towards meeting the $30 billion overall need in ihs. lastly, i want to address a few of the legislative proposals in the fy '17 budget request that we want the agency to consider to support. reclassification of contract support costs as mandatory which we've worked on. permanently authorizing the special diabetes program for indians. including language in appropriations bills or passing legislation in these areas would provide great benefits for indian country. congress must answer the moral and legal call to action so native peoples can look forward to forward prosperity and progress for future generations. tribes exercise self-determination, success stories abound. we need partnership to pass a federal budget in the indian country that reflects and hon norps the trust responsibility of the united states. thank you and i'm happy to answer any questions that you may have. >> thank you very much. appreciate your comments. miss smith, i'd like to start with you.

i agree with your comments about the challenges, the situation being unacceptable, saying if we aren't talking about the problems, we aren't addressing them. aggressively working in the great plains area. members of the senate a couple weeks ago who weren't on the committee such as senator thune were here because of the concern that we have with regard to the conditions of the indian health service in the great plains areas specifically. in fiscal year 2016 -- i know you've only been on the job for a short period ever time -- congress appropriated $2 million specifically to help address some of these emergent issues. despite the dire conditions in the great plains area, it took the administration several months to even figure out what to do with the $2 million in appropriated funds. i know you weren't there at the time. meanwhile, the facilities in the area have lost their medicare provider status, on the verge of losing it.

patients at the facilities are ultimately paying the price. i note funds wouldn't have solved all problems in the area with be but they were appropriated for the specific purpose and i think they could have made a difference. do you know what it is that takes the administration so long to figure out what to do with the funds? >> thank you, senator. first of all, i do want to thank the senators for this funding. i think the funding you are referring to is -- it was funding allocated to any facility that had received a notice of deficiency from the centers of medicare and medicaid, and that was $2 million. and we are greatly appreciative. i will let you know that we had decided to use that funding to replace equipment needs. some of the needs that were

cited by cms. we started replacing that commitment and in getting the procurements in process before we were able to apportion the money. but i will tell you, it was a process and it was a thoughtful process because we wanted to make sure that the funds were distributed equitably. so we had three facilities that were eligible for this funding and what we agreed to do was for the first million we would divide them up equally. it was a process, and it was a thoughtful process because we wanted to make sure the funds were distributed equitably. what we agreed to do was for the first million was divide them up equally. we wanted to make sure the tribal communities had access to the funds, and then the second million, we wanted to make sure that we went with the senate's intent on that money to replace a possible lost billing.

and then went to collections. and then we went through what equipment is needed, but i will make clear that for the equipment at rose bud that was cited by cms, we had already either replaced that equipment or put it in procurement. that's money on top of the $2 million and what we decided to do with the $2 million is we will replace at each facility the central monitoring unit, which is a unit that pretty much holds the whole hospital together. and i understand that those funds will be available to the area this week. thank you, again. >> attorney, if you're looking at the whole funding issue, the health and human services acting deputy secretary mary wakefield testified in this committee that funding for the indian health services increased about 42 -- i'm sorry, 43% over the past number of years and continue to hear they're underfunded in the service. aye big part of the problem seems to be related to transparency, accountability. you used some of those own words in your testimony. people don't know where the money is going and i'm hoping you can help us get a better understanding. you may have to get this back to us for the last fiscal year and

prior years under this administration. what percentage of the appropriated funds was used for patient care, because that's what we heard a lot of in the discussion. less for patient care is being used, whereas a larger percentage is using for administrative and other purposes. so if you could get that to us in terms of the percentages and actually dollar figures, as we're all looking for this accountability in getting this understanding. >> certainly, we'll get that to you, senator. >> you raised the issue of the great plains. the committee got a letter from the tribal association about the situation, the great plains, you're familiar with the situation, obviously. it asks that we take swift action to ensure that the indian

health services is working to address the immediate needs of indian people in the great plains. it goes on to say that the crisis in the great plains continues to escalate, even after the hearing last month. an example is the impact of diverting patients from rose bud. indian health service emergency room. people dying in transit to non-indian hospitals and surrounding communities. the other hospitals are getting overwhelmed. about a 67% spike in patients. they report to us that the indian health services have been communicating with the hospitals where the patients are going to to ensure patient safety. the tribes really continue to be outraged and i think they have a right to be. this is a bipartisan issue, trying to help here. you need to know, we need real swift action. no band-aids, no more recycled plans to make plans. could you help us talk about specifically what the indian health services will do to make things right in the greater plains area? >> thank you, senator, and we have seen the letter as well. i agree with you. i perfectly understand the

frustration of the tribe, and the situation is unacceptable. there is an urgency at the indian health service. and we are working on it. like i said, i've only been in this position for a week, but there is no more important thing than we need to work on than getting the three hospitals on track. we -- one of the major challenges with the hospital is the staffing levels. so we have a three-pronged approach that we're working on to address the staffing issues. in the short-term, we are doing the deployment of commission corps officers to get the emergency department at rose bud specifically back up and running. we are also working on a contract to contract for providers and long-term strategies for permanent hires. in fact, i have one little bit of good news. one of the challenges we face is the pay that we're able to pay, certainly versus the private sector, but even other

government agencies, even the v.a. just this week, we got approval for a pay package, so that we are able to provide line doctors, our emergency room doctors, $300,000 and able to pay supervisors $325,000. that will help in our permanent hire. we are attacking it on many levels. >> thank you, miss smith. senator cantwell? >> thank you, mr. chairman. i want to thank the vice chairman for allowing me to proceed. and i want to ask miss ramirez about the low income housing tax credit, as it is used in indian country. i know you described the president's budget and $50 million in indian housing after years of stagnant funding, but as a member of the finance committee, i have actualline been to montana where we saw low-income housing projects being used. so i'm wondering how you think

that that tax credit could be used to leverage housing development in indian country. >> thank you, senator, for the question. you're absolutely correct. it is, as we all know, a financing resource that enables tribes to be able to build affordable housing or mixed income housing. in fact, during my testimony, i referenced that i had an opportunity to visit the yakey nation and they were successful with securing five low-income housing tax credits designations. we are very focused on increasing the public and private partnerships. and just to that point, we are working closely with tribal leaders and also with senator highcamp on pulling together a housing forum that will enable tribes to understand other private sector funding resources that are better able to address the need. >> you'd say it's a valuable tool?

>> it is a very valuable tool, yes. >> good, thank you. mr. roberts, senator tester and i also introduced the safety act, which is about facilitating the tribal school construction improvements. i'm pleased to see the $138 million, the bump-up, was i)f"y maintained but clearly not enough to deal with the short fall. one of the issues seems to be the facility conditions index. for example, the tribal school that is at capacity and has two modular units but when you applied for the grant, they said it was operated for 37 years but the building was only 50 years old. i feel like there's always a lot of mystery here in what gets funded. i am getting nods. it shouldn't be a mystery. how are they fixing the index? >> thank you, senator, for that question. i will say in terms of the process that we're going to

address new school construction for campus-wide facilities, the rules are very clearly laid out through the negotiated rule-making that tribes were a part of in that process. i will say that having observed that process, come into that process a little late in the game, i think there are ways that we can work with tribes in terms of future funding in terms of better addressing and making common sense choices. facility condition and index is key, right? and as part of this process for those ten schools that were invited by the committee to present, we reached out to all the tribes to say, hey, we need to make sure that all the tribal schools make sure that the facility condition indexes were up to date. so we did a lot of outreach over the course of the last year, to reach out with each of those schools to offer technical assistance and, also, we visit -- we have contractors visit those schools every three

years to do a facility condition index. having said all of that, moving forward for schools, quite frankly, i think some of the schools, we need to take a look at how many students they are serving. i don't think that was a metric within the proposed rule making, or the negotiated rule making that was resolved. i do know that the facility condition index was 85% of the total scoring and a 15% scoring for those top ten schools that i worked in construction moved forward. i hope that answers your question. i think the facility condition index is vitally important. >> i'm not sure it does. i think -- here would be my goal. it reminds me of transportation funding, at least in our state that you have projects.

and you have a certain degree where you are on the list. and where funding meets a certain level, you might actually get funded. and i think here, there are people they feel like they are on the list for decades and never know when they're going to get funding. it seems to be a mystery. i get that you want to have an index, and i think the index is great, but i think we need to have predictability for indian country when their project is likely to be funded, if ever, or if it's a constant thing where other projects because of population. that gives policy makers the ability to look at policies as well and maybe make suggestions or changes if people are falling

through the cracks. so. >> thank you, senator. that gets to one of the statements senator tester made in his opening statement, and that is that while we are completing the school construction for the schools that were on the 2004 lives and we are selecting the five schools for the 2016 list, the department is going to be internally working at a long-term program to lay out for this committee and for tribes generally sort of, okay, here's where we are. here's the funding that's needed. and here's how we propose to move forward. >> my time is expired, thank you. >> thank you senator cantwell. senator danes. >> thank you. they get hit with massive fines because of the obamacare employer mandate. for example, the black feet tribe is going to face $1.1 million in penalties. the crow tribe will be hit with a $1.6 million penalty unless something changes. i've introduced the tribal employment and job protection act which will exempt tribes and tribal employers from the obamacare mandate and prevent these unreasonable, i would argue outrageous fines. the national congress of

american indians and the national indian health board have endorsed this bill. and while the president recognizes the impact of obamacare on many and requested changes to other provisions like the cadillac tax, fails to be concerned with the employer mandate on indian country. for secretary payment on question, could you speak to the burden that the employer mandate places on tribes and the need for this legislation to exempt them from this mandate? >> the question is catered to me because i have been echoing this and speaking loudly on this issue. so for my tribe in particular as an example, i'm here to speak for nci but i have an example, the cost for the full implementation of the employer mandate is likely to be $3 million for my tribe. so we're beginning to see some of the gains under the affordable care act and the reauthorization of the ihs under the affordable care act. we're grateful for the affordable care act and permanent reauthorization and seeing some of the gains we received be erased because of the consequence of the employer

mandate. probably more importantly on a broader sense and we met with representatives from the white house is we need to understand the full impact and the unintended consequences before implementation, not afterwards. so we've asked for that. there's a way the funding gets to indian tribes through self-governance tribes. then there's also tribes have insurances, some tribes don't have insurance. there's a complex maze to figure out what the unintended consequences are going to be, but i would venture to guess it's over $15 million in indian country, the negative consequence of the employer mandate. i would ask that this be put on hold until after we do consultation with tribes and we fully appreciate what the full costs are going to be. >> thank you, secretary payment. i want to shift gears and talk

about wildfires. in 2015 montana experienced one of its worst fire seasons and montana tribal reservations were no exception. the fires in the black river reservation were so severe that the tribe opened a separate facility for elders and those with special health needs that were displaced by area wildfires. here's one of the challenges. oftentimes, these fires start on federal lands and then spread to tribal lands. the tribal force protection act of 2004 did attempt to address that problem and a proposal passed the house to provide tribes more freedom to protect the tribal resources. mr. roberts, do you support increasing tribe's authority to more actively manage the tribal lands and the neighboring federal forest lands? >> thank you for the question. i am not familiar with the act but i am generally supportive of obviously greater tribal self-determination and sovereignty and i understand that the act is particularly focused on the department of agriculture. so i understand that it does provide deadlines for certain types of funding to be provided to tribes. i think generally, we're supportive of deadlines. so i would like to talk more with my colleagues at the department of agriculture and circle back with my staff on

questions that we might have. >> we saw some very clear examples of proper forest treatment management to stop from spreading but wildfires are not a respecter of boundaries. that interface is very important, so what i'd like is to get your commitment to work with me and the usda to address these tribal forests. >> absolutely. >> thank you mr. chairman and vice chairman for letting me go first. you know, i think when we usually do these hearings and other committees, there is one agency sitting in front of us who we can hold accountable for outcomes. one of our great challenges is the siloing of services for the tribes, whether it's health care with ihs, which is really hhs, whether it is housing or hud, whether it is all of the issues that fall in all of the above

with the department of interior and obviously the department of justice. and i want to say i applaud this administration for doing the most that i've ever seen to try and coordinate among all of you to try to build relationships across the agencies to change outcomes. but with that said, we continue to see incredible challenges, whether it's housing or indian education, indian health care, law enforcement, respect for sovereignty and respect for consultation. and so i just start at that juncture, and i kind of be rapidfire here because there's so much to talk about. miss mason, obviously, we've extended an invitation to director comey to come to north dakota and come to even montana and see what's happening with the lack of law enforcement personnel, the lack of really protection for a very vulnerable population hasn't responded and i hope you will go back and ask him once again, given that you have primary jurisdiction in many of our states. >> i will share that information with the director, but i would

also like to point out that in partnership with the department of interior, the office for victims of crime and the office on violence against women have been working collaboratively to provide services. >> it hasn't stopped drugs from coming onto the reservation, trust me. we're debating right now an opioid bill, a heroin bill. let me tell you, if you want children born under conditions they should not be born come to any one of my reservations, and there are people operating there with impunity. and that crosses over to the problems that we have in indian health and in housing. i want to applaud the great work of secretary castro.

we've had a number of meetings. thank you for mentioning our efforts to get a major summit. i am curious about the report, when you expect it to be done, and when we will be seeing you all in north dakota or even maybe montana. i've offered maybe to share the responsibility, but we know we have a housing crisis. >> right. thank you, senator, thank you very much. and we very much appreciate the opportunity to continue to do what we can to foster private and public partnerships. with regard to the housing needs, a study report will be completed this year. we are looking at the preliminary -- >> can you narrow it? this year is a pretty big -- >> yes, i can. i definitely can. in july of this year we will release the preliminary findings stemming from the report. at that time, the report will be made available to the tribes for further tribal consultation. we welcome the opportunity to present to this committee the findings of the report.

the final report will be completed by no later than december of 2016. >> terrific. i think that's critically important we look beyond the we're doing right now. it's obviously not getting the job done as it relates to indian housing and that exacerbates all of these problems, whether it's locating law enforcement where the crimes are being committed or whether it's getting medical personnel into critical jobs. so i guess my last question would be for miss smith, recognizing that you haven't been at it very long. but i think to follow up on the chairman's comment, you know, we're being asked to provide more resources, and most of you know that i am in that camp. the resources we're providing right now are not adequate to meet treating obligations, not adequate to fulfill our responsibility. but we need to make sure that what's being spent is being spent appropriately. and we look forward to hearing

the outcome of what deputy secretary wakefield told us was the new structure for analyzing these problems and working across the line. but i will encourage you. so many members actually qualify for medicaid and could provide a third party reimbursement funding source that would, in fact, satisfy some of my hospital's concerns that ihs doesn't pay the bills. so that happens. so i want to continue to encourage you to encourage tribal members to enroll in medicare and medicaid and somehow, i know that this is a great concern that somehow that's an aggregation or inappropriate given the treaty obligation. hopefully the national congress can work with us to get the message out and we can fashion a

program that could, in fact, make indian people more comfortable with getting health care through a third party fee-for-payment service. >> senator, thank you for the question. we are working very hard on encouraging people to sign up for medicaid and i actually spoke to tribal leaders in bismarck, north dakota, two months ago about medicaid expansion and that's exactly the topic we were talking about. we are collaborating closely with cms. >> i will tell you, tribal leaders get it. unfortunately, many tribal members don't. and somehow, we're missing that. and i think the more advocacy that we can get out there, the better the opportunity to expand services and give native american people a choice on where they get their health care. thank you, chairman. i'm sorry, one over. -- i'm sorry i went over. >> senator murkowski. >> thank you chairman and for each of you, thank you for the work that you do.

i want to begin this afternoon by general comment about consultation. over the past few months, i can't tell you the number of conversations that i have had with alaska/native people both here in washington, d.c. and in alaska that are expressing more concern about the processes and the policies around consultation. we all know that the imperative behind consultation, the federal government has a duty to consult with tribes and to do so in a way that is meaningful, not just a check the box exercise. in terms of responsibilities that you all have with your respective agencies, i look at it and say, it's got to be one of our top responsibilities. so i'm just urging all of you, within your agencies, within your departments, as you develop your budgets and develop procedures, in your day-to-day

operations, keep these cons consultations as a very high priority. i think some of you are doing a better job than others, and i'm not going to single anybody out, but i will put it front and center that when you do all that you do on a daily basis, do not forget the consultation part of that. i did have an opportunity to spend a fair amount of time with you, miss smith, in the appropriations committee this morning. i thank you for that and for -- i also thank you for your willingness to come to the state and see some of the issues that we have discussed. and miss castro ramirez, i invite you to come to rural alaska to see some of the housing issues you speak very informed about, but knowing that we have some concerns and some issues that are perhaps a little unique. i want to ask you specifically about this comprehensive housing needs study. you say that this is close to completion and the results of this study are intended to be used to be driving policy and strategy. this concerns me.

it concerns me because i'm told that out of the 229 federally recognized tribes in alaska, there were only three that were included in your household survey. that was chickaloon, quinault and king cove. so you have a sampling rate that is vastly lower for alaskan tribes than tribes in the lower 48. that was brought to the attention of hud and to your contractors. know i'm very concerned about what this very important study upon which you're going to be basing future decisions, i want to make sure that alaska and alaska tribes are not under-represented or misrepresented. so i just need to know that this has clearly been brought to your attention. >> senator, thank you very much for the question. i just wanted to provide some context. the housing study that is being conducted by hud, essentially,

by our policy department, the study is a national study. it is using a statistically valid sample, and we have engaged in substantial tribal consultation. this is one of the reasons why there has been a delay. we are working very closely with the alaska tribes. in fact, we held two tribal consultation sessions, but i will definitely follow up, senator, and i note your concern. and i will follow up. >> i appreciate that. because, again, it's three out of 229, and these are very small communities, for the most part. i want to ask you a question, mr. roberts, regarding tribal courts. as you know, i have made tribal courts in alaska a priority as well as other pl 280 states. we had language included in the omnibus last year, well, no, in

'15, that directed a study of the budgetary needs of tribal courts, and then last year in the omni, there was $10 million for pilot tribal systems in the pl-280 states. we're making some progress there. as i keep saying, we've got our foot in the door, but the question to you is whether or not you have an update for me on how this pilot system may move forward and then also, the fy17 budget request plans to cut the funding that we had included, the $10 million, by $8 million from the 16 enacted levels. so the question is on the pilot and then any explanation for the proposed decrease. >> okay. thank you, senator. thank you so much for the funding. we really appreciate it.

it's extremely important. i've heard from a number of tribal leaders in alaska when from ncai about the funding. one of the things to do is it's important to get the funding as quickly as possible. i think it's also important to consult with the tribes and the pl-280 states. how we are going to move forward is we have to have telephonic consultations within the next 30 to 35 days. we have a couple of days of telephonic consultations with the tribes in the pl-280 states. whether that funding, how that funding should be utilized. so i've heard a number of different things from tribes in alaska and other places in the pl-280 states. i think it's very important to have the court assessments but i heard it's very important for the tribes to implement some of the money in the tribal courts themselves. so that's going to be part of the consultation with tribes given that it is $10 million. as you mentioned, the fy-'17 request had a bump-up from $15

million. the 2016 budget was passed in the closing days of the year. so we weren't able to necessarily maintain that funding for the '17 request. but i know i'll be talking with tribal leaders as part of our tribal interior budget council in a couple of weeks. i'm really hopeful that we can build off of the great work we did for the fy18 budget but i agree with you 100%. it's very much needed, and we're going to try to make the best use of those dollars that we can. >> well, i appreciate that, and we really want to try to make a success of this. i do want to just add, mr. chairman, i was prepared to kind of jump on mr. roberts here this afternoon about some payments as they relate to compact funding

due to bristol bay native association, the second largest employer in the region. they were looking to lay off or furlough some of their employees because they hadn't received the fy-'16 compact funds. and i received this afternoon that the issue was resolved and remaining funds go out today. so i can tell you ralph anderson and some there have been appreciative, waiting since december, and they're very appreciative that this has been resolved. so thank you. >> thank you, mr. murkowski. searpt -- senator franken? >> thank you, mr. chairman and vice chairman for holding this hearing. mr. roberts, ever since i first came to the senate, i have been raising an alarm, i guess, about the nagonagesha lake school in minnesota and pushing very hard every year to get construction

money to rebuild the school. i was pleased that secretary jewel came to the lake reservation, an opportunity not just to see the school, but spend some real time there and see the deplorable conditions herself first hand. and what the teachers and the students have to deal with every day. and this is kind of disgraceful, this school. have you had a chance to go to the school? >> i have not yet, senator. >> okay. it is drafty. it is cold. structurally, it's not sound enough. if the wind blows hard, they have to leave the school. and that's very hard. in minnesota, it gets really cold. and if the wind is blowing more than a certain amount, they have to leave and run to another

building, but it is, it's a deplorable condition. and so my question is, and i'm, you know, i've been trying to get this thing rebuilt every year, what is the status, can you tell me? >> yes. so, thank you, senator, for the question. as you mentioned, secretary jewel has been out there and my predecessor, kevin washburn, had visited. everyone i talked to within the department notes the horrible condition of the building, and it's a building that was never really intended for educational purposes at the outset. so there were some questions by your colleagues about the bie campus-wide replacement. the bug school doesn't fit in that category because it's a single building, essentially. so we do have appropriations. i'm hoping that within the next 30 days or so, i have an answer for you on how we're moving

forward with the bug school. that's my hope. i am meeting with the chairwoman of leetch lake later this month. with you i'm also -- but i'm also meeting internally with the team. everything i've heard is that there isn't a building in necessarily worse condition there. i don't have anything for you today except that i am very well aware of it and focused and i appreciate each amping of this issue. i have been to some of the schools on the campus-wide construction list, and the process that we have for school replacement right now, we need a lot more resources. >> well, usually at this budget meetings, that becomes abundantly clear, and i just want to say to my colleagues again, who are on this committee, that i believe it's

our job to go to our caucuses and tell them. because we're the only ones who are hearing this testimony from indian country and about our native people. and we need to, we are not honoring our moral obligations or treaty obligations. and i think it's something we need to be, all of us on both sides of the aisle, we need to be telling our caucuses. especially when we have this hearing reporting on budget, it becomes especially apparent. i want to talk about opioid use. it has become epidemic in native indian country. in minnesota and in urban settings. whim american indians infants in

minnesota make up 3% of kids born in public systems programs, they make up 28% of the infants born with neonatal abs sense syndrome. i know, ms. smith, i know tawahee initiative is intended, in part, to address this. are you hearing about similar rates of opioid use in indian country as i am hearing from minnesota and how will the tawahee initiative or other programs in the budget fight this rapidly increasing problem in my state and around the country? >> thank you, senator, for that question, and for your leadership on that topic. unfortunately, there is a very real problem with opioid abuse in indian country. we are working on it.

we have, you know, in our budget, we have included $15 million for additional funding for our substance abuse initiative, but on an operational basis, we're attacking it on a three pronged basis. we have a policy that goes out to our providers as to how to prescribe correct dosages. we have mandatory training for all our providers, and then in terms of treatment, we utilize what's called m.a.t., medication assisted treatment to ensure that we're trying to, you know, address this epidemic. >> that's methadone? >> well, and then, we actually, since we're on this panel, it's not a solution but one of the things that helps with the problem. we are cooperating with the bureau of indian affairs, we have providedenal -- provided

nalox own, we rolled it out in oklahoma and we are going to move that out to other areas. >> for o.d.s. i'm out of time. i just want to say that that epidemic is very much tied to the poor housing, the poor health care, the poor -- the job situation, in the sense of hopelessness that people get when they're living in those kind of conditions. thank you. >> thank you, senator franken. senator hoken. >> my questions are for deputy director mary smith. in your testimony, you note the challenges of recruiting and retaining quality health care professionals, specifically in the great plains region. and recently, i was informed of the credential process required under ihs and i heard that this process is cumbersome because it must be renewed every year.

so i'm concerned that this may disqualify qualified professionals who are in good standing with the state medical boards from working in some of these underserved areas. and so i just wanted to get your thoughts on that. what's the purpose of the credential, in particular, having to go through this every single year, and do you think it does have an impact on retaining, attracting and retaining qualified staff? >> thanks for your question about attracting or retaining staff. we do have a number of challenges there. in terms of the credentialing, obviously, credentialing is necessary to ensure we are providing quality health care and the providers are credentialed, but with respect to our credentialing system, i do think there are improvements that can be made. we have a new quality consortium that is going to look at a lot of these quality standards, and one of the areas they're looking at is a more uniform credentialing process that would

make, allow more flexibility for providers. so i appreciate your question. >> is that a change you anticipate you will be making, or is that something you're just looking into? >> i think we will make changes. i don't know exactly specifically what change. one of the things we're looking at is a different software package for credentialing. i don't have an answer today, like, whether that will go forward. we definitely will make changes to streamline the process. >> do you have any estimate on timeline for that? >> i hope we will be able to do at least some changes this year. >> something this year. >> yes. >> okay, and as you know, there are serious problems at the ihs facilities in the great plains region. many problems were due to lack of funding, no question about

it. but in other cases, it's a lack of accountability. my next question, in your opinion, how does the president's budget leverage resources to empower ihs facilities and hold them accountable? one of the things we talked about was trying to leverage ihs facilities to address the resource issue. so how do you do that? and then, how do you get accountability, make sure you have accountability for performance on the part of ihs? >> thanks for the question. i think it is not easy, sometimes. but i think it's creating a culture of quality and accountability. and i think it starts at the top. and i think you need key leadership positions. and one of the things we're doing, and there is money for this in the budget, there's $2 million for our quality consortium. as i mentioned, we created a new position. deputy director of quality. and we are going to be setting

up a quality system, which is essentially a compliance system with training. and we are going to be working to ensure that the systems are in place and that people are held accountable. and i think that was one of the problems that, why those problems arose in the great plains. so that is one of the top priorities that we will be addressing this year. >> well, i think there are other service providers that you can partner with to leverage your resources, but as part of that too, and this goes to the accountability, is reimbursement to hospitals, clinics, doctors, and others that do provide services either on or off the reservation. they have a real problem with backlog and accounts receivable or getting or collecting those receivables from ihs. so anything you can do to make sure that ihs, working with the tribes, gets payments out to the health care providers in a

timely basis, i think now is not only important for them, for the service providers, health care providers themselves, but will help generate more services both on and off the reservation for native people. >> yes, thank you, senator. i agree. leveraging the resources and ensuring prompt payment. and i actually was talking to the person who runs our purchase referred care program yesterday about the processes she's putting in place to try to streamline those payments, so thank you, senator. >> yay, anything you can do there, because we really hear from the health care providers they really need help collecting the receivables. so thank you. >> thank you, and senator tester. >> i want to thank the panels for being here today. we're going to start with you, carol. the grand funds implements ballot is at $5 million. last year, i believe it was $2.5 million. you can correct me if i'm wrong. is $5 million going to be adequate? >> thank you for the question, senator.

as you know, in march of '15, it went into full implementation of the expanded ability to prosecute non-native offenders for domestic violence. we have 45 tribes who are participating in our voluntary working group, so we expect the $5 million since 2014 and others implemented, we expect we'll have many more people applying for the money than -- >> is $5 million going to be adequate? >> we will make it adequate, but the need exceeds that. >> that's all i need to know. the doj appendage mentions allocating $1 million for research on violence against native women. it's in the same section about implementation. is that $1 million coming out of the $5 million or separate? >> that's a separate funding source. >> that's good news. now over to you, larry. you've heard this before. we will come in and talk to you

about different kind of issues in indian country and they've got a lot of them. and we often say to you, you've got to fight harder during the budgeting process to make sure the budget meets the needs of indian country. does this budget meet the needs of indian country? >> thank you, sir, for the question. so i do think that the budget reflects the president's commitment to indian country. as i said earlier, the discretionary funding across federal agencies is less than 1% increase. for indian country -- >> i got you, but that wasn't the question. >> i know, i know. so the -- what i will say is, tribal rates still haven't regained the footing. from sequester. that was $142 million. so if there's anything, i know this congress, and i know many of you for the '16 budget help

-- >> what i hear you are saying is this is the best you can do but it's still not adequate. >> i think everyone needs -- knows there's still additional needs in indian country. >> perfect, larry. i want to go back to what the chairman said when he opened up. if you've got metrics to bring to this committee to justify the increases in budget, it would be helpful. because i don't think there's anybody in this committee that doesn't understand some or all the programs. -- are in trouble, the sequester, the obama administration has done a pretty good job, but it was so doggone bad last -- they had a long ways to go. >> some of the metrics we can provide tomorrow are the great work that we've done in indian country with tribes. >> okay. >> on preventing violent crimes, reducing recidivism. >> i got it. otherwise, we just bring you in here to hammer you. that's why it's important. we have an obligation too. we've heard from tribes, tribal organizations, and entities to

do business in indian country, and the loan program is a great economic development tool, and god knows in my neck of the woods, they need economic development in indian country. this is level funded. is that because the request for the loan guarantee program have been flat? >> it's a great program. we could use more. we can't always bump up everywhere across the budget. so we're focused on schools and youth and social services. it is a great program. we're doing the most we can. it leverages dollars for indian country. >> all right. i want to go to ms. ramirez. this year's budget proposal proposes a $50 million increase for native housing, which is good. press conference questions about the housing, but it's been stagnant for almost 20 years. i appreciate the advocacy for a bump-up.

do you feel the additional dollars will be able to get out the door? >> yes, senator. i definitely believe the dollars will be able to get out of the door and the tribes will be able to invest and make use of these dollars. >> do you think the program is critically important when it comes to housing in indian country? do you think this is one of the big programs or kind of an ancillary program, there's other ones out there to fill this need? >> senator, this is the core program of nahasta, to provide the single source of funding to provide tribes the opportunity to develop affordable housing, to renovate -- >> so can i ask you a question? if this is the primary one. have you guys done an assessment on the standards of housing in indian country? like, are they, what percent are substandard? have you been able to do any of that? >> we have, senator.

i mentioned earlier that we are in the process of completing a housing needs study that speaks to the conditions of housing across -- >> what does that study show? 80% substandard, 10%? >> in 2014, we released preliminary results using the census and american community survey. a few key statistics that were included were, one, a very severe overcrowding problem in indian country. three or four times that of the national average. we also know, senator, that tribes are having to use more of their ihgb funding to rehabilitate and renovate existing stock, and less is going into the creation of new affordable housing. >> thank you for the courtesy, mr. chairman. >> thank you, senator. i'll start a second round. would you like to start?

>> thank you, mr. chairman, and a couple things, and they don't go necessarily to this budget, but they go to the potential for change. and one is obviously something that we've been working on in this committee, and that is looking across the board on trauma and making sure that we have trauma-informed health care professionals, making sure that we have trauma-informed and trauma-based folks in our department of justice and in the bureau of indian education. just making sure that everybody understands this kind of new brain research that is going on. and so i will kind of warn you that i will continue to be a broken record as it relates to trauma as a potential path forward for change. the other thing, obviously, we've been talking a lot about this week is opioid abuse, heroin abuse. and i've met yesterday with a

number of folks. it's that time of the year. but one of the meetings that sparked a great deal of interest with me was when i met with the women representing the ob/gyns. they believe there's prescription medications dispensed in a different way. and i can't speak to all the options that are out there, that would actually provide treatment, that's not methadone treatment for women who are addicted, who are pregnant. and i wonder whether indian health has taken an active look on other kinds of treatment options that they have for addiction, especially with pregnant women. >> thank you, senator. yes, i know. we are working on a multi-prong approach with opioid dependence.

i don't, we have a whole division of behavioral health, and i was just talking with a dr. cotton, who heads that, yesterday, about the opioid crisis. and i know we're looking at a number of different things. we can get you, if we are doing anything specifically with respect to pregnant women, i can get you that information. >> we've been looking at it, but in the meantime, this is basically ballooned into a full-blown, absolute, horrible crisis, especially in indian country, but across the country, but especially in indian country in north dakota. if we are not pursuing state-of-the-art treatment options, then we're going to fail. and if we're not offering help to those who come in in dealing with their addiction, i think, obviously, from the standpoint of very many of the people who provide services to pregnant women, there is a big incentive for women to look at addiction and change behavior.

and to me, there's a real option to get this done. and one of the frustrations i have with indian health is you continue to do what you've always done over and over and over again and expect a different result in indian country. it's not going to happen. we've got to change how we approach it, and we've got to look at a system that really treats the family. a system that treats the individual, and doesn't just say, okay, here's your diabetes and expect people to be compliant when they're addicted. i mean, it's just not going to happen, and we're going to continue to spend dollar after dollar without really treating the individual. so i would appreciate any kind of information on the structure that you plan on pursuing, especially for addicted, pregnant women, which has become a crisis. in fact, we've heard reports as high as women in 50% of the babies born from women who are addicted.

i've heard the same kind of information. that's not a formula for a successful society in any case. and so falls on your shoulders, and we expect to know what we're doing about it. so thank you, ms. smith. >> thank you, senator highcamp. ms. ramirez, the budget for the -- your office proposes to raise the indian loan guarantee annual fee from 15 basis points to 25 basis points. the impact on a budget request to a $11 buyer monthly mortgage, $130 a year. this increase is now going to be assessed with some of the people who are most at risk homeowners. you stated the tribal consultation will take place prior to implementation. raising it from 15 to 25. currently, you use a negotiated rule-making.

to conduct true and meaningful tribal consultation. despite recent concerning examples, this appears to be a successful model for a tribal consultation. are you going to be open to using this negotiated rule-making to implement this increase and a 184 program annual fee and how do you plan to go ahead with that? >> thank you, chairman, for the question. as you stated, the loan guarantee program is a critical program in indian country. we know that this is a program that works and enables the opportunity for home ownership. with regard to the modest annual fee increase, this modest annual fee increase is driven by the credit reform act of 1990. it is not a program of nahasda, hence, it's not subject to negotiated rule-making, but you

have our full commitment that as we begin to have further discussions with tribes, we will engage in tribal consultation on the changes to the 184 program but also on the opportunities for the department to be able to improve the program in general. >> thank you. mr. roberts, the road :l)l maintenance program is responsible for maintaining almost 29,700 -- almost 30,000 miles of bia-owned roads, 931 owned bridges constructed with federal funds. the administration requested funding level for this year with a need to maintain only 16% of the road and 62% of it with the bridges in acceptable conditions. the funds are used to simply maintain the current condition. far too many public roads are in -- on indian reservations are in poor or failing conditions as i drive wind river reservation. so if only 16% of the bia roads

and 62% of the bridges are going to be an acceptable condition, how can we safely get kids to school, drive somebody to the hospital without safe roads in which to drive? is the funding level in the president's budget too low given the importance of the travel community? >> it is an incredible importance in indian country. we hear about it all the time. the department of transportation takes the lead on those funding issues. i will say the president's budget, as you say, chairman, reflects maintaining the roads that you identified as in moderate or fair or acceptable conditions. so it's extraordinarily challenging to improve infrastructure in this fiscal climate, but so i share your concern about the issue. >> in addition to transportation, i go to education in the president's fiscal year 2017 budget request. education funding requests has increased. we all understand the urgent need to fix the broken school systems.

i would like to bring to your attention the request for $20.4 -- $24.8 million for education management. can you talk about what services or type of services that education management provides? >> absolutely. and so, basically, chairman, the president's budget requests an $8 million plus-up for $24 million overall for that line. and the plus-up is essentially for 15 positions. contracting, acquisitions, construction, construction budget planning, ip education specialists. it's all of the, it's the 15 positions that we need for bie to address those services under the reorganization. and so it's really looking at human resource specialists, recruiters, budget planning. those type of things. so i'm more than happy to provide additional information to your staff on that funding. >> thank you. and secretary mace mason, want to talk about the division 21

project focused on current crime victimization and enhancing partnerships, improving integration to crime victims' rights. it's intended to facilitate to facility the ability of networks to meet current crime victims needs, organizational flexibility and stronger collaboration, those things that you talked about previously. the collaboration of crimes victims' rights and then the budget's request to include a project grant. can you talk about how you're going to, how will the development of these grants be tailored to tribal communities and incorporate tribal consultation prior to announcing the grants? >> thank you for the question. the $25 million request in the president's fiscal year 2017 budget is designed to give us more flexibility than we currently have with the voca funding and we have a history of consulting with the tribes and this is -- this request is a result of having numerous conversations with our tribal partners. >> senator, any additional

questions? >> i do. thank you, mr. chairman. we go back to you, larry. there's a request in here, i think you discussed in your testimony of a $4 million request for native one stop initiative. is it -- it is an internet site. is there more to it an than internet site? >> absolutely. so it will, the internet site will basically, all of the different agencies across the federal government have their information fed into this internet site to provide tribes and individuals, you know, they can access the programs. let's say they have a housing issue. they can access the site and say, hud's got a program, we've got a program. >> let me refine my program. is there funding for a physical site too to go to or is it all internet? >> my understanding is it's all internet at this point. >> okay. okay, so $4 million, this must be one hell of an internet site.

that's a lot of dough for an internet site. >> fair enough. but when you have a number of different federal government agencies across the government in indian country, there's quite a bit of data too. >> no doubt about that. let me ask you. how, broadband is pretty deficient in indian country. are we building something that they will not have access to? >> i think -- >> don't misunderstand me, i think it's a great idea, but if they don't have internet service, how are they going to access the website? >> so the president's budget got -- does support additional broadband access to bie schools. so there is increases. i'm not sure what the other federal agencies have for broadband, but i don't think this internet site will be something that needs the highest capabilities. i think tribes will be able to access it. it's something tribes have been

asking us for, as a one-stop to identify those programs that serve them. so i think it's well worth the small investment and hopefully what it does, it saves tribes a lot of money as they're going through that process. >> your testimony talks about an office of services to work with assisting tribes in adopting and updating tribal court codes. and the same thing kinda for uniform commercial codes. updating tribes -- helping tribes update those. any of that work being done now? >> i believe it is. i would have to get you more information on that. >> if you could. i think, once again, i think it's a great idea. my next question would be, do you have the infrastructure to do this? >> we have a great team in ojs. i just don't have the details on that for you now, senator. >> that's good. and i have one last question for miss ramirez if i might.

it has to do with the loan program. this is one of the programs we saw cut from last year's budget. and quite frankly, native americans, they want this expanded to include native americans that live off reservation. so i have two questions for you. number one, would you support that if this program was expanded? to be able to use this money, these loan guarantees for homes outside of the reservation? >> in principle, yes, i would support it. i would need to look into the technical requirements behind the loan guarantee program, because i know that it was designed for indian country. but, yes, i think anything that we can do to expand and increase home ownership opportunities. >> okay, that's good. and the second thing is, it's kind of the same question i asked other people in other programs, but this is a pretty

doggone good program. and so -- and it's being cut. what is the justification? is it simply dollars, that's it, you had to cut somewhere, so this is the one that got the axe? >> senator, our request for $5.5 million for fy 2017, takes into account carryover funds that we are projecting from prior years. >> all right. how much carryover do you have? >> we're projecting close to a million dollars of carryover funds. >> on one hand, that's good. we'll just leave it at that. thank you, mr. chairman. i appreciate it. and appreciate all your testimony. i grilled mary pretty hard this morning, so i told her i'd let her off the hook this afternoon. and aaron, i'm sorry. i'll catch you next time. thanks. on what senator tester's talking about and asking the question on

broadband deficiency in indian country, putting all this effort into a state-of-the-art website where all this information can be integrated. can you talk a little bit about how the needs are, because there's some infrastructure lack in the community. >> so i testified earlier of some of the hard infrastructure, when you think of infrastructure like pipes and indian country is largely neglected with that. indian country, we've built basically what we do have. in my tribe's case, we were recognized late in 1972, so we've had to acquire everything that we have. mostly what we were able to acquire was old swamp land. so we're in rural communities and old swamp land that we have to build the infrastructure ourselves. so broadband is a critical need in indian country. we are not as rural as most other tribal communities. so we do have some access, but our access is limited. we have council meetings in the districts and we find we don't have the ability to connect and

our tribal staff look at us and laugh at us because we can't connect. but they live with that day to day and try to do their jobs day to day. so i would say absolutely if the program that we're talking about is a wonderful concept, which is to connect across agencies, we've talked about that recently and try to get permanency across agencies, but if that's going to work, tribes have to have access. otherwise we're building a structure that is not going to be used by indian people. >> and it's a loss of opportunity to use the resources is there. >> i don't want to get in the middle of a fight. i would say that you need to -- >> well, with that -- >> if there are no more questions for today, members may submit questions. the record will remain open for two weeks. want to thank all of you for being here for your time and your testimony today. the hearing is adjourned.

the supreme court is vested with this outsized amount of power, and with that power comes greater responsibility. the idea that you have individuals sitting on the court for, unfettered for 30, 35 years, is just not -- just doesn't pass the smell test when it comes to a modern democracy. >> sunday night on q & a, gabe

roth talks about changes he'd like to see at the supreme court, including opening up oral arguments to cameras, imposing term limits on the justices, and requiring justices to adhere to the same code of ethics that other federal judges follow. >> the supreme court's decisions affect all americans. all americans are aware of the third branch of government, and in the last 10, 15 years, the third branch of government has become so powerful. the idea that issues on voting and marriage and health care and immigration and women's rights, pregnancy discrimination, i could go on and on. these issues that maybe 20, 30 years ago, congress and the executive branch would get together and figure out a compromise and put together a bill. that doesn't really happen anymore. the buck stops with the supreme court in a way that i feel is unprecedented in our history. and given that the supreme court is making these very impactful decisions on our lives, the least we as the public can do is press them to comport with modern expectations and

accountability. >> sunday night on c-span's q & a at 8:00 eastern. >> when i tune into it on the weekends, usually it's authors sharing new releases. >> watching the non-fiction authors on book tv is the best television for serious readers. >> on c-span, they can have a longer conversation and delve into their subject. >> book tv weekends, they bring you author after author after author that spotlight the work of fascinating people. >> i love book tv, and i'm a c-span fan. >> next, france's interior minister talks about how his country has worked to combat terrorism since the attacks in paris last year. he also takes questions on relations with turkey. and accessing encrypted phones and other digital devices. from george washington university center for cyber and homeland security, this is about

an hour. [ applause ] >> cyber and homeland security director, ambassador, ladies and gentlemen, dear friends, i would like to thank you for welcoming me today. i am honored to be speaking in front of you at the prestigious george washington university where so many great american political figures honed their skills. i am thinking of former secretaries of state, john foster dallas and colin powell as well as former first lady jackie kennedy. i also would like, of course, to

warmly thank the members of the center of cyber and home security, especially the director who was kind enough to invite me to give you this lecture on france and the terror threat. france and the united states have a very long-shared history. and despite the occasional quarrel, we have always been bound by very strong, even passionate friendship. i would even describe it as a unique friendship because when we are confronted to our times, we always pull together. after the attacks in france last

year, i read the great american philosopher explain that for you are french are not seen as completely -- which is why you were so deeply affected by the tragedy we had just experienced. it's also for this reason that we were driving by the same emotion after the slaughter committed in san bernardino on december 2, 2015. i would like to express my deep condolence to the families and their grief. i therefore would like to thank you from the bottom of my heart, both personally and on behalf of france and the french people for the solidarity you demonstrated during the terribly difficult time we have just been through. the strong support shown by president obama and the american

people meant so much to us. we will never forget. and france will never forget. and we will never forget the reaction of three american citizens, spencer stone, anthony sadler, and alex skarl at os. they contribute to avoid another terrorist tragedy in the train, which was carrying more than 500 passengers from amsterdam to paris. for that bravery, president hollande awarded them our highest decoration. in 2015, my country was the target of terrorist attacks of unprecedented kind and scale.

149 innocent victims lost their lives and others were seriously injured. in january, the targets chosen by the terrorists had an obvious symbolic significance. the editorial staff of "charlie hebdo." famous satirical newspaper. and police officers. they targeted freedom of conscience and expression, democracy and pluralism, and the values of the french republique. on november 13th, 2015, the killers struck indiscriminately at the very heart of paris, in our street. the bataclan concert hall and outside the stade de france.

they attacked our young people. they attacked our way of life. among the bataclan victims was a young american student, naomi gonzalez. my thoughts go out to her family, loved ones, friends. before talking about the main lines of action we are conducting against terrorist networks in france and in europe, i would like to give you my analysis of the threat we are all facing. i believe we must understand it in order to protect ourselves more efficiently. over the past ten years, the threat has considerably evolved. the november attacks were planned from syria and coordinated abroad, yet all those were perpetrated by people radicalized on french soil. sometimes in a very short period

of time. today, in fact, the threat is more and more diffuse. from our point of view the threat now takes many forms. on the one hand, it involves individual or small groups with accelerated training in handling weapons in syria or iraq. back in europe, sleeper cells capable as in november 13th of moving into action in cooperation with the syrian base of isis. on the other hand, individuals who are being progressively radicalized through environment, sometimes with the help of very informal networks which are thus even more difficult to identify. they feel they are responding to

a general call to jihad by isis or by many other terrorists inspired by an organization. consequently, sociological and psychological profiles of jihadists or candidates for jihad has become more varied. some are criminals or former criminals who have been radicalized in prison or through encounters with islamists. this was for example the case of one of the terrorists involved in the attacks of january 2015. others are psychologically vulnerable and for various reasons, have developed feelings of hatred for the society in which they grew up. others finally tell themselves they are looking for meaning and have a fantasy conception of the islamist revolution thanks to

the propaganda on the internet and on social networks. the jihadist organization rely on elaborate propaganda. i am thinking especially of the videos broadcast on social networks and of online media prepared by isis, such as dabiq written in english, or written in french. the battle against terrorism that is often fought in civil place, indeed most who have traveled or are seeking to travel to syria or iraq, have been radicalized online. basically the new jihadis is a combination of society and social networks. i am deeply convinced that authorities must cooperate with

the actors of the digital community. just under a year ago, i was in california to meet the representatives of the major digital companies for enhanced cooperation on terrorist threats. since then, we have managed to agree upon a set of best practices which we collectively adopted in 2015. together, we are establishing a form of positive cooperation which must be encouraged. my staff and the digital professionals meet in an atmosphere of mutual trust and france has been a pioneer in this area. one may ask what is exactly the terrorist intent. not only to kill, but to foster terror, so that no one can feel

safe anywhere. for that, there is an atmosphere of mistrust. our citizens pit against one another, on the contrary, neglect the fundamental principles of legitimacy by seeking innocent victims, terrorists attempt to place society on a permanent war footing. they seek to erase the boundaries between domestic and foreign, combat aant and non-combatant, and between civilian and military. this is what we must avoid at all costs. the response to terrorism is a state and the rule of law. very early, france realized the totally new and multi-faced nature of the threat.

since 2012, we have constantly strengthened our counterterrorist capabilities adapted our arsenal to the evolving situation. i would like to tackle a few of the main aspects of this response. in france, in europe, of course, and quite obviously in cooperation with the united states. first and foremost, at the national level, to combat terrorist action and propaganda we have obtained new legal means better suited to the new time of the natural threat. since 2012, counterterrorism law has allowed prosecution of french citizens for participation in terrorist crimes abroad, which could not be done previously. this is vital for handing down

sentences against returnees who were in syria or in iraq. then a second counterterrorist act adopted last 2014 instituted four major innovations. french nationals suspected of wanting to join active terrorist groups in the middle east are barred from leaving french soil. forbidding non-resident foreigners from presenting a threat to national security, from entering or living in the country. finding the individual terrorist undertaking as an offense. finally, legally blocking and removing websites advocating or glorifying terrorism. those measures are being applied in an extremely firm way and are proving efficient.

in july 2015, we also adopted a major law on intelligence. our intelligence services now have a modern and consistent legal framework in line with the new threats, the most recent technological changes in the developments of national and international law. at the same time, we strengthened our homeland security and intelligence services by giving them additional human and monetary resources. last june i also created a specific terrorism prevention department that oversees monitoring of identified individuals and is enabling us to establish and update a system that covers such sensitive areas as education and facilities.

so while the threat level has never been higher, france's response has never been so strong. this is demonstrated by the fact that 11 attacks have been foiled since 2013. six of them during last spring and last summer. we obviously strengthened our means against terrorists but we also developed innovative methods to prevent radicalization. telephone reporting hotlines set up in april 2014 allowed us to save over 4,007 reports. it enabled us to guide many families who benefit from valuable support and can report the risk of departure of syria or iraq when one of their relatives is on the brink of leaving france.

thanks to this, we have already prevented many people from leaving and we acted before french youngsters succumb to violent radicalization. secondly, strengthening our protection against terrorism is also a key issue at the european level. it is why finally after the november attacks, i have obtained from our european partners many major improvements, strengthening of external border control, through modification of the schengen code, in order to finally implement systematic check at the eu's extended borders for all persons entering and leaving the eu. this will also apply to european citizens through the systematic consultation of european databases, the schengen information system, of course,

and international databases such as interpol databases, of lost and stolen passports. in order to ensure these controls are effective, member states must systematically include