U.S. House Committee on Natural Resources
March 14, 2007
Washington, D.C. - A $1.17 billion shortfall in backing for sanitation and health facilities in rural Alaska and expanded dental care programs for Alaska Natives were among several important programs highlighted by U.S. Representative Don Young (R-Alaska) in a new Indian Health Care bill he is supporting in Congress.
Young discussed the issues during a hearing today by the House Committee on Natural Resources on "The Indian Health Care Improvement Act Reauthorization" (H.R. 1328). Young, the Ranking Member on the Committee, helped author the bipartisan legislation which was introduced in the House earlier this month.
Valerie Davidson of Anchorage testified at the hearing on behalf of the Alaska Native Tribal Health Consortium. Her testimony is included here as an attachment.
Young's Statement During Today's Hearing
"Mr. Chairman (Rep. Nick J. Rahall, D-WV), I would like to thank you for holding this hearing today on The Indian Health Care Improvement Act Reauthorization - a bill which is very important for American Indians and Alaska Natives. For the last 2 Congresses, I have worked very hard with tribes and Alaska Natives to move this essential bill forward by introducing a bi-partisan bill with my colleagues in the U.S. House of Representatives.
"We came very close to finalizing a bill in the last Congress, and I want to thank this Committee for fulfilling its responsibility by favorably reporting my bipartisan bill out of this Committee last year.
"I am pleased to see that this hearing will focus on many aspects of the bill, including sanitation and health facilities construction programs, health disparities, Urban Indian programs and the problem with retaining health care professionals in the most rural parts of our nation.
"In Alaska, we have an unmet need of $1.17 billion for sanitation and health facilities - a situation which should not exist in the in the 21st century.
" Alaska Is Experiencing A True Dental Crisis"
"I want to thank the Alaska Native Tribal Health Consortium (ANTHC) and all of the Alaska Native Tribal health organizations for their commitment to ensure that my Alaska Native rural residents have access to dental care.
"Currently, Alaska is experiencing a true dental crisis. In excess of one-third of rural Alaska school children have missed school because of dental pain. Recruitment and retention of rural dentists cannot make dental care accessible in most villages except on an itinerant basis. Even if we filled every vacancy in rural Alaska , it would take over ten years to catch up on the accumulation of dental needs.
"Our Dental Health Aide Therapists Plan was initiated in 2003 by the Alaska Native Tribal Health Consortium to address the dental crisis in rural Alaska . Hundreds of Alaska Natives have had the opportunity to be treated by the new dental therapists and report positive experiences with the quality of care.
"I have had several public health organizations, including those of dentists, endorse the Dental Health Aide Therapist Program. Also, I have reviewed and met with participants of the Yukon-Kuskokwim Health Corporation program. I was extremely impressed with the training the dental therapists receive, with their oversight and supervision by a licensed dentist, and with their quality of care. While prevention activities are crucial, they must be coupled with treatment, the kind of treatment that these therapists can provide safely.
"There was a recent article in the Washington Post entitled, "For Want of a Dentist, Prince George 's Boy Dies After Bacteria from Tooth Spread to Brain." This story outlines the critical problem of access-to-care and its horrible consequences when it comes to dental health - a problem keenly felt in rural Alaska Native villages. On top of this, an additional problem in rural Alaska was that most dentists will not accept Medicaid patients. This situation should not exist in the wealthiest nation in the world. It is inexcusable.
"Before I close, I want to welcome all of my Alaska constituents who have traveled to this important hearing today. Welcome.
"I look forward to working with Chairman Rahall to finalize a bill for passage."
Background Information On H.R. 1328
H.R. 1328 was introduced by Natural Resources Committee Chairman Nick Rahall (D-WV), Congressman Frank Pallone (D-NJ) and Congressman Don Young on March 5, 2007. The purpose of the Act is to implement the federal responsibility for the care and education of American Indians and Alaska Natives by improving the services and facilities of Federal Indian health programs and encouraging the maximum participation of American Indians and Alaska Natives in such programs.
The Indian Health Care Improvement Act (IHCIA) became Public Law 94-437 in the 94th Congress (September 30, 1976), and has been amended 7 times. The IHCIA provides for health care delivery to over 2 million American Indians and Alaska Natives.
H.R. 1328 responds to the changes that have occurred in the delivery of Indian health services in the decade since the last reauthorization of IHCIA. In this period, In excess of half of the tribes in the have exercised their rights under the Indian Self-Determination and Education Assistance Act to assume responsibility to carry out programs of the Indian Health Service (IHS) on their own behalf.
This, along with enhancements in the IHS direct operations, have led to hospitals being accredited by the Joint Commission on Accreditation of Healthcare Organizations, and health delivery systems being tailored to expanded outpatient and home and community based services had become commonplace in the private sector. Medicare, Medicaid and other 3rd party revenue were important to achieving these gains and are crucial for retaining them. Equally important is the need to reinforce the authority provided to tribal health programs under self-determination and self-governance to allow tribes to establish their own priorities and to determine the best ways to respond to the specific needs of their tribal members.
Some highlights of the ways in which H.R. 1328 addresses these changes:
Title I. Indian Health, Human Resources, and Development. The purpose of this is to increase, to the maximum extent feasible, the number of Indians entering the health professions and providing health services, and to assure an optimum supply of health professionals to the Indian Health programs and Urban Indian Organizations involved in the provision of health services to Indians.
Title II. Health Services. This title will establish programs that respond to the health needs of American Indians and Alaska Natives. For example, American Indians and Alaska Natives have disproportionably high rate of diabetes (death rate for this disease is In excess of 300 percent of the rate of the population generally), so this title has a specific diabetes provision. It also includes the Indian Health Care Improvement Fund through which the Appropriation Act supply funds to eliminate health deficiencies and disparities in resources made accessible to American Indians and Alaska Native tribes and communities.
Title III. Facilities. This title relates to the construction of health facilities including hospitals, clinics, and health stations necessary for staff quarters, and of sanitation facilities for Indian communities and homes.
Title IV. Access to Health Services. This title addresses payments to the IHS and tribes for services covered by the Social Security Act Health Care programs, and to enable Indian health programs to access reimbursement from 3rd party collections.
Title V. Health Services for Urban Indians. This title establishes programs in urban centers to make health services more accessible to Indians who live in urban areas rather than on reservations or Alaska Native villages.
Title VI. Organizational Improvements. This title addresses the establishment of the IHS as an agency of the PHS (Public Health Service). It also authorizes the Secretary to establish an automated management information system and authorizes appropriations to carry out this title.
Title VII. Behavioral Health Programs. This title is revised from current law (which only addresses substance abuse programs) in order to focus on behavioral health. It combines all substance abuse, mental health and social service programs in one title and integrates these programs to enhance performance and efficiency.
Title VIII. Miscellaneous. This title addresses various topics including the Secretary's reporting of the progress made in meeting the objectives of this Act to Congress. It requires the Secretary to develop IHCIA regulations, describes the eligibility of California Indians for IHS, establishes a Countrywide Bipartisan Commission on Indian Health Care, and authorizes appropriators.
