Prepared Statement of Jarred-Michael Erickson, Confederated Tribes of the Colville Reservation (July 28, 2022)
Summary
A prepared statement of Jarred-Michael Erickson, Chairman of the Confederated Tribes of the Colville Reservation, for the House Committee on Natural Resources Subcommittee for the Indigenous Peoples of the United States legislative hearing on H.R. 5549, the Indian Health Service Advance Appropriations Act, dated July 28, 2022. The statement says the Colville Tribes is a direct service tribe whose health care is provided by Indian Health Service employees, and that direct service tribes have the most demonstrable interest in IHS having a full year of appropriated funding. It states that the Colville Tribes supports H.R. 5549 and urges the Committee to swiftly pass it. It adds that the tribes have further comments on advance appropriations authority and the Committee's oversight of IHS.
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“Prepared Statement of Jarred-Michael Erickson, Confederated Tribes of the Colville Reservation (July 28, 2022).”
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The Confederated Tribes of the Colville Reservation
Prepared Statement of the Honorable Jarred-Michael Erickson, Chairman
Confederated Tribes of the Colville Reservation
House Committee on Natural Resources
Subcommittee for the Indigenous Peoples of the United States
Legislative Hearing on H.R. 5549, the “Indian Health Service Advance Appropriations Act”
July 28, 2022
As a rural, land-based Indian tribe, the Confederated Tribes of the Colville Reservation
(“Colville Tribes” or the “CCT”) has unique challenges to providing health care for our tribal
community. The CCT is a direct service tribe, which means that health care and associated
billing and administrative support is provided by Indian Health Service (“IHS”) employees.
Direct service tribes have the most demonstratable interest of all tribal stakeholders in IHS
having a full year of appropriated funding because the health providers in our communities are
IHS employees and are the first to be affected when IHS funding is disrupted.
The Colville Tribes supports H.R. 5549, the “Indian Health Service Advance
Appropriations Act,” and urges the Committee to swiftly pass it. The Colville Tribes has some
additional comments and recommendations for the Committee to consider related to both
advanced appropriations authority and the Committee’s oversight of IHS generally.
By way of background, although now considered a single Indian tribe, the Confederated
Tribes of the Colville Reservation is a confederation of twelve aboriginal tribes and bands from
across eastern Washington state, northeastern Oregon, Idaho, and British Columbia. The present-
day Colville Reservation is in north-central Washington state and was established by Executive
Order in 1872. The Colville Reservation covers more than 1.4 million acres and its boundaries
include portions of both Okanogan and Ferry counties. Geographically, the Colville Reservation
is larger than the state of Delaware and is the largest Indian reservation in the pacific Northwest.
A. Government Shutdowns and Continuing Resolutions Aggravate Ongoing
Problems with the Lack of Health Providers and Staffing
IHS funding is dependent on Congress passing the Interior spending bill before the end of
the fiscal year, which very rarely happens. Instead, Congress usually passes a Continuing
Resolution (CR) to fund the federal government until it has time to enact final spending bills.
Receiving funds under a CR limits IHS’s activities because IHS can only expend funds
for the duration of a CR, which prohibits the agency from making longer-term, potentially cost-
saving purchases and decisions. Recruitment and retention of health care providers also suffers
because CRs and government shutdowns disrupt recruitment activities like application reviews,
interviews, and extending job offers to health providers.
Like other rural health providers, the Colville Service Unit faces immense challenges
recruiting and retaining doctors and medical staff, even during stable budget years. For decades,
the CCT has endured chronically low staffing levels and high vacancy rates. At one point during
the past decade, IHS calculated that the Colville Service Unit had less than one third of the
required number of clinical staff and only one quarter of the required number of dental staff.
Staffing shortages not only increase the wait times for patients but, in the CCT’s case,
have also had other consequences. Lack of health providers has resulted in fewer patient
encounters, which has had a negative domino effect on the CCT’s Purchased/Referred Care
funding and user population. The staffing shortages have also prompted the CCT’s health care
providers to seek other employment because many of the patients in their respective panels have
chronic illnesses that multiply the number of visits in their annual workloads.
The budgetary disruption caused by a government shutdown or a CR makes the lack of
health providers even more acute. When Congress fails to pass annual spending bills or a CR and
the federal government must shut down, IHS has. in the past. limited at least some services for
both contracted and direct service tribes until the shutdown ends.
During the last government shutdown, interviews and other activities related to filling
vacancies in the Colville Service Unit were put on hold, making potential applicants even less
inclined to want to navigate the federal hiring process. For this reason alone, the Colville Tribes
supports H.R. 5549 because advance appropriations, if enacted, would insulate IHS and the
Colville Service Unit from this type of disruption in the future.
B. Transparency will be Needed for IHS to Provide Reliable Budget Estimates
As the COVID-19 pandemic demonstrated, unforeseen events sometimes arise that will
impact federal agency budgets. The CCT understands that IHS begins planning for its budget
request three years in advance. Beginning the budget process that far in advance is helpful for
tribal and tribal organizational stakeholders to participate in the budget formulation process. It
also illustrates, however, that no matter how reliable budget forecasts may be, circumstances can
arise that no one could reasonably predict that require budget modifications.
As the Committee is aware, the Veterans Health Administration is the other federal
agency with advanced appropriations authority. Modifications to that agency’s budget appear to
have been addressed by Congress on a case-by-case basis as issues arise.
While IHS has invited tribal advisory committees and tribal organizations to have some
input into IHS’s budget formulation, the Colville Tribes recommends that IHS and the
Committee make information related to IHS’s budget formulation process and the projection
models that IHS will use to estimate advance appropriations available to all of Indian country.
Making this information readily accessible would provide transparency and enable all Indian
tribes the opportunity to provide input on IHS’s budget estimates for advance appropriations, not
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PREPARED STATEMENT OF THE CONFEDERATED TRIBES OF THE COLVILLE RESERVATION
just the small number of tribes and organizations that are involved with IHS budget advisory
committees.
C. The Committee Should Also Address other IHS and Indian Health-Related
Issues
Apart from H.R. 5549 and the need for advance appropriations, there are some
longstanding issues with IHS, particularly with its provision of services for direct service tribes,
that the CCT is hopeful that this Committee will also prioritize and take legislative action on.
The Colville Tribes has previously testified before this Committee about the unique
challenges that direct service tribes face in updating their staffing levels. For the CCT and
similarly situated direct service tribes, these staffing ratios are determined when their initial IHS
health facility opens for operation. While these levels may increase incrementally as the IHS
base budget increases, they can never be brought anywhere close to what is needed in modern
times.
Tribes that have not been able to update their staffing ratios by constructing a new facility
under the Priority List or the Joint Venture facility Construction programs are frozen in time for
staffing ratio purposes. For the CCT, these historic staffing ratios date back to 1927 when the
U.S. Public Health Service converted a Department of War building in Nespelem, Washington,
for use as the CCT’s initial health clinic.
While the Colville Tribes was fortunate to have been awarded a Joint Venture facility
construction project in 2020 during the last solicitation round and hopes to update its staffing
levels soon, many other Indian tribes nationally continue to face challenges associated with
historically low staffing levels.
Other IHS organizational and management issues have manifested themselves at the
Colville Service Unit, including delays associated with the IHS’s processing of third-party
billing. These delays have led our members, including members of the Colville Business
Council, to be turned over to collection agencies, among other negative impacts.
Provisions to address staffing and recruitment and retention issues were included in the
“Restoring Accountability in the Indian Health Service Act,” which was introduced in prior
congresses. In addition to advanced appropriations for IHS, the Colville Tribes urges the
Committee to pursue these reforms going forward.
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