Senator STEVENS. You're going to worry me here pretty soon. I'm interested again in trying to see if there is some formula we might develop in legislation that would provide for less than total opting out as was mentioned in the Sitka situation. I can understand where some communities would want to perform all the services, others would want to perform some services and others would entirely want to rely on a regional entity depending on the circumstance and the area in the State from which they come. There are areas in the State, you know, that get postal service about once every 4 months. They can hardly meet deadlines and get their applications and other things in on time because of communication problems, and they are going to regional organizations almost exclusively where there is lack of communication capability.

I don't think we can do something in this area except on a formula that would give the right of local self-determination to everybody in the State, and I'm trying to find out, do you have any ideas about what area you would refuse to delegate to a regional group like T&H?

Mr. STEVE HоTCH. Isn't that the intention of the Self-Determination Act that the people on the local level handle their own determination? If the answer is yes, I agree with Sitka; if not, you'll have to give another interpretation.

Senator STEVENS. All right.

Mr. STEVE HоTCH. We have no further comment.

Senator GRAVEL. The next witness would be Brian Burgess. Sam Demmert, is Sam here?

Mr. DEMMERT. Yes, I don't have any prepared statement at this time for the hearings. I'll present a formal statement. [Statement not received in time to be included in the printed record.]

Senator GRAVEL. Conrad Baines. Bob, if you want to join him, Bob Willard and Conrad Baines, and do it as a panel.

STATEMENT OF CONRAD BAINES, JR., EXECUTIVE DIRECTOR, SOUTHEAST ALASKA REGIONAL HEALTH CORP., ACCOMPANIED BY ROBERT WILLARD, EXECUTIVE DIRECTOR, TLINGIT AND HAIDA CONTRACTORS ASSOCIATION, JUNEAU, ALASKA

Mr. BAINES. The reason why Bob has come up here is there is a lot of things that I have to say pertain to Indian Health Care Improvement Act and Bob has done a lot of work in this area.

I have about five areas I would like to make some comments on before questions-I don't know how Bob wants to proceed.

Senator GRAVEL. Bob, what's your wish, do you want to proceed that way? You were going to be a witness in your own right. Mr. WILLARD. Fine.

Mr. BAINES. I do have a formal written testimony and it is included as part of central council's packet. Here is the original copy even though you have a Xerox copy of it.

Senator GRAVEL. Thank you.

Senator STEVENS. Is that in the T. & H. packet?

Mr. BAINES. Yes, it is.

MS. LEWIS. Before Mr. Baines continues, for the record, is he here as an individual or here representing an agency?

Mr. BAINES. That's what I would like to clarify at the beginning of my statement.

Senator GRAVEL. Go ahead and clarify and proceed.

Mr. BAINES. First of all, I would like to state that I am the executive director of the Southeast Regional Health Corp., but the statements I do have are not board approved statements and should not be construed as official boad policy of the Southeast Regional Health Corp. I am drawing upon my experience of the past year as director of the Native Health Corp. for the Southeast District.

The first remarks I would like to say is what health corporations are in Alaska. As you all are aware, each region has a-there are 12 Native regions in the State of Alaska and where health corporations arose, they are spinoffs from the Alaska Native Land Claims. Health corporations were not created under the Alaska Native Land Claims.

In some regions, the health corporations are the same as nonprofit, such as the Tanana Chiefs. The Tanana Chief Health Authority is the same thing as a nonprofit. They use the same articles of incorporation and the same bylaws. However, in other regions, such as here in southeast, the health corporation is completely separate from nonprofit and this situation exists, at least in the 4 years that I know of. These areas are the Norton Sound Corp., which is the same region as the Bering Straits Native Association; Yukon Kuskokwim Health Corp., the same thing as Calista, and ABCP region.

The functions of health corporations are to act as tribal health departments and, as such, we are affiliated with the central council which Ray Paddock is the president of.

We are tribal entities, but they are not tribal governing bodies.

The health corporation has been interested in 93-628 type contracts but the situation is so vague. In order to obtain a 93-638 contract, we must obtain tribal clearance. But who is the tribe?

The other four areas I would like to speak upon involve the Indian Health Care and Improvement Act, 93-641, National Health Plan and Resources Development Act. Contracting National Health Service Corps I'm really not sure if I have enough time to cover all this, but it is in the packet here.

The Indian Health Care Improvement Act, I would like to state our support for the act. The need is large, especially here in southeast Alaska.

In talking to the Mount Edgecumbe service unit, the need for this region is $5.5 million, and that is what this document here is, is a cost out of the unmet needs.

The budget right now for the Indian Health Service for this region is $6 million, so essentially it's offering about half of what the projected needs are in order to do a good job.

Also pertaining to the Indian Health Care Improvement Act, I would like to state my own personal opposition to the Secretary of HEW's idea about where the Indian Health Care Improvement Act should be channeled. The Secretary of HEW, David Matthew, if the Indian Health Care funds were to go through-administratively, he thinks the money should go to the Social Security Act instead of going to the Indian Health Service. The social security in rural areas is, in my opinion, completely unsatisfactory, unworkable.

Pertaining to 93-641. there are a couple of things I would like to say about that law. As you know-how familiar are you with the law 93-641?

Senator ABOUREZK. Which law is it?

Mr. BAINES. National Health Planning Research and Development Act. Helps agencies, statewide health coordinating councils. Well, the purpose of that bill is to set up planning areas and in Alaska there are three planning areas, southeast, Anchorage area and the Fairbanks area. Funds from the Federal Government go to tribal organizations are exempt from Health Systems Agency approval, however, Health System Agencies do have a review and comment authority over all proposals that the tribal entities may submit to the region.

It is my opinion that the Health System Agency can have a detrimental effect to tribes due to the fact that they have authority to hold up any projects up to 60 days in making comments to the secretary of any Indian projects.

Senator STEVENS. Well, that's not long, is it, really? I mean, you look at what we were trying to do to replace HMO's and provide for areawide, statewide, regionalwide coordination of planning to eliminate what we ended up with, in some situations in the country where they had a hospital shortage, and other areas where they were just over built in terms of hospitals.

Mr. BAINES. I'm speaking of Indian projects.

Senator STEVENS. I understand, but what they are saying is that the plans that come from the regional-Indian entities, while they are not subject to veto, at least they ought to have the time to talk with them about how they fit in the overall regional plan. I think, as a matter of fact, Senator Metcalf and I had something to do with putting that in there to make certain that we did try to coordinate the Indian efforts with the overall regional aspects of this planning mechanism for health delivery. As a matter of fact, it came, as I recall from searching my memory, from up north in the Yukon Kuskokwin organization wanting to be certain that they were involved in the statewide plans.

Mr. BAINES. Oh, yeah, they are.

Senator STEVENS. But a 60-day delay when you're talking about building a hospital or talking about making a plan for 4 or 5 years for this purpose

Mr. BAINES. No, I'm not speaking of hospitals.

Senator STEVENS. Oh, but that's part of the planning mechanism. Mr. BAINES. I'm speaking in general of Indian health projects. Like the contract we have right now at Indian Health Service, our proposals for contracts will have to be cleared by the Health Systems Agency and if they place a negative comment on that proposal, the Secretary of HEW can hold up a proposal after 60 days in reaction to a negative comment.

Senator ABOUREZK. I think we're getting off the subject. I mean this is something that ought to be done, but it's outside the scope.

Mr. BAINES. But my point here is my main point here in speaking on this is the opposition to the Indian Health Care Plan being channeled through the Social Securities Act. That is the Secretary's opinion of what should happen administratively to the fund.

On contracting, I think most of the issue has been covered but even though Indian Health Service has suffered from BIA in most of the issues are the same there.

Senator ABOUREZK. May I ask a question? When I was out of the room, did you discuss the local versus regional contracting set up at all?

Senator STEVENS. No, not with this witness.

Mr. BAINES. No.

Senator ABOUREZK. What do you think of that?

Mr. BAINES. Regional and

Senator ABOUREZK. As to how, you know, Indian self-determination ought to be administered.

Mr. BAINES. In the health field?

Senator ABOUREZK. Anything. How should a tribe be defined, as a community or the regional government or whatever?

Mr. BAINES. In my mind, it should be done regionally. The central council is the ideal body to do it. Sure, there are problem areas. I think locally-there are some things that can be done locally, such as education and like that. Ed Thomas and others testified on that.

Senator ABOUREZK. Some things done better locally, some things done better regionally.

Mr. BAINES. Like education.

Senator ABOUREZK. Would you think that, like if T. & H. were the contracting agent, or "tribe" under the definition, that if there is something that might be done better locally, that it could be subcontracted from them locally-on a local level? Would that be a better way of doing it? Have you thought about this whole concept that much? Mr. BAINES. Yes; I have. I've been involved with many activities that

Senator ABOUREZK. Well, what do you think of it then?

Mr. BAINES. It's sure a headache. Sealaska is a profitmaking corporation. I can't see how they could administer human services type activities and still try to make a profit.

Senator STEVENS. I think, Mr. Chairman, if I might interpret, is suggesting what we understand is probably going on to a certain extent already. If T. & H. has a contract for health services, and if thejust a minute-and it decides that Ketchikan ought to have self-determination in that area, the community ought to have a subcontract. He's saying, would you think that that is workable or do you think that we ought to require that if Ketchikan is going to have a relationship to health services, that it ought to contract directly with the agency providing the money instead of going through T. & H.? Am I making it too much?

Senator ABOUREZK. No.

Senator STEVENS. You're in that field, now, would you rather deal with T. & H. which would have a regional contract with the agency that has the money in Indian Health Services and other services, BIA; or would you rather be in the situation that if you were at the local level of contracting directly with those agencies for the services that ought to be reserved to the local governments, local entities.

Mr. BAINES. Speaking as an administrator, I think regionally would be a more feasible idea at this time simply due to the manpower.

There are no Indians at all in the clinical field. There exists no Tlingit or Haida or Tsimpsean physicians in the United States. There are a few administrators. I would say that that is one of the biggest problems our health corporation has had within the past year. There exists a few Tlingit, Haidas, and Tsimpseans with background in health administration planners. There is one Native position assistant in the whole State that I know of and that's Fred Lewis and we were fortunate enough to get him on our staff.

I'm taking up a lot of time. I think

Senator ABOUREZK. Did you have anything you wanted to say in answer to that question I posed?

Mr. WILLARD. Mr. Chairman, I was scheduled to appear on behalf of the organization I represent which is the Tlingit and Haida Contractors Association with regard to the Indian Health Care Improvement Act.

There is under title 3, of section 303, which concerned us which was in the Senate version of S. 522 which was absent in the House version H.R. 2525. We were concerned as to whether or not that provision was going to be incorporated into any bill that the President is now probably sitting on or is on his desk or whatever

Senator ABOUREZK. What provision?

Mr. WILLARD. That pertains to preferential treatment of Indian contractors in any expenditure that was allocated under the act. Senator ABOUREZK. The Buy Indian Act?

Mr. WILLARD. Not the Buy Indian Act. The bi-Indian Act, the negotiating authority of the June 25, 1910, act is mentioned in the Indian Health Care Improvement Act under section 303, but it is absent in the House version. That's my understanding that it is absent.

Senator ABOUREZK. I don't know what the House has got, to be honest with you.

Mr. WILLARD. We did submit our letter to the President urging that he, at such a time as the act does reach his desk, that he sign it into law. It is our understanding that he has indicated the idea of exercising his veto.

Senator ABOUREZK. Yeah. I wasn't following you at first. You're saying that the Indian preference and contracting in the Indian Health Service passed the Senate but is not in the House version.

Mr. WILLARD. Yes.

Senator ABOUREZK. Let me-is it still in conference? It's still in conference, but I put that section in the Senate.

Mr. WILLARD. I am well aware.

Senator ABOUREZK. You started talking about something totally different than I was thinking about at the time. I don't know what they are going to do about it, I would hope they keep it in, but that's still off the subject. We're trying to define-or trying to make an effort to define what a tribe is for purposes of Alaska. We need your help. The more you talk about other things, the less help I'm going to get from

you.

Mr. WILLARD. I might just clarify my position. I am the executive director of the Tlingit and Haida Contractor's Association representing its interest in southeast.