I
Testimony of
Julia A. Davis, Chair
Northwest Portland Area Indian Health Board
Before the Senate Committee on Indian Affairs
February 25, 1998
It is an honor to be here today to present testimony on behalf of the Northwest Portland Area
Indian Health Board, a tribal organization which represents 40 Federally-recognized tribes in
Oregon, Washington, and Idaho on health-related issues.
This organization is charged each year with reviewing the President's budget for the Indian Health
Service and analyzing its impact on Indian health programs for our member tribes. We presented
that analysis to tribal delegates last week and are submitting that analysis as our written testimony.
I am here to share with you a brief summary of our concerns about this budget.
This Administration has committed itself to extending health care to children of the working poor.
But apparently that commitment does not extend to Indian children. Working poor Indian parents
seek medical care for their children from Indian health clinics.
This Administration has proposed to extend health care to more older Americans by expanding
Medicare coverage. But apparently that commitment does not include expanding health care for
Indian elders who seek their medical care from Indian health clinics.
This Administration is committed to achieving the objectives set by the Government Performance
Requirements Act and has used the objectives developed by the Indian Health Service as models
for the Department. But apparently this commitment does not extend to providing the financial
support needed by IHS to achieve those objectives.
This Administration has committed itself to reducing racial health disparities, but proposes to pay
for the two initiatives it proposes for Indian people by cutting base program funding.
This Administration says it is committed to the Policy of Indian Self- Determination and to tribal
consultation but has effectively ended the opportunity for self-determination by not providing new
contract support cost funding ignoring one of the top priority items identified in budget
consultation with tribes.
This Administration has proposed to increase the budgets for the National Institutes of Health, the
Agency for Health Care Policy Research, and Centers for Disease Control by $1.2 Billion in 1999
and $17 Billion over 5 years. And yet it has effectively cut the IHS Health Services budget-a
budget dwarfed by that of NIH. There are health research and epidemiology programs, health
policy initiatives, and disease prevention and control programs all under the Indian Health Service
umbrella. Why were Indian people not considered important enough to be included in this huge
commitment of new health resources?
This budget is a disaster for the Indian health programs in the Northwest that provide medical
care to over 85,000 people. Indian health programs have given, and given, and given, to balance
the Federal Budget. From 1993-1999 Indian health programs will have absorbed over $1.2 billion
in unfunded mandatory cost increases due to medical and general inflation and population growth.
When does it become the turn of other Federal health agencies to bear some of this burden?
In the past, Republican Administrations proposed unrealistic Medicaid collections to justify unfair
budgets for the Indian Health Service and Democratic Congresses recognized this and restored
funding. Now a Democratic Administration is making unrealistic Medicaid collection estimates to
justify an unfair budget. The question is will a Republican Congress see through this gimmickry
and provide a fair and equitable budget for the Indian Health Service.
Every American citizen, including Indian citizens wants the Federal govermnent to fund programs
that show success. What other program can this government point to which in such a short time
has had such dramatic success. The disparity in life expectancy and disease burden for American
Indians has changed dramatically since 1955 when the Indian Health Service was transferred to
the Public Health Service. IHS brought health care for the first time to rural isolated
communities. When the goal of this country as stated in the Healthy People 2000 and 2010 is to
improve health status, why is the health status of Indian people not important enough to maintain
the ability of programs to provide care? And how are we expected to address those areas in
which our health status lags behind the rest of the country--diabetes, accidents, suicide, and
tuberculosis?
The proposed Indian Health Service budget will reduce the number of health care services that are provided, end Self-Determination contracting by tribes, and harm facilities. It is the sincere hope of the Northwest Portland Area Indian Health Board that Congress will:
Restore the Indian Self-Determination Fund;
Provide funding for mandatory cost increases;
Restore Maintenance and Improvement funds to safeguard the investment made in health care facilities; and
Provide opportunities for tribes to use their own resources to replace inadequate facilities
through Joint Venture projects.
The Administration has proposed an average budget increase of 8.4% for those agencies in the
Department of Health and Human Services considered discretionary. Indian health programs
should share in this commitment to improve the health of the American people.