Senator James Abourezk -3 September 1, 1976 4) Budget Revision. The contracts that IHS initiates require a five percent (5%) or $5,000 allowable transfer of line items. Any variance from the 5% flexibility is an unallowable cost. In order to get a budget amended, the contract allows the contract officer 30 days to respond to the proposed budget amendment. We find this 30 days clearly objectionable and unworkable. This response time must be reduced to a much shorter workable time, such as five (5) working days. INDIAN HEALTH CARE IMPROVEMENT ACT Testimony would also like to be provided on the Indian Health Care Improvement Act. First of all, we would like to reaffirm our support for the act and would like to emphasize the need for the bill to be passed in the $2 billion magnitude. The projected estimated unmet needs for the Indian health services in Southeastern Alaska is in the vicinity of $5.5 million. The documentation of this figure is presented within the Mt. Edgecumbe Service Unit Operating Plan. This plan has been obtained from Arthur Willman, Service Unit Director. The Indian Health Care Improvement Act provides for Indian manpower development. This provision is needed in order to truly fulfill goals of Indian Self-Determination. Since the inception of SEARHC April 1975, one of the main problems we have had is finding Indian manpower with formal education and experience in the health field. Indian people with administrative and/or clinical background are virtually nonexistent. To provide an example, since the inception of SEARHC, as the executive director, I have been the only staff member having a masters degree in a health related field. Information drawn from the Association of American Indian Physicians, shows that there exists no Tlingit physicians anywhere in the United States; however, there is a fourth year dental student who is a Tlingit presently working in Anchorage at this time. It is common knowledge from IHS printouts that most deaths among Southeast Alaska Indians are related to alcohol abuse and accidents. However, at this time, there exists no alcoholism treatment or injury control programs at the community levels. Most Indian communities in Southeast Alaska have either inadequate clinics or none at all. Although it is known and documented what the Indian health problems are, there exists no manpower, facilities or programs to combat the problems. The Indian Health Care Improvement Act can help remedy some of the problems. SEARHC has been corresponding with staff of the Secretary of Senator James Abourezk September 1, 1976 Correspondence from David Matthews indicates that he recognizes the need for improvement of health services; but, it is the opinion of the Secretary that the services should be improved through Titles XVIII and XIX of the Social Security Act. SEARHC would like to state our SPROSATL to the idea of using Medicare and Medicaid as the sole agents for improving health services to the American Indians. The Indian Health Service definitely is the mechanism to improve the services. PL 93-641 There is another area that SEARHC would like to make comments on. These comments pertain to Public Law 93-641. The law is the National Health Planning and Resources Development Act of 1974. Even though the rural medically underserved are the number one priority, in Southeast Alaska these are Indian. There are no travel funds for the people from the area to participate in SEAHSA activities. The importance of PL 93-641 to the Indian community cannot be overlooked. While the HSA will have only review and comment authority where Indian projects are concerned, the HSA, in performing their function, can defer forwarding Indian project proposals to the Secretary of HEW up to 60 days. Such delay could interrupt services supported by various grants and/or contracts. Further, a negative comment concerning Indian proposals could influence the Secretary's decision to fund or not to fund an Indian health proposal. Personally, I feel this seems to be an infringement upon the American Indians special relationship with the United States federal government. We would like to thank you, Mr. Chairman, for coming to Southeast Alaska and hope you return again. Sincerely Comod P. Bain). Conrad P. Baines, Jr. Executive Director CPB/rp Enclosures As I indicated in my statement at the Juneau hearing on September 2, 1976, I attach a formal statement, with exhibits, to be incorporated into the record. You will note the absence of a position on the primary purpose In addressing the issue though of tribal governing status in Southeast Alaska, we recommend as follows: That the Central be recognized as the Regional Tribal Governing Senator Abourezk Re: P.L. 93-638 September 16, 1976 For the purpose of regional planning, and that of implementing socio-economic programs beneficial to the Tlingit & Haida people, we support the Central Council of the Tlingit & Haida Indians of Alaska as the governing body of the Tlingit & Haida tribes. In effect, this is the case now and has proven its effectiveness. The working relationship with the communities within Southeast is excellent. As a rule, the Central Council never initiates any action without the concurrence of the affected community and only after the regional planning process has been complete. Conversely, the communities, or the federal or state agencies, never enter the villages without first securing concurrence from the Central Council. I dis- I disagree with testimony presented by the Sitka delegation. agree that the fraternal organizations are eligible for tribal status. federally approved constitution and bylaws, only persons of Tlingit & Haida descent are eligible for (federal) certification as members of the T & H Central Council. This is widely known throughout Alaska. A good example of effective regionalized program planning and effective implementation would be any of the entities (or departments) of Tlingit & Haida. Some of these are: the Tlingit & Haida Regional Housing Authority; Southeast Agency of the BIA; Southeast Alaska Regional Health Corporation; Tlingit & Haida Federal Credit Union; to mention a few. These were all established with the written concurrent resolutions from all of the T & H Community Councils, ANB ANS, IRA Councils, and, the City Councils so as not to slight anyone. In fact, this is compulsory, as ordered by the Central Council. The composition of the various boards of directors is carefully structured to have representation from the communities most impacted by the Tlingit & Haida operations. That being the case, this meets any provision for local input and involvement in the planning processes. This substantially complies with 93-638. Senator Abourezk Re: P.L. 93-638 September 16, 1976 The effect of federally recognizing Tlingit & Haida would extend to all T & H communities within the Southeast Alaska region. If in the best interest of the impacted community, contractual arrangements are possible. The primary rationale though would be coordination and improving the delivery of service. A goal which we feel you are striving for. I apologize for the length of this letter. At the time we were notified of hearings, we were advised that this would cover all aspects of federal policy as relates to Indians of Alaska. Hence, my formal statement addressed our views and regards the federal policies as affacts those Native owned economic enterprises which we represent. |