STATEMENT OF JOSEPH BRESETTE, EXECUTIVE DIRECTOR, GREAT LAKES INTER-TRIBAL COUNCIL, LAC DU FLAMBEAU, WI

Mr. BRESETTE. Thank you very much.

I come here representing 11 tribes from Wisconsin this morning. They would like to leave with you, and I will leave some written testimony, but they would like to say that they, too, are in favor of maintaining Indian Health Service as a separate entity to provide services to the tribes.

In Wisconsin all the tribes have contract services. There are no Indian Health Service hospitals or facilities, per se. They are all contracted out to the individual tribes. Recently, the tribe decided to go a step further and contracted the functions that were previously provided by the field office. Contracted those services and functions and delegated those responsibilities to Great Lakes intertribal council. That was just done at the beginning of May, and so we really can't tell you how well we're doing yet, other than to say that that initiative came from the Health Directors' Association in Wisconsin.

The Health Directors' Association there has initiated legislation in Wisconsin which creates the Advisory Council on American Indian Health which advises the Secretary of DHSS in Wisconsin on issues of concern of health care in Wisconsin. They are in the process of being organized and expect to use that council, in that input, to begin to fill in the gaps where services are important and cannot be provided because of the underfunding of IHS.

We look forward to using that type of collaborative effort over there to, I guess, face the reality that the budgets aren't there. All tribes under-in Wisconsin, face some sort of priority system providing services every fiscal year. We believe that we need to face, in terms of budgets. The Indian Health Service budget has to be improved. How can we do that? We're not sure. But I think that's a given point of all our tribes over there.

The reality is that the money isn't there, so we need to turn to other agencies and other means of meeting our needs over there. And that's why we've worked so hard with the State of Wisconsin to get them familiar with the needs of the tribes and hopefully begin a process where we can turn to them to fill some of those needs.

It's almost like a two-faced approach because we have agreements with the U.S. Government to provide those needs. Those needs are not being provided. The reality says you need to do something about that because your people need service. You can sit and wait for the funds to come through IHS, and, I guess, you would sit and wait. Or we can begin to do other things and take other approaches.

What we would wish this process of health care reform, is that not only will we prefer to see Indian Health separate and continued, but we would like to see the system, the-we would like the health care issue to come from the tribe and not in terms of Indian Health Service deciding things on what's important.

And, very general, this is the way the money's coming down. We want to see more tribal control and input and flexibility. That's our main concern over there. Is that we the people out in Washington

surely don't know what's important to the people in Mow Lake [phonetic], WI, or the concerns they have at that particular place or the priority.

So we need-in the final term we would recommend that flexibility in financing Indian health care be looked at as part of this whole process.

I want to thank you again for holding this hearing. I will present this written testimony, and thank you very much.

Senator WELLSTONE. Well, thank you. Thank you very much.
Mr. Walt, thank you for being here.

STATEMENT OF CHUCK WALT, ASSOCIATE DIRECTOR, FOND DU LAC HEALTH SERVICES

Mr. WALT. Thank you for being here today to take this testimony.

My name is Chuck Walt. I'm the associate director of human services for the Fond du Lac Reservation. I'm an enrolled member of the Fond du Lac Band. I have been employed by the reservation in the health area over that past 10 years.

I guess I'd like to start out by personally thanking the Senator for his past support of our transitional housing program in Duluth, both him and his wife, Sheila, and his generous contributions to that program. And, as I'm sure you're aware, that program is running successfully and is serving members of all the bands from this area. So I'd like to personally thank you on behalf of the Fond du Lac Band, for your past support, and Sheila's past support, of that project.

My purpose here today is to offer some comments about the future of Indian health care, and some concerns about the present health care delivery system.

I think that it's clear that health care reform-you all have to bear with me. I also have one of these viruses that is similar to what I think you have today, so I'll try to be as clear as I can.

What I would like to say is that health care reform is coming to Indian country, and I believe that health care reform is here already. And for all of you out there, as I heard your testimony, I think it is clear that Indian people have implemented many of the principles of health care reform. We have learned to work on limited budgets already, on restricted budgets.

I can identify with Luella when she talks about that fact that these limited resources, having to deny people care, is something that no health director, no health person likes to do. But, unfortunately, I'm also the person who gets to sign on the letter when people get denied care.

But I believe that even with the limited resources available, and for Fond du Lac that means a quarter of what is required to provide an HMO-type service to a person, less $1,000 per year is our per capita payment is for-on health services to Fond du Lac enrollees. We've done pretty well, and we've done that by taking those resources, stretching them as far as we can by using other resources from private foundations, by-by supplements from our own tribal government to provide the health services that are there.

And that's not to say that the Indian Health Service for the Federal Government should feel relieved that we are able to use those resources wisely or solicit resources from other areas other than the Federal Government. But it is to say that Indian people are resourceful. And, as part of the health care reform, we are already stretching that budget as best as we can, and, I believe, doing a good job.

We provide primary care services from our facility. We use nurse practitioners. We use public health nurses, to a large extent, to not only deliver that primary medical care, but to provide those secondary services. And so we're proud of that and believe we're doing a good job there.

Something that I believe is true about the services that come from our facility and from our reservation to Indian people, is that we provide that highest quality service for an accredited facility, and we're second to none in our area as far as the type of health services that we provide. And I think it has a lot to do with the commitment of our tribe to provide the best quality service and provide preventative-type services.

Senator WELLSTONE. Excuse me, Mr. Walt. I take it, you-from what you've just said about your delivery, you put a really strong, strong emphasis on the primary preventative health care part.

Mr. WALT. Absolutely. Primary and the prevention. We probably have, certainly, the largest public health nursing program in the area. And we've made the sacrifices to shift some of those resources from primary care to preventative-type care. Looking toward the future and hoping that not only are we going to enhance the quality of life for Indian people on the Fond du Lac Reservation, but also use our resources most efficiently this way. And we're preventing these amputations and preventing illnesses from getting to the point where people need that care out in the hospital and specialty care. So we're happy about that.

I think there is much to be learned, and I think there's a great deal to be lost. And when we hear about cutbacks at the area office or at the local level, it's almost insulting, I think, to Indian people who have already, in a sense, been doing health care reform to have to think about cutting back now, at this point, when we're just developing our programs. So that's an issue that, I think, needs to be addressed.

My concern for the future is the resources. That's a primary concern that we need to continue to have that steady flow of adequate dollars to continue to provide this high quality of service that we are providing right now.

Health care reform needs to include a culturally appropriate emphasis for Indian people. That's what make us unique. And that's what keeps Indian people coming to us for the service that we have to provide.

I believe in the community-based system, and we need input from the community in order to create the best product and deliver a service to Indian people that they're going to use. And these wrap-around services are essential, and we need to be able to continue to provide the services. That needs to be in the funding base. As far as competition goes, I'm concerned that, although we're getting better and there's all sorts of different levels of sophistica

tion amongst the tribes that are represented here today, but I think we need to be real careful that the Indian Health Service remains separate. That we are in control of those dollars. And for Fond du Lac, which is close to a large medical community, we're concerned that if every Fond du Lac enrollee has the opportunity to sign up with another provider-not that we can't provide a great service but it certainly could compromise us if people decide to sign up with, let's say, the Duluth Clinic or a provider other than

our own.

And then finally, I just want to mention self-government. Fond du Lac is one of the tribes that will be signing the self-government contract starting next year. We believe that's a good process for tribes and gives us more control. And I think we can do a better job with a self-government contract. Two tribes in the Bemidji area will go this year or next year, and it will take a long time for us to for all the tribes to go at that rate. I think that is something that needs to be opened up, and an opportunity that needs to be made available to all tribes that would like to do that. And that should be done soon.

Senator WELLSTONE. Let me ask. With the permission of everyone, this is the way I would like to proceed. I'd like to ask one question of you all and get your response, which I think will then be a bridge to open-mike discussion.

We'll take only a 5-minute break so everybody can kind of stand up and stretch, and then we will, no later than 12 o'clock, go to open-mike. We want to give people an opportunity to present testimony.

One question that comes up-and I believe I know your answer, but I think it should be on the record-is, there are those who say, "Well, but there's gaming, and there are now resources to be made from gaming, and doesn't that take care of some of the issues of budgets and financing health care?”

And I wonder how each of you would respond to that. I'm sure this question comes up over and over again.

Mr. WALT. It's the tribe's right to-it's the tribe's right and responsibility to decide how is the best way for them to utilize those gaming resources. And some tribes, such as ours, have decided to use some of those resources to supplement the health care programs.

But I believe that it's a-it's-that's a double-edged sword. And I think that we have to be careful that we don't relieve the Federal Government of their trust responsibilities to Indian people to provide health care.

Gaming may not be here forever, and Indian people's health needs will be here forever. And so I think that we really have to be careful how we approach that. And I think it's up to the tribal governments to decide how they want to spend the gaming profits. Senator WELLSTONE. Mr. Milbridge, would you want to respond? You certainly-Mr. Walt, you had at least one person if not more, who strongly supported what you just said.

For the record, I would just be interested in your response to this. The Question's raised over and over again.

Mr. BRESETTE. Well, I think that the question of gambling income, gaming income, does come up over and over. And no matter

where the tribes turn, trying to look at some of the issues of concern. People have in back of their mind that there are gold mines out there taking care of all the problems that tribes have faced for the many years that we've been here. And, in fact, I think that we read a lot about how well some of the tribes are doing. But, in fact, the income that comes in is-is not the same for everyone.

Many of the tribes in Wisconsin, and I'm sure it's true here, the further away you get from metropolitan areas, the less your income is. Some of the tribes in Wisconsin are doing quite well and some are doing not very well.

The tribes that have the ability to invest back into their community, now whether it's health care facilities or programming, are doing that. Those that-but there's a tremendous need for that money in many areas. Whether it's economic development, education, schools are being built, just the infrastructure of those communities have been neglected for years. And it's going to take a long time before the reinvestment back into those communities is complete. All the tribes have health care as the priority.

Whether they can just-whether anyone can expect them to meet their health care needs because of gaming dollars, I think that is not looking at the issue fairly.

Senator WELLSTONE. Mr. Milbridge.

Mr. MILBRIDGE. We've answered this question many times and our answer is always, "You can't wipe out 500 years of poverty with 3 years of gaming.'

And we sat down our-the program directors and the council sat down a week ago today. And we were going to try to address some or list some priorities for the next year in our-what we plan for our 1995 budget. And we weren't able to come up with any priorities, because everything was a priority. Housing and education and there are just so many needs, and we just can't address it with a little cash cow.

Senator WELLSTONE. And that's an interesting comment from you, because I haven't had the chance yet to visit the clinic. But I know you have done some really good work in the health care

area.

I can remember those memorable words. "You cannot wipe out 500 years of poverty with 3 years of gaming." Is that what you said?

That will be an official part of the record.

At noon there are 15 people who want to speak, and I came here to take testimony. So I don't want to shut anyone out. So I'd like for you all to get focused on being succinct; because it will be 2 minutes, each person.

And we will start at noon, which will be in 5 or, 7 minutes.
[Whereupon a short recess was taken.]

Senator WELLSTONE. Why don't we get started.

I think, actually, what I'll do is-we have a list of names that I think we'll just kind of take people in order of people standing

up.

You can be in any order. Why don't you start out simply in order.
Mr. WHITEFEATHER. Thank you, Senator.

Senator WELLSTONE. Thank you for being here.

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