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I have read clear through your statement. I have beat you to it, and it is a good statement. I think maybe we will print it all in the record as though you had read it in full, and then I will have some questions on which you and your colleague can give us some advice that we may need.

Mr. POOLAW. That will be fine.

The CHAIRMAN. I note on page 2 of your statement you are talking about the difficulty of recruiting more Indian physicians. I like what you are doing. I like the Albuquerque seminar where you give these students an opportunity to be questioned in the manner they will probably face when they decide finally to go. What is the survival rate of every 10 Indians that enter medical school? How many of them are still there on graduation day?

Mr. POOLAW. I am not really sure, but maybe Mr. Wilson has more specific answers. Maybe once a person is accepted to medical school, the survival rates are considerably well-considering my own experiences and whatever. You would think it would be a lot larger than it has been.

The CHAIRMAN. You went to Dartmouth?

Mr. POOLAW. Yes, sir.

The CHAIRMAN. Where is your home? Where did you grow up?
Mr. POOLAW. I grew up in Anadarko.

The CHAIRMAN. You mentioned the urban program. In your judgment, would it work best to have it administered so that you were setting up separate health clinics for urban Indians? Or is this more designed to get you access to ongoing programs in the community-medicare, medicaid, other kinds of programs?

Mr. POOLAW. I think both. When you talk about urban or any health programs, by that definition you get the impression these are isolated things in various cities. Each program is almost a different entity in itself. They need to have some

The CHAIRMAN. In my hometown, we have a number of neighborhood medical programs that are run by the county or local organizations. These are in low-income areas, and in many of those areas, we have a fairly sizable Indian population. We have some outreach programs to get these folks coming in, but it seems to me that that is the most efficient way rather than trying to generate a whole new set of Indian health clinics when we are in trouble on appropriations as it is.

Mr. POOLAW. You see, a lot of these things are already established. I am not trying to exclude new things that could be, particularly with the ones I am familiar with in Oklahoma City. As a resident in my training in the past 3 years, I worked at an urban Indian clinic.

The CHAIRMAN. Is there anything we can do to interest more young Indian students in going on to medicine? The Indian students tend to be older than the other students in the program, so they may need family support as well as scholarships to pay their tuition. Is this correct?

Mr. POOLAW. Yes.

The CHAIRMAN. Is there any way in that area that we can give you more help?

Mr. POOLAW. You can always give us more money. It is a big problem-I think it starts out-this is not my opinion, it is a shared opin

ion-that a lot of this begins when you are in kindergarten, first grade, and on up. This is implied inflection from your parents, your teachers, that you are going to do this and to do that. Myself, I have had parents that never finished school themselves. I really had no intention of becoming a doctor after I went to college, but, you know, the background is set. It is too late to decide these things after you are in college. You really need to prepare yourself for this profession early on in life-not to be a doctor, but to make yourself diversified to do whatever. It is too late when you are too old. A lot of these people are making these changes, though, and some of them are doing it successfully-changing careers and whatever.

The CHAIRMAN. Let me give you advice or counsel here. I introduced this bill. I took great pride in 1976 in playing a part in getting this bill passed in the first place. I think we were wise to plan to come back to it to discuss funding levels and reauthorizations at this time.

We are in a crunch, even worse than the usual type of budget crunch we have been having around here. I met yesterday with some of my colleagues. It looks like we are going to have to make cuts in a number of these programs that come out of this committee. So I am not sure how realistic the recommendations on page 6 are. I do think this is an important program, and I am going to be willing to fight for all the support I can get.

Certainly the figures in the bill are nothing more than my estimate. I took the programs and added a little bit for the inflation factor and so on. But the actual figures in my bill are not sacred, and it may well be that if we have got to accept some cuts in this very important program, that those of you testifying here today and other interested friends in the Indian community could tell us which ones are really critical and which ones might be able to bear a cut this year if we get into a budget-cutting operation.

I am very concerned about this. It is the whole range of social programs. It is going to hit very hard on some of our Indian programs unless those of us who are sympathetic are willing to get in there and join the battle. So we will appreciate any advice on that as we go along.

Mr. POOLAW. Mr. Chairman, I think my executive director, Mr. Wilson, would like to say just a few words before we close here. The CHAIRMAN. Yes.

Mr. WILSON. Thank you, Dr. Poolaw. Mr. Chairman, I agree with what you are trying wholeheartedly, and I know that we are in a period of inflation and money is tight. But historically, I think one of the problems-and I think we have to put ourselves in the right frame of mind-historically, Indian programs have called for large needs. When funding actually came about, the amount of money that was actually given was quite less than what was needed-or what would solve that need. And in closing, I would like to say-No. The point I want to make is that in the period of inflation that we are in, the money that was appropriated to solve the needs of the Indian people with the health problems they had the initial amount given was not enough. Had we had an adequate amount in the beginning, it would seem reasonable to make some cuts in certain areas. But I think all parts of 437 are so critical that there are no places to cut because initially there was not enough money given at the

start. So when you say, where can you cut, I do not think there is any way we could recommend a cut be made.

In answer to your question about how can you interest people into becoming a health professional-as an example, under title I, section 102 last year, there was only $900,000 given to set up recruitment activities. The first year, I think, there was nine tribes that had a grant. This past year, I think there were 22 tribes. The problem is Indian people, for the most part, are not used to dealing with the system and this is what holds them out. There is a lack of role modelsthere is a lack of counseling. So the programs in 102 are very needed, if we are to interest any of these people to become health professionals. In answer to your question, that needs to be tripled or quadrupled, as the case may be.

You indicated that those figures were very high on the last page, which they are, but the job of specific health plans, as we understand it or Indian people understood it, was to show the needs that Indian people have. If the tribal specific health plans mean anything, then of course you do not need to be funded at that level. If they are not, then they need to be done away with. We can come back every year and request additional dollars.

The CHAIRMAN. You make some good points. The gentleman from Alaska?

Mr. YOUNG. I have no questions, Mr. Chairman.

The CHAIRMAN. Mr. Kogovsek?

Mr. KOGOVSEK. I have no questions, Mr. Chairman.
The CHAIRMAN. Thank you very much.

Mr. WILSON. Thank you.

The CHAIRMAN. Our next witness is Mr. Jake Whitecrow, from the National Indian Health Board.

[Prepared statement of Jake Whitecrow may be found in the appendix.]


Mr. WHITECROW. Good morning, Mr. Chairman.
The CHAIRMAN. Good morning.

Mr. WHITECROW. Members of the committee, my name is Jake Whitecrow, the executive director of the National Indian Health Board. I would like to introduce on my right our general counsel, Mr. Dan Press.

The CHAIRMAN. Glad to have you, sir.

Mr. WHITECROW. We are here this morning to testify for the reauthorization of Public Law 94-437, introduced in the Congress recently as H.R. 6629.

We have submitted written testimony, and I will be very concise and brief with our recommendations. First of all, we would like to state that we wholeheartedly endorse and support the full funding of 94-437. I will get into those specific details and recommendations as I proceed.

I would also like to state prior to our testimony that the testimony we have submitted has been concurred in by the National

Congress of American Indians, the National Tribal Chairmen's Association, the Association of American Indian Physicians and the American Indian Health Care Association.

The National Indian Health Board was established in 1972 to bring about a movement so that Indian health care could be improved and that the health care of Indian people could be brought up to the national average. This particular organization is composed of 12 board members serving each of the 12 areas-and are paralleling the Indian Health Care regional offices.

In stating that we are supporting full funding for Public Law 94-437, as has been indicated in H.R. 6629, we would like to state that from the standpoint of the National Indian Health Board, we have some recommendations specifically about each of the types.

We do support the full funding of each title, however, we have some recommendations that we would like to make regarding each of these separate titles.

In regard to title I, we would like to recommend full funding and we do support those recommendations that have been made by the Association of American Indian Physicians.

In title II, we have some reservations. Title II was never fully funded. It was authorized $100 million, and only $25 million was actually appropriated during the 3 years and the existence of Public Law 94-437. We would like to recommend that it be fully funded in the coming session.

We would also like to call your attention to the testimony_the National Indian Health Board gave before this committee on February 18, 1980, whereby we recommended the etablishment of a benefit health package, in which the Indian Health Service would be required to establish a budgetary system whereby Congress could actually determine and examine those budgets to determine whether or not they would be able to fulfill those obligations to the American Indian people to be sure that their health care was brought up to those standards attained by other citizens of our Nation.

We would also like to point out in title II the question of physician allocation. The Indian Health Care Improvement Act provided for 1,830 positions, but the Presidential freeze on positions has prohibited the Indian Health Service from filling those positions which are providing grave dangers to the health care of Indian people. We would encourage you to lift that freeze by special language in the report so that Indian people can receive quality health care and, when they need it, those positions would be available and will be filled to provide that health care.

We are looking at a situation here where we have life and death involved. And in that particular setting, I would like to cover the fact that without full funding of the positions that we have and that the Congress in their wisdom has provided and the Presidential administration comes along and cuts back those positions, in effect we are not advancing in the Indian world like the Congress has intended for us to do.

We want to do this. Our Indian people are suffering each and every day as a result of a lack of professional people to give them that attendance they so desire.

In title III, we would like to call your attention to some specific situations that have occurred on reservations, whereby Indian trainees functioning with the CETA program and the Indian action team program have not been allowed to partake in the construction projects due to the fact that the Bureau of Apprenticeship and Training and their regulations are not workable insofar as allowing Indians to participate in those construction jobs.

We would encourage you in this report to include language that would require the Bureau of Apprenticeship and Training to contact these tribes involved and encourage certification of those training programs so that those Indian people functioning in those positions can achieve better health standards and a better quality of life.

In title IV, we would ask that two things be considered by this committee. First of all, we would like to requires section 401 to allow IHS to be reimbursed by medicare and when it provides medicare services to all IHS facilities. We would also like to point out this fact: The National Indian Health Board has received many, many inquiries from Indian people stating that the Indian Health Service requires them to go out and degrade themselves and become and show all kinds of degrading situations whereby they have to go into various county medicare offices, medicaid offices, social rehab service offices and make themselves humble to receive those cares the special unique relationship that they have with the Congress of the United States so provides. So therefore, we would like to encourage you to include specific language in this authorization that requires the Indian Health Service to get out and make those contacts and provide so that the Indian people can go to one physician only and receive all of those eligibility statements. If it is necessary to deputize IHS personnel to allow them to do this, then we would encourage you to do so.

Simultaneously, we would like you to include language in this specific organization that would require the Office of Civil Rights within HEW to take action when they have complaints. In the past, we are informed that complaints have been submitted without any action whatsoever from the Office of Civil Rights. We would encourage this particular type of investigation.

In title V, we would encourage full funding and we certainly support those recommendations that will be made by the American Indian Health Care Association insofar as including a separate title for rural Indians. Those members of the American Indian Health Care Association have shown in the past that they have been able to take small amounts of money and include other elements-alternative resources from other elements of Federal and State assistance and expand that and deliver top quality care to our Indian people who were prior to their establishment not receiving any care whatsoever in those metropolitan and urban areas.

Lastly, we would like to point out to this fine committee that the tribal specific health plans that have been developed through the Indian Health Service they have been developed and we would encourage you to qualify your particular language to require the Indian Health Service to provide for continued budgeting and future budgeting so that those tribal specific health plans can be brought up to date like all other health plans that are authorized through the

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