when i was first afoibtd the director of the indian health service i heard input from tribes, patients and our staff that we needed to change and improve the indian health service in many ways. and although we've made significant progress in addressing our priorities, much work remains to be done. the population we serve continues to grow and the challenges of providing health care in rural america are ever present. our data continues to show the incredible need for services by the patients we serve and we continue to work hard to meet our mission with available resources. the increases in ihs funding over the past few years have helped us make progress but we still have much more to do. so the 2013 president's budget request for ihs will help us address these challenges and make progress. our agency priorities through tar get investments, to increased access to care, improved quality of care, support our oversight and accountability functions and address tribal management support costs. the budget request is $4.24 billion, an increase of $116 million over 2012. and that includes funds

mcswain that what the indian health service was doing to protect the patients and employees and it was a specific hospital he was familiar with, clairemore in oklahoma. they were working with local jurisdictions so law enforcement could protect patients and staff at that facility. four years later. again it was not something that you were charged with, you inherited this problem but it's four years later and there's still not really been an adequate resolution to the problem. can you maybe help address what needs done resolve this matter? >> yes. well we are aware that the issue at clairemore indian hospital is serious and needs to be resolved as soon as possible. i just recently was briefed by staff. it looks like we've been working very closely with the department of justice and the bureau of indian affairs and they have outlined some administrative and possible legislative options. and so the next step would be to decide what our priorities are for those options, and then to consult with the tribes because some of those options actually do involve whether the tribes will be helping

next, we welcome the honorable yvette roubideaux, director of indian health service, department of healthand human services. accompanying ms. roubideaux is mr. randy grenell, deputy director of the indian health service. let me just thank you for your patience, and i've been looking forward to this hearing. so secretary echo hawk, would you please proceed with your testimony? >> thank you, chairman akaka. we have previously submitted a written statement, but i will summarize my statement to begin with. we thank you for this opportunity to provide the department statement on the fiscal year 2013 president's budget request. the 2013 budget request for indian affairs within the department of the interior totals 2.5 billion in current appropriations. this is 4.6 million below last years enacted level, which amounts to a reduction of two-tenths of 1%. as you know, indian affairs meets with tribes on a quarterly basis on the budget through the tribal interior budget council, and through this informed consultation with tribes, we included in this budget request $43.8 million in program increases

when i was first appointed to be the director of the indian health service, i heard input from tribes, patience, and our staff that we needed to change and improve the indian health service in many ways. although we have made significant progress in addressing our priorities, much work remains to be done. the population we serve continues to grow and the challenges of providing health care in rural america are ever present. our data continues to show the incredible need for services by the patients we serve and we continue to work hard to meet our mission with available resources. the increases in ihs funding over the past few years have helped us make progress but we still have much more to do. the 2013 president budget request for ihs will help us address these challenges and make progress on our agency priorities for targeted investments from access to care and quality of care and support our oversight and accountability functions and address tribal management support costs. the budget request is $4.42 billion, an increase of $160 million over 2012. that includes funds to support a

i know that you're working on on with the indian health services to help provide services to the native american veterans, and i commend you and all your -- all your involvement in these efforts. ms. secretary, can i get your commitment to look into possible ways of working with the native hawaiian healthcare systems and native american veteran systems to provide services for this case, native hawaiian veterans who live in the rural parts of the state of hawaii? >> senator, you have my assurance that we will do our utmost to provide for my of our veterans, wherever they live. the most rural and remote areas. the same access and quality to healthcare and services as we provide to someone living in a more urban area. there is a challenge with that, but we are not insensitive to that challenge and we're working hard to provide v.a. provided services and where we can't to make arrangements where if quality services exist in those areas, making arrangements for veterans to be able to participate in those local opportunities. we are i think you know working and have been now for some time on

on the hill in a district not in finance we are not afforded people right here to jobs to indian health serviceto this. to anything here and there's only three thousand of us books here and for us being the homeowner are the ones that made the treaty and the united states government made a nation to nation agreement with full blooded in a did not make it was half breeds that is why we have to have a blood degree the federal government can find out when the last bullet into life that went out for good stead no more treaty no more blackmail no more hiring no more indian health service. to my nation the law. through the first nation to militarily defeat the united states of america on the field of battle and then ended in eighteen sixty eight from the moment states of america and birds for peace and we gave it to. and there when the sign of truth appears based on international law and so we granted that to them in fact we already knew there were issues or couldn't be trusted so we are allowed him to write history of priest and his online bridge so he could understand through still my. assignment t

with the indian health service so that wherever they have facilities and we have vested interest that a veteran -- eligible veteran going to an indian health service facility will be covered by va's payments. and we're in the stages of trying to bring that m.o.u. to conclusion. we intend to do that. and where tribes approach us prior to the signing of that m.o.u. and want to establish tr a tribal nation with va a direct relationship because they have a medical facility and would like us to provide the same coverage, we're willing to do that, but that would be on a case-by-case basis. >> thank you. secretary shinseki, staffing shortages continue to be a problem, although there's been progre progress. but some clinics are seeing staffing levels below 50%, causing excessive waiting times for veterans that need care. understand this is an issue you've been working on. as you know the number of veterans needing services is growing yearly. it shows that you have been making progress. can you provide an update to the department's progress to address staffing levels? >> mr. secretary, thank y

as i describe, we're working with the indian health service to establish this mou which would open a lot of processes for -- especially for alaska native veterans. but in the meantime, based on my visit to alaska, the alaskan native medical consortium, we've also established discussions with them trying to ensure that however the ihs mou progressing that we have are ready to provide help to veterans who are being seen now. >> you feel that's going in the right direction with the travel concerns? >> let me talk to dr. petzel since -- >> in negotiations and discussion. >> thank you, mr. secretary. senator begich, i really do sim -- sympathize with the ruralness of alaska. as well as other parts of the country. while we're waiting for the mou to be finished, alaska is one of two places where we are proceeding with tribal interactions and i hesitate to use the word pilot. but to get specific agreements within a tribal unit in alaska. i believe it's the southeast alaskan tribal association and we are progressing in getting some arrangements made. it would be wonderful from my perspective

but the reason for that is because members of indian tribes obtain their health care through the indian health service, which is a clinic-based system, that doesn't involve insurance at all. it's an entirely different system. they were taken out of this statute, because they get their health care through a different system, and it doesn't make any sense to think that person is getting their health care through the indian health service are violating the law, because -- exempt only from the penalty but still under a legal obligation to have insurance when the whole point is -- >> is your point is that this was inartful drafting by congress? that to the extent that there is an exemption under the penalty, it's an exemption from the legal obligation? >> i guess what i would say about it, your honor, is that the way in which this statute is drafted doesn't permit the inference my friends are trying to draw from it. and there is a text you'll of that, which is at page 13 of our reply brief. this is a provision that is 42usca, section 18022e. this is a provision that provides for a certification that certai

i know that you're working on an mou with the indian health service to find solutions to help provide services to our native american veterans, and i commend you and all your, all your involvement in these efforts. many secretary, can -- mr. secretary, can i get your commitment to look into possible ways of working with the native hawaiian health care systems and the native american veterans systems to provide services for in this case native hawaiian veterans who live in many rural points of the state of hawaii? >> senator, you have my assurance that we will do our utmost to provide for any of our veterans, wherever they live, the most rural and remote areas the same access and quality to health care and services as we provide to someone live anything a more urban area. there is a challenge with that, but we are not insensitive to that challenge, and we're working hard to provide va-provided services. l -- and where we can't, to make arrangements where if quality services exist in those areas, making arrangements for veterans to be able to participate in those local opportunities. um

net we welcome the director of indian health services in the department of health and human services. accompanying him is randy granell, deputy director of the indian health services. let me thank you for your patience. i have been looking forward to this hearing. will you please proceed with your testimony. >> thank you, chairman akaka. we have previously submitted a written statement, but i will summarize my statement to begin with. we thank you for this opportunity to provide the department's statement on the fiscal year 2013 president's budget request. the 2013 budget request for indian affairs within the department of interior totals $2.50 billion in current appropriations. this is $4.60 million below last year's, which amounts to a reduction of 0.2%. as you know, indian affairs meets with tribes on a quarterly basis on the budget through the tribal interior budget council and through this informed consultation with tribes, we included in this budget request $43.80 million in program increases in priority areas such as contract support cost, rights protection implementation, and

are -- i think you know, working and have been now for some time on signing an mou with the indian health service. wherever there are facilities and we have a vested interest, an eligible veteran going to an indian health service facility will be covered by va's payments. we are in stages of trying to bring that mou to a conclusion. we intend to do that. and where tribes approached us prior to the signing of that mou and want to establish from a tribal nation with a va a direct relationship because they have a medical facility and would like us to provide the same coverage, we are willing to do that, but that would be on a case by case basis. >> thank you. secretary shinseki, staffing shortages continue to be a problem, although there has been progress. some clinics are seeing staffing levels below 50%, causing excess of waiting times for veterans that need care. understand this is an issue you have been working on. as you know, the number of veterans needing services is growing yearly, and it shows that you have been making progress. can you provide an update on the department's progress to addr

rubideaux is here and is leading efforts in the indian health service at hhs. to get indian people into programs involved and how we can expand the services to all native americans. i want to thank her for that support and that help. that's a great -- a great topic for us to discuss. it's something we need to continue. thank you for that question. i know i didn't answer it, but it's a great question. >> yes? >> mary jane with the office of minority community outreach. i want to commend ncai for bridging the digital divide and bringing this foreup into the classrooms that are educating our children. are we going to have any kind of a pulse on how many of our native youth across the country in our public schools had access and opportunity to participate? and as a follow-up, maybe a challenge for you to engage our youth through like a twitter feed or something because i really want to know what our native youth feedback from this phenomenal event is. >> great, thank you. yes, we did. we did extensive outreach and i will tell you, we have a tweet here from a youth w

the administration, we've increased substantially, 10% in the house, appropriations for the indian health service. the president is facing a difficult budget. reduced the budget slightly. we thought it was too much and we stored some of that funding. and if you look at indian funding on impact aid, on things like housing across the board, well, it didn't see the same increases that we saw in other areas. it was actually essentially held harmless in the house and that's a good thing when we're experiencing difficulties in other areas. so that bipartisan relationship has been very powerful and very good. you've seen it expressed in the establishment in the natural resources committee for the first time in many, many years in the house, a subcommittee on indian and native alaskan affai affairs. that's something my good friend and i have worked on for many, many years and finally came to fruition. that would not have happened if doc hastings had not been supportive of that. and he put in as the chairman don young from alaska and we have no better ally on native american issues than don young and his

the headsst indian health service and the bureau of indian education and a cherokee chief and other representatives from tribal organizations. that hearing has been moved to 3:30 eastern. we'll have it live on c-span3. this is c-span3 with politics and public affairs programming throughout the week and every weekend 48 hours of people and events telling the american story on american history tv. get our schedules and see past programs at our web sites. and you can join in the conversation on social media sites. earlier this year the scripts howard news service found millions of dollars in fraud in the food stamp program. reports said that hundreds of retailers banned from the programs continued accepting food stamps, some in exchange for beer, cigarettes and cash. this morning the house oversight committee held a hearing on the issue. this is about 90 minutes. >> the meeting will come to order. americans have a right to know that the money washington takes from them is well spent. and second, americans deserve an efficient, effective government that works for them. our duty on the oversight and gov

we'll hear from the assistant interior secretary foreindian affairs the heads of the indian health service and bureau for endian education and a cherokee chief and other organizations of tribal organizations getting under way at 2:15 live eastern here on c-span3. >>> not fighting and dying because they're al qaeda, not fighting and dying and sacrif e sacrificing their lives because their muslim extremists. they're fighting and dying because they want the same universal rights and freedom that we guaranteed in our constitution. >> i think if we don't get the international community together in a coalition of the willing soon we're going to look back and say we not only didn't do the right thing morally to stop innocence from being killed we missed an extraordinary strategic opportunity. >> i want to make the point that the concerns that senator mccain and you and others have expressed are exactly the concerns of the administration. we're not divided here, and we are not holding back. this administration has led in iraq, we've led in fc afghanistan, we've led in the war on terrorism and led

at this hearing we'll hear witnesses including assistant interior secretary, heads of indian health service and bureau as well as cherokee chief and other representatives of the tribal organizations. we'll have it live for you when it starts on c-span3. until then part of the conversation from this morning's washington journal. >> joining us is representative jackie spears. she's a democrat from california, we spent the first 45 minutes talking about u.s. policy in syria and whether u.s. military intervention is an option. your commit, what's your feeling about that? >> i think if we do engage, we need to do it as we did in libya, where it is a joint force going in. i think the times of us moving in solo to try and take over the world have to cease. so as a nato parts panther pant, i would say yes. i think the blood shed that's going on there is something we cannot continue to just observe. >> so do you see this as a to just observe. >> do you think this is a short-term possibility? >> i would see it as a short-term possibility. but when it comes to war it's not two days, two months, or two

and social security administration and the agency for health care research and quality, the indian health service, cdc, nih. our agencies complement each other's work. there may be a high incident of tbi in a particular group in a state. they may then use cdc material and conduct statewide education campaign for students, parents and schools about the risk and consequences of tbi. likewise, they may utilize screening protocol by nih research to implement a student athlete tbi screening program. in addition to education and screening, they would connect students and families with needed resources. strategies like these allow grantees to leverage resources of other agencies to identify and serve children with sustaining tbi. opportunities for such collaboration is a key focus of the inner agency committee. they will have assess bl and appropriate services and support and nih are making strides in areas of research and surveillance and behavioral health working to ensure that efforts are complementary and strategy e strategic levering of resources. this completes my prepared remarks. thank you for t

and it doesn't make any sense to think that persons getting their health care through the indian health service are violating the law because - exempt only from the penalty, but still under a legal obligation to have insurance, when the whole point of this is that they're supposed to be in a clinic-based system. >> is your whole point that this was inartful drafting by congress. that, to the extent that there is an exemption under the penalty, it's an exemption from the legal obligation? >> i guess what i would say about it, your honor, is that the way in which this statute is drafted doesn't permit the inference that my friends from the nib are trying to draw from it. and there is an additional textural indication of that, which one can find at page 13 of our reply brief. this is a provision that is 42 u.s.c. a, section 18022(e). this is a provision that provides for a certification that certain individuals can get. and it's the paragraph starting with the words "other provisions," contains the quote. and it says, "an individual with a certification that the individual is exempt from the requi

> well, see, right away i got involved with - how i got involved was through the american indian health services of chicago - that's the first place i went. and i asked them, told them that i was interested in running sweats here, who i talk and who i contact, is basically what i did. and my first sweat i ran was for the staff, the doctors and nurses, through the native american health services here in chicago. and from there, it just, i started getting calls to speak and things around chicago within the indian community. >> i'd like to follow-up on a question, tom. in our class - and we may differ over the terminology - but we've been looking at how the great stories - and you've talked about the singing and the songs, and by that, the ones we're talking about that talk about heroes and powerful events and they guide a person's life. can you think of any story in your tradition that relates to a specific kind of ritual practice, any great ancient story that you use to do some sort of ritual practice, whether it's purification or something along those lines? >> well, actually, the story is from

i know that you are working on an mou with the indian health service. you find solutions to help provide services to our native american veterans and i commend you and all of your involvement in these efforts. ms. secretary can i get your commitment to look into possible ways of working with the native hawaiian health care system and the native american veterans to provide services for in this case native hawaiian veterans who lived in many of the rural parts of the state of hawaii? >> senator, you have my assurance that we will do our utmost to provide for many of our veterans, wherever they live, the rows -- most rural in remote areas, the same access and quality to health care health care and services as we provide to someone living in a more urban area. there is a challenge with that but we are not as sensitive to that challenge and we are working hard to provide va provided services and where we can, to make arrangements where if quality services exist in those areas, making arrangements for veterans to be able to participate with those local opport

it's a little like indian health service. i represent a lot of native americans. there is a saying in arizona, you better get sick before july. twha do they mean? theyor a budget. if you get sick in the latter part of the year, they probably run out of money and have you to wait until next year to get the operation or the care. so it's a sick joke, but that same thing could apply to medicare, with the i.p.a.b., that means they have to ration care. >> greta: there are a lot of people that make decisions who are not elected. i understand that. but in this instance, these are decisions on the budget, essentially. these are budgetary decisions, not made by members of congress, so if we don't like it, we can't throw you out. they are appointees of this president, the next president. is there any objection to the fact that it is nonelected officials that would serve on this? >> sure. that's one of the problems. the first problem is that inevitably, whoever you put in that position will have to ration care. and that should not be in america. we shouldn't have a governmen

as i describe working with the indian health service to establish it to open a lot of processes for -- especially for alaskan native veterans, but in the meantime, based on my visit to alaska, the alaskan native consortium -- medical consortium, we've also established discussions with them. and trying to ensure that however the ihsmou progresses, that we have -- are ready to provide help to veterans who are being seen now and -- >> do you feel that's going in the right direction with the travel consortium? >> let me turn to dr. petzel -- >> are in negotiations and discussions, okay. >> thank you, mr. secretary, senator begich, i really sympathize with the ruralness of alaska and other parts of the country. while we're waiting for the mou to be finished, alaska is one of two places where we are proceeding with tribal interactions and i hesitate to use the word "pilot," to get -- >> right. >> specific agreements within a tribal unit in alaska. i believe it's the southeast alaskan tribal association, and we are progressing in getting some arrangements made. it would be wonderful from my

structure of the statute but the reason for this because the murders of indian tribes of to their health care through the indian health service which is a system that doesn't involve insurance at all in a different system they were taken out of the statute because they get it to a different system and it doesn't make any sense to think the person getting their health care through the indian health service are violating the law because only from the penalty but still under the legal obligation having insurance when the point of this -- >> is you're point that this was an artful drafting by congress to the extent there's an exemption under the penalty from the legal obligation? >> i guess what i would say, your honor, is the way in which the statute is drafted doesn't permit the inference that my friends are trying to draw from it isn't an additional text will indication of that page 13th 14 u.s. c.a. section 18 to zero this is a provision that provides a certification certain individuals can get and it contains a quote and it says an individual with a certification is exempt from the requirement under section 5008 by reason on

for the indian health service, a portion of our budget actually is protect it in the automatic decrease would be less. but it stood the 2%. and 2% for a budget equates to around $88 million that would have to be applied to both of our accounts and services in the 70s. and so, we argue now that our system is tied to its overt a lot of costs, including high medical costs of inflation and so on. and having another $88 million to try dude sorry been our budget would be very painful, very difficult for health care facilities and would certainly impact services. and so we are following the progress in congress and have been talking the tribes about if this occurs, what is your preference is that where we might absorb these costs and of course the tribes are just not very -- they are very reluctant to have the conversation because they don't want this to happen because they've told me this will have a very significant impact on the services in their communities. so we're following this very closely and it will have a great impact, even the indian health service does get treated a little bit be

i know that you are working on an ammo do with the indian health service to find solutions for -- to vide services to our native american veterans. and i commend you and all your involvement in these areas. mr. secretary, can i get your commitment to look into possible ways of working with the native hawaiian health care system and the native americans system to provide services for in this case native hawaiian veterans who live in many of the. [roll call] parts of the state of whole why he? >> senator, you have my assurance that we will do our utmost to provide for any of our veterans, wherever they live from the most rural in remote areas, the same access and quality to health care and services as we provided to someone living in a more urban area. there is a challenge with that but we are not insensitive to that challenge and we are working hard to provide va provided services and where we can't, to make arrangements where it if quality services exist in those areas, making arrangements for governments to be able to participate in those local opportunities. we are, i think you know

they would cut funding for the indian health service by 19% beginning in 2014. that would greatly diminish access to health care for the american indians who already suffered disproportionately from many diseases and as a result have a very low life expectancy compared to the white population. there are cuts to funding to the center for medicare and medicaid services which would make it very difficult for that agency to meet its responsibilities in overseeing these critical programs. there are also cuts to the food and drug administration which would reverse what democrats were able to do to strengthen protections in food and medicines and put the -- those -- cutting back on those programs would put the american public at an increased risk. while in this difficult economic climate, the president's budget managed to fund n.i.h. at its current level, the republican ryan budget would jeopardize new research by cutting that budget, that research that would lead to innovations in medicine and improve lives would be jeopardized. in addition, they cut w.i.c. and turned

and it doesn't make any sense to think that persons getting their health care through the indian health service are violating the law because - exempt only from the penalty, but still under a legal obligation to have insurance, when the whole point of this is that they're supposed to be in a clinic-based system. >> is your whole point that this was inartful drafting by congress. that, to the extent that there is an exemption under the penalty, it's an exemption from the legal obligation? >> i guess what i would say about it, your honor, is that the way in which this statute is drafted doesn't permit the inference that my friends from the nib are trying to draw from it. and there is an additional textural indication of that, which one can find at page 13 of our reply brief. this is a provision that is 42 u.s.c. a, section 18022(e). this is a provision that provides for a certification that certain individuals can get. and it's the paragraph starting with the words "other provisions," contains the quote. and it says, "an individual with a certification that the individual is exempt from the requi

housing, trust and national resources, economic development, welfare assistance, indian health care, office of adjusted services, law enforcement, travel courts and transportation. i would like to again remind the committee as tribal nation we know what our needs are and will continue to satisfy our needs with every resource available. without the necessary funding levels for governmental services as obligated in our signed treaties our needs will not be fully met. on behalf of the great plains, i thank you for your time and consideration of our needs and recommendations. thank you. >> thank you very much for your testimony, mr. chairman. president sharp, you mentioned tribes are ineligible for dozens of natural resource programs across federal agencies and are disproportionately under-funded per acre. how can we bring parity to tribal resource funding? >> that's an excellent question. thank you, chairman. there's a couple of things come to mind. the first would be to look at the eligibility of tribes to participate in the many opportunities throughout the federal agencies to contend with natural resource areas

indians, the chinese and the turks in areas such as alternative energy. health care and education. the u.s. brand is extremely popular still. what we're facing is sometimes a 30% of the cost of our products and services when you look at india, china, turkey and other competitors. what we need to do and what i see in the u.s. companies who are willing to go to the united arab emirates, i see pursuing the potential in the country with its young dynamic leadership with its vision for the region. as i said last year there was a slowdown in projects but the world future energy summitt, moving beyond traditional oil and gas, into areas like solar and other areas, offers a great potential for u.s. business. i see u.s. businesses, the small and medium companies coming to the uae and finding an atmosphere there that's very conducive to business for the region and beyond. as i said that transit hub. we've got almost 800 u.s. company there is already. there's more coming. we need to encourage more companies to come there and do battle with the indias and turkies and chinas of the world. we can can be successful because the u.s. brand name is still so popular if we can just beat our competition on price and we c