PAGE FOUR STATEMENT OF CHAIRMAN ALFRED R. PEMBERTON "HISTORICAL PERSPECTIVE OF INDIAN HEALTH CARE" Indian Tribes in Michigan, Minnesota, Iowa and Wisconsin. They call for a Tribal Nations Summit with President They also call for basic principles to be maintained to protect laws and statutes previously enacted providing for health care for Indians. They also provide for protection of tribal sovereignty and to protect Indian Health Services from negative impact by state health care reform efforts. Most important, the resolutions require that appropriations for national health care reform ensure continuation of existing services and expanded supplemental benefits to meet unmet needs. The resolutions oppose administrative cost and FTE reductions in the Indian Health Service because they place an additional negative impact on an already underfunded service and underserved population. The reductions are also disproportionately high when compared to other federal agencies. Also. consultation with tribes must begin and continue during the consideration of the Health Security Act. In closing, let me say that the Indian Health Service has acknowledged that it is only meeting 49% of the level of need in Indian country. Additionally, the IHS has acknowledged a backlog of in excess of $1.6 billion in sanitation needs. President Clintons Fiscal Year 1995 Appropriation request for the Indian Health Service will not provide sufficient funding to maintain the current level of health services available. The shortfall appears to be at least $160 million. It also includes an unrealistic projection of $87.896 million increase in reimbursements from private insurance. Historically, the annual increases in collections from private insurance have been $4 to $6 million. The estimated increase for FY 94 is less than $1 million: (FY 94 $18,184,000 compared to FY 95 $18,957,000) This proposed requirement is in violation of Section 207 (b) of the Indian Health Care Improvement Act. (P.L. 94-437) which states, PAGE FIVE STATEMENT OF CHAIRMAN ALFRED R. PEMBERTON "HISTORICAL PERSPECTIVE OF INDIAN HEALTH CARE" "The Service may not offset or limit the amount of funds obligated to any service unit or entity under contract with the Service because of the receipt of reimbursements. The highest priority for the Fiscal Year 1995 budget should be to provide sufficient funding to permit the Indian Health Service, Tribes and Urban Indian Programs to maintain the present level of health services and consider the 2% annual increase in population and restoration of the Congressional prohibition on imposing personnel ceilings or grade restrictions on IHS personnel. We commend you for your efforts in health care reform but we must remind you of the federal governments legal obligation and trust responsibility to our people. AS, EAS, REAS, The United States Government is responsible fi providing a comprehensive health service delive system for American Indians as provided by trea obligations, including but not limited to the Snyd Act of 1921, the Indian Self-Determination a Education Assistance Act of 1975, and the Indian Heal Care Improvement Act of 1976; and The American Indians have paid for this right through cession of millions of acres of land to the United States and relinquishment of minerals and other natur resources; and The Health Security Act is currently under debate the United States Congress (S. 1757, S. 1775, H.3600) with consideration of the bills during second session of the 103rd Congress. | THEREFORE, BE IT RESOLVED, that the 4-State Assembly here supports a tribal nations summit to be convened President Clinton, First Lady Hillary Clinto Secretary of Health and Human Services Donna Shala and Assistant Secretary Phillip Lee for the purpose consultation with tribal nations on the Health Securi Act, in Washington, D.C., in the spring of 1994. IT FURTHER RESOLVED, that the above meeting and the fo regional field meetings to be held with Dr. Phillip I be held in conjunction with a series of hearings the purpose of consulting with and receiving t advisement of Indian nations and Indian people on t impact of health care reform in Indian Country. CERTIFICATION We do hereby certify that the foregoing Resolution was duly presented and acted upon by a vote of 23 For, 0 Against, 7 Silent, at a meeting of the 4-State Intertribal Assembly quorum present, held on January 12-13, 1994 at Bloomington, Minnesota. a WHEREAS, WHEREAS, WHEREAS, WHEREAS, 4-STATE INTERTRIBAL ASSEMBLY Resolution 1-12-94-02 The 4-State Intertribal Assembly is an intertribal assembly ncse Membership 13 comprised CE the thirty federally recognized American Indian Tribes of Michigan, Minnesota, Iowa and Wisconsin; and The United States Government is responsible for providing a comprehensive health services delivery system for American Indians and Alaska Natives as provided by treaty obligations, including but not limited to, the Snyder Act of 1921, the Indian SelfDetermination and Education Assistance Act of 1975, and the Indian Health Care Improvement Act of 1976; and The American Indians and Alaska Natives have paid for this right through the cession of millions of acres of land to the United States, and relinqueshment of minerals and other natural resources; and The Health Security Act is currently under debate in the United States Congress (S.1757, S.1775, and H.R.3600) with consideration of the Bills during the second session of the 103rd Congress. NOW THEREFORE, BE IT RESOLVED, that the 4-State Intertribal Assembly supports the general principles of legislation with the following qualifiers: the That all sections of the Health Security Act authorizing the Indian health care delivery programs be defined as an "entitlement" by virtue of the special political relationship that exists between Indian nations and the United States and reaffirmed through numerous treaties, executive agreements, federal statutes and case law. The current Alternative Resource Rule/Payor of Last Resort Policy be eliminated, and to clarify the role of Indian Health Service as the primary provider of health care to Indian people, direct Federal reimbursement be provided to Indian health programs for services provided to patients eligible for third party reimbursements. The plan must ensure the right of sovereign tribal governments to authorize automatic enrollment of their members into the Indian health program until such time as the member elects to enroll in a non-Indian health plan. * Exemption from payment of employee premiums by all businesses located within the exterior boundaries of the |