▶ 0:15:26acting director Benjamin Smith. Thank you for your leadership of the IHS and for being with us today to discuss the administration's fiscal year 2026 budget request. I would also like to welcome and thank Congressman Tom Cole for joining us today in his role as full committee chair.
▶ 0:15:44Chairman Cole is the first Native American to ever chair the Appropriations Committee and is champion for Indian country, ensuring that tribes receive the resources they need to take care of their communities and I also like to welcome the full committee ranking member Rosa DeLauro, who's always been a champion for Indian health and Indian Under both Republican and Democratic leadership, this committee has continued to prioritize and support health care services for American Indians and Alaska Natives.
▶ 0:16:15I have no doubt that Chairman Cole will continue to advance this critical bipartisan effort as he continues to lead the committee. There is no one better for the job and I, as well as ranking member Pingree, stand by ready to help. In FY 2023, Congress provided advanced appropriations for Indian Health Services for the first time. That was under the leadership of ranking member Pingree at the time and I we thank you for for doing that.
▶ 0:16:41Advanced appropriations continue to provide Indian health system with the certainty needed to properly properly serve communities, provide stability for health care providers, and improve long-term planning for services. I know this funding does not begin to meet the full need, but it's a step in the right direction and a signal of our understanding and commitment to upholding our trust and treaty For FY 2026, the president's budget uh 7.9 billion in discretionary funding for IHS
▶ 0:17:12maintains the funding for critical programs and fully funding OMB estimates for contract support costs and 105 one leases. the request does not include advanced appropriations for FY 2027. As I mentioned before, this subcommittee is very proud of the work it has done on advanced appropriations to provide tribes with a bit of certainty while relying on the federal government to support basic services.
▶ 0:17:38I look forward to hearing a little more about this decision and how we can work together to ensure tribes are taken care under possible continuing resolution I will continue to advocate for providing certainty to health care professionals and programs in Indian country and will not include in the and while not included in the request, I look forward to hearing how advanced appropriations can continue to support planning and operations for IHS Acting director Director Smith, your leadership at IHS is
▶ 0:18:08vital not only to upholding our trust and treaty but ensuring adequate and accessible health care to all tribal members. Thank you again for joining us this afternoon and I look forward to our discussion. Now, I'd like to yield to ranking member Pingree for her opening statement. Uh thank you very much, Mr. Chair. Good afternoon, acting Director Smith and Director Curtis. Thank you so much for being with us today to discuss the fiscal 2026 budget request for Indian Health Service.
▶ 0:18:36The Indian Health Service operates as the 18th largest health care system in the nation and provides health care to approximately 2.8 million American Indians and Alaska Natives through a network of over 600 hospitals, clinics, and health stations on or near Indian reservations.
▶ 0:18:53With 70% of American Indians and Alaska Natives currently living in urban areas, the IHS funds 41 health care organizations in urban IHS relies on an annual discretionary appropriations for its funding. And despite this subcommittee's bipartisan efforts, this funding has not kept pace with need. The statistics on health disparities, as you know, in Indian country are far worse than other populations in America.
▶ 0:19:21In order to make progress in addressing these disparities, we must invest more in health care. So, I strongly oppose the reductions proposed in the Indian Health Service budget. This includes the proposed 87% reduction to sanitation facilities construction. This proposed cut is out of touch with the reality that there is over a billion dollar backlog for sanitation facilities.
▶ 0:19:49I'm also alarmed that the administration has proposed to terminate advanced appropriations for the Indian Health The subcommittee has been dedicated to finding solutions for addressing the healthcare needs of American Indians and Alaska Natives. The inclusion of advanced appropriations was a major step forward. I appreciate the chair mentioning it and the bipartisan nature that we were able to move this forward and I will do everything I can to advocate for its continuation.
▶ 0:20:17I also want to take a moment to speak more broadly about how deeply troubled I am by this administration's assault on healthcare in the United States and the dismantling of programs and research that tribal nations rely on to ensure well-being of their communities. NIH, CDC, FDA, there is a nexus between the agencies and Indian Health and tribal communities are suffering the consequences of the havoc inflicted by this administration on the Department of Health and Human Services.
▶ 0:20:48Not to mention the devastating impact that an $800 cut to Medicaid would have on both tribal members since 2.7 American Indians and Alaska Natives are enrolled including 49% of children and IHS facilities that rely on third-party reimbursements. Your fiscal year 2026 budget request assumes collections of 1.3 billion from Medicaid. Acting Director Smith and Director Curtis, thank you again for being here today.
▶ 0:21:18Thank you for your dedication to the IHS mission. I look forward to discussing the request and know under the leadership of Chairman Simpson this subcommittee will continue to work in a bipartisan fashion to honor the United States treaty obligations to tribal nations and I want to say also with Chairman Cole at the helm and we're very grateful for the support you give IHS and other Indian programs. Thank you and I yield back. Chairman Cole. Thank you very much Mr.
▶ 0:21:45Chairman and thank you Ranking Member Pingree and it's always been a pleasure to be here with my good friend the Ranking Member of the full committee. Uh you know Acting Director Smith, Ms. Curtis, again thank you for being here to discuss Indian Health Service fiscal year 2026 budget request. As an enrolled member of the Chickasaw Nation of Oklahoma I've always prioritized tribal issues in my work as a member of Congress and of this important subcommittee.
▶ 0:22:14I have been and will remain committed to ensuring the federal government upholds its trust responsibility to Native Americans to provide basic services and resources throughout Indian country. And I appreciate the important role IHS plays in this effort delivering critical healthcare services to roughly 2.8 million individuals.
▶ 0:22:35As long-time advocate of providing advanced appropriations for the Indian Health Service, I was very pleased Congress was finally able to secure those resources for the agency starting FY23 and again Chairman Simpson said, appreciate the the role that Ms. Pingree played in that. And very much appreciate my friend Betty McCollum. We did this for years back and forth each of us submitting and co-sponsoring the others legislation.
▶ 0:23:03So this was a long bipartisan struggle and the one thing I can assure you we didn't get here to give it up. So I can just tell you now uh we will be retaining advanced appropriations. If anything it's it's more critical now. You know we have situation of extreme polarization. You could stumble into a government shutdown at any point uh and that should not affect the care of Native Americans any more than we would let it affect the care of veterans. I mean this is the same thing.
▶ 0:23:33This is a a essentially a discretionary dependent healthcare system and we've got to maintain that flow of dollars. So you can just take that to the bank. Um I I don't know where we will end up. I've got a bunch of other prepared things to say but I look on this document as a as a start and it's in some ways a good start.
▶ 0:23:54Actually there was a I think a good faith effort by our friends at OMB to try and make sure this was more robust than some of the things I've said it but I don't take this as where we will necessarily end up. Um you know so we want you to be forthcoming. I think this committee is on this issue very bipartisan and frankly very aware that the needs here have traditionally outstripped resources that we've had available. We've made progress but we're not where any of us want to be.
▶ 0:24:24Uh and we certainly look forward to working with you to try and make sure we give you both the stability and the flexibility that you need to provide excellent care to Native Americans and I was very heartened honestly Mr. Smith at your appointment. I you have a long background here. You have an expertise on the subject and I just thought it was a superb appointment and I know you'll do a great job.
▶ 0:24:53Our job is to make sure that you have the tools to to do that. Uh so long as Congress continues providing discretionary funding the IHS again I'll continue to advocate for increased funding and support to ensure tribal communities are not at risk of losing healthcare especially in case of a government shutdown. And again while I appreciate the administration's effort to protect programs for tribes I share the concerns that Mr.
▶ 0:25:18Simpson mentioned about eliminating advanced Pleased to see the budget prioritize funding for the purchase and referred care program. This funding ensures tribal members can access healthcare services when certain medical care is only available outside IHS or tribal healthcare facilities. I also appreciate the continued support for scholarship and loan repayment programs.
▶ 0:25:44These initiatives play a vital role in recruitment and retention of healthcare professionals in Indian country. And I look forward to hearing more about what the IHS is doing to to address staffing shortages a chronic problem for our healthcare facilities in Indian country. I'll end by saying I've always valued again the bipartisan dedication of this subcommittee under both Democratic and Republican leadership.
▶ 0:26:11Uh this group has continually worked toward fulfilling our trust and treaty responsibilities which include providing essential healthcare services. Tribes have played a very important role in American history and I'll continue to ensure that we protect their traditions and expand their sovereignty and capacity for self-government. And I look forward to working with my colleagues and IHS to advance our commitment to tribal communities across the country.
▶ 0:26:40Before I end one last point and I'm just going to throw this out now and we can address it later. I'll I'll put it in the form of a question. Um and this doesn't presuppose anything but I've always wondered you know one of the challenges we have on this is it's this is our most expensive portion of the total subcommittee budget and appropriately so but this is a relatively small jurisdiction and you know technically obviously you're you're not part of
▶ 0:27:10the Department of the Interior you're over with HHS. Uh and I've always want I used to fantasize about this when I was Labor H chair that we could somehow move you over and because there's such a bigger pot of money quite frankly where you can systematically think long-term.
▶ 0:27:27Okay, we're going to be able to add this much you know over three or four years and actually plan in a way that's very difficult for this committee with the best of circumstances to do and I've always wondered about this division of why this is over here.
▶ 0:27:41Uh and Simpson told me one occasion he said, "Well you can have them as long as you leave me all the money." So I could spend it in other Native cuz again this is this this this particular subcommittee does have enormous range of responsibilities and a comparatively small budget. But someday you know and I'm I wouldn't ask you go on record or anything today but I'd like to have that talk with you.
▶ 0:28:05Do we have IHS positioned in the right place in terms of jurisdictions and you know something like that we'd have to talk to leadership and talk to the committees and talk to the Senate. So I don't know if it ever gets done but this is a chronic problem and we've had great chairman of both parties here that have done their very best to address it with the money that they have but I don't know if you'd be better off to be part of a bigger pool. There's always some pushback on that.
▶ 0:28:33Well then we wouldn't be as special and we've got a committee that's much more familiar with us which is true uh right now. So just think about it sometime and we'll have a discussion offline if that makes any sense. But again we truly are here to help in a bipartisan sense. We wish you well. We look forward to working with you and with that Mr. Chairman thanks for letting me blow the eight and I'll yield back. Thank you Chairman. We could just make it mandatory funding. But that would be another story.
▶ 0:29:04thank you for those comments Ranking Member DeLauro. Thank you very much Mr. Chairman and thank you and Ranking Member Pingree for the holding this hearing. I want to welcome the Acting Director and Ms. Curtis the Director of the finance here the you know it's where the money decisions are made. That's where we make money decisions here.
▶ 0:29:28And just to let me just follow up on something that the the chair spoke about and that is all my my colleagues so far is I just one point is about advanced funding. There are two areas in which we deal with advanced funding. One is for veterans and one is for IHS.
▶ 0:29:46And I think what I would just say clearly the the chair has said that um that um you know, what there will be advanced funding for the IHS and I just say yes, there will be and there will be advanced funding for veterans as well because group can get caught up um in the um use a Yiddish word the mishigas of the appropriations process.
▶ 0:30:12Um and what may happen is a group should not be at risk because of what any of the political differences may be. I would just add one more footnote to what my colleague and we we have talked about IHS and Labor HHS where I serve as the ranking member.
▶ 0:30:29I'm a little bit concerned that these days with the pecking order on where Labor H stands in terms of its view of importance um that for the moment you may be better off where you are and I don't know what is going to going to happen with with Labor HHS, but I think it is something that ought to be discussed so for the future. But let me just say thank you again thank you both for being here.
▶ 0:30:57Before we turn to the budget request, my view woefully under funds IHS. Let me just tell you what I believe is happening now. American people today are demanding help with the cost of And President Trump is not laser focused on the cost of living crisis. He's actually again my view making it worse. He promised to fight for workers, middle for working families, but instead he's put billionaires in charge of the government.
▶ 0:31:23This administration is attacking programs and services that protect vulnerable, disadvantaged, and underserved Americans including tribal communities in order to pay for a tax cut for billionaires. We need the government to fight for these folks, for the middle class, for the working class, and for the vulnerable. And we have an administration doing the opposite.
▶ 0:31:45Before President Trump and Elon began to take a wrecking ball to the federal government, the Indian Health Service already faced chronic issues that made it difficult to meet the health care needs of tribal communities. But IHS was thrown into a deeper, greater chaos in the early days of the administration with the president's illegal funding freeze, blocked access to IHS funds until the courts intervened, allowed the services life-saving care for Native Americans and Alaskan Natives
▶ 0:32:15to continue. The hiring freeze at the Department of Health and Human Services further jeopardized life-saving care including emergency services, maternity care, and cancer treatments. IHS already faces enduring staff shortages and administration's negligent hiring freeze from which only a limited number of positions are exempt further hurts the services ability to fill critical vacancies for medical professionals and for support staff.
▶ 0:32:46My view again it's shameful that under the guise of eliminating waste, fraud, and abuse that the administration is targeting the largest health care provider for Native Americans and Alaskan Natives. Turning to the budget for the Indian Health Service for 2026 as been mentioned the administration's request reduces funding for the sanitation facilities construction by 87% when despite funding from the infrastructure investment and jobs act a backlog of over a billion dollars in projects remain.
▶ 0:33:17Troubling the budget provides no advanced appropriations for 2027 to enable IHS to continue to serve patients in the event of a funding lapse. Tribal communities including the Mohegan and Mashantucket Pequot tribes are in my state of Connecticut. We fought for this assurance to protect their care and not to leave it to the whims of people who would grandstand in the Congress. We must ensure that IHS services are accessible and hospitals stay open even during a government shutdown.
▶ 0:33:47We must include advanced appropriations for the Indian Health Service. We must do everything in our power to uphold our commitments and responsibilities to tribal nations. It's abhorrent that under the guise of eliminating waste, fraud, and abuse that this administration would undermine, and underserved Native Americans and Alaskan Natives. We can and we must do better and I know what the sentiments are in this committee.
▶ 0:34:15Um and that we will do better. So I thank you and look forward to your testimony though I am it's been a busy day with markups and hearings and uh so but I wanted to be at this one because for me this is a very critically important issue. And I think we need not to let it be in the shadows, but come forward and talk about what what what IHS needs in order to be able to carry out its mission.
▶ 0:34:44So thank you very much. Yield back. Thank you ranking member DeLauro. Acting Director Smith, you may proceed with your opening statement. Your official submitted testimony will be included in the record. Floor is Thank you. Good afternoon Chairman Simpson, ranking member Pingree, Chairman Cole, ranking member DeLauro, and members of this committee. Thank you for the opportunity to testify on the president's fiscal year 2026 budget request for the Indian Health Service.
▶ 0:35:15Before I turn to the request, I want to first acknowledge and thank each of you for the work over the years to grow the Indian Health Service budget, but more importantly to prioritize health throughout Indian country. The budget advances our Indian Health Service mission, which is to raise the physical, mental, social, and spiritual health of American Indians and Alaskan Natives to the highest level.
▶ 0:35:40As the 18th largest health care system in the United States, the Indian Health Service provides a wide range of clinical, public health, community, and facilities infrastructure services to approximately 2.8 million American Indians and Alaskan Natives from 574 federally recognized tribes across 37 With your support, the Indian Health Service discretionary budget has grown by 45% over the past decade.
▶ 0:36:08We know that type of growth is challenging to accomplish in a constrained discretionary funding environment. Over the years, this work with our tribal and urban partners underscored our shared goal to improve health outcomes for all American Indians and Alaskan Natives.
▶ 0:36:24The fiscal year 26 president's budget includes 8.1 billion in total funding which includes 7.9 billion in discretionary funding and 159 million in proposed mandatory funding for the special diabetes program for Indians.
▶ 0:36:40The administration prioritizes the Indian Health Service by maintaining funding for direct health care services and providing key increases to uphold the federal government's commitment to its statutory authorities and government-to-government relationship with each Indian tribe. In alignment with the administration's Make America Healthy Again initiative, Indian Health Service programs support national health improvement by focusing on efficiency and prevention.
▶ 0:37:08Consistent with these priorities, the budget includes 87 million to fully fund staffing and operations at five newly construction constructed or expanded joint venture facilities. This investment will ensure that clinical positions are filled and sustained in areas where access to care is limited.
▶ 0:37:28These sites will deliver patient-centered services that address health care needs at the community Staffing resources allow facilities to operate at full capacity, reduce patient wait times, and expand the range of services available, ultimately improving health outcomes in tribal communities in advancing long-term wellness consistent with Make America Healthy Again goals.
▶ 0:37:51The budget also upholds the administration's commitment to tribal self-governance by maintaining an indefinite discretionary appropriation for contract support costs and This investment reflects in in contract support costs reflects the US Supreme Court's June 2024 decision in Becerra v. San Carlos Apache Tribe.
▶ 0:38:15In response to this ruling, the budget increases funding for contract support costs by adding an additional 657 million for a total of 1.7 billion. Separately, the budget updates the estimated score for section 105L leases by adding an additional 264 million for a total of 413 million. The budget also maintains funding for infrastructure reflecting the continued importance of foundational investments in health care delivery.
▶ 0:38:45A corner cornerstone of cornerstone of that effort is modernizing our electronic health record system and the budget includes 191 million for this effort. Replacing the outdated system will help improve patient safety, clinical outcomes, disease tracking, care coordination, opioid monitoring, and public health reporting, which would create a more responsive and data-driven care environment across Indian country.
▶ 0:39:13It is with these shared goals in mind that the administration approached the fiscal year 2026 budget request for the Indian Health Service. The budget request helps to address stark health outcome gaps in tribal American Indians and Alaskan Natives born today have an average life expectancy that is 10.9 years fewer than the US all races population.
▶ 0:39:37Addressing these differences is a moral imperative for our nation and it will require bold action from all of us to ensure we are upholding our commitments to Indian country. The Indian Health Service remains firmly committed to improving quality, safety, and access to health care for American Indians and Alaskan Natives. We appreciate all of your efforts in helping us to provide the best possible health care services to the communities that we serve. Thank you again for this opportunity to speak with you today, and I'm happy to answer any questions the committee may have.
▶ 0:40:07Thank you, Director. I'm going to turn first to our folk many chairman, Mr. Cole. Thank you very much, Mr. Chairman. Just a couple of quick questions. Obviously, as I mentioned in my rambling remarks, one of our big problems is just the recruitment and retention of staff. You know, we've got a 30% vacancy rate, I understand, now.
▶ 0:40:30So, could you give us a quick overview of the things that, number one, you are doing and think we should do to both attract and retain the kind of staff we need to operate the facilities that we have. Thank Thank you, Chairman, for the question. Indeed, staffing and recruitment is absolutely essential for any health care system. You could even have a robust facility, but if you don't have the staff to operate it, there's going to be issues.
▶ 0:40:55Unfortunately, we have been carrying a 30% vacancy rate now for a number of years, and that is problematic. We had It required immediate actions on the Indian Health Service to really look at ways to streamline our operations, and that is exactly what we've done. We've looked at ways to pool resources for those employees that can carry out um expedited um hiring process.
▶ 0:41:19We've looked at ways to um amplify our scholarship program, loan repayment, to retain and give people experiences of our system. So, there are a lot of examples I could go into. I'd be happy to um share share those with you if if time permits. Um well, I don't want to take too much time, but I'd love to visit with you offline again. There are things that we can do that would help address those issues.
▶ 0:41:44And again, I've seen everything from well, I was traveling one time with my friend Chairman Simpson here when we went through multiple reservations. I think Mr. Cole was on that trip as well. And we both commented later that every time they found out Simpson was a dentist, they wanted to hire him. You know, he's like, when he's done with Congress, I think he's got a choice of facilities to go go work for.
▶ 0:42:12So, we know it's a a big big problem. Another one is really just a a question, I'm curious about what the balance of you know, we've got tribes, a lot of them in Oklahoma. I know as we were discussing earlier, you work with Choctaws that basically run their own health care system.
▶ 0:42:30They obviously get significant federal support, and and and in those cases sometimes, and certainly in the case of Choctaws and Cherokees, Chickasaws, they have extra money they're able to put in on top of and augment. So, they have an advantage. I think other tribes would do the same thing if they could.
▶ 0:42:48But what's the mix between um facilities that are run by the tribes themselves as opposed to those, and I have I think you have a large IHS facility in Lawton, where our tribes in the Southwest do not. So, they count on IHS. And again, to me, that's a tribal choice. That's up to them which way they want to go.
▶ 0:43:09I'm just curious what the mix is and and how you um assess um the advantages and disadvantages of each Again, thank thank you so much for the question. An excellent point. Um certainly, this all hinges upon the inherent right for tribes to make their decisions through tribal sovereignty. And at the Indian Health Service, we we respect that.
▶ 0:43:35Whether a tribe chooses to have the federal government provide those health care services to them, or in the instance of of uh Choctaw Nation, where they're exercising their rights to assume operations with those resources that the Indian Health Service would otherwise provide, I'm happy to follow up with you on the exact um numbers of hospital operations. But today, as it stands, 60% of the entire IHS appropriation is now tribally managed and operated through the authority of the Indian Self-Determination Education Assistance Act.
▶ 0:44:05Just looking at the hospitals, you almost have an equal split of IHS managed and tribal health programs managing those hospitals. That's really good to know. I wouldn't have guessed it was that high. I'm glad it is.
▶ 0:44:19You know, it I think if the tribes themselves have a stake in it, I think there's And there's also a legitimate concern some tribes will gosh, if we take it over, they'll quit really supporting it as much, and and the responsibility will all fall on us. And I've had that discussion with tribes, and they're usually tribes that, you know, are in more difficult circumstances. They don't have any extra money to make care.
▶ 0:44:42So, they're they're commendably cautious about what they do They're afraid they'll be forgotten or neglected, and there's plenty of proof in history that that's that's a very legitimate concern to have. Um but while you respect their decisions, you don't encourage one way or the other, do you? It's just really up to them to make this decision. You are absolutely right. It's tribally driven, and it's a tribal choice.
▶ 0:45:12But we respect that choice, whatever option they choose. We equally see a tribe that chooses to have Indian Health Service directly provide those services to them as an expression of tribal self-determination and self-governance. Absolutely right. Well, I've got other questions I could take a lot more time, but I won't. You were very kind, Mr. Chairman, to let me go first. So, with that, you're back. But again, we we really do want to work with you.
▶ 0:45:40So, please don't be shy about reaching out to this committee and letting us know what concerns and needs are. Thank you. You're back. Thank you, Chairman Cole. Ms. Pingree. Oh, thank you. Okay. Um well, I have been very interested in the produce prescription pilot program, and I'd love to ask you about that. Um we all know that access to healthy food has a direct impact on overall health, especially looking at development and maintenance of chronic diseases like diabetes.
▶ 0:46:09Um despite the pledge to make America healthy again, the Trump administration is disregarding this fact by cutting aid to food banks that provide access to healthy foods. About one in four Native people experience food insecurity compared to one in nine Americans That's why I helped establish the produce prescription pilot program at the Indian Health Service.
▶ 0:46:28I am very pleased that the IHS has implemented this program with awards to five tribal communities to increase access to fruits, vegetables, and traditional foods in the American Indian and Alaskan Native communities at risk for food insecurity. Uh can you tell me what amount of funding was awarded in FY 2025 for this Yes, thank you very much for the question, and thank you so much for your support in in this program. We have seen just amazing benefits um of the pilot project. That's great.
▶ 0:46:58In fiscal year 2025, we've awarded 2.5 Great. Um anything else you want to say about how the program is empowering and supporting tribal communities? Absolutely. Well, many may not know this, but food is very sacred to tribal communities, and it aligns perfectly with the Indian Health Service mission in the four components of physical, mental, social, and spiritual health.
▶ 0:47:24Um it is really affording everybody an opportunity to revisit the benefits of indigenous foods and get into topics of food sovereignty. We are very pleased that um Secretary Kennedy Kennedy himself as one of his first stops in Make America Healthy Again tour, uh visited an urban Indian organization site in Mesa, Arizona to experience firsthand the benefits of of these foods within the Indian Health System.
▶ 0:47:53We look forward to showcasing that more. That's great. Um if we were able to provide additional funding in 2026, how many additional communities do you think could participate? Thank you for the question. I I don't want to guestimate, but what I would say is there is a lot of interest, if additional funds come in, believe me, we will be ready to expand the program. Great. Thank you. Um if I may, another question? All right.
▶ 0:48:21This isn't as fun or interesting, but I want to talk about electronic health records. Um The FY26 budget request 191 million for electronic health record system, equal to the 25 enacted level. So, right now, the Indian Health Service has a vacancy rate of 30%, and staff um being recruited in the pipeline to fill critical EHR positions were lost when this administration imposed a hiring freeze.
▶ 0:48:48You provided a list of position series exempt from the hiring freeze, which does not appear to include positions needed for the EHR effort. What's the current status of vacant positions for this program, and how will IHS be able to advance this effort with these Thank for the question. Just to clarify, these are specific to EHR vacancies. Yes. Um So, currently, we're running approximately about 50 vacancies, right in that ballpark.
▶ 0:49:15We can certainly circle back and get to you an exact But this is our largest investment in the Indian Indian Health Services right now, and looking forward to working with Um they Is the IHS still on schedule for a June 2026 rollout of the EHR pilot at the Lawton service unit and its two remote clinics in the IHS Oklahoma City area?
▶ 0:49:36And how will this pilot allow IHS to identify and address issues, minimize facility disruptions, and improve patient care and health care operations in future deployment efforts? Thank you. Yes, I'm happy to say yes. We are on target for this pilot, and it's really going to be the first opportunity to stretch test, try to break the system. You you have it.
▶ 0:49:59The the sites that's been selected has a range of direct patient care, community health clinic to a school system. So, we're very excited about what we're going to learn through this initial pilot site. That's great. having served myself on Milken VA, and knowing how complicated this is, I'm curious about whether the IHS has been talking with Veterans Affairs to understand the challenges they've experienced in developing, and to ensure the two separate systems will be I think Thank
▶ 0:50:30you again for the The right answer is yes. We actually meet very often with our colleagues at at VA. We have a memorandum of understanding with them. It gives us opportunities to check in at the the top leadership level, and we are able to share stories, which has really benefited us as we're getting into the building phase of this EHR multi-year Uh last question about this important innovation that you're working on.
▶ 0:51:00Um what amount of funding is required in FY 26 to maintain the operation of the current resource and patient management system? When will the current Vista VA Vista system, which is the backbone of RPMS stop operating? As I shared earlier, we have 191 million that's proposed in the President's budget to continue operations moving forward.
▶ 0:51:23I will need to circle back on the exact dates of of Vista exiting the system, because as you know, database contains a lot of information, and we are currently using it with our current system. Thank you, Mr. Chairman. Yield back. Thank you. Let me follow up a couple questions that our chairman asked. Uh I continually hear from tribes about direct appropriations, in fact, getting rid of IHS.
▶ 0:51:53Their feeling is that too much comes off the top, and they would get more if we direct appropriated. Of course, there are tribes who don't feel that, cuz they don't have the I don't know if the word sophistication is the right thing, but they are more advanced in being able to do that. Smaller tribes have a problem with with that. How much overhead do you have? Um wait, overhead?
▶ 0:52:13If I could just ask a clarifying question about overhead, what is How much How much of the total appropriation goes to Indian Health Services comes off of the top to to fund IHS? Oh, I I see what you Okay. Yes, so within within our budget structure, because we do have a legal obligation and the Indian Self-Determination and Education Assistance Act, our entire budget is mapped out with tribal shares.
▶ 0:52:40And as I mentioned earlier, 60% of that total appropriation is now tribally managed and operated by tribal health programs. That means the remaining is left for the Indian Health Service to carry out those same legal obligations without diminishing health care services to the tribes that choose to um uh have Indian Health Service as their direct health care provider. So, how much of that uh of the total budget the 60% that is directly funded?
▶ 0:53:10How much is that compared to the 40% in terms of Um if I could turn to our CFO just for a quick half question. Sure. I don't have the calculator right in my pocket right now. I understand totally. That's why I'm asking the question. We're happy to pull out the email math. about about 5 5 billion or a little bit more is directly contracted or compacted by tribes. Okay.
▶ 0:53:38Uh the other question, tell me if you my analysis is right. After years of looking at How do you get physicians, and as Tom said, dentists I was a dentist in the real world. How do you get them out on some of these large reservations that are in remote areas and stuff? You graduate from dental school or medical school, you've got debt. The incentive to go out to one of these reservations in in South Dakota that's out kind of in the middle of nowhere is you're not going to be able to pay off your debt, frankly.
▶ 0:54:09Uh and I've felt the long-term solution to this is got to be Indian education, where we take uh Native Americans on these reservations, educate them, let them go to college, go to dental school, medical school, cuz they're more likely to return to the reservation to service those things and stuff.
▶ 0:54:32In the long term, I know that it doesn't address the short term, but in the long term, I think that's how you're going to have to do this, because you can do loan forgiveness and all that kind of stuff, everything I've learned about loan forgiveness, whether it's with teachers or things, they come, they're in your community for a couple years, they paid off their loan or their their commitment, and then they're gone. We want people to stay there, to get to know their community and stuff. Is that the long-term solution, do you think?
▶ 0:54:57What I can say, Chairman, is I I agree with you in in terms of what we've seen at Indian Health Service, those providers that have an experience in rural settings tend to stay in rural settings. Yeah. I would like to explore some opportunities with you on ways to to magnify that.
▶ 0:55:15I know we're working on a couple of proposals on graduate medical education right now, looking at scholarship ways to refine our scholarships, but it is a multifaceted issue that requires a lot of work with academic institutions, federal agencies, as well as Congress. But your goals certainly align with the direction we want to go. Okay.
▶ 0:55:38Uh I got I was interested I don't want to take what Elsie's going to talk about, cuz I know he's going to mention this, is that average lifespan 10 years younger or 10 years shorter. We're not doing something right. Something we're doing wrong. That's got to change. Don't have to answer that. I'm sure that Mr. Elsie's going to ask you about that. Tell me about Discuss the impact of the advanced appropriations have had on Indian Everybody's mentioned that we're going to continue advanced appropriation.
▶ 0:56:09What has IHS learned over the past few years with advanced appropriation, and what else needs to be done to provide certainty in Indian country? Thank you so much for the question. And right now, we are currently evaluating that. Um and we'll be happy to to inform you once that evaluation's complete to provide a full picture. That But that's where we're at right now. We've been able to execute it, um but haven't fully evaluated.
▶ 0:56:38It will be uh as everyone has said, as you can imagine, it will be in this bill. Anyway, thank you for being here. Uh Ms. McCollum. Thank you, Mr. Chairman. Well, I think you've got the gist, and you've been around You've been around at Capitol Hill long enough to know I I even take it one step further and say when it comes to tribal issues, we work in a non-partisan way um here.
▶ 0:57:05Um because we believe it's our our obligation, our sacred trust to uphold our trust and treaty responsibilities. I'm going to get I will get to advanced appropriations in in a second, but I want to kind of like lay the budget out a little bit, cuz you did you did a good job, and you know, you you can only do with what kind of you're you're directed by the administration, but I'm going to set the table just a little different on the Uh while the Indian Health Service looks to have a healthy
▶ 0:57:35increase at first glance at 921 billion dollars plus, the vast majority of it is to cover costs, contract support, and 501L These are important supports for tribal And the courts have mandated that they must be paid in full to the tribes. So, lots of times when things go to the there's a thing called a judgment fund, and it doesn't start coming out of the committee's money.
▶ 0:58:03You lost in court, it went to the judgment fund. For whatever reason, I wasn't here, I'm not an attorney, I wasn't on the court. The decision was made somewhere along the line not to do this in the judgment fund. So, we have to keep absorbing every time that the federal government, rightly so in my opinion, loses on these tribal health arguments, we have to absorb that out of the the small the small dollars that we have in this committee that funds parks, pollution control, all kinds of you you know, other all the other
▶ 0:58:33related agencies. All starts to have to come out of here. Um so, I don't know if there's any way to ever go back to the judgment fund, but this what what has happened, in my opinion, has been a real injustice to not only the tribal nations, because the adjustment fund also gets adjusted as you win more in court. And I'm prefacing with I'm not an attorney, but also, it would be very helpful you wouldn't have to worry, Mr. Chairman, about asking Mr. Cole for the money back.
▶ 0:59:02It would be So, when you start calculating what happens and what we're obligated to do by court responsibilities, the actual services, any add-on services for facilities for IHS is flat funded. Cuz you're living up your you're following the law of the land, that's your obligation, you're doing that, but everything else becomes flat funded.
▶ 0:59:27Increases for care and staffing are primarily for new facilities, and those are offset by cuts to public So, um there again, it create it puts you in a difficult position. It puts this committee in a difficult position of a lose-lose. Somebody's going to have to lose, uh and somebody's going to lose a little more if we don't do things in the way that we're supposed to.
▶ 0:59:51Um and so, I'm I'm I'm going to just be very bold and just say, you know, we got to figure out something different cuz flat funding for Indian Health Services is what this this budget kind of is at the end of game, which is not your fault, but it's just unex- it it just has to be unacceptable. Um we have to meet the needs of the Native Americans and the Native Alaskans we're charged to serve with. Um and if we don't do something about that, it's going to continue the uh lower life expectancy that you were talking about.
▶ 1:00:20We're going to see continued greater uh illnesses uh disproportionately, and um we're going to continue to see barriers to access to care. So, we want to be partners with you on this, but we have to figure out how to be better partners to to the tribal communities. So, we have our work cut out for us. So, I'm going to just, you know, make my point on advanced appropriations. And and Mr.
▶ 1:00:44Chair, um and full committee chair, I'm I'm going to choose my words carefully on this, but this is just how I feel in my heart. And I'm not going to put you on the spot. I'm going to This is a rhetorical question. So, I wonder, I'm not asking, I wonder if the Trump administration didn't think it was important enough to continue advanced appropriations for stability in Indian country. Or is it by accident? Maybe it was just an oversight. Or were they hoping Congress would eliminate it?
▶ 1:01:14I think you've heard loud and clear from uh on our answer is it shouldn't be an oversight. If it was, it was a mistake. We're not going to eliminate it, and it's important to stability. When you were talking about doing a review on this, you know, it's going to be hard to prove it's going to be hard to prove that it's really improving Indian health. And I don't think that's the question here. The question is it protects Indian health in a government shutdown. It And that's what it's designed to do.
▶ 1:01:44It's designed to keep the clinics and the hospitals open. The same thing with the VA. We went through a government shutdown. We had hearings on this, and many of us were, you know, present for them. I conducted one when I was chair of the of literally medicines being locked. Advanced appropriations prevents that from happening. So, does it add to a positive thing that you can dynamically score right now? It depends upon how you choose to dynamically score.
▶ 1:02:13So, if you wanted to dynamically score that we don't cause death, illness, inconvenience, and hardship, advanced appropriation, I believe, wins in all those categories. Um I'd like to just ask if there's any conversation that takes place, or you've been able to uh since January with all the stuff that DOJ has done and the executive orders and everything, and what is happening to the work that you do with the money that's in CDC to prevent suicide?
▶ 1:02:44What's happening in CDC with addiction um uh support and and help and counseling? What's happening when there's NIH funding that's cut off uh for working on minority health? Um uh so, I'm just going to ask a big picture question. Are you part of those conversations? Because if you're not, you really need to be at the table when these decisions are being made because they impact the services you're able to deliver.
▶ 1:03:13So, Tommy, how did the discussions go? And if if there aren't any discussions, we want to help you have them. Thank Thank you, Representative. Um a lot to think about. And thank you for your words. And they'll certainly assist us as we're contemplating our our evaluation efforts moving forward.
▶ 1:03:39What I do want to share is that from from day one, Secretary Kennedy has been very vocal about prioritizing Indian health um service delivery. And um certainly we've seen that within the Indian Health Service, but immediately in convening um his secretary's tribal advisory committee.
▶ 1:03:59He's held two um secretary tribal advisory committee meetings, which brings in not only uh tribal leadership representing all the 574 federally recognized tribes across the country, but also uh senior leadership from the various agencies so that we are having the conversations about um these important areas that that you're talking about.
▶ 1:04:21Uh so, I I point that out in addition to um Indian Health Service fulfilling its um statutory requirements to consult annually with with tribes on the annual budget uh process because he also convened that at the departmental level, where we also were able to hear more insight into um the needs of in these various health domains, and perhaps funding gaps or funding opportunities.
▶ 1:04:51So, I point this out just to to share that conversations are going, and um leadership throughout our agency are engaged actively side by side with tribal leaders. Well, I I I really hope so, but I hope that you're getting a cost cut cost cut so you can see what happened in CDC. Uh yesterday we voted on on a bill, and I and I voted for it. I had misgivings of voting for it, and I'll tell you why.
▶ 1:05:21Uh I I have language in there to work on fetal alcohol syndrome. Okay. I There's a lot of other things in there that I care deeply about. But SAMHSA's been gutted. So, I voted for a that there's nobody to administer. And I'm afraid I'm going to be voting for a bill that Mr. Cole is going to be wanting to put more money in, but because of his budget crunch, he's going to he's going to be in a dilemma. I just don't want to vote for concepts.
▶ 1:05:50I want to vote for things that that are And I really think it's really important when it comes to the NIH, the cuts to veterans health care research, where Native Americans are a large disproportionately large uh service All those are going to have an impact on on what we want to help you to be able to deliver. So, uh I'm going to ask more questions in writing and kind of follow on this.
▶ 1:06:17And and sometimes if we don't look at everything that's happening, we can think we're moving forward in a really good way, but then we turn around, and I don't want to turn around 2 years later and say, "Oh, this program has decimated what we had been moving forward in Indian country." Thank you, Mr. Chair. And thank you, and I know you're acting, but uh you're acting really good in this position. I'm so glad you're here. Thank you. Uh Mr. Zinke.
▶ 1:06:47Thank you, Mr. Chairman. Just a very brief and ugly history about IHS for the Blackfeet Nation. As we discussed earlier, the Blackfeet Nation has an IRS I IHS facility that had a physician that was abusing the most vulnerable. IHS knew about it. IHS then sent him to another reservation, where he again conducted the same the same protocol, and now is in prison. As a result of that, the IHS committed to upgrade the facility.
▶ 1:07:18They did not honor that commitment. Through the leadership of Mr. Cole and and others, unfortunately, we could not uh appropriate an IHS facility, but what we did do is we appropriated a youth center. And once again, the IHS director previously committed for a physician's assistant or a nurse to uh to staff that facility.
▶ 1:07:43I just ask you, do you still honor that commitment uh to staff once that facility is is completed, which their construction has been funded? They're the the the construction process. Do I have your commitment to honor that obligation to do staff it with either a physician's assistant or a nurse? Uh Th- Thank you for that background. And yes, you do. You have our commitment. Thank you. Let's turn a little to drugs.
▶ 1:08:11what percentage, just roughly, uh on IHS facilities as as patients what you come in are related to opioids drug abuse uh and and and that uh certain area? Thank you for the questions. I do not have the exact statistics with me on hand, but I'm certainly happy to to follow up with you. Do you think it's a problem, drugs on the reservation? know this is a problem.
▶ 1:08:37Not only uh drugs, but even alcohol, um all forms of substance abuse. This is a huge uh priority for the agency that we've been targeting for several years. And no doubt it costs the IHS a lot of money uh to provide help and assistance for opioid abuse and drugs. Absolutely. Well, you know, during the last administration Trump administration, we put a task force together for opioids. It's a multi-agency in coordination with the Indian tribes.
▶ 1:09:07And that task force went after the of those drugs. It was an effective I think they did over 60 raids. I don't know the statistics, but it was a lot. And I was disappointed to see the Biden administration, particularly uh Secretary Haaland, end that program.
▶ 1:09:27Um so, if we're going to get serious about drugs and opioids, I would I would also recommend that we that we find and look at redoing that task force because it was an effective program. Again, I especially disappointed the last administration ended what I thought was an effective program. That look, the drugs in the reservations are rampant and without without going after the suppliers, they continue to be rampant. With that, I yield, Mr. Chairman. Thank you. Mr. Olson. Thank you, Mr. Chairman.
▶ 1:09:57Thank you, Director. Thank you for being the life expectancy expectancy issue as as an observer no talk tribes in my district just south of Dallas. Uh but it's horrifying to know that there's 10 year less life expectancy. But as you think about we know why. If you're on a reservation, there's no adequate food, you live in a food desert, not adequate jobs, so there's hopelessness.
▶ 1:10:27If you are a woman in a tribe, you are two and a half times more likely to be raped than any other group in the country of One in three Indian women is raped. So, then you get you're dealing with that. Then you ask for 911 and there's nobody there. Nobody shows And then you go to the clinic. There may or may not be rape kits to identify who it is.
▶ 1:10:57Life expectancy depends on hope and opportunity and jobs and good food. Otherwise, you're going to be unhealthy. And then what we end up doing it is having to spend more money on IHS to treat the problems that we know already So, let me start with the question about rape kits. We've heard about this from time to time when the tribes come to town and and and testify.
▶ 1:11:24There's not enough rape kits when these when these crimes occur. Are you adequately funded and adequately resourced for rape kits in IHS? Uh thank you for the question. I will need to follow up with you to get exact analysis.
▶ 1:11:42I I don't believe we've done that across the entire system given that the most of the funding that have come in for those specific programs have been through initiative funding through our domestic violence prevention initiative for example or domestic violence program. Okay. Well, the rape kit issue is is part and parcel of the law enforcement issue, which is not in your purview, but we know that that is a crisis in Indian country, too.
▶ 1:12:10But back to the you know, my wife always tells me your good health begins in the gut and there's there was a case study done in 2015 that I looked up food insecurity in Indian country, case study approach by Kelly Kelly Bagay. It's 15 years old and I identified all the problems. And if you look at the map of the United States where there are tribes, food deserts in Indian country there they're everywhere. So, I have an idea, which usually makes my staff go yay and roll their eyes.
▶ 1:12:37But it occurs to me as we talk about Indian country and Indian Health Service and medical clinics in military veterans issues and Indian health issues as well. The construct is very similar and being in the Navy in some very remote bases in food deserts where we had to have our own clinic, we had to have our own commissary. I envision a day, Mr.
▶ 1:13:01Chairman, where sometime in order to provide food, hope, um jobs for the tribes that in conjunction with the IHS, we establish a commissary and exchange system in which the food deserts go away. You have a commissary that that services each tribe in their cultural needs and and the food that that helps them be healthy and prevent the need for such an uh uh an exorbitant amount to IHS.
▶ 1:13:28And I think there will be something you could partner with the exchange system in the military right now. You don't have to have a brick and mortar. I guarantee you there there going to be buildings there, but you partner with the military on how to provide adequate food to each tribe throughout the country and Alaska, throughout the 48 and Alaska in a way that at least gives them a jobs program where they can take pride in providing healthy food for their people and and provide food that's going to make them healthy so that they don't need to spend so much time in the clinics.
▶ 1:13:58And I and I is the money there right now? Absolutely not. And it's and it's a dream. It's a it's an idea. I don't even know if it's achievable and I'm and I'm sorry for springing it on you, Mr. Chairman, and and lot of everything else that we've got going on, but something has to be done differently. And if we know that health starts in the gut, we need to start with the food and we need to be able to provide at least start it because it's going to provide an income source for the tribes, for the people and and and it's not a handout.
▶ 1:14:27So, they can take pride in the fact that they're going and in today's environment, what do we do with with Amazon and what do we do with Walmart? They deliver. So, if you've got some folks who are homebound, but live on the res, you can also deliver that food to them that they paid for, that they take pride in, that they provided for themselves. And so, it's it's more of a comment. I know that you're doing a great job, but we have to do something different and we start with prevention and prevention starts with food. So, let's see if we can go down that avenue somehow. So, thank you, Mr. Chairman. I yield back.
▶ 1:14:57Thank you. Mr. Lowey. It's hard to see the light from here. I couldn't tell if it was on or not. Uh that wasn't a deliberate dramatic Thank you, Mr. Chairman. Uh thank you for being here. I am also on the Natural Resources Committee. So, I I kind of have overlapping interests when it comes to Native issues. And I was in Oklahoma a couple months ago with Mr.
▶ 1:15:26Olson for a field hearing on tribal issues and we mostly it was about self-determination, but we heard a lot about the health care that tribes are doing for themselves and how successful it is. And so, I was excited to hear you say it's 60% of tribal health care is done that way. It just it was obvious talking to tribal members how proud they are of the services that they're providing for their own people. Um that's not a question, just a comment. I was glad to hear that.
▶ 1:15:56Um but because of my overlapping interests, I want to talk about purchased referred care programs or PRC programs. Um one of the things that we've worked on in Natural Resources is, you know, the tribal members have limited access to these PRC programs because of the 12 step approval process.
▶ 1:16:20And then IHS's service units sometimes um make them hard to access because they exhaust their annual pool of money or they save it for the most serious health Um and back in December, IHS provided testimony to the Natural Resources Committee saying a 25% reduction in overall pended PRC claims, the ones that have been submitted but haven't been completed, and a 43% reduction in pended claims awaiting a vendor response.
▶ 1:16:46And so, I just want to know if you've got an update on that. What How are we going? Are we still going in the right direction? Is it getting better? Is it getting worse? Thank you, Representative, for the question. Certainly, purchased referred care is such an important program within the Indian Health Service. I am happy to report that yes, it is going in in the the right direction. Good. Um today we have uh claims pending with vendors is now at 21%. So, you can already see the progress we're making.
▶ 1:17:18Um and the average time for clean PRC is they said it was between 18 and 20 days. Are again, are we going in the right direction? Is it getting better? Is it getting worse? You're correct. We're going in the right direction. In fact, we're we've upped our timeline by two days. that that shows that we're moving forward. Yes. That that is really good to hear. Thank you. It's we don't always get good responses in these committee hearings to the things we're worried about.
▶ 1:17:47This feels like it's going really And and I just while what Sorry, did you have something at? Oh, I thought you were turning your your mic. While we're on the topic, what are what are you doing to ensure I know you're acting, but what are you doing to ensure that these improvements are being sustained and institutionalized so that the progress is permanent and this isn't a spike and then we drop back off. Absolutely.
▶ 1:18:09I'll tell you first and foremost, accountability is key and setting the metrics of how we're going to monitor this over time is a starting point. So, having that setting a measure to hold people accountable to, and then executing on it. And um we have been very successful in this and having routine oversight from each service unit, service unit by service unit.
▶ 1:18:34And to build awareness the process and how how to how to submit those those clean um uh those clean claims so that they can be expedited in the review process. So, I'm happy to go into details if you have specific questions, but there's a lot going on in terms of just setting up program for success in this area moving Well, I'm glad to hear we're setting up a program for success.
▶ 1:19:01I may submit written questions for more details, but I appreciate that answer. Um I do also want to ask about urban Indian health programs. We have an urban Indian Health Organization in Salt Lake City. Um and I know you know, more than 80% of Natives in the United States live in urban areas. We we have issues out on reservations. We have issues in remote rural areas, but most of the population is in urban areas.
▶ 1:19:28What are the current challenges and needs faced by cultural hubs like the urban India urban Indian center of Salt Lake in providing health care services to the urban American Indian populations. Thank you for the the question. We've we've heard that we've heard similar uh comments especially from that urban Indian organization at the Indian Health Service communication is key.
▶ 1:19:56So, not only are we statutorily required to confer with urban Indian organizations, but we've set policy to make sure that we have the forums whether they want to bring an issue directly to me as the acting Indian Health Service director any of my senior staff to bring issues to the forefront. So, um we we learned a lot through that process.
▶ 1:20:16If there's specific issues that are not being addressed that specific location, we can certainly reach out to them, but we'd be happy to learn more about the specific issues as our confer policy is really a change the dynamic and landscape of of how we're able to engage in that level of conversation with urban Indian organizations. Okay, thank you. And I don't need to be in the middle of that relationship, but if there's any way me or my staff can be Absolutely. Thank you. Let us help you with that.
▶ 1:20:46Okay, that went faster than I thought it would. So, I'm going to ask one more question if I'm not totally out of time about the SDPI the special diabetes program for Indians. um Given the rising rates of diabetes among native youth, how is SDPI working to engage younger generations in prevention efforts? I know there was a 2025 launch, how is it going and what's the plan moving forward?
▶ 1:21:13The special diabetes program for Indians is critical for reducing high rates of diabetes prevalence across Indian country. And to show you how important this is especially for native youth, um we're seeing about 80% of the dollars being invested into youth programs for that very elementary education and activity-based portion of the of the of this statutorily mandated grants.
▶ 1:21:41Um there is so much that's that the the SDPI program has brought to Indian Health Service including evidence-based um support for this very important program. So, I can't tout it enough. I would love to go into all the details with you I in setting up a separate briefing, but there there's so much. If there's specific areas of interest, um let let me know. I would just like to see it be successful. Again, referring to Mr.
▶ 1:22:10Elsie and his questions, if if we're good food and good food education, prevention is cheaper than treatment with this and life quality is better with prevention than treatment. Um So, I may submit further questions in writing, but I'm glad to hear that you're excited about it and I'm excited to see where it's going. And it's good to have a fellow Cougar Thank you.
▶ 1:22:42I understand talking to different tribes on different reservations that one of the most successful diabetes programs is getting back to the native foods and which could fit in very well with what Mr. Elsie said the commissaries and stuff. They could be different for different reservations cuz they all have different tastes and different foods and that are traditional and stuff. So, interesting. Miss Pingree. Thank you, Mr. Chair. And I appreciate my colleagues emphasis on healthy foods, fresh fruits and vegetables, making sure people have access to that.
▶ 1:23:11That's one of the reasons I supported the produce prescription program, which is a little more um specific, but it is yet another way to make sure that people have access to that particularly help prevent chronic disease, but I'm all in favor of more access to healthy fruits and vegetables. So, anything we can do and also native foods as you were talking A couple more questions. One is on the proposed reduction to sanitation facilities construction.
▶ 1:23:34So, in this 26 budget, there is a 93 million or 87% reduction in sanitation facilities construction. Um my understanding is the current backlog is 4.7 billion and even with the 3.5 billion provided through the bipartisan infrastructure investment and jobs act, the backlog is over a billion. Do you know what the current number of sanitation facilities construction projects are needed?
▶ 1:24:04Yes, thank you. You know, 13 roughly around 1,300 at this time. Um so, I mean it's a big word, but it's basically just making sure people have clean water and healthy sewage facilities. And so, when we're talking about making sure just people have the basics of life, it's it's unthinkable that there are that many places where people still don't have that access.
▶ 1:24:26So, if we were able to provide more resources, would the Indian Health Service follow congressional direction and allocate that funding to address the remaining backlog? Absolutely. We are committed to following the law. You know, you created it, so yes, we will adhere to it. Great. That is music to my ears.
▶ 1:24:46Every time someone on the other side of the table says they're committed to following the law um in this particular appropriation cycle, we have not always seen congressionally directed funding going to exactly where it needs to be and I don't mean congressionally directed funding like earmarks. I just mean the things that appropriations does being carried out. Um lastly, the committee is aware of the challenges of recruiting and retaining health professionals in the Indian Health Service and that the IHS continues to look for ways to improve health and wellness of their staff.
▶ 1:25:14Strengthening strengthening graduate medical education program is one way to do this. Last year I raised this concern because of the lack of opportunities in Maine for physicians in training to serve and learn in Wabanaki tribes health centers. What has the Indian Health Service done to support the development of residency programs and rotations for federal, tribal, and urban sites specifically? Have you been able to create additional training opportunities through your work with Veterans Affairs and HRSA?
▶ 1:25:44Thank you, Representative, for the question. This is such an important component to you any recruitment for those recent medical graduates. And you know, we have been very proactive and um uh intentional in in meeting with not only VA, but with HRSA as well as CMS, who all have um current GME programs and finding ways to to leverage with them especially when the law calls out Indian Health Service.
▶ 1:26:14So, the mission act in particular is one area that we have been working alongside VA uh to to bring those um that those those spots into our system. This is a important area for us and I'm happy to look into it more with you. Great. I'm glad to hear you say that.
▶ 1:26:32Last question, how is the uncertainty of funding and staffing from the administrations assault on health care created challenges in developing residency program in IHS operated and tribally operated programs and in urban health organizations? I may defer to my CFO about this. Don't have the data in front of me. My understanding is that there aren't new barriers as a result of those activities, but we can certainly follow up if there's anything that we have to share there. Great.
▶ 1:27:02We will follow up with you on that. Thank you very much. You'll bet. Thank you. Just a couple comments before I ask my final question. Miss McCollum brought up a really important issue and that is how much of this budget is continuing continually being eaten up by judgment judgments that we end up having to pay And I will tell you the one that's really going to eat this budget over the next
▶ 1:27:32several years and that is Indian water rights. And these are big big things and why they are not funded through the judgment fund, I don't know. They should be like other settlements are, but if we don't do something about it or figure out a way to pay for them, these Indian water rights settlements throughout the West are going to be a real real issue and a challenge for the rest of the budget. And I was glad to hear you mention Secretary Kennedy.
▶ 1:28:00I sit on the Labor H Committee also when he testified and I was very glad to hear him talk about the importance of Indian Health Services and that he was committed to maintaining and increasing the health service for Native Americans. The question the question I have is the committee has recently been informed that the IHS received an exemption from all lease terminations are now in the process of revoking them.
▶ 1:28:24We heard from several tribes, tribal members, and other members of Congress about their concerns for closing these These remain vital to IHS functions in the states and provide important services in direct contact with tribes in their region. I appreciate your continued effort to ensure these facilities remain open and operational. I understand how important these facilities are to Indian country and I ask that you continue to keep us updated as we know things are very fluid right Absolutely.
▶ 1:28:53We're committed to keeping you updated. Thank you. Miss McCollum. Well, as we're talking about, you know, recruiting and retention, something that that we witnessed and I've I've traveled in in Maine to a school with with Miss Pingree back back several years ago is if you're going to young staff or want people to stay you have to have good schools, right? Travel reservations goals.
▶ 1:29:24You have to have housing. Some of this stuff is not in your control. And so I go back again about how I really think you get squeezed in the cross cuts more than anybody else. And so I'm going to kind of you know, ask you to think about it. I'm going to try to figure out how to ask the question. But what came what made it easy a question that would be easy to ask like to Mr. Elsie's point about rape kits.
▶ 1:29:51If the Department of Justice is not stocking your your clinics and your hospitals with rape kits that that are mandated under VAWA, um you know, we we need to know so that we can put uh we can put forward some questions and ask them why not. But here's what happens. There isn't the rape kit there. We don't hear about it. You know, a tribal member comes in and shares that with somebody.
▶ 1:30:17We have the discussion here, but we aren't we don't do the Department of Justice funding. So you you know, so much of what you do gets caught up whether it's CDC, SAMHSA, and everything else. Do you have um and maybe this is more to Miss Miss Curtis.
▶ 1:30:38Do you have anything that kind of lets that that you could kind of share with the committee that lets us know how interdependent you are on some of these other things for your research needs or is that so siloed that it would be not not your fault, but so siloed it's impossible for you to keep track of if if a DOJ cut um you know, uh a research in in in IHS that affected some diseases that are prevalent in Indian country with diabetes care.
▶ 1:31:07How how do you know who lets you know? Um how can we be of help in getting you that information so that we can make decisions in the full committee to support some of the things that we want to work on in the subcommittee. It's a it may be a I said I didn't like the fund concepts. I just gave you a concept, but I'm not asking you to fund it. I'm just asking you to provide the provide the blanks. Sure.
▶ 1:31:31My my recollection is that uh the Department of Interior has in the past produced uh a sort of funding cross cut for tribal programs and you you're the one that asked for that. Yes. I'm not sure what the status is um of that um cross cut today, um but we can certainly go back and connect with our partners. Mr.
▶ 1:31:50Chair, it might be easier to see what what's what the state of that cross cut is if we if we narrow it down just maybe in one area um for you know, Indian Health Service rather than ask for everything that we touch in in in in Indian. I'd I'd be interested in seeing that cuz the tribes don't even know who to go to for help if funding's cut off on something. They come to you probably first if they think it's health care, but it might not be you at all. Good point. Mr. Elsie.
▶ 1:32:22Thank you, Mr. Chairman. Just one last comment is that um I think this is the first time you've been before our subcommittee. Correct. Uh but when you see the lineup here and for everybody who's in the audience and anybody who might be watching in Indian country to to try to figure out if we really care or not, uh every member of this subcommittee was here for this. That rarely happens. This is a busy time.
▶ 1:32:48This is appropriations time where you're you're torn in different directions and and you have a lot of things going on. as was said earlier, this is a non-partisan issue and everybody here cares about Indian country and Indian health. And so I was just it's just remarkable to see everybody that's on this panel was here on time when this when this when this questioning started when this hearing started.
▶ 1:33:15And and we really care and we're we're trying as hard as we can as a group and as individuals to work with the administration to find a way to to fulfill our obligations per the treaties that we signed a couple of hundred years ago and and and what we owe the tribes.
▶ 1:33:33And so I just want you to know that it's a big deal when you get everybody here and that rarely happens and so our commitment is to continue to work every day and this staff and I want to point out that this staff works day and night trying to find ways for tribes that are spread across the entire United States including Alaska. Very small group of people trying to do a very big job and I want to thank everybody on the staff for doing it as well and helping us in that in that mission.
▶ 1:34:02So thank you for your mission and the things that you're both doing on behalf of the Indian country and with that I yield back. Mr. LaVoy. If there's no other questions, thank you for taking time to join us You've acquitted yourself very well and we we look forward to working with you to address what we all know that Mr. Elsie just talked about as a problem in Indian country and we've got to do something about it. And this committee is a is has been mentioned several times.
▶ 1:34:31This is a bipartisan issue. Everybody on this committee realizes how important this is and that we continue moving forward on it. And so we're going to be doing that and thank you Jake for mentioning the staff cuz they do a ton of work behind the scenes that we never see. So we appreciate all that we look forward to working with you to to address the challenges that we face Uh it's been a productive discussion. We look forward as I said to working with and with that the committee stands