact aid. I hope there are 

questions so we can flush that out later. 

I have much, much more that I could address but I think I am 

out of time. There is a lot more in my written testimony. I hope 

that you lots and lots of questions for me. 

Thank you. 

[The prepared statement of Mr. Payment follows:] 

35 

PREPARED STATEMENT OF HON. AARON PAYMENT, MIDWEST AREA VICE PRESIDENT, 

NATIONAL CONGRESS OF AMERICAN INDIANS; CHAIRMAN, SAULT STE. MARIE TRIBE

OF CHIPPEWA INDIANS


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The CHAIRMAN. Thank you, Mr. Payment. 

Mr. Joseph, you are up. 


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STATEMENT OF HON. ANDREW JOSEPH, JR., MEMBER-ATLARGE/PORTLAND AREA REPRESENTATIVE, NATIONAL 

INDIAN HEALTH BOARD; CHAIR, NORTHWEST 

PORTLAND AREA INDIAN HEALTH BOARD 

Mr. JOSEPH. Good afternoon, Chairman Tester. 

I thank you for holding this important hearing on the fiscal year 

2015 budget. 

On behalf of the National Indian Health Board and the 566 federally-recognized tribes we serve, I submit this testimony. 

My name is Andrew Joseph, Jr. I am an at-large executive committee member of the National Indian Health Board. I also serve 

as the Chair of the Northwest Portland Area Indian Health Board 

and as tribal co-chair to the National Tribal Budget Work Formulation Work Group. 

First, I would like to thank the Committee for the work it has 

done to advance health care priorities for our people. In fact, due 

to the help of many members of this Committee, we were able to 

change the mind of the Administration on contract support costs. 

For this and all you have done and continue to do for the first people of this country, thank you. 

Despite important changes in health care funding we have 

achieved over the last several years, we still experience many disparities. I look back home to my tribe and see us burying too many 

people. It is tough to be here at meetings in Washington and see 

three or four of our people have passed by the time I get home. 

This has to stop. The Federal Government has not fulfilled its 

promise and our people continue to suffer. 

Considering the level of funding appropriated to IHS, these statistics are not surprising. In 2013, the IHS per capita expenditure 

for patient health services was $2,800 compared to almost $8,000 

per person for health care spending nationally. The first people of 

this Nation should not be last when it comes to help. Let’s change 

that now. 

For fiscal year 2015, NIHB echoes the recommendations for the 

Tribal Budget Formulation Work Group and recommends $5.3 billion for IHS overall. This request would allow the funding of current services and include program expansion increases in several 

key areas including Purchased/Referred Care hospitals and clinics, 

mental health, alcohol and substance abuse. 

These programs represent the core of IHS work and areas of 

most critical need to our people. You will see in NIHB’s written testimony greater details about each priority. 

We also ask that sequestration cuts from fiscal years 2013 and 

2014 be fully restored. Congress did not provide enough funding to 

fund contract support costs and restore the sequestration or provide increases in the other crucial service areas. Some accounts 

even received cuts beyond the fiscal year 2013 sequestration level 

in fiscal 2014. This, combined with medical inflation and additional 

staffing costs has not really allowed these budgets to move forward. 

We are once again losing ground in addressing health disparities 

suffered by our people. 

I would also like to support several policy changes that would enable our IHS budget to be used in a better way. NIHB strongly 

supports Medicare-like rates for IHS Purchase/Referred Care. In 

65 

2003, Congress enacted legislation to require hospital providers to 

only pay Medicare-like rates when billing IHS through the Purchase/Referred Care Program, but non-hospital providers do not 

have this requirement. 

We also echo the recommendation of the GAO who said that reimbursements for providers should be capped at Medicare-like 

rates. 

Advance appropriations for IHS would allow tribally operated 

IHS programs to know what kind of funding they have a year in 

advance. This would mean that we could not only save the administration cost but would also be able to provide a better compendium of care for our people. 

Finally, we support the immediate renewal of the Special Diabetes Program for Indians. This is saving lives and taxpayer dollars 

and must be renewed now. 

You will see additional policy recommendations detailed in our 

written testimony. Thank you again for this opportunity to testify 

before the Committee today and for all the work you do to support 

Indian health. 

I am happy to answer any questions you might have. 

[The prepared statement of Mr. Joseph follows:] 

PREPARED STATEMENT OF HON. ANDREW JOSEPH, JR., MEMBER-AT-LARGE/PORTLAND

AREA REPRESENTATIVE, NATIONAL INDIAN HEALTH BOARD; CHAIR, NORTHWEST

PORTLAND AREA INDIAN HEALTH BOARD

Chairman Tester, Vice Chairman Barrasso, and Members of the Committee, 

thank you for holding this important hearing on the FY 2015 President’s Budget 

Request. On behalf of the National Indian Health Board and the 566 federally-recognized Tribes we serve, I submit this testimony. 

First, I would like to start by thanking the members of this committee for their 

dogged determination in advocating for the rights of American Indian and Alaska 

Native (AI/AN) peoples. Consistently, this committee has been willing and ready to 

stand up for the trust obligations the Federal Government has toward American Indians and Alaska Natives. The United States assumed this responsibility through 

a series of treaties with Tribes, exchanging compensation and benefits for Tribal 

land and peace. The Snyder Act of 1921 (25 USC 13) legislatively affirmed this trust 

responsibility. To facilitate upholding its responsibility, the Federal Government created the Indian Health Service (IHS) and tasked the agency with providing health 

services to AI/ANs. Since its creation in 1955, IHS has worked to fulfill the federal 

promise to provide health care to Native people. 

In passing the Affordable Care Act, Congress also reauthorized and made permanent the Indian Health Care Improvement Act (IHCIA). In renewing the IHCIA, 

Congress reaffirmed the duty of the Federal Government to American Indians and 

Alaska Natives, declaring that ‘‘it is the policy of this Nation, in fulfillment of its 

special trust responsibilities and legal obligations to Indians—to ensure the highest 

possible health status for Indians and urban Indians and to provide all resources 

necessary to effect that policy.’’ 

Health Discrepancies for American Indians and Alaska Natives 

Despite these promises, the health of AI/ANs continues to fall far short of the 

health status of all other Americans. The AI/AN life expectancy is 4.1 years less 

than the rate for the U.S. all races population. AI/ANs suffer disproportionally from 

a variety of diseases. According to IHS data from 2005–2007, AI/AN people die at 

higher rates than other Americans from alcoholism (552 percent higher), diabetes 

(182 percent higher), unintentional injuries (138 percent higher), homicide (83 percent higher) and suicide (74 percent higher). Additionally, AI/ANs suffer from higher 

mortality rates from cervical cancer (1.2 times higher); pneumonia/influenza (1.4 

times higher); and maternal deaths (1.4 times higher). 

Devastating health risks from historical trauma, poverty and a lack of adequate 

treatment resources also continue to plague Tribal communities. According to IHS 

data, 39 percent of AI/AN women experience intimate partner violence, which is the 

highest rate of any ethnic group in the United States. One in three women in AI/ 

66 

AN communities will be sexually assaulted in her lifetime. AI/ANs suffer at higher 

rates from psychological distress; feelings of sadness, hopelessness and worthlessness; feelings of nervousness or restlessness and suicide. Additionally, public health 

risks due to alcohol and substance abuse are sadly widespread in many Tribal communities, leading to other health disparities such as poverty, mental illness, and increased mortality from liver disease, unintentional injuries and suicide. Dental 

health concerns also continue to affect AI/ANs at higher rates than other Americans. Ninety percent of AI/AN children suffer from dental caries by the age of eight, 

compared with 50 percent for the same age in the US all races population. Our children ages 2 to 5 have an average of six decayed teeth, when children in the U.S. 

all races population have only one. 

Clearly, more must be done to alleviate these health risks for our people and to 

fulfill the trust obligations to AI/ANs. When considering the level of funding appropriated to IHS, these statistics are not surprising. In 2013, the IHS per capita expenditures for patient health services were just $2,849, compared to $7,717 per person for health care spending nationally. Despite the historic increases that Congress 

has given to the IHS budget over the last several years, funding discrepancies unambiguously remain. The First People of this nation should not be last when it 

comes to health. Let’s change that now. 

Sequestration in FY 2013 and the FY 2014 Budget 

As the Committee is well aware, the IHS budget lost $220 million due to sequestration in FY 2013. This, combined with the two week long government shutdown 

at the start of FY 2014 was devastating many Tribal health programs. Many sites 

cut patient visits, furloughed staff and delayed or denied needed medical procedures. The tragedy of sequestration in Indian Country was a clear denial of the federal trust responsibility to Tribes and our communities became, yet again, an unfortunate victim of unrelated political battles in Washington. As then Senate Committee on Indian Affairs Chairwoman Maria Cantwell stated on November 14, 2013, 

‘‘Our country’s financial troubles are not really stemming from our obligations to Indian Country, and frankly, we’re not doing a good job in fulfilling those obligations.’’ 

The Congress, in the FY 2014 budget did make a commitment to replace some 

of the funding lost due to sequestration in the previous year. However, due to priorities outlined by Congress and the rightful funding of Contract Support Costs, the 

IHS was not able to alleviate sequestration across most accounts and provided only 

nominal increases for those where the funding was restored. Some accounts even 

received cuts beyond the FY 2013 sequestration level in FY 2014. This, combined 

with medical inflation and additional staffing costs, have not really allowed these 


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budgets to move forward. Despite receiving these urgently needed increases, we are 

once again losing ground in addressing health disparities suffered by our people. 

For FY 2015, Congress, at a bare minimum must truly restore these sequestration 

cuts, and adjust for inflation and population growth. Otherwise, our people will continue to experience some of the worst health disparities in the nation and continue 

to experience loss of lives due to sequestration cuts. To that end, Tribes also request 

that Congress enact legislation to exempt IHS and all programs serving Indian 

Country from any future sequestration. While discretionary spending is not facing 

sequestration in FY 2015, we urge this committee to continue to advocate with your 

colleagues in Congress to create a permanent, full exemption from sequestration, as 

well as rescissions, for Tribal programs for FY 2016 and beyond. 

FY 2015 President’s Budget Request 

NIHB echoes the recommendations of the Tribal Budget Formulation Workgroup 

for FY 2015. The Tribal Budget request continues to be full funding of the Total 

Tribal Needs base budget of 28.7 Billion dollars over a 12 year period. This includes 

amounts for personal health services, wrap-around community health services and 

facility capital investments. However, for FY 2015, Tribes request total funding 

amount of $5.3 billion. This request would enable the funding of current services 

and include program expansion increases in several key areas including purchased/ 

referred care; hospitals and clinics; mental health and alcohol and substance abuse. 

The NIHB and Tribes believe that the President’s FY 2015 request a positive step 

forward for Indian Country. The President’s overall proposal restores the cuts 

caused by sequestration and the cuts made in the FY 2014 IHS operating plan. 

NIHB commends the Administration for including a $63 million increase to account 

for medical inflation and an additional $2.6 million for pay cost increases at both 

the IHS and Tribal level. However, other challenges still remain in the federal budget, such as a long-term solution on Contract Support Costs when a long-term commitment is required; increased funding for Purchased/Referred Care (formerly Contract Health Services); increase for Mental Health care, screenings and services; and 

alcohol and substance abuse. 

Contract Support Costs 

Importantly, the FY 2015 budget request also fully funds Contract Support Costs 

(CSC) in accordance with the U.S. Supreme Court decision in Salazar v. Ramah 

Navajo Chapter. The request includes a $30 million increase in order to fund the 

increases requested for the IHS in FY 2015. This represents a historic shift in a 

decades-long battle. As you recall, in FY 2014, the Administration proposed capping 

CSC for individual contracts, which Indian Country unanimously pointed out was 

a violation of both the federal trust responsibility and the principles of Ramah decision. Congress rejected this proposal in FY 2014 and provided a pathway for the 

Administration to fund CSC in FY 2014. NIHB would like to again, thank this committee for the work it did to not only elevate the issue, but also to change the position of the Administration. 

However, as noted above, this CSC funding obligation should not have been 

achieved at the expense of other Tribal programs. It is unfair to force Tribes to 

choose between increased services and funding of costs already owed to us to operate our programs. Funding CSC at the expense of other direct services is a continuation of the injustice, and is simply ‘‘robbing Peter to pay Paul.’’ The increases provided in the FY 2014 budget to fund CSC only restored obligations to the Federal 

Government has already made to Tribes, and did not provide a true increase to the 

overall budget in terms of real health dollars. 

NIHB is encouraged by statements that the Administration recently made that 

it wants to continue to find a long-term solution for funding CSC. We urge Congress 

and the Administration to work together with Tribes in order to ensure that funding 

for CSC can be maintained without making sacrifices to other areas of the budget. 

Purchased/Referred Care 

Over the last several years both Congress and the Administration have heard the 

call of Tribes to increase funding for Purchased/Referred Care (PRC) (formerly 

called Contract Health Services). Purchased/Referred Care dollars fund for IHS patients health care services that cannot be directly provided by an IHS or Tribal 

health facility. These dollars have historically been so scarce that many health programs run out of funding by June 1 of the fiscal year. This dearth of funding creates 

an emergency ‘‘life or limb’’ scenario (Priority I) where an amputation will be paid 

for when the preventative care that could prevent the amputation will not—or 

where painkillers will be paid for when orthopedic surgery is needed. This has to 

stop. Tribes are grateful that since FY 2009 PRC has increased by $244.1 million, 

or 38 percent. Before sequestration, some clinics were actually able to start treating 

68 

cases that were nonlife threatening (Priority II). In FY 2015, the President’s request 

includes an $18 million increase for PRC. However, funding is so short for this program that Tribes have requested $1.1 billion for PRC in FY 2015, which is $22 million above the FY 2014 enacted level and $17 million above the FY 2015 request. 

At current levels (and especially after sequestration), the IHS budget typically only 

covers Priority I or ‘‘Life or Limb’’ referrals. Through lack of funding and deprioritizing preventative opportunities, this cycle creates increased costs for needed 

health care by increasing costs to the Purchased/Referred Care programs specifically, and to the IHS health delivery system overall. 

Medicare Like Rates for PRC 

In addition to providing additional funding for PRC, one common-sense solution 

to enable these funds to go further is for Congress to enact legislation that would 

require that PRC reimbursements to nonhospital providers are made at ‘‘Medicare 

Like Rates.’’ In 2003, Congress amended the Medicare law to authorize the Secretary of Health and Human Services to establish a rate cap on the amount hospitals may charge IHS and Tribal health programs for care purchased from hospitals under the PRC program. However, hospital services represent only a fraction 

of the services provided through the PRC system. The IHS PRC program may be 

the only Federal Government entity that does so; neither the Veterans’ Administration nor the Department of Defense pay full billed charges for health care from outside providers. 

On April 11, 2013, the Government Accountability Office (GAO) issued a report 

that concluded ‘‘Congress should consider imposing a cap on payments for physician 

and other nonhospital services made through IHS’s CHS program that is consistent 

with the rate paid by other federal agencies.’’ We agree: these savings would result 

in IHS being able to provide approximately 253,000 additional physician services 

annually. This number will even be greater when you consider Tribally-run programs, which means that total savings are more likely to be around $100 million 

annually. NIHB and Tribes encourage Congress to swiftly enact the legislative 

change to make PRC subject to Medicare Like Rates. 

Hospitals and Clinics 

In FY 2015, Tribes request $2.1 billion for Hospitals and Clinics (H&C) in order 

to better provide health services for 2.1 million AI/ANs. This represents an increase 

of $297 million, or 16 percent over the FY 2014 enacted level. H&C includes medical 

and surgical inpatient care, routine and emergency ambulatory care, and other medical support services. H&C funds also support community health initiatives targeting health conditions disproportionately affecting AI/ANs, such as specialized 

programs for diabetes, maternal and child health, women’s health, and elder health. 

The services provided by H&C are constantly being challenged by many factors 

including inflation, population growth and an increased rates of chronic diseases. 

Additionally, IHS/Tribal/Urban-managed facilities often have great difficulty in recruiting and retaining medical staff meaning due to remote locations and funding 

difficulties. If the health status of AI/ANs is ever going to improve, Congress must 

prioritize this core program now. 

Mental Health 

For FY 2015, NIHB recommends $130 million for mental health services. This 

represents a $52.7 million increase over the FY 2014 enacted level. As noted above, 

American Indians and Alaska Natives suffer from a high incidence of mental health 

disorder, illnesses and suicide rates; in fact, suicide is the second leading cause of 

death for AI/AN children and youth. Failure to treat mental health conditions and 

providing appropriate and timely interventions and care, effectively results in community-wide public health risks both on and off reservations for AI/ANs. For example, the Navajo Area suicide rate that is four times greater than the US all races 

rate for youth aged 5–14. In 2010, in one town with a population of only 8,000, there 

were 15 suicides. Sadly, many communities throughout Indian Country also experience this tragic story. The trauma and emotional injury stemming from a suicide 

in Tribal communities impacts elders, mothers and fathers, sons and daughters, 

friends and destabilizes the cultural and community fabric of our Nations. Our 

young people in Indian Country often experience a life filled with a variety of social 

problems such as substance abuse and poverty, and envision a future without promise or hope for a better life. For the sake of the next Seven Generations, we must 

all work together to find a serious, comprehensive solution to end this disturbing 

epidemic. 

Treating these issues among AI/ANs must utilize a comprehensive approach that 

targets early intervention and engages all aspects of life. Services that IHS currently provides, when resources are available, include comprehensive outpatient 

69 

mental health treatment, crisis response services, prevention programming, collaborative treatment planning with alcohol and substance abuse treatment providers, 

group therapies, and traditional healing methodologies, in addition to other evidence-based approaches to mental health treatment. Overall, these solutions are 

more reactive than they are proactive. Services generally not available at IHS or 

Tribally-operated facilities, but instead must be procured through third party contracts, include inpatient and residential treatment services, group homes, and independent living centers. 

One of the most critical problems Tribal communities face is the recruitment and 

retention of qualified fulltime psychiatrists and psychiatric nurse practitioners. This 

is one of the many reasons NIHB supports a legislative fix that would enable IHS 

Student Loan Repayment Program and Health Professions Scholarship Program to 

have tax exempt status. It would enable IHS to fund an addition 105 new repayment awards to combat the 1,550 vacancies for health care professionals in the IHS 

system. In the House of Representatives (H.R. 3391), bipartisan legislation has been 

introduced to address this concern. We urge the members of this committee to introduce a Senate companion bill to H.R. 3391 and swiftly pass it out of committee. 

NIHB also urges this committee to seriously investigate the contributing factors 

to mental health and work with Tribes, federal agencies and other stakeholders to 

find a real solution to this difficult problem. 

Alcohol and Substance Abuse 

Closely linked with mental health issues are chronic problems stemming not only 

from historical trauma, but from emotional injuries related to domestic violence as 

well as alcohol and substance abuse in Tribal communities. As mentioned above, AI/ 

ANs are consistently overrepresented in statistics relating to alcohol and substance 

abuse disorders, leading to widespread health issues for individuals, families and 

even entire communities. 

For FY 2015, we recommend $236 million for Alcohol and Substance Abuse, or 

$50 million above the FY 2014 enacted level and $43 million above the FY 2015 

President’s request. IHS programs and Tribally operated alcohol and substance 

abuse programs employ a variety of treatment modalities consistent with evidencedbased approaches to address substance abuse disorders and addictions through individual and group counseling, peer support, and inpatient and residential placement. 

However, it is essential that treatment approaches also include traditional healing 

techniques designed to improve outcomes and to tie services provided back to valuable cultural practices and the individual AI/AN’s spiritual journey. 

IHS funding supports the operation of adult and youth residential facilities and 

placement contracts with third party agencies, but limited funding often results in 

placement decisions based on the availability of alternate resources and the providers’ clinical recommendations. IHS-funded alcohol and substance abuse programs 

continue to focus on integrating primary care, mental health and substance abuse 

services, and the exploration and development of partnerships and alliances with 

other community stakeholders. 

Again, treatment for alcohol and substance abuse must be approached from a 

community-wide perspective and integrate not only health programs, but also Tribal 

justice, and education initiatives. Communities in Indian Country experience these 

tragic issues due to a large and complex list of contributing factors, so approaches 

to solve these problems must also address all aspects of society. 

Fund IHCIA New Authorities 

The adoption of the Patient Protection and Affordable Care Act (ACA) (P.L. 110– 

148) in 2010 was historic for Tribes in many ways. Most importantly, it renewed 

the Indian Health Care Improvement Act (IHCIA). The effort to renew IHCIA took 

10 years and represents a true victory for Indian health. The Act updates and modernizes health delivery services, such as cancer screenings, home and community 

based services and long-term care for the elderly and disabled. It also establishes 

a continuum of care through integrated behavioral health programs (both prevention and treatment) to address alcohol/substance abuse problems and the social 

service and mental health needs of Indian people. 

However, many of these provisions remain unfunded, which again, represents another failure to follow through on promises to our people. All provisions of the 

IHCIA are critcal to advancing the health care of American Indian and Alaska Native people and should be implemented immediately. Adequate funding for the implementation of these long awaited provisions is needed now. Tribes recommend 

funding of $300 million in order to fully implement IHCIA in FY 2015. 

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Definition of Indian in the Affordable Act 

As NIHB testified previously, we urge Congress to enact a legislative ‘‘fix’’ for the 

Definition of Indian in the Affordable Care Act. The ‘‘Definitions of Indian’’ in the 

ACA are not consistent with the definitions already used by the Indian Health Service (IHS), Medicaid and the Children’s Health Insurance Plan (CHIP) for services 

provided to American Indians and Alaska Natives. The ACA definitions, which currently require that a person is a member of a federally recognized Tribe or an Alaska Native Claims Settlement Act (ANCSA) corporation, are narrower than those 

used by IHS, Medicaid and CHIP, thereby excluding a sizeable population of AI/ANs 

that the ACA was intended to benefit and protect. Unless the definition of Indian 

in the ACA is changed, many AI/ANs will not be eligible for the special protections 

and benefits intended for them in the law. 

NIHB requests that the committee use all methods at its disposal to resolve this 

issue. On October 16, 2013, Senator Mark Begich (D–AK) introduced S. 1575 which 

would address this issue. NIHB encourages the committee to swiftly consider and 

favorably report S. 1575 to ensure that all AI/ANs are eligible for the benefits intended for them in the ACA. 

Other Policy Recommendations 

The Administration’s FY 2015 Budget Request Contains three legislative policy 

provisions: (1) Provide Tax Exempt Status for the Indian Health Service Health Professions Scholarship Program and the Health Professions Loan Repayment Program; 

(2) Renew the Special Diabetes Program for Indians at $150 million for three years. 

NIHB supports these legislative priorities, in addition to Advance Appropriations for 

the Indian Health Service. 

Renewal of the Special Diabetes Program for Indians 

As part of the Balanced Budget Act of 1997, Congress established the Special Diabetes Program for Indians (SDPI) to address the growing epidemic of Type II diabetes in American Indian and Alaska Native (AI/AN) communities. The Special Diabetes Program for Type 1 Diabetes (SDP) was established at the same time to address 

the serious limitations in Type 1 diabetes research resources. Together, these programs have become the nation’s most strategic, successful and comprehensive effort 

to combat diabetes. SDPI is transforming lives and changing the diabetes landscape 

in America. 

According to the Centers for Disease Control and Prevention (CDC), AI/AN adults 

have the highest ageadjusted prevalence rate of diagnosed diabetes compared to 

other major racial and ethnic groups at 16.1 percent. By comparison, this is almost 

twice the rate for the total U.S. adult population. Some regions of Indian Country 

have diabetes rates as high as 33.5 percent, with specific communities having Type 

II diabetes reach a level as high as 60 percent. 

Today, SDPI is funded at a level of $150 million per year and supports 404 diabetes treatment and prevention programs in 35 states. With funding for this critical 

program set to expire on September 30, 2014, Tribes are requesting a renewal of 

this program of $200 million/year for 5 years. While we understand an increase in 

funds during this budgetary environment is difficult, SDPI has been level-funded 

since 2002. This represents an effective decrease. Calculating for inflation, $150 million in 2002 would be about $115 million in 2014—or 23 percent less. In order to 

keep the momentum of this important program alive, it is critical that Congress continue to invest in SDPI, which will save millions in preventative care over the long 

term. When taking into account additional Tribes that have gained federal recognition since 2002, the dollars are even scarcer. 

NIHB wishes to express its gratitude for the work that members of this committee 

have done so far to support renewal of SDPI. With the deadline of September 30th 

in mind, I urge you to support a multi-year reauthorization of the SDPI by March 

31st of this year. We have a critical opportunity to see the program renewed by 

March 31, when Congress must renew the Medicare Extender legislation—and that 

legislative vehicle is typically the legislative vehicle for SDPI renewals. Without an 

immediate, long-term reauthorization, critical infrastructure that the Tribes have 

built to address the Diabetes epidemic in Indian Country has greatly contributed 

to the success of SDPI. A delay in renewal will mean loss of SDPI staff—loss of 

jobs—that will severely impact tribal health: both in terms of patient health and 

community economic health. Also, because SDPI is a grant program, the Indian 

Health Service requires four months to advertise and complete the grant process— 

so please actively shepherd through the reauthorization of SDPI by March 31, 2014. 

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Support for Advance Appropriations 

In addition to the policy recommendations outlined by the Administration, NIHB 

would like to reiterate its support for Advance Appropriations for the Indian Health 

Service. On October 10, 2013, Senator Lisa Murkowski (R–AK) introduced legislation, S. 1570, to provide advance appropriations for the IHS. While this measure 

will not solve the complex budget issues at IHS, it will be an important first-step 

in ensuring that AI/ANs receive the health care they deserve. Advance appropriations would allow Indian health programs to effectively and efficiently manage 

budgets, coordinate care, and improve health quality outcomes for AI/ANs. The need 

for advance appropriations was no more obvious during the Federal Government 

shutdown at the start FY 2014. Many Tribal health programs were forced to furlough employees, close their clinics and deny services during this period. 

This change in the appropriations schedule will help the Federal Government 

meet its trust obligation to Tribal governments and bring parity to the federal 

health care system. Adopting advance appropriations for IHS would result in the 

ability for health administrators to continue treating patients without wondering 

if—or when—they would have the necessary funding. Additionally, IHS administrators would not waste valuable resources, time and energy re-allocating their budget 

each time Congress passed a continuing resolution. 

At the Department of Health and Human Services Budget FY 2016 Tribal Budget 

Consultation on March 7, 2014, agency officials noted that they are seriously considering this issue with the Office of Management and Budget. They are also engaged 

in conversations with the Veterans’ Administration to learn how they implemented 

advance appropriations when they received this status in 2010. NIHB is highly encouraged by these statements and urges this Committee to quickly consider S. 1570 

and report the bill favorably to ensure that Tribes can move forward to a more stable funding mechanism. 

Conclusion 

On behalf of the National Indian Health Board and the 566 federally recognized 

Tribes we serve, thank you to the Committee for holding this important hearing on 

the FY 2015 budget. While we have made important gains in the IHS funding budget over the last several years, the scourge of sequestration has eliminated much of 

that progress. Tribal communities still continue to suffer greatly from chronic public 

health risks exacerbated by grossly underfunded health services in Indian Country. 

For FY 2015, Tribes are requesting: 

1) Begin implementation of a plan to achieve a Needs Based Budget for IHS 

at 28.7 billion. 

2) Fund IHS at $5.3 billion for FY 2015. 

3) Restore Cuts/Shortfalls in FY2013–15 resulting from sequestration, inadequate increases to cover Congressionally mandated budget categories, and no 

provision for inflation for Continuing Services & Binding Obligations and advocate that Tribes and Tribal programs be permanently exempted from any future 

sequestration. 

4) Provide an additional $300 million to implement the provisions authorized 

in the Indian Health Care Improvement Act (IHCIA). 

State and local governments have the power to tax in order to fund government 

services. Tribes do not have that option. In many remote Tribal communities, economic development is also unfeasible. Tribal governments depend more heavily on 

Federal Government sources, thereby making the need to fund Tribal programs at 

a sustainable level even greater. It is a matter of justice and equity—failure to 

prioritize an IHS budget that makes a meaningful investment in the health of AI/ 

ANs is a violation of the federal trust responsibility and denial of the sacrifices that 

our people have made to this country. 

Thank you for the opportunity to offer this testimony. 

The CHAIRMAN. Thank you, Mr. Joseph. I appreciate your testimony. 

I appreciate both your testimonies and both of you taking time 

from your busy schedules to be here today to advocate for causes 

I know you both feel are very, very important. I feel the same. 

I will start with you, Mr. Payment. With the President’s fiscal year 2015 budget request for $2.6 million for Indian Affairs at the 

Department of Interior, my understanding from your testimony is 

72 

that the NCAI full budget request is, at almost every line item in 

the Indian Affairs budget, underfunded. 

NCAI testimony mentions an across the board $139 million increase, knowing that there are unmet needs for basically all the Indian Affairs programs. Is an across the board increase the best 

place to start or would it be better to start with specific programs 

and if so, could you prioritize a few of those? 

Mr. PAYMENT. I would say we have a critical need with law enforcement right now. We do have a detention center and it actually 

covers its own costs. We are able to use the revenue from the detention center but have been doing that for the last couple of years, 

so that fund is almost gone. 

We have used that to make up for the Federal Government not 

adequately funding our law enforcement and conservation. In about 

a year that fund will be depleted and it then will compete with our 

other self governance funds. 

We have a very rural area like a lot of tribes, so our law enforcement is minimally covered right now. We just signed a couple years 

ago the permanent settlement of our treaty rights, so the conservation portion of that is going to increase. I am not sure how we are 

going to cover that, so law enforcement would be one. 

Education is critical. I am working on my doctorate in education. 

We have a 50 percent dropout rate. The solution is not only in the 

BIE. Ninety percent of our kids don’t go to school in Indian schools. 

We do have a tribal school in my community and we just got the 

highest MEAP scores in the region, higher than the local schools. 

When we do it, we do it right. 

We can’t abandon those who attend public schools because there 

needs to be a focused attention there. How does impact aid benefit 

communities? A friend of mine is a superintendent of a school that 

serves about 50 percent Native American children. They are underfunded. 

With the cuts that happened last year, the funding to impact aid 

happened in the middle of the school year so they didn’t have time 

to adjust. When cuts happen to public schools, to impact aid, it impacts the highest need people because that is the first thing cut. 

Our people happen to be the highest need people. The connection 

with impact aid is there. 

Social welfare, we need a new commitment in social welfare, especially with mixed messages coming from the Supreme Court in 

Indian child welfare. We need much, much more resources in Indian child welfare. Juvenile placements in detention, we need direct funding for that. 

The last one I will say is suicides. We have a very high rate of 

suicide in our community. We need direct funding from SAMHSA 

to tribes. We need to skip the State compacting process and come 

directly to the tribes because I think we know best how to serve 

our people and meet those needs. 

The CHAIRMAN. A very good point. 

I am going to cut to another area that has to do with consultation. When I go around the State and around the country as far 

as that goes, there is an understanding that Indian Affairs does a 

reasonable job in consultation. Other departments, not so much. 

73 

I don’t want to be critical of them because, quite frankly, they 

don’t deal with Native American issues all the time and consultation is a different way of doing business than they are used to. 

I want your input or NCAI’s input. We will start with the two 

biggies, the Department of Interior and the Office of Management 

and Budget. Do they give sufficient opportunity to talk about the 

resources for programs? 

Mr. PAYMENT. I would say that the Obama Administration especially consultation has been a priority for many Federal agencies. 

What is consultation? It is not completely and universally understood how it should actually happen. There are some templates 

that suggest how it should happen. 

I would say there is definitely a need to educate OMB to carry 

forward the trust obligation and to understand and appreciate it 

better. I think something is lost in the translation when it gets to 

OMB. I think more work is needed there. 

NCAI has requested that a Native American desk be established 

in the OMB so they better understand so the translation from the 

President’s office and from Congress’ commitment make its way to 

the OMB. 

I think the problem is systemic and it is much bigger. I think 

with creation of the White House Counsel and in fact, this week 

the Midwest Alliance of Sovereign Tribes passed a resolution which 

I drafted calling for some infrastructure that will go along with the 

commitment and asking the White House Counsel to put in place 

some consultation and maybe an advisory council of tribal leaders 

across the country to advise the White House Counsel. 

I think the silo problem of the different departments and OMB 

being kind of over here leads to lack of communication. The problems that happened with IHS not being exempted from sequestration is a perfect example of that. 

The CHAIRMAN. I would just say this. I don’t like to point fingers 

without a few pointing back to us but Congress hasn’t been particularly helpful on a lot of these issues too. I would just say to 

both of you if there are things we can do to help with consultation, 

getting input to people who need to have input, please let us know 

so we can try to help facilitate. 

You make good decisions based on good information. Let’s just 

put it that way. If you don’t have good information, you aren’t 

going to make good decisions. 

I want to go to you for a second, Mr. Joseph, on IHS staffing. The 

Northwest Portland Area Indian Health Board has often had concerns about staffing levels in the region’s Indian Health Service facilities. I am aware this is not just a problem in that region. Have 

you seen any change in staffing of facilities in Indian Country? Has 

it been static? Has it gotten better or has it gotten worse? 

Mr. JOSEPH. Right now, my tribe has declared a state of emergency for staffing. It is an IHS Federal service unit. The Portland 

Board and the California Rural Indian Health Board have a joint 

resolution on staffing needs. A lot of our tribes have built their own 

facilities, we couldn’t wait for the government. We are kind of like 

the Wind River Tribe that was talked about earlier. 

We built our clinics. Two of the four were written into the master 

plan by IHS. We still have the staffing from I’d say the 1950’s or 

74 

maybe before then. The Affordable Health Care Act is an excellent 

bill, I helped write it, but tribes like mine that have poor staffing 

or low staffing are not able to take advantage of all of the good language written in that bill. 

I believe every tribe needs to look at facilities and staffing across 

the country. I am really grateful for the ones that get it because 

they get the full deal, they get the facilities, staffing and then they 

get to take advantage. Some tribes have been waiting as long. If 

we could have staffing, it would be helpful. 

I took my son to the dentist, he had an emergency a couple of 

weeks ago, and there is only one dentist. We have one we brought 

back from retirement and he comes in part-time. I was waiting for 

my son and an elder came in and asked if he could get an appointment. He was told, give me your name and number and we will call 

you maybe in two or three months. There is about a six month 

waiting time for an actual appointment. Staffing is a big need. 

The reason why Portland is opposed to staffing is because they 

that increase right off the top of the budget and it affects the overall medical part of health that IHS has to provide. Based on last 

year’s 2013 budget when we did get sequestered, there was $53 

million that went into staff two new facilities and that was taken 

right off the top of the increase. The real medical increase wasn’t 

as high as the Senate thought it would be. 

Like I said, I am grateful there are tribes who got it but the rest 

of us kind of suffered from it. 

The CHAIRMAN. In your opinion, is the problem with staffing 

budgetary or is it lack of availability of professionals for IHS? 

Mr. JOSEPH. It kind of hits on the question you asked Aaron 

about OMB. We have been submitting our budget and asking for 

what we really need for quite a few years now. The real need for 

the IHS budget is $28.1 billion. We are stuck at the $4 billion level. 

When I first started working on the budget 11 years ago, I was 

wishing they would just round off the number to $3 billion. We 

were really struggling then. Our population and the cost of providing medical health has gone way up. 

The CHAIRMAN. For sure. 

You both talked about advance funding. I would just say the Veterans Administration already has advance funding. You probably 

know that. You Native Americans serve at a higher rate than other 

minority in this country. We have some questions that we are 

going to talk to Dr. Roubideaux about. 

I want to tell you guys since you are part of organizations that 

one of the ways the Veterans Administration got advance funding 

was because all the groups out there wanted it. I think it would 

be an incredible plus for Indian Country if we got advance funding. 

I think it is possible to get done. In fact, I have a bill to do that, 

a piece of legislation to do exactly that. 

I think it is going to take some real force from Indian Country 

to get it done, to get in there and talk about how important it is 

and how it can help in a very big way. I think if everyone gets on 

the same sheet and is very focused, it can happen. Anything short 

of that is going to be very difficult. 

75 

I would thank you very much for your testimony. We have a few 

more but this hearing has gone two hours which is a little longer 

than I anticipated but there were some good questions here today. 

I want to thank all witnesses for their testimony, the two of you 

included. It is great to hear the information not only from the Administration but the folks out on the ground. Once again, this testimony shows the agencies and the tribes are resourceful but you 

can’t get blood out of a turnip. We need to make sure we do what 

we can do here and through the Appropriations Committee to try 

to plus up this budget. It needs to be. 

I know there is always a lot of interest in this testimony. I think 

the fact we had the folks here even though I can tell you right now 

I missed three meetings while this hearing was going on so everyone else is in that same boat, no disrespect. 

This hearing record will remain open for two weeks for any additional comments that anyone may add to it. 

Once again, gentlemen, thank you for your testimony. 

This hearing is adjourned. 

[Whereupon, at 5:45 p.m., the Committee was adjourned.] 

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A P P E N D I X 

PREPARED STATEMENT OF ALBERT A. YAZZIE, PRESIDENT, CRYSTAL BOARDING

SCHOOL BOARD OF EDUCATION


326d9.eps
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PREPARED STATEMENT OF HON. BRIAN PATTERSON, PRESIDENT, UNITED SOUTH AND

EASTERN TRIBES, INC. 

Introduction. 

Chairman Tester, Vice Chairman Barrasso and members of the Committee, my 

name is Brian Patterson. I serve as president of the United South and Eastern 

Tribes, Inc. (USET), as well as on the Men’s Council of the Oneida Nation of New 

York. Thank you for this opportunity to provide written testimony regarding the 

budget priorities of USET. 

USET is an inter-tribal organization representing 26 federally recognized Tribes 

from Texas across to Florida and up to Maine. The USET Tribes are within the 

Eastern Region of the Bureau of Indian Affairs (BIA), covering a large expanse of 

land compared to other BIA Regions. Due to this large geographic area, the Tribes 

in the Eastern Region have great diversity. From an economic standpoint, some of 

our Tribes have highly developed economies, while others remain mired in poverty. 

All of our Tribes, however, look to the United States to live up to its trust responsibility, to support Tribal sovereignty, and to work with us on a government-to-government basis, especially on a matter as central to the trust responsibility as Federal budget policy. 

The Role of this Committee—Defending American Values, such as the Trust 

Responsibility 

The role of this Committee, or that of any of the Congressional committee, is ultimately not about dividing up money and power, but rather determining, deciding 

and defending American values. For example, under budget sequestration the Veterans Administration’s hospital system was exempt. That demonstrates a great 

American value—fulfilling the commitment to honor our obligations to those who 

put their lives on the line to defend American freedom. However, it is not an American value that the Indian Health Service was not exempted, putting the life, health 

and well-being of generations of Native peoples at risk in a system that already 

strains to deliver basic healthcare. This Committee can and should demand that the 

IHS be funded in a manner consistent with an important American value—our Nation’s commitment to its First Peoples. 


326d10.eps
79 

Similarly, the sequestration exempted many low-income programs (e.g., Child 

Care Entitlement to States; Child Health Insurance Fund; Family Support Programs and Temporary Assistance for Needy Families) demonstrating the great 

American value that we will leave nobody behind when it comes to basic needs. And 

yet, the sequestration applied fully to virtually all Federal Indian programs, even 

though many Native communities suffer the worst social and economic statistics in 

the country, largely due to Federal action and policies in place over the last two 

hundred years. The application of sequestration to Native programs was not an 

American value. Federal budget problems should not be addressed on the back of 

Native peoples. USET respectfully asks that this Committee support funding increases for Federal Indian programs that consistently exceed the relevant rate of inflation in order to achieve real progress in closing the services gap for Natives. As 

described below, Federal Indian program should not be deemed discretionary, but 

rather mandatory. 

The Constitution, Indian Tribes, Treaties and the Laws of the United States 

From the earliest days of the United States, the Founders recognized the importance of America’s relationship with Native nations and Native peoples. They wove 

important references to those relationships into the Constitution (e.g., Art. I, Section 

8, Cl. 3 (Indian Commerce Clause); Article II, Section 2, Cl. 2 (Treaty Clause). 

Natives influenced the Founders in the development of the Constitution as recognized by the 100th Congress, when the Senate and the House passed a concurrent 

resolution acknowledging the ‘‘historical debt’’ the United States owes to Indian 

tribes. 

[O]n the occasion of the 200th Anniversary of the signing of the United States 

Constitution, acknowledges the historical debt which this Republic of the United 

States of America owes to the Iroquois Confederacy and other Indian Nations 

for their demonstration of enlightened, democratic principles of government and 

their example of a free association of independent Indian nations;. . . 

S. Con. Res. 76, 100th Congress. One has only to walk the halls of the Capitol 

to see many works of art and sculpture that depict the central role that Native nations have played in the development of America’s national identity. Not depicted 

on the walls of the Capitol are the many injustices that Native peoples have suffered as a result of Federal policy, including Federal actions that sought to erode 

Native territories, learning, and cultures. Out of those injustices, and from other 

legal sources, there has arisen a Federal trust obligation to support Native governments and Native peoples. 

The Indian provisions in the Constitution were given immediate life in treaties 

that the United States entered into with Indian nations beginning with the Treaty 

with the Delaware in 1778 and continuing through another 373 treaties. Additionally, in the first decades of the United States, numerous laws were enacted addressing the details of the Federal-Tribal relationship (e.g., Trade and Intercourse Acts 

of 1790, 1793, 1796, 1799, 1802, and 1834), even as the Federal courts defined the 

Federal Government’s trust obligation to Indian nations (e.g., Cherokee Nation v. 

Georgia (1831)). Notwithstanding this Constitutional foundation, the Federal Government engaged in many actions that betrayed the treaties and trust obligation to 

Indian nations, such as the seizure of Indian lands and the forced assimilation efforts of the Indian boarding school system. Fortunately, American greatness has led 

to more enlightened policies since the boarding school era, reflected in a host of laws 

that support tribal sovereignty and are critical to the vitality and well-being of tribal communities. Regrettably, these laws are rarely funded to the level necessary to 

achieve their intended purposes. 

Because of this history, the Trust obligation of the Federal Government to Native 

peoples, as reflected in the Federal budget, is fundamentally different from ordinary 

discretionary spending and should be considered mandatory in nature. As a 1977 

U.S. Congress/American Indian Policy Review Commission Report stated: 

The purpose behind the trust is and always has been to ensure the survival and 

welfare of Indian tribes and people. This includes an obligation to provide those 

services required to protect and enhance Indian lands, resources, and 

selfgovernment, and also includes those economic and social programs that are 

necessary to raise the standard of living and social well-being of the Indian people to a level comparable to the non-Indian society. 

80 

The World has its Eyes upon the United States and its Leadership—the 

United Nations Declaration on the Rights of Indigenous Peoples 

As a sovereign nation, the United States exercises jurisdiction within its boundaries. However, the United States is also part of a community of nations that has 

come together through the United Nations to develop common principles for the 

benefit of all mankind. These principles are used to place a light on those in the 

international community who do not live up to international human rights standards. 

With regard to Indigenous peoples, the United Nations has adopted the Declaration on the Rights of Indigenous Peoples (UNDRIP). With regard to the improvement of the economic and social conditions of Indigenous peoples, Article 21(2) provides: ‘‘States shall take effective measures, and, where appropriate, special measures to ensure continuing improvement of their economic and social conditions.’’ 

Further, Article 38 provides that: ‘‘States, in consultation and cooperation with indigenous peoples, shall take the appropriate measures, including legislative measures, to achieve the ends of this Declaration.’’ Those ends include advances in wellbeing of Indigenous peoples in the social, economic, cultural, political, environmental, and other areas. One of the primary mechanisms or ‘‘effective measure’’ that 

States routinely use to address such problems is funding to achieve UNDRIP’s 

standards, which Article 43 summarizes as: ‘‘. . . the minimum standards for the 

survival, dignity and well-being of the indigenous peoples of the world.’’ Federal Indian program funding should also be measured against international standards. 

The Spectre of Sequestration Remains 

The budget sequestration of FY 2013 was devastating to Federal Indian programs 

and to the tribal communities they serve. While Congress has provided an alternative budget structure for FY 2014 and FY 2015, sequestration could be re-imposed 

in FY 2016. Although this may seem early to raise this concern, USET urges the 

Committee to educate other members of the Senate that the application of sequestration to Indian programs violates the trust responsibility, does not make economic 

sense, and should not be countenanced going forward. For example, when some Federal health programs were rightfully exempted from sequestration, it was morally 

wrong that the Indian Health Service was not. That should not happen again. 

Contract Support Costs—Robbing Peter to Pay Paul 

Congress provided that the Indian Health Service and the Bureau of Indian Affairs must pay the full amount of contract support costs in FY 2014, as they are 

contractually obligated to do anyway! However, Congress, while fully funding CSC 

in FY14, did so principally through restoration of pre-sequestration funding. This 

meant that fully funding CSC was at the expense of other Federal Indian programs. 

Full funding for CSC must not come with a penalty—namely, a reduction in program funding or effective permanent sequestration of Indian program funds. That 

result would have the same devastating effect on our service delivery as the failure 

to fully fund CSC. Yet Congress, in the Joint Explanatory Statement accompanying 

the FY 2014 Consolidated Appropriations Act, noted that ‘‘since [CSC] fall under 

discretionary spending, they have the potential to impact all other programs funded 

under the Interior and Environment Appropriations bill, including other equally important tribal programs.’’ Moreover, without any permanent measure to ensure full 

funding, payment of CSC remains subject to agency ‘‘discretion’’ from year to year, 

even though tribes are legally entitled to payment under the ISDEAA. Noting these 

ongoing conflicts of law, Congress directed the agencies to consult with tribes on a 

permanent solution. 

In our view, there is a logical permanent solution which Congress is empowered 

to implement: CSC should be appropriated as a mandatory entitlement. The full 

payment of CSC is not discretionary; it is a legal obligation, affirmed twice by the 

U.S. Supreme Court. Yet the budget authority for CSC is currently provided and 

controlled through appropriation acts—as if it were a discretionary program. The solution then is to bring the appropriations process in line with the statutory requirements and to recognize CSC for what it is: a mandatory entitlement, not a discretionary program. We therefore strongly urge the Congress to move to appropriate 

funding for CSC on a mandatory basis. 

Additionally, the settlement of past CSC claims continues to move at an unacceptable slow pace. The settlement of past CSC claims must be prioritized and resolved 

expeditiously. 

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Fundamental Philosophical Flaw in the Tribal Interior Budget Council 

(TBIC) Format 

The Tribal/Interior Budget Council (TIBC) was established to allow Tribes and 

Tribal organizations to work with Interior officials in the formulation of the Indian 

Affairs and Office of the Special Trustee (OST) annual budget requests and performance plans in the spirit of the President’s Government-to-Government consultation 

and collaboration policy. 

However, TBIC is structured in a fashion that results in a warping of Tribal 

views. Federal representatives to TBIC urge Tribal leaders to prioritize areas of 

need, a virtually impossible task for many Tribal communities where deficiencies 

are found in all areas of development and social need. Although this is pointed out, 

Federal officials respond that in the absence of Tribal guidance the officials themselves will set the priorities. At that point Tribal leaders, reluctantly, attempt to 

prioritize the needs of their communities. 

While we understand that the budget planning process pushes Federal officials 

to in turn push Tribal officials to establish a limited number of priorities, setting 

such priorities should not be used against important Tribal interests. For example, 

when a Tribal leader brings up a ‘‘non-prioritized’’ need, Federal officials should not 

use as an excuse for not supporting that need that Tribal leaders did not prioritize 

it. One example of this is education funding. Education funding did not make it on 

a recent ‘‘priority’’ list. When Federal officials were questioned by Congress about 

education funding, they said it was not a Tribal priority. That is a misuse of this 

process. Essentially, the TBIC process is being used in a way that allows Federal 

officials to affirmatively argue against a particular need even though that was never 

the Tribal intent. The Committee should provide corrective guidance to Interior on 

this point. 

The bottom line: while the Federal-Tribal Nation relationship is understood to be 

‘‘special’’ and ‘‘unique’’, the budget process currently utilized does not allow for the 

United States to fulfill its fiduciary trust responsibilities and obligations. The process needs to move away from a ‘‘needs based’’ understanding to a ‘‘fulfilling obligations’’ understanding. A significant part of the challenge is in the reality that OMB 

approaches this budgeting process no different than any other area; resulting in an 

expressed disrespect for the uniqueness of the sacred federal fiduciary responsibilities and obligations. 

Advancing the Appropriations Process by Providing for Advance 

Appropriations 

Advance appropriations are enacted a year before the funds become available, 

thus allowing the federal agency knowledge of its funding level a year in advance. 

The advance appropriations process does not put additional pressure on the appropriations subcommittees’ allocations. For instance, if FY 2015 IHS advance appropriations were included in the FY 2014 Interior, Environment, and Related Agencies 

Appropriations Act, those advance appropriations would not be counted against the 

FY 2014 Interior Appropriations Subcommittee allocation but rather would be 

counted against its FY 2015 allocation. For the first year of advance appropriations 

Congress would enact two years of IHS funds, and thereafter revert to appropriations one year at a time. 

Veterans organizations advocated for years for Congress to provide the Veterans 

Administration (VA) with advance appropriations, noting that chronically late funding negatively affected their ability to properly plan and manage its resources, including recruitment and retention of medical personnel. In 2009 Congress responded 

by authorizing advance appropriations for the VA medical accounts. Like the VA, 

the IHS and tribal organizations provide direct, federally-funded health care services to a specific population. 

Just like the VA, the IHS has been very adversely affected by recurrent delays 

in the passage of appropriations bills and by Federal Government shutdowns. Advance appropriations would dramatically reduce, if not eliminate, this problem. 

For example, if IHS was receiving funding on an advance appropriations schedule, 

its FY 2014 appropriations would have been enacted as part of a FY 2013 appropriations act and the IHS and tribal health care providers would not have entered FY 

2014 with no knowledge of what amount of funding to expect. Instead, the IHS had 

to furlough some employees and had others working on an unpaid status. Tribal 

health care providers were similarly affected. 

Enactment of legislation authorizing advance appropriations is the first step in 

actually realizing such funding. The Budget Resolution, while not having the effect 

of law, lists particular programs which may have advance appropriations. In order 

for IHS advance appropriations to not be subject to a point of order, the IHS ServVerDate Mar 15 2010 12:43 Jul 18, 2014 Jkt 088726 PO 00000 Frm 00085 Fmt 6601 Sfmt 6621 S:\DOCS\88726.TXT JACK
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ices and the IHS Facilities accounts should be included on that list in the Budget 

Resolution. 

Medicare-Like Rate Caps—Stretching Precious Federal Health Care Dollars 

As this Committee fully understands, the unmet health needs of American Indians and Alaska Natives are severe and the health status of American Indians and 

Alaska Natives is far below that of the general population of the United States, resulting in an average life expectancy for American Indians and Alaska Natives 4.1 

years less than that for the U.S. all races population. 

The Indian Health Service and Tribal Purchased/Referred Care programs purchase primary and specialty care services from private health care providers when 

those services are not available at Indian Health Service or Tribal health facilities. 

However, Purchased/Referred Care funds have been insufficient to ensure access to 

care for American Indians and Alaska Natives, resulting in rationed care and diagnosis and treatment delays that lead to the need for more intensive and expensive 

treatment, further reducing already scarce Purchased/Referred Care funds. 

In 2003, Congress amended XVIII of the Social Security Act to require 

Medicareparticipating hospitals to accept patients referred from the Indian Health 

Service and Tribal Purchased/Referred Care programs and to accept payment at no 

more than Medicare rates—the Medicare-Like Rate cap—for the services provided. 

However, the Medicare-Like Rate cap only applies to hospital services, and does not 

apply to other types of Medicare-participating providers and suppliers. 

Unlike other federal health care programs, the IHS and Tribal Purchased/Referred Care programs routinely continue to pay full billed charges for non-hospital 

services, resulting in needless waste of scarce federal Purchased/Referred Care 

funds. Because Purchased/Referred programs continue to pay full billed charges for 

non-hospital services, in many cases the Indian Health Service may only treat the 

most desperate ‘‘Life’’ or ‘‘Limb’’ cases, leading to many undesirable health outcomes 

for American Indians and Alaska Natives, and ultimately increasing costs to the 

Purchased/Referred Care programs. 

In the near future, legislation will be introduced to provide for the application of 

the Medicare-Like Rate cap to all IHS Medicare-participating providers and suppliers. In April 2013, GAO recommended that Congress enact such legislation, and 

HHS concurred in that recommendation. USET urges this Committee to strongly endorse such legislation and support its rapid advancement. 

Carcieri Fix 

This Committee has strongly supported Carcieri fix language over the last several 

years. In doing so, this Committee has sought to overturn the unjust Supreme Court 

decision in Carcieri v. Salazar, which has led to two classes of Tribes—those that 

can take land into trust and build up their communities and those that cannot. Further, this holding has severely hampered economic development in Indian Country 

and created a public safety risk through jurisdictional confusion. President Obama 

has requested this Fix in his budget and USET asks that this Committee elevate 

the urgency to resolve this injustice and once again take up the fight for fair and 

equal treatment of all Tribal nations and advance a Carcieri fix. In an era of Tribal 

Nation rebuilding and the pursuit of economic success and prosperity, the confusion 

and chaos that has resulted from this SCOTUS decision serves as one of our most 

significant barriers and challenges to this pursuit. 

Support Tribal Sovereignty in the Area of Taxation 

With Federal budget restrictions in place for years to come, Tribal tax rights become more important, both for Tribal economic success and as a matter of sovereignty. 

USET calls upon Congress to ensure that federal tax law treats Indian Tribes in 

a manner consistent with their governmental status, as reflected under the U.S. 

Constitution and numerous federal laws, treaties and federal court decisions. Indian 

Tribes have a governmental structure, and have the power and responsibility to 

enact civil and criminal laws regulating the conduct and affairs of their members 

and reservations. They operate and fund courts of law, police forces and fire departments. They provide a broad range of governmental services to their citizens, including education, transportation, public utilities, health, economic assistance, and domestic and social programs. Like states and local governments, Tribes—as political 

bodies—are not subject to income tax under the Code. The non-taxable status of 

Tribal governments is a matter of governmental fairness and parity. Improvements 

to the Tax Code are also vitally needed to align federal tax policy with the critical 

federal policy objectives of Tribal self-determination, Tribal economic growth and 

self-sufficiency and the promotion of strong Tribal governments on equal footing 

with other sovereigns within the federal system. Tax policy fairness toward Tribal 

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governments and the promotion of economic growth are of central importance in Indian Country. Tribal governments must stimulate reservation-based economic 

growth to generate the level of revenue needed to deliver vital programs and services within their territories. While Tribal governments carry out responsibilities in 

their communities that are similar in many respects to those of states and local governments; Tribal governments are not able to rely on a robust tax base for revenue. 

Instead, Tribal governments rely on revenue generated from economic development 

to meet and supplement vital programs and services. This makes clear that Congress must create reliable and effective federal tax policy to firmly support Tribal 

governance while protecting the ability of Tribes to generate and retain the full use 

of Tribal revenue. 

Tribal governments also have responsibilities that are distinct from those of other 

sovereigns. Tribes and their elected representatives have the added responsibility of 

ensuring they have the revenue needed to fulfill responsibilities to maintain Tribal 

language, culture, and ceremonies. Preservation and restoration of Tribal culture remains a significant federal policy objective. 

We ask that this Committee be supportive of this effort as we work on addressing 

the larger budget picture for all of Indian Country. 

Fair Funding for Newly Recognized Tribes 

Federal recognition obligates the government to provide for the health and welfare 

of Tribal nations. Yet, two recently recognized Tribes in the Nashville Area, the 

Shinnecock and Tonawanda Nations are forced to operate without the appropriated 

funds for health care services to which they are legally entitled. This has gone on 

for several years, in spite of previous requests for funding from the IHS. While other 

Tribes have access to their apportionment of IHS dollars, these Tribes have only a 

small amount of ‘‘bridge’’ funding through the Purchased and Referred Care program, access to which was only given in February of 2013. 

USET was pleased to learn that IHS has, once again, requested funding for these 

Tribes and that the Administration acknowledged their obligation to the Tribes and 

proposed $8 million in the FY 2015 President’s Budget Request for five newly recognized or restored Tribes in the California and Nashville Areas. However, as the Congressional Justification reveals, the Administration has requested only $4.2 million 

and $1.7 million for Shinnecock and Tonawanda, respectively. These levels are far 

below those formulated and requested by the Nashville Area IHS Office in previous 

years: $6.2 million in 2012 for Shinnecock and $2.6 million in 2010 for Tonawanda. 

Adjusting for inflation, IHS’ FY 2015 funding requests for Shinnecock and Tonawanda are markedly insufficient. 

This Administration and Congress must deliver on the promise made to these 

‘‘new’’ Tribes and provide new appropriations that will allow for parity with other 

Indian health programs nationally. We urge the Committee to advocate for funding 

for new Tribes at a level reflective of their true need. 

Definition of ‘‘Indian’’—Support the Indian Definition of ‘‘Indian’’! 

USET joins other Tribes and Tribal Organizations in calling for a fix to inconsistencies in the definition of ‘‘Indian’’ in the Affordable Care Act (ACA). While we believe the intent of Congress was to allow all IHS beneficiaries access to the special 

benefits and protections reserved for American Indians and Alaska Natives (AI/AN) 

in the ACA, the ACA has been interpreted to limit access to only enrolled Tribal 

members and Alaska Native Claims Settlement Act Shareholders. The result is an 

uneven and unfair application of the law to IHS’ patients, including those served 

by facilities in the Nashville Area—USET’s area-and confusion across Indian Country. In addition to a fix through regulation, USET fully supports passage of S. 1575, 

which would streamline the definitions of Indian in the ACA to reflect the statutory 

definition of Indian used to determine eligibility for IHS services. While the Committee works to favorably report S. 1575, we ask that Congress clarify its intent to 

the Department of Health and Human Services (HHS) that the special benefits and 

protections for AI/ANs in the ACA are intended to apply all IHS beneficiaries. As 

millions of Americans begin to experience the benefits of the ACA, the Committee 

should use all methods at its disposal to ensure that all AI/AN receive the benefits 

Congress intended for them. 

Health Information Technology—Renew Funding for FY 2015 for the 

Successful Nashville Area Program 

Due in part to congressional reporting requirements like the Government Performance and Results Act (GPRA) and improving efficiency in health care delivery, 

Health Information Technology (HIT) is an ongoing need throughout Indian Country. The Indian Health Service Resource Patient Management System (RPMS) Electronic Health Record (EHR) is a data system designed to meet the varying needs 

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of the IHS and Tribal hospitals and clinics. The goal of RPMS EHR is to provide 

meaningful and rapid access to information for direct support of health care delivery 

and resource management. Although HIT has advanced to make it easier for IHS/ 

Tribes/Urban (I/T/U) programs to report on the quality of health care they deliver 

to their beneficiaries, additional advancement is needed to modernize the I/T/U systems to be at par with other health care delivery systems across the United States. 

The IHS has been providing USET with funding to assist Tribes in taking full 

advantage of their RPMS systems in an attempt to increase GPRA reporting. For 

FY15, USET was disappointed to learn that IHS does not plan to renew funding 

for the GPRA program in the Nashville Area. These funds have been vital to the 

success of USET Tribes, and the IHS in meeting health indicators that are reported 

to Congress each year. Over time, this data has shown the efficacy of increased 

funding to the Indian Health Service. We urge Congress to consider additional funds 

to assist I/T/U in advancing their HIT needs. 

Inflation and the Budget for Federal Indian Programs 

In evaluating whether the Federal budget fulfills the Trust responsibility, USET 

believes that it is critical to take into account the effects of inflation. From FY 2002 

through FY 2008, despite annual increases, after taking into account the effect of 

inflation, most Federal domestic programs, including the Indian programs, saw a 

purchase power decrease of approximately 14 percent. The large budget increase in 

FY 2009, including ARRA funding, was approximately enough to make up for this 

effective cut and bring the purchase power of Indian programs back to FY 2002 levels, but in the intervening 12 years, Indian country needs have grown substantially. 

And, of course, the FY 2002 levels were inadequate to address the needs of Indian 

country or to fulfill the Federal Government’s trust obligation. 

Further, with regard to inflation, the rate the Federal Government uses does not 

accurately reflect true levels of inflation. In the FY15 President’s Budget Request, 

IHS requested $34 million for inflation. This reflects a blanket rate of 3.6 percent 

for medical inflation and 1.5 percent for non-medical identified by OMB, the same 

they used last year, and is earmarked for increases in Purchased/Referred Care (formerly CHS). However, the Consumer Price Index (CPI) contains different rates that 

correspond to different parts of the IHS delivery system. Inpatient hospital care is 

at 4.3 percent and outpatient is at 3.8 percent. Inflation for various line items in 

the IHS budget, H&C, PRC, Mental Health, etc. should be calculated based on relevant components in the CPI. 

In a very real way, the budget of the United States government reflects the values 

of the American people. Courtesy of the National Congress of American Indians 

(NCAI), set forth below is a chart that depicts the percentage of the Federal budget 

dedicated to funding the BIA. As you can see, as a percentage of the overall budget, 

the BIA budget has declined from .115 percent in FY 1995 to .075 percent (correcting chart typo) in FY 2011, approximately a one-third decline as a percentage 

of the overall budget (despite a small bump up in FY 2010). Below that chart is 

another which demonstrates that over the last ten years, when funding increases 

have come to the Department of the Interior they have been greater for other major 

agencies within the Department than for the Bureau of Indian Affairs. 

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Conclusion 

USET recognizes that in challenging times, all Americans must be called upon to 

sacrifice for the common good of all. USET suggests, however, that when it comes 

to sacrificing for the good of all Americans, the historic record demonstrates that 

nobody has sacrificed more than Native Americans. We ask that this Committee 

support and advocate for a budget based on American values that reflects the trust 

responsibility and fair dealing for Indian Tribes. 

PREPARED STATEMENT OF THE NATIVE HAWAIIAN EDUCATION COUNCIL

Aloha Chairman Tester and members of the Senate Committee on Indian Affairs, 

Mahalo, thank you, for allowing us an opportunity to submit comments at your 

oversight hearing on the President’s FY 2015 Budget. 

We are seeking continued funding at pre-sequestration levels for the Native Hawaiian Education Program (NHEP) that targets the Native Hawaiian student population. The NHEP is an important part of fulfilling the trust relationship between 

the U.S. and Native Hawaiians, and it helps to improve the educational status of 

Native Hawaiians. It is an important element in the Native community’s effort to 

control its education programs and policies and to achieve educational parity. NHEP 

aims to close the education achievement gap between Native Hawaiians and the 

general population, and also functions to fulfill the trust relationship between the 

United States and Native Hawaiians, the indigenous people of a once sovereign nation. During the time of their own sovereignty in the kingdom of Hawai‘i, Native 

Hawaiians had a higher rate of literacy than citizens of the United States. The educational achievement gap has occurred during the intervening years since the loss 

of Native Hawaiian sovereignty, so that today Native Hawaiians are among the 

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The NHEP Works 

NHEP has been effective over the years in meeting the goals of the program. For 

example, NHEA has been instrumental in preserving and protecting the Native Hawaiian language through funding projects that are designed to address the use of 

the Native Hawaiian language in instruction, one of the priorities named in the 

NHEA. The number of speakers nearly doubled in 18 years from 8,872 speakers in 

1990 to 16,864 in 2008 (Source: OHA Data Book 2011 Tables 4.19 and 4.44) 

The NHEP has funded programs that incorporate culture and indigenous teaching 

practices in the classroom that leads to better outcomes for Native Hawaiian students. An example is the improvement in the graduation rates for Native Hawaiians 

and math and reading scores. Graduation rates for Native Hawaiians between 2002 

and 2010 rose from 70 percent to 72.2 percent (Sources: Kamehameha Schools’ Native Hawaiian Education Assessment Update 2009, Fig. 9 and HI DOE 2005–06 to 

2009–10). 

Similarly, math and reading scores have risen for Native Hawaiians. The percent 

of Native Hawaiians scoring ‘‘Proficient or Above ‘‘ from 2007 to 2012 rose from 27 

percent to 49 percent in math and from 41 percent to 62 percent in reading (Source: 

Hawaii DOE Longitudinal Data System ). 

School attendance rates in schools with student populations that are over 50 percent Native Hawaiian have increased from 90.1 percent in the 2000–01 school year 

to 91.3 percent in the 2011–12 school year (Source: Kamehameha Schools’ draft Ka 

Huaka‘i update, p. 58) 

The Need Still Exists 

In spite of the gains that Native Hawaiians have made educationally, the need 

for innovative programs to assist Native Hawaiians to improve their academic performance still exists, since Native Hawaiians have not yet attained parity with the 

rest of the students in the state. 

Timely high school graduation rates for students in the state rose from 77 percent 

to 79.6 percent in the same time period that it rose from 70 percent to 72.2 percent 

for Native Hawaiians (Sources: Kamehameha Schools’ Native Hawaiian Education 

Assessment Update 2009, Fig. 9 and HI DOE 2005–06 to 2009–10). 

Native Hawaiians still lag behind the rest of the state in academic performance; 

however the gap between the Native Hawaiians and others is decreasing. From 

2007 to 2012 the increase in the percentage of Native Hawaiians scoring ‘‘Proficient 

or Above’’ in math rose 22 percentage points, while the increase for the state during 

the same time period was 21 percentage points. The increase for Native Hawaiians 

in reading was even more dramatic during that time period, increasing 21 percentage points compared to the state increase of only 11 percentage points. Unfortunately those gains were not enough to bring Native Hawaiians to parity. In 2012 

Native Hawaiians were still 10 points behind the state in the percentage scoring 

‘‘Proficient or Above’’ in math and nine points behind in the percentage scoring ‘‘Proficient or Above’’ in reading. 

Percent Scoring Proficient or Above 

2007 2012 Change 

Native Hawaiians Math ...................... 27% 49% 22 

State Totals Math ...................... 38% 59% 21 

Difference .............. -11 -10 

Native Hawaiians Reading ................. 41% 62% 21 

State Totals Reading ................. 60% 71% 11 

Difference .............. -19 -9 

Source: Hawaii DOE Longitudinal Data System 

In the area of Native Hawaiian language immersion, although the gains have 

been tremendous, the nearly 17,000 speakers in 2008 only represents 6 percent of 

the approximately 290,000 Native Hawaiians in Hawai‘i (2010 U.S. Census). 

Appropriations Request 

The pre-sequestration appropriations level for the NHEP was $34 million. Sequestration reduced the amount by $2 million to $32 million, which is the amount entered into the President’s budget. For such a small program as the NHEP, the $2 

million reduction makes a significant negative impact on the program. We would 

like to continue to make gains in the educational achievement of Native Hawaiians, 

and request the pre-sequestration level of $34 million so that we don’t lose the momentum of improvement. 

87 

NHEP funds programs to help improve the educational attainment of Native Hawaiians in ways that are linguistically and culturally aligned to the needs of our 

Native students and communities in Hawai‘i. Improving education, particularly for 

the most depressed groups, eventually leads to cost savings over time through decreased incarceration, poor health, and public assistance.(Barnett, W. S., & Ackerman, D. J. 2006. Costs, benefits, and the long-term effects of early care and education 

programs: Cautions and recommendations for community developers. Journal of the 

Community Development Society, 37(2), 86–100.) Academic achievement is also correlated with positive economic outcomes. (Belfield, C. 2008, June. The economic investments of early education in Hawaii. Issue Brief. Flushing, NY: Queen’s College, 

City University of New York.) 

Please help us sustain the NHEP to its pre-sequestration level in order to continue the educational gains that have taken this program years to accomplish. 

PREPARED STATEMENT OF THE NATIONAL INDIAN CHILD WELFARE ASSOCIATION

(NICWA) 


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PREPARED STATEMENT OF NATIONAL INDIAN EDUCATION ASSOCIATION (NIEA) 

The National Indian Education Association (NIEA) appreciates the work of the 

Senate Committee on Indian Affairs for making education a priority. As the Committee works with appropriators and the Administration, we request this written 

testimony be submitted into the record, so Native education stakeholders are represented. NIEA was incorporated in 1970 and is the most representative Native 

education organization in the United States. NIEA’s mission is to advance comprehensive and equal educational opportunities for American Indian, Alaska Native, 

and Native Hawaiian students. NIEA supports tribal sovereignty over education as 

well as strengthening traditional Native cultures and values that enable Native 

learners to become contributing members of their communities. As the most inclusive Native education organization, NIEA membership consists of tribal leaders, 

educators, students, researchers, and education stakeholders from all 50 states. 

From communities in Hawaii, to tribal reservations across the continental U.S., to 


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villages in Alaska and urban communities in major cities, NIEA has the most reach 

of any Native education organization in the country. 

The State of Native Education 

Native education is in a state of emergency. Native students lag behind their 

peers on every educational indicator, from academic achievement to high school and 

college graduation rates. Just over 50 percent of Native students are graduating 

high school, compared to nearly 80 percent for the majority population nationally. 

Further, only one in four Native high school graduates who took the ACT scored 

at the college-ready level in math and only one-third in reading comprehension, as 

compared to more than half for white graduates. Increasingly alarming, only 40 percent of Native college enrollees in 2004 actually graduated college with a bachelor’s 

degree by 2010. Nearly 62 percent of the majority students graduated. For Native 

students to succeed in college and careers, they must have a strong education foundation that also meets their local needs and strengthens their linguistic and cultural 

identity. 

Uphold the Trust Responsibility 

The federal government has a trust relationship with tribes established through 

treaties, federal law, and U.S. Supreme Court decisions. This relationship includes 

a fiduciary obligation to provide parity in access and equal resources to American 

Indian and Alaska Native students. National fiscal and policy concerns should not 

be addressed by decreasing funds and investment to Native students or the programs that serve them. 

Native education is one of the most effective and efficient investments the federal 

government can make. Unfortunately, historical funding trends illustrate that the 

federal government is abandoning its trust responsibility by decreasing federal 

funds to Native-serving programs by more than half in the last 30 years. Sequestration only exacerbated those shortfalls. As tribes and Native communities work with 

Congress to increase their role and responsibility in administering education, federal 

support should increase for tribal governments and Native education institutions to 

repair the damage caused by shrinking budgets. 

Fiscal Year 2014 Funding Requests 

While FY 2014 funding increases over sequestration levels are welcome, funding 

continues to be insufficient for effectively and equally serving Native students. Until 

the federal government fully appropriates funding to bridge the educational attainment gap among Native and non-Native students, the trust responsibility will be 

undermined. The federal government should fund Native education programs at the 

levels below as the programmatic requests detail the minimum appropriations needed to maintain a system that is already struggling and underfunded. Further, NIEA 

supports the budget requests of the National Congress of American Indians and the 

American Indian Higher Education Consortium. 

DEPARTMENT OF EDUCATION—LABOR, HEALTH AND HUMAN SERVICES AND

EDUCATION APPROPRIATIONS BILL

Title I, Part A Local Education Agency Grants 

Provide $25 billion for Title I, Part A. An increase of $10.6 billion. 

• Title I of the Elementary and Secondary Education Act provides critical financial assistance to local educational agencies and schools with high percentages 

of children from low-income families that ensure all children meet challenging 

state academic standards. 

• Currently, there are over 600,000 Native students across the country with nearly 93 percent of those students attending non-federal institutions, such as traditional public schools in rural and urban locations. 

• A drastic increase in funding to counter annual inflation and sequestration, as 

well as match the amount appropriated under the American Reinvestment and 

Recovery Act, is necessary to meet the needs of Native students and students 

from low-income families. 

State-Tribal Education Partnership (STEP) Program 

Provide $5 million. An increase of $3 million. 

• Congress appropriated roughly $2 million dollars for the STEP program to five 

participating tribes in FY 2012 and FY 2013 under the Tribal Education Department appropriations. 

94 

• In order for this program to continue to succeed and thrive, it must receive its 

own line and authorization of appropriations in FY 2015. 

• Collaboration between tribal education agencies and state educational agencies 

is crucial to developing the tribal capacity to assume the roles, responsibilities, 

and accountability of Native education departments and increasing self-governance over Native education. 

Impact Aid 

• Provide $2 billion for Impact Aid, under ESEA Title VIII. An increase of 

$711 million. 

• Impact Aid provides direct payments to public school districts as reimbursement 

for the loss of traditional property taxes due to a federal presence or activity, 

including the existence of an Indian reservation. 

• With nearly 93 percent of Native students enrolling in public schools, Impact 

Aid provides essential funding for schools serving Native students. 

• Funding for Impact Aid must not be less than this requested amount. 

Title VII (Indian Education Formula Grants) 

Provide $198 million under ESEA Title VII, Part A. An increase of $76 million. 

• This grant funding is designed to supplement the regular school program and 

assist Native students so they have the opportunity to achieve the same educational standards and attain parity with their non-Native peers. 

• Title VII funds support early-childhood andfamily programs, academic enrichment programs, curriculum development, professional development, and culturally-related activities. 

• Title VII programs were maintained at the 2013 sequestration level of $124 million. 

• While these levels are higher than what would have been incurred under another year of sequestration, current funding results in inadequate support for 

critical culturally-relevant educational services. 

Native Hawaiian Education Program 

Provide $35 million under ESEA Title VII, Part B. An increase of $3 million. 

• This program funds the development of curricula and education programs that 

address the education needs of Native Hawaiian students to help bring equity 

this Native population. 

• The Native Hawaiian Education program empowers innovative culturally appropriate programs to enhance the quality of education for Native Hawaiians. 

When establishing the Native Hawaiian Education Program, Congress acknowledged the trust relationship between the Native Hawaiian people and the 

United States. 

• These programs strengthen the Native Hawaiian culture and improve educational attainment, both of which are correlated with positive economic outcomes. 

• Native Hawaiian-serving programs under Title VII were also maintained at the 

2013 sequestration level, reducing much-needed services to Native students. 

Alaska Native Education Equity Assistance Program 

Provide $35 million under ESEA Title VII, Part C. An increase of $4 million. 

• This assistance program funds the development of curricula and education programs that address the unique educational needs of Alaska Native students, as 

well as the development and operation of student enrichment programs in 

science and mathematics. 

• This funding is crucial to closing the gap between Alaska Native students and 

their non-Native peers. 

• Other eligible activities include professional development for educators, activities carried out through Even Start programs and Head Start programs, family 

literacy services, and dropout prevention programs. 

• Alaska Native-serving programs under Title VII were also maintained at the 

2013 sequestration level, reducing much-needed services to Native students. 

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Tribal Colleges and Universities: Supporting Financially Disadvantaged 

Students 

Provide $60 million ($30 million in discretionary funding and $30 million 

in mandatory funding) for Title III–A grants under the Higher Education 

Act for Tribal Colleges and Universities. An increase of $35.5 million. 

• Titles III and V of the Higher Education Act, known as Aid for Institutional 

Development programs, support institutions with a large proportion of financially disadvantaged students and low cost-per-student expenditures. 

• Tribal Colleges and Universities (TCUs) clearly fit this definition. The nation’s 

37 TCUs serve Native and non-Native students in some of the most impoverished areas in the nation. 

• Congress recognized the TCUs as emergent institutions, and as such, authorized a separate section of Title III (Part A, Sec. 316) specifically to address their 

needs. 

• Additionally, a separate section (Sec. 317) was created to address similar needs 

of Alaska Native and Native Hawaiian institutions. Sixty million should be provided ($30 million discretionary/appropriations and $30 million in mandatory 

funding under SAFRA) in FY 2015 to continue to fund grants to these vital institutions. 

Tribal Colleges and Universities: Adult/Basic Education 

Provide $8 million for American Indian Adult/Basic Education at Tribal 

Colleges and Universities, from existing funds appropriated for state block 

grant funding. An increase of $8 million. 

• Despite an absence of dedicated funding, TCUs must find ways to continue to 

provide basic adult education classes for those American Indians that the 

present K–12 Indian education system has failed. 

• At TCUs, the number of students in need of remedial education before embarking on their degree programs is substantial. 

• There is a wide-ranging need for basic adult education and literacy programs 

and TCUs need adequate funding to support the ever increasing demand for 

basic adult education and remediation program services. 

Tribally Controlled Post-Secondary Career and Technical Institutions 

Provide $8.2 million for postsecondary career and technical institutions 

program funds under Carl Perkins Technical and Career Education Act. An 

increase of $.5 million. 

• Section 117 of the Carl Perkins Career and Technical Education Improvement 

Act authorizes funding for operations at tribally-controlled postsecondary career 

and technical institutions. 

• Vocational education/training programs are very expensive to conduct, but are 

vital to preparing a future workforce that will operate safely and efficiently contributing greatly to the global economy. 

• Currently, two TCUs participate in this funding program: United Tribes Technical College in Bismarck, North Dakota, and Navajo Technical College in 

Crownpoint, New Mexico. The TCUs urge Congress to appropriate $8.5 million 

for Sec. 117 of the Act. 

Native American-Serving, non-Tribal Institutions (Higher Education Act 

Title III–F) 

Provide $10 million for non-tribal, Native-serving institutions of higher 

education. An increase of $7 million. 

• As the primary federal funding for Native-serving, non-tribal institutions of 

higher education, the current appropriation of $5 million is insufficient. 

• With nearly 100 institutions potentially qualifying as Native-serving, non-tribal 

institutions, this strains the small amount of available funding. 

• To ease the high-level of competition between Native-serving schools, increasing 

the funding will provide the opportunity for more Native-serving institutions to 

better serve their students and increase graduation rates among Native students. 

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DEPARTMENT OF EDUCATION AND DEPARTMENT OF THE INTERIOR—LABOR, HEALTH

AND HUMAN SERVICES AND EDUCATION APPROPRIATIONS BILL, AND INTERIOR— 

ENVIRONMENT APPROPRIATIONS BILL

Tribal Education Departments 

Provide $10 million to fund Tribal Education Departments. An increase of 

$5 million, collectively. 

• Five million dollars should be appropriated to the Department of the Interior, 

and $5 million should be appropriated to the Department of Education to support tribal education departments (TEDs). 

• This funding assists TEDs, who are uniquely situated at the local level to implement innovative education programs that improve Native education. 

• Because they are administered by tribes, TEDs are best equipped to deliver 

education programs tailored to improve education parity for Natives. 

• TEDs would use this much-needed funding to develop academic standards, assess student progress, and create math and science programs that require high 

academic standards for students in tribal, public, and Bureau of Indian Education schools. 

• Tribes utilizing self-governance over education have been very successful because they better understand the circumstances of their populations and can develop initiatives that meet local needs. 

DEPARTMENT OF THE INTERIOR—INTERIOR—ENVIRONMENT APPROPRIATIONS BILL

School Construction and Repair 

Provide $263.4 million for Bureau of Indian Education (BIE) school construction and repair. An increase of $153.3 million. 

• This funding category includes school construction, facilities improvement and 

repair, and replacement school construction. 

• Schools operating within the BIE system are woefully outdated and in some 

cases, dangerous for student and staff. 

• Currently more than 60 BIE schools are rated in ‘‘poor’’ condition, which puts 

Native students at an unfair disadvantage. 

Johnson O’Malley 

Provide $42 million for full funding. An increase of $27 million. 

• The Johnson O’Malley program has provided grants to supplement basic student needs since 1934. 

• It is currently being used across the country in innovative ways to assist with 

the unique cultural and scholastic needs of Native students. 

• Current funding provides less than $76 per student, which are often the only 

source through which Native students—including those in public schools—can 

engage in basic activities expected of all American students. 

• $95 per student was the allocation of JOM funding per student in 1995. 

Student Transportation 

Provide $73 million for student transportation in the BIE system. An increase of $20 million. 

• BIE schools incur significant costs in transporting Native students to and from 

school. 

• These costs are considerably higher than most school systems due to the oftenrural location of BIE facilities. 

• Poor road conditions that link the BIE-funded schools increase vehicle maintenance costs. 

• These high costs often lead to funding shortfalls, which then must either go unpaid or funded by diverting funds from other education programs. 

Tribal Grant Support Costs 

Provide $73 million for tribal grant support costs for tribally-operated 

schools. An increase of $26 million. 

• Tribal Grant Support Costs fund the administrative costs of existing triballyoperated schools. 

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• The current funding levels only pays 65 percent of the current need and must 

not be reduced in the upcoming budget cycle. 

• This funding also help tribes expand self-governance and tribal control over 

education programs by allocating monies for administrative costs such as accounting, payroll, and other legal requirements. 

• Schools must divert critical teaching and learning funding to cover any shortfalls in operational costs. 

Facilities Operations 

Provide $109 million for BIE facilities operations. An increase of $50 million. 

• BIE schools use this funding for costs such as electricity, heating fuels, communications, GSA vehicle rentals, custodial services, and other vital operating expenses. 

• For years, schools have only received roughly 50 percent of funding needed for 

these expenses. This shortfall is unacceptable as costs continue to rise for vital 

services. 

Facilities Maintenance 

Provide $76 million for BIE facilities maintenance. An increase of $25 million. 

• BIE schools use this funding for the preventative and routine upkeep, as well 

as for unscheduled maintenance of school buildings, grounds, and utility systems. 

• Underfunding of maintenance continues to be an issue as buildings are in poor 

conditions and cannot maintain proper standards. 

Indian School Equalization Program (ISEP) 

Provide $431 million for the Indian School Equalization Program. An increase of $35 million. 

• These funds provide the core budget account for BIE elementary and secondary 

schools by covering teacher salaries, aides, principals, and other personnel. 

• ISEP funds are often reallocated to cover the program cuts in other areas of 

education. 

• ISEP must have adequate funding to ensure all program needs are fulfilled and 

must not be reduced to provide funds for new initiatives that have not been vetted by tribes. 

Juvenile Detention Education 

Reinstate $620,000 for juvenile detention education in BIA-funded facilities. 

• These critical funds were eliminated for FY 2012. 

• This essential funding was used to provide educational services to detained and 

incarcerated youth at 24 BIA-funded juvenile detention facilities. 

• One of the best methods to rehabilitate individuals is through education. 

• Eliminating this program creates additional costs by increasing the rate of repeat offenders. 

Tribal Colleges and Universities’ Institutional Operations 

Provide $94.3 million for Titles I and II under the Tribally Controlled Colleges and Universities Assistance Act. An increase of $30 million. 

• Title I: To fully fund Title I of the Tribally Controlled Colleges and Universities 

Assistance Act of 1978 (Tribal College Act), which provides day-to-day operating 

funds for 26 TCUs, would require $77.3 million. 

• Since the Act was first funded in 1981, the number of TCUs has more than 

quadrupled and enrollments have increased by more than 325 percent. 

• Title I TCUs receive $5,665 per Indian student toward their institutional operating budgets. Accounting for inflation, the program’s funding level is more 

than $1,500 less per Indian student than it was under the program’s initial 

FY 1981 appropriation, which was $2,831 per Indian student. 

• Despite the constraints of the current economy, Congress has an obligation 

to make these critical institutions whole now rather than continuing to make 

hollow promises for the future. 

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• Title II: Dine ́ College has indicated a need for $17 million to operate its multiple campuses and education sites located on the Navajo Nation. 

• Five other TCUs receive institutional operating funds through the annual Department of the Interior Appropriation measure, under separate various authorities. 

• To support the basic day-to-day operating budgets of these TCUs, NIEA requests the following: 

• $9.3 million for institutional operations of tribally-chartered career and technical institutions under Title V of the Tribally Controlled Colleges and Universities Assistance Act of 1978; 

• $4.8 million in a one-time payment to allow the institutions to be forward 

funded; 

• Adequate funds for continued and expanded operations of Haskell Indian Nations University in Kansas and Southwestern Indian Polytechnic Institute in 

New Mexico under the Snyder Act of 1921; and 

• $27.7 million for a one-time appropriation, equal to 75 percent of the current 

combined funding of the institutional operations grants of those TCUs not 

funded under Titles I or II of the Tribally Controlled Colleges and Universities Assistance Act of 1978, necessary to transition these programs to be forward funded. 

Forward Fund Remaining Five Tribal Colleges and Universities 

Provide a One-Time Appropriation of $22 million to forward fund five 

TCUs. 

• All other TCUs are able to plan multi-year budgets and start each school year 

with predictable funding for operations. Forward funding these remaining five 

institutions is necessary for Haskell Indian Nations University; Southwestern 

Indian Polytechnic Institute; Institute of American Indian Arts; Navajo Technical University; and United Tribes Technical College. 

• These five tribal colleges, which are the only education institutions funded 

through the BIE that are not forward funded, have received no new operating 

funds and were in danger of closing their doors to the thousands of Native students they serve during the October 2013 federal government shutdown. 

Institute of American Indian Arts (IAIA) and Center for Lifelong Education 

Provide $13.3 million to the Center & Museum under the American Indian, Alaska Native, and Native Hawaiian Culture and Art Development 

Act. An increase of $5.3 million. 

• IAIA is the only four-year degree fine arts institution devoted to the study of 

contemporary Native American and Alaska Native arts. 

• IAIA has graduated more than 3 ,800 students from federally-recognized tribes 

and beyond. Of the $13.3 million requested, provide $9.3 million, with an additional one-time payment of $4 million to allow for forward funding. 

Haskell Indian Nations University (HINU) and Southwestern Indian Polytechnic (SIPI) 

Provide $36.9 million to HINU and SIPI under the Snyder Act. An increase 

of $19.4 million. 

• As the first TCUs, these institutions are funded separately from the other institutions and require additional funding considerations. 

• Appropriations of $14.3 million to HINU and $8.5 million to SIPI are necessary 

to ensure adequate services are provided to Native students. 

• A one-time payment of $13.2 million would help forward fund the institutions. 

DEPARTMENT OF AGRICULTURE—AGRICULTURE APPROPRIATIONS BILL

1994 Extension Program 

Provide $6 million for the 1994 Extension Grants Program. An increase of 

$2.1 million. 

• The 1994 Extension Program is designed to complement, not duplicate, the federally recognized tribe extension program (FRTEP). Ironically, the 1994 Institutions—tribal colleges and universities—are the only members of the land grant 

system that are not eligible to compete for these grant dollars. 

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• The 1994 Extension Program activities include: outreach to at-risk youth; business skills development for local agriculture entrepreneurs; Native plant restoration and horticulture projects; environmental analysis and water quality 

projects; and nutrition projects aimed at addressing health disparities, such as 

high rates of diabetes among Native populations. 

• Ten years ago, while the 1994 Extension Program suffered a 13 percent cut in 

appropriated funding, the 1862 and 1890 extension programs were reduced by 

just 0.59 percent. In the years since, the 1994 Extension Programs has been 

struggling to recovered lost funds and opportunities. It is time that Congress 

adequately invests in the extension programs benefiting our reservation communities. 

1994 Institutions Research Grants 

Provide $3 million for the 1994 Research Grants Program. An increase of 

$1.2 million. 

• The 1994 Research Grants Program allows TCUs to partner with communities 

in research areas such as agriculture marketing, renewable energy, nutrition 

and health, Native plants and horticulture, water quality, and land management. 

• These research areas are of increasing importance as tribal economies and 

tribes’ efforts to address pressing challenges depend on access to quality data 

and evidence. 

• Challenges include the disproportionate impacts of climate change on tribal 

lands and people, as well as the impact of poor economic conditions. 

• TCUs need and deserve a level of funding that will increase their capacity for 

further developing and conducting research and to strengthen education and 

sustainable economic development important to their tribal communities. 

• In FY 2013, the program was cut a further 7.6 percent by sequestration to only 

$1.664 million. 

Educational Equity Grant Program 

Provide $6 million to the Educational Equity Grant Program for 1994 

land-grant institutions. An increase of $2.7 million. 

• The Education Equity Grant Program assists TCU land-grants to establish academic programs within the field of agriculture that explore areas such as natural resource management, nutrition, environmental science, horticulture, sustainable development, and forestry. 

• The funding requested will help in preparing to address issues of climate 

change and its impact on agriculture, ecosystems, and natural resources focusing on remote reservation communities. 

• This investment will support TCU efforts to provide increased nutrition education to their reservation communities, who experience diabetes and other 

health issues at rates far greater than the national average. 

• In FY 2013, the program was cut a further 7.6 percent by sequestration to only 

$3.081 million. 

The 1994 Native American Institutions Endowment Fund 

Provide a $136 million endowed payment into the 1994 Institutions Native American Endowment Fund. An increase of $124 million. 

• The Native American Institutions Endowment Fund, managed by the US Treasury, provides funds to TCU land-grant institutions through dissemination of the 

annual interest yield. Although Congress has made regular contributions to the 

corpus of the endowment, the latest interest yield shared by the 32 eligible 1994 

institutions amounted to just $4.5 million. 

• These funds assist in strengthening academic programs, including agriculture 

curricula development, faculty development, instructional delivery, and experiential learning. 

• Funds are also used to enhance student recruitment and retention in the agricultural sciences, as well as to address the ongoing need for improved facilities 

at the 1994 land-grant institutions. 

• The 1994 institutions request that a payment of $136 million be made, which 

would essentially double the principle amount funded for the 1994 Native 

American Institutions Endowment. 

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• Since only the annual interest yield is distributed to the 1994 land-grant institutions, only the interest on the Fund-and not the appropriated payment 

amount-is scored as budget outlay, yet the additional interest available to the 

TCUs, will yield get dividends in community-based programs. 

Essential Community Facilities at Tribal Colleges and Universities Grant 

Program 

Provide $10 million for the TCU Essential Community Facilities Grant 

Program. An increase of $6.9 million. 

• The USDA-Rural Development program provides grants for Essential Community Facilities at TCUs funds the ever-growing need for construction, improvement, and maintenance of TCU facilities, such as advanced science laboratories, 

computer labs, student housing, day care centers, and community service facilities. 

• Although the situation has improved at many TCUs over the past several years, 

some institutions still operate partially in temporary and inadequate buildings. 

• Few TCUs have dormitories, even fewer have student health centers, and only 

a handful of TCUs have full research laboratories. 

• The 1994 land-grant institutions need a commitment of $5 million each year for 

the next five fiscal years to support construction, improvement, and maintenance of TCU facilities. 

DEPARTMENT OF HEALTH AND HUMAN SERVICES—LABOR, HEALTH AND HUMAN

SERVICES—EDUCATION APPROPRIATIONS BILL

Head Start 

Provide $9.6 billion in total funding for Head Start, which includes Indian Head Start. An increase of $1 billion. 

• Head Start has been and continues to play an instrumental role in Native education. 

• In 2012, Head Start funds provided early education to over 24,000 Native children. 

• This vital program combines education, health, and family services to model 

traditional Native education, which accounts for its success rate. 

• Current funding dollars provide less for Native populations as inflation and fiscal constraints increase. 

• It is now conventional wisdom that there is a return of at least $7 for every 

single dollar invested in Head Start 

• Congress should increase funds to Head Start and Early Head Start to ensure 

Indian Head Start can reach more tribal communities and help more Native 

people by triggering the Indian special expansion funding provisions (after a full 

Cost of Living Allowance has been paid to all Head Start programs). 

• The definition of ‘‘expansion’’ for funding purposes should include not only new 

positions, but also the establishment of new programs in unserved Indian communities, as well as quality improvements (e.g., increased staffing, professional 

development, transportation equipment, computer technology/web access, facility renovations and repair, etc.). 

• Expansion should also include going from part-day to full-day, from home-based 

to center-based, full year services and from Head Start to Early Head Start. 

Native Languages Preservation (Esther Martinez Program Grants) 

Provide $12 million for Native language preservation with $5 million designated to fund the Esther Martinez Language Programs. An increase of $3 

million. 

• Native language grant programs are essential to revitalizing Native languages 

and cultures, many of which are at risk of disappearing in the next decades. 

• With adequate funding, Esther Martinez Program Grants support and strengthen Native American language immersion programs. 

• In addition to protecting Native languages, these immersion programs have 

been shown to promote higher academic success for participating students in 

comparison to their Native peers who do not participate. 

• The federal budget should include $12 million as part of the appropriation to 

the Administration for Native Americans for Native language preservation activities. 

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• The appropriation should include $5 million designated to support Esther Martinez Language Programs’ Native language immersion initiatives, as they have 

demonstrated success in supporting Native language revitalization. 

DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT (HUD)—TRANSPORTATION, 

HOUSING AND URBAN DEVELOPMENT APPROPRIATIONS BILL

HUD-University Partnership Program for Tribal Colleges and Universities 

Provide $5.5 million to the HUD-University Partnership Program for 

TCUs. An increase of $5.5 million. 

• Executive Order 13592, ‘‘Improving American Indian and Alaska Native Educational Opportunities and Strengthening Tribal Colleges and Universities,’’ 

holds federal agencies accountable for developing plans to integrate TCUs into 

their programs. 

• TCUs work with tribes and communities to address all aspects of reservation 

life, including the continuum of education, housing, economic development, 

health promotion, law enforcement training, and crime prevention. 

• Likewise, federal agencies need to work with TCUs. To achieve results, Congress needs to hold the Administration accountable for strengthening the TCUs, 

including their physical plants and that they are routinely included as full partners in all existing and potential federal higher education programs. 

• The HUD–TCU competitive grants program, administered by the Office of University Partnerships, is an excellent place to start. 

• This competitive grants program has enabled TCUs to expand their roles and 

efficacy in addressing development and revitalization needs within their respective communities. 

NATIONAL SCIENCE FOUNDATION (NSF)—COMMERCE, JUSTICE, AND SCIENCE

APPROPRIATIONS BILL

Education and Human Resources (EHR) 

Provide at least $13.3 million to the Tribal Colleges and Universities Program. An increase of $1 million.An increase of $1 million. 

• In FY 2009, NSF awarded $4.2 billion in science and engineering (SE) funding 

to the nation’s institutions of higher education, and TCUs only received $10.5 

million, or one-quarter of one percent of this funding.An increase of $1 million. 

• Among other minority serving institutions, NSF awarded $144.2 million in SE 

funding to 174 historically black colleges and universities and Hispanic serving 

institutions, averaging $828,545 per institution, while 29 TCUs received an average of only $362,000 per institution.An increase of $1 million. 

• This disproportionate distribution trend must be addressed in FY 2015.An increase of $1 million. 

Conclusion 

NIEA appreciates the continued support of this Committee and we look forward 

to working closely with its members under the leadership of Chairman Tester and 

Ranking Member Barrasso. We share your commitment to Native education and 

want to strengthen our partnership with you to ensure programs serving Native 

communities are as efficient and effective as possible. 

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