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to urban Indians, we recommend a separate Title specifically for rural
Indians with a beginning appropriation of $100,000 for the first year,
increasing this each year to a total of $700,000 for four years. At present,
the rural groups are in a poor position to compete with urban groups for

Mr. Chairman, we would like to call attention to the research provision of PL-437. Our Association was the only one calling for this provision in this bill. We are happy to note that a modest number of proposals have been funded by this mechanism. Some of the studies include a long term evaluation

of children with post-streptococcal glomerulonephritis, a study of bronchiectasis in Alaskan children, a study of the effectiveness of dul floride programs, and studies of alcoholism and mental diseases. We strongly urge an independent evaluation of these research activities and continued funding. It would not be inappropriate to develop a separate title and funding for research to dispel any notion that reasearch dollars are being diverted from patient care.

Mr. Chairman, in closing we would like to point out that the Tribal Specific Health Plans, which arose from PL 94-437, called for vastly expanded appropriations in order to meet needs expressed by Indian people themselves. It is our opinion that the recommendations of these Tribal Specific Health Plans should be given fullest consideration. If they are disregarded, a great deal of time and effort would have been wasted. The following are some of the recommended appropriations developed by the Tribal Specific Health Plans:

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In addition, a total of 12,365 staff positions are needed to support these activities. In regard to staffing of Indian Health Service, PL 95-454 imposes unrealistic personnel ceilings upon Indian Health Service making it impossible to carry out the mandate of Congress as expressed in PL 94-437. We believe full staffing must be maintained if the provisions of PL 94-437 are to be achieved.

The original intentions of the Indian Health Care Improvement Act as stated as a declaration of policy, "The Congress hereby declares that it is the policy of the Nation, in fulfillment of its special responsibilities and legal obligations to the American Indian people, to meet the national goal of providing the highest possible health status to Indians and to provide existing Indian Health Services with all resources necessary to effect that policy." Without full funding of all Titles as indicated by the Tribal Specific Health Plans, these intentions cannot be fulfilled and would testify to the fact of the inability of the United States to meet even the minimal needs of this Nation's original citizens.

In closing, I emphasize that full appropriation for the Indian Health Care Improvement Act as indicated by Tribal Specific Health Plans, along with full base and mandatory appropriation for the Agencies responsible for health care delivery for American Indians stand as vigorous testimony that the long road of privations, discrimination, and cultural isolation may finally be turning toward a future horizon of Indian self-determination and of full and productive citizenship for the American Indian and Alaskan Native.

Thank You.


The National Indian Health Board (NIHB) located in Denver,

Colorado, was organized in 1972 to advocate that "health care services delivered to American Indians and Alaska Natives should be of the highest quality and of sufficient quantity so that American Indians and Alaska Natives attain a health condition equal to that of other American citizens." Its Board of Directors, numbering twelve members, are elected from the twelve area Indian health boards, which geographically parallel the Indian Health Service Area Offices. The area health boards, in turn, are composed of representatives of the service unit boards and/or tribes in that area. As a result, NIHB represents a broad cross section of the Indians and Alaska Natives served by IHS.

The National Indian Health Board goals for 1980 are:

1) To provide technical assistance to American Indians and
Alaska Natives in specific areas which will assist them


to develop more informed decision making processes and more adequate health systems;

Advocate for Indian health needs;

3) To disseminate information on health issues facing Indian

interests, tribes, and organizations;

4) To develop strong positions on new NIHB initiatives on national Indian health issues, e.g., nuclear development,

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energy development, traditional customs and beliefs and
their impact on individual health, and increasing the

effectiveness of Indian people to impact, evaluate, and
control their own health.

The National Indian Health Board is pleased to testify before this Committee on the reauthorization of the Indian Health Care Improvement Act. We believe that this Act is one of the major pieces of Indian health legislation passed in the last 50 years and we strongly endorse its reauthorization, subject to the few minor changes we recommend below. We also would like to take this opportunity to thank this Committee for the time and effort it is taking to consider this important piece of legislation. Our testimony consists of comments and recommendations on each of the Titles of the Act.

Title I. The National Indian Health Board supports and endorses the reauthorization of Title I of the Act, subject to the changes recommended by the Association of American Indian Physicians. We believe the changes recommended by AAIP will hasten the development of an adequate pool of Indian health professionals, an important factor in improving the health care received by Indian people. Title II. The National Indian Health Board endorses the reauthorization of Title II of the Indian Health Care Improvement However, it also wishes to point out that this Title has had much less of an impact than desired or intended on improved health care to Indians. The Act authorized a total of $100 million in


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increased expenditures for basic patient care during the three years the Act has been in effect. This amount was determined by calculating the amount of appropriations needed to provide decent health care for all of the basic health care services to all of the Indian people eligible to receive such care. However, during the relevant three year period, the President recommended and the Congress appropriated only $25 million of this amount 25% of the amount needed.


The National Indian Health Board believes that the Congress, while reauthorizing Title II of the IHCIA, should begin to look at new funding approaches to the Indian health care situation, since the approach taken under the IHCIA has failed to push HEW and OMB to recommend full funding for basic health services to Indians. Specifically, the National Indian Health Board is supporting the examination of the guaranteed benefit package approach to IHS funding, an approach raised by the NIHB in its testimony before this Committee February 19, 1980, at the oversight hearings. Our testimony submitted at the time provides a detailed description of the benefit package approach and we will not repeat it here. We want to point out that even if the benefit package were not to be fully funded immediately, the benefit package approach would more forcefully highlight the discrepancies between the real needs of Indian people and the amount actually appropriated by Congress to meet these needs.

As a first step towards the implementation of a guaranteed benefit package, the National Indian Health Board recommends that

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