WASHINGTON D.C. – Former Colville Business Council member Andy Joseph Jr. testified on behalf of the National Indian Health Board at a Congressional hearing, held first time in at least 30 years on the health care needs of tribal veterans. The Oct. 30 event brought together tribal leaders from across Indian Country to share their concerns with lawmakers over tribal veterans’ barriers to quality health care.

Speaking as the chair of the Sub- committee on Health, a component of the House Committee on Veterans’, Rep. Julia Brownley, D-Calif., called the hearing historic and further noted the federal government’s special relation- ship to native veterans.

“This hearing is different than most this committee holds as it is an examination of not only the VA and the health status of Native Ameri- cans, but of the VA as part of a feder- al government that has a solemn duty to uphold trust and treaty obligations to tribal people,” said Brownley. “It is essential we recognize this federal obligation does not stop at the doors of the Indian Health Service. It is an obligation of all parts of our government.”

Former Colville Business Council member Andy Joseph Jr., who testified on behalf of the National Indian Health Board at the event, reiterated Brownley’s point.

“The federal government has a dual responsibility to Native veterans – one obligation because of our political status as native people and one because of our military service,” said Joseph.

And while tribal people serve in the military more frequently than any other group, Brownley noted, “They have the lowest health status of any other race or ethnicity of the US. Na- tive Veterans are more likely to have service-connected disabilities, experience sexual assault and post-trau- matic stress and die by suicide.”

In 2010, the Indian Health Service and Veterans Affairs signed a memorandum of understanding that aimed to improve health status of tribal veterans, continued Brownley in her introduction, noting the agencies intend to update the MOU in 2020.

“We would like to check in on the progress made over the past nine years, what went well, what didn’t and what is needed in the new MOU to ensure we truly are improving the health status of American Indian and Alaska Native veterans,” said Brownley.

In his written testimony, Joseph shared the following suggestions to the subcommittee:

1. Congress should pass bipartisan legislation that would enact advance appropriations for Indian programs.

Joseph’s testimony noted that“Of the four major federal healthcare en- tities, IHS, is the only one subject to the devastating impacts of govern- ment shutdowns and continuing reso- lutions (CRs). This is because Medi- care and Medicaid receive mandatory appropriations, and the VHA was au- thorized by Congress to receive ad- vance appropriations nearly a decade ago. As a result, the VHA has been insulated from every government shutdown, CR, and discretionary se- questration over the past decade.”

2. Congress should clarify statutory language under section 405(c) of the Indian Health Care Improvement Act and make explicit the VHA’s require- ment to reimburse IHS and Tribes for services under Purchased/Referred Care (PRC).

“Despite repeated requests from Tribes, the VA has not provided re- imbursement for PRC specialty and referral care provided through IHS/ THPs. This is highly problematic, as AI/AN Veterans should have the freedom to obtain care from either the VA or an Indian health program. If a Veteran chooses an Indian health program, that program should be re- imbursed even if the service could have been provided by a VA facility or program in the same community.”

3. The VHA should work with IHS to create written policy or guidelines to clarify how referrals from IHS and THP facilities to VHA facilities for specialty care should be managed, and to establish specific targets for measuring action on MOU perfor- mance measures.

4. The VHA should consult with Tribes and work through their MOU with IHS to create and publish a liv- ing list of available Veterans Liai- sons/Tribal Veterans Representatives across all IHS and VHA regions.

5. Congress should pass legislation exempting Native Veterans from co- pays and deductibles.

6. Congress should pass the bipar- tisan H.R. 2791 – Department of Vet- erans Affair Tribal Advisory Commit- tee Act of 2019.

7. Congress must ensure parity be- tween the VA and IHS in appropri- ations and technical assistance for health IT modernization.

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