Indian Health Services, but as identified by the tribal governments and their health providers on that reservation.

All tribes should have the opportunity to provide a wide range of health care services for their tribal members, offering prenatal care to long-term nursing home care.

As health care reform progresses we need to assure that the Snyder Act, the Indian Self-Determination Act, the Health Care Improvement Act, and other acts regarding health care remain as law and policy. We, as a sovereign nation, reserve the right to automatically enroll all our persons receiving services in our health facilities in 638 health programs. The individuals may thereafter elect to enroll with another alliance or program.

We need to assure that all health services that we are currently provided are funded annually with the increases, not decreases. And, again, we should no longer be subject to annualized budget

cuts.

All tribal businesses should remain exempt from having to pay employer health insurance premiums. It should be left up to the tribal governments to determine if non-Indians can receive health care services in their respective reservation hospitals and clinics.

The current eligibility regulations must continue for health care health services. All services that we currently provide must be included as part of the comprehensive benefits package for wraparound benefits. We need to have direct access to third-party reimbursements. And all tribal members should be eligible fordual eligibility for Indian patients should continue. That means they should-they all receive services wherever they are also in the State of Minnesota.

The Federal Government cannot give States jurisdiction over our health care programs. We do not want the State of Minnesota to have control over our health care services. If we are forced to join the Minnesota plan, we would be identified as an essential care provider. This is only if the commissioner of Minnesota accepted the tribe as an ECP. Under the system we would only be an ECP for 3 years. And during the 3-year period Minnesota would work with the tribe to assimilate our health services into the general population system. After this 3-year period expired, we would have no right or privileges. Through the Red Lake Band this mean termination. As an ECP we would also have to serve all Indian people not included without any recommendations from the tribal governments.

I only have 2 minutes left or something like that. So one of things I'd like to address is our

Senator WELLSTONE. He actually doesn't have any time. But he reserved himself another 2 minutes. I know this man. I know how he operates. [Laughter.]

Mr. BEAULIEU. I would like to address the status on the 1995 Indian Health Service budget. You know President Clinton generously gave us $125 billion back in our budgets, but what that Senator WELLSTONE. You said $125 billion. You meant $85 billion?

Mr. BEAULIEU. No; $125 million.

Senator WELLSTONE. Because if it had been $125 billion, it would truly have been generous.

Mr. BEAULIEU. Well, I thought you wouldn't catch that.

But $42.5 million went toward sanitation facilities construction on PL-86121, and that's only one-half of what's available for this fiscal year, 1994. Seven point five million went toward expended indirect cost fund for tribal contracts. Seventy-five million went to restore the hospital's and clinic's accounts previously required to collect private insurance to cover differences. You know this still is $11 million short. And also if we totaled it with the amount that we were supposed to collect last year, it's about $20 million that the Indian Health Service and tribes are expected to collect for private insurances only. That does not include Medicare-Medicaid cost reimbursements.

So with that, we're looking at 1995 the Indian Health Service have no mandatory increases, no new dollars for construction, no pay act funds which means additional—and also included with that is the additional reduction 3 percent over the 1994 3 percent cutso, again, if we look at the dollars for 1995, it looks like the Indian Health Service will probably recommend having to cut services for Indians as a result of that.

And the other part I'd just like to mention is, the 638 regulations we've been waiting for since around 1998-1988. And it'll probably be 1998 before we get them. [Laughter.]

But we're looking at-we thought when the regulations came out that it was the intentions of Congress to make the regulations easier for tribes to contract their health services. And currently, by the way their drafts look, they're very complicated. They'll cause more paperwork for tribes and also make it more paperwork for the Indian Health Services, which is at a time when it's-they're cutting staff through the FT reductions. It's going to be almost an impossible task to manage.

Thank you.

Senator WELLSTONE. I would thank each of you. I am—I mean, I'm very concerned about the budgets, and this is of all-of course all set within the budget caps that are low now, given the focus on cuts. And then you get some trade-off between, will there be more for Indian Health Service, and then less for other parts of public health. And it gets to be an impossible kind of a trade-off, given the place the budgets have been set at.

So I do think that, you know, I have known this from prior visits, but there is something about the testimony from each of you all which sort of drives home this point in a way that I-that is just extremely important. And I'm hoping that other members of the committee are really obtaining the same kind of testimony around the country that go back to Dr. Annette at the beginning and building on Kathy's points. We the budgets give lie to the promise that there will be the same high-quality health care for all citizens, including people in Indian country. You can't have it within the budgets that we're working within right now.

I don't know how we turn that around, but that's one of the, I think, the strongest messages that come back to Washington from your testimony.

I thank each of you all very much.

We'll move on to the fourth panel. And we're doing a very good job. I thank you all for your patience for staying on time. Because we intend to go to open mike as well.

Dan Milbridge, director of Mille Lacs health services; Joe Bressette, director of Great Lakes Inter-Tribal Council, WI; Chuck Walt, MPH, associate director, Fond du Lac health services; and Robert Grey Eagle, tribal attorney, Prairie Island Dakota community.

STATEMENT OF DAN MILBRIDGE, DIRECTOR, MILLE LACS

HEALTH SERVICES

Mr. MILBRIDGE. My name is Dan Milbridge from Central Minnesota for the Mille Lacs tribe [inaudible]-to fully negotiate a compact under Self-Government, Indian Health Service.

I'm here to submit views on health care reform on behalf of the chief executive of the Mille Lacs Band, Marge Anderson.

We applaud the goal of the Federal guarantee of universal health care coverage for all Americans. We think all Americans should have this guarantee and hope that the United States has the will to actually implement that guarantee for all Americans. But as Indian people, we find some of the discussion painfully ironic.

For decades we Indian people have had a similar Federal guarantee of health care coverage, at least, in theory. However, based on treaties and agreements, we have made an exchange for our land on ensuing trust relationship our federal governments have had with the United States. But for generations the United States has miserably failed to actually carry out this guarantee to Indian people.

Our health statistics places us with the worst of the worst-off Americans. We have been sharply limited to where and when we can get our guaranteed health care. When we do get it, our health care is often, all too often, been relatively poor quality. In frustration, more and more tribes for the past 20 years have taken over the administration and management of the IHS health operations.

The fatal problem with the Federal guarantee of Indian health coverage is that, regardless of whether they are federally or tribally run, Indian health programs must annually scramble and panhandle the appropriation process for funds out of the diminishing discretionary Federal budget.

Threats have repeatedly asserted that Indian health funding should be treated as entitlement funding in the Federal budget with Social Security and Medicare and Medicaid are treated, are calls that have never been heeded. Health care is an entitlement for native Americans and the status of that health care is diminished with annual insufficient IHS budget increases and a proposed historical IHS budget decrease this year. The health status of the Indian country within the Bemidji area has no chance for improvement.

About 100 years ago the native American was the healthiest man on the planet. Today we have little hope of restoring those days of excellent health, as the Federal Government continues to ignore the poor health of Indians by not fully funding the IHS budget.

We are getting tired of rationing health care to our people when their notes should be paid in full as an obligation of the Federal Government.

Senator Inouye said it best, at an Indian health care reform summit meeting in Bethesda, MD, when he stated that "native Americans have the only prepaid health care in America. It is however not prepaid in full.”

We spent the majority of our health care budget reacting to health care symptoms and conditions and treating those. We do not have resources remaining to investment into adequate preventative health care.

Tribes have learned to stretch their health care dollar as thin as possible in the vast array of health problems on reservations. We have learned and adapted technical billing systems to help generate additional revenue to supplement our IHS budgets. But that incentive is being threatened. The Federal Government intends to take our third-party revenue and deduct it from our base-funding level, leaving the tribe with no additional funds. Is this an example of reinventing government? Then it's just another means of taking from the Indian people.

Mille Lacs is one of many progressive tribes in the Bemidji area and understands the health care system on all levels of government and all aspects of the health care industry. This so-called health care crisis Americans experience is not new to us. Indian people have been in a health care crisis for 502 years.

As bureaucracy moves toward the Government-controlled health care system, the identity and uniqueness of the IHS must remain. When and if health care reform impacts the IHS, it must only supplement what we already have and not replace it.

The American Indian should be automatically enrolled in the tribal health system, and then be allowed to enroll in an outside health alliance, if that is the direction that the administration moves. We are members of two nations and should be eligible for two health care systems at no cost to the individual.

Transition funding will be necessary immediately after passage of a health care reform if the IHS is to make the transition to provide those services.

Traditional healers must be recognized in health care reform under the definition of the health professional. At Mille Lacs we have incorporated a medicine man into our direct health care delivery system and this has proven to be a significant factor in the healing process.

On concluding, I wish to thank this committee for holding this field hearing on such a critical issue. Indian programs have already shouldered more than their fair share of budget cuts over the last 12 years. For this administration to expect Indian tribes to accept more cuts on health care, especially when those cuts are proportionally greater than any other program in public health service, is unacceptable.

I am confident that with this committee's assistance, advocacy, and oversight the eventual result will, in fact, be a better Indian Health Service and better primary health care programs on all reservations, nationwide.

Thank you, again, for this opportunity to submit testimony.

Senator WELLSTONE. Thank you, Mr. Milbridge.

Just to clarify one point on the two nations. Your argument was that the Indian Health Services should be that part of a contract and that should be free. You weren't arguing that the alliance was would be at no cost either, were you?

Mr. MILBRIDGE. Yes.

Senator WELLSTONE. You were.

Mr. MILBRIDGE. Yes; both.

Senator WELLSTONE. And why, if someone in Indian country decides to enroll in an alliance, why would that be also free-cost, as opposed to a contribution like other citizens?

Mr. MILBRIDGE. Who are you saying would make that contribution? The Indian Health Service?

Senator WELLSTONE. No; I understood. I'm just trying to seek a clarification.

Mr. MILBRIDGE. Okay.

Senator WELLSTONE. So I understand what you're saying.

First we talked about Indian Health Services kept separate, and the issue there is that there is a strong consensus it be kept separate. And that—but that it, in fact, have the funding and resources and the support so that it really can provide high-quality care, comparable high-quality care.

Then you were saying that people in Indian country also want to be able to belong to an alliance. So that if they want to go through one of these networks that is funded by an alliance, they should be able to participate in that.

Now, generally speaking, an alliance is purchasing if that's what happens. And we don't know the following form-but if you have one alliance in Minnesota or, let's say you have different regions, you have a number of different regional alliances, at least the current idea, businesses and individuals would be contributing money to the alliances and an alliance would purchase a plan. But you're arguing that Indian people wouldn't contribute anything to the alliance?

Mr. MILBRIDGE. Correct. I would base that on the alliance would be providing a more comprehensive health care than the tribe is allowed or able to provide through its budget.

Senator WELLSTONE. So you would see that as a part of the contract, historically.

Mr. MILBRIDGE. Correct.

Senator WELLSTONE. That's what I am just trying to get.
Mr. MILBRIDGE. Okay.

Senator WELLSTONE. Mr. Bresette, thank you for coming from Wisconsin.

Mr. BRESETTE. Thank you, Senator. I appreciate the opportunity to be here this morning. The opportunity to attend one of your previous hearings here in Minnesota, and I appreciate your deep concern about the issues for the Indian people.

Senator WELLSTONE. And I will make sure, also, that your comments get to both Senators in Wisconsin.