Under President Trump, the U.S. government is deeply committed to fulfilling its solemn obligations to American Indians and Alaska Natives, and fulfilling them in a spirit of partnership and collaboration.
As Prepared for Delivery
Good morning, and thank you for that introduction and wonderful welcome.
Thank you to Chief Joe Crittenden and the entire Cherokee Nation for being such gracious hosts, as well as to the Pawnee Nation for the same.
It is a great honor to join this year’s first meeting of the Secretary’s Tribal Advisory Committee.
Thank you to every member of the STAC who is joining us here today, including our new members – your service is essential to maintaining strong, productive communication between Indian Country and the federal government in Washington.
I’d also like to offer a special thank you to our chairman, Chester Antone of the Tohono O’odham Nation.
It is a great honor to take this commitment to a new level, by making this meeting, the 22nd meeting of the STAC, its very first meeting in Indian Country.
That decision is representative of the new level of commitment to tribal issues you are going to see from the federal government, under President Trump.
In the nearly eight months we’ve now been at the Department of Health and Human Services, it has been a particular privilege to dive into tribal issues.
As a physician, this particular part of the government-to-government relationship is close to my heart. There is no greater honor than to care for one’s neighbor.
But, as you know, as a government, in some places, we have not always performed this task as effectively as we should.
That is intolerable. Under this administration, we are going to have no patience for substandard care at any IHS facility, by any IHS provider, for any IHS patient.
So how are we going to make sure every American Indian and Alaska Native patient receives the very best care possible? In part, by forging better, more accountable and productive relationships between your governments and ours.
As I shared with many of you at the Tribal Budget Consultation in March, at HHS, we like to talk about the three P’s: people, patients, and partnerships.
A strong government-to-government partnership will mean real progress in improving patient care, and we have the privilege of announcing one significant step in this direction today.
As many of you know, we recently had the chance to travel to Alaska to visit facilities run by the Alaska Native Tribal Health Consortium, a self-governance venture run by the Alaska Native tribes.
We were incredibly impressed by what we saw, as we have been impressed over these last few days in the Cherokee and Pawnee Nations.
The spirit of caring for the whole patient in Indian Country is remarkable – something of which all of you should be proud.
As I’ve said in a number of places, it’s actually something from which the rest of the country could learn.
We had the opportunity to hear from Alaska Native leaders while we were there, learn from their experiences, and solicit their concerns.
One of the issues they raised is the threshold HHS sets for requiring department approval for capital projects, like repairing facilities or building new clinics.
Currently, land-owning operating divisions of HHS, which include IHS, need department-level approval for capital projects exceeding certain budget numbers. This applies even to projects that are authorized by Congress or funded solely by tribal dollars.
There is a role for department oversight in such decisions, but tribes should not be hamstrung by these rules when they’re trying to make meaningful investments in their capacity to provide care.
So it is a pleasure to announce today that HHS is raising the thresholds for approval of IHS capital projects. There are a few different thresholds depending on the project: The threshold will go from $1 million to $5 million for construction, from $2 million to $10 million for renovations, and from $5 million to $15 million for repairs.
In addition, capital projects that are funded by tribes and authorized by Congress or funded by tribal dollars, regardless of size, won’t require HHS approval.
Altogether, this means a lot more decisions can be made out here, in Indian Country, by those who understand the needs here best.
We are excited to make this change: It will help empower all of you to move more quickly on decisions and projects that will enable you to better serve patients.
Needless to say, this should also serve as a reminder that we are listening intently in these sessions—in STAC meetings, in tribal budget consultations, and in meetings like we’ve had in Cherokee and Pawnee Nations this week.
Most important, this is also a recognition of the special government-to-government relationship between the federal government and your tribes. Where possible, we want to empower you to make your own decisions, for your people.
We believe that our collaborative approach has already begun to bear fruit:
Earlier this month, the Rosebud Hospital in the Great Plains area exited its Systems Improvement Agreement with CMS.
Around the same time, IHS announced new wait times standards for primary and specialist care.
We look forward to more such victories to come. In particular, we look forward to cooperation on the three clinical priorities we’ve set out at HHS: the opioid crisis, serious mental illness, and childhood obesity.
We were just at a substance-abuse-treatment facility here in Cherokee Nation yesterday. We know these are problems that have hit Indian Country especially hard, so we look forward to working with tribal governments and communities on them and incorporating your perspectives.
Our government-to-government relationship shines especially not just in confronting these public health challenges, but also during our times of crisis.
IHS has provided support and resources for hurricane relief efforts in Texas and Florida, and some tribal elders in Florida were evacuated. We’ve also been closely monitoring this summer’s dangerous fires out west and the threats they could pose to tribal communities and IHS facilities.
Ongoing natural disasters like those require up-to-the-minute communications. But on an everyday basis, too, we are committed to open and collaborative communication between the federal government and tribes, and we hope you will reciprocate.
As I shared at a tribal meeting at the White House recently, which a couple of you attended, under President Trump, the U.S. government is deeply committed to fulfilling its solemn obligations to American Indians and Alaska Natives, and fulfilling them in a spirit of partnership and collaboration.
Thank you again for having me, and we look forward to strengthening our partnership here today.
