On behalf of the Colorado River Indian Tribe (Tribes) in Parker, Arizona, I want to thank the Chairman and members of the Committee for providing me the opportunity to address you today. My name is Dan Eddy and I am Chairman of the Colorado River Indian Tribes. Tribes was federally recognized and our reservation created during the Administration of President Abraham Lincoln in 1865. Currently, there are approximately 3000 members of our Tribes and our reservation encompasses about 268,000 acres in Southwestern Arizona.

The fact that the Committee is holding a hearing on the Unmet Health Care in Indian Country is recognition of the severe crisis that currently exists on our reservations and I commend the Committee for focusing attention on this vital issue Quality health care for tribal members continues to rank among the top priorities oi nation's tribal governments. As you know, the Indian Health Services (IHS) has historically suffered from under funding leading to inadequate medical services, facilities and treatment programs in most tribal communities. With Indian people suffering the highest levels of chronic health problems, including diabetes, infant mortality, teen suicide and substance abuse, the health care needs that go unmet on our nation's Indian reservations are infinite. I don't think any of us can honestly say that the federal government is meeting the trust responsibilities incumbent upon it when we give health care in Indian Country an examination.

With the decline in funding for the IHS that we have experienced since FY 96, contrasted with the funding increases for other non-Indian health programs, the funding level for IHS is truly discouraging. While we appreciate the Administration's commitment to balance the federal budget, we maintain that such laudable initiatives cannot fulfill the Federal government's basic trust responsibilities to Indian tribes.

In the Parker Service unit area for our reservation, the lack of essential health care services and an adequate facility in which to provide those services creates a desperate , " health care delivery system. Many diseases and sicknesses often go unattended until conditions turn catastrophic. For example, our service area currently has over 900 diabetic cases, a majority with foot ulcers. Because of a lack of podiatry services and a modern facility, our amputation rate has increased above the national level.

For dental services, there is a waiting list of over 350 persons currently waiting for an appointment. It takes one year to get an appointment. Because of this backlog, it is common for our tribal members to go without routine dental examinations and preventive dental services.

Obviously there is a critical shortage of IHS funding for both operating expenses and construction. Even if we had adequate funding for operating expenses, many of our facilities are so old that we could not handle the demands that currently exist. Such is the case on our reservation.

Funding for the construction and staffing of the new Parker Outpatient Facility has been the top rated priority by the IHS for the last ten years. Yet we are still waiting for funding to build our facility. The existing facility was originally constructed 68 years ago and is so old and obsolete that it cannot adequately service the medical needs of our growing population. Nor does it adequately serve the needs of four other tribes from our region or the visiting Native Americans who regularly call upon our existing facility for care.

Funding for the architecture and engineering design of the Parker Facility was appropriated in FY 88. After many years of delays in the planning process, the Tribes eventually assumed responsibility of the project in the Summer of 1996. We were the first tribe in the country to manage the design and drawings of a health care facility under a 638 contract. Through careful management and financial discipline, we completed the designs and drawings under budget and on-time. Final approval by IHS is expected this summer. We feel that we could achieve similar results if we were able to receive a minimal amount of funding in this Congress to begin construction of our facility. We certainly feel as if we have waited long enough.

The Parker project is budgeted for a construction cost of $21,479,000 dollars. Our Tribal government is so eager for the new facility that we have repeatedly indicated that we would be willing to provide some funding for the construction of the facility. We realize that the construction of the Parker Facility is one of the least expensive projects among those projects currently awaiting funding on the IHS priority list. We have seen other facilities lower on the priority list receiving funding before us and have concerns that the construction costs of facilities yet to be built could further delay our project. In fact, one facility on the list could eat up the entire IHS construction budget for the next four years.

Having said this, let me again reiterate our appreciation of the difficult funding questions that must be addressed by the Congress. We realize that while the funding available for facility construction is inadequate, the lack of funding available for operations is similarly wanting. This greatly increases the competition for these scarce dollars. Again, in our area, the funding level for Contract Health Care Services does not come close to providing for the increasing CHS services needed. Lack of funds has caused CHS services to be put on a priority one category, which is a life or limb situation. There are no funds for preventive services. There are no funds for physical therapy services.

With alcoholism rates on Indian reservations ranking among the highest in the nation, programs to battle this problem are severely under funded. There are no funds to sufficiently cover treatment and aftercare for our members who need these services. There are no funds for other services that are urgently needed. There are insufficient funds for psychiatric services, drug counseling, mammographies, health care for the elderly, hearing aids and eye glasses for adults and children.

Third party billing does not address the shortfalls for health care services. party billings are generally targeted to offset a hospital's deficit and do not go towards providing additional services. There is no local input on where these funds are targeted. We would like to see these funds go towards providing more services.

What I am telling you today is no different from that which every witness who appears before you today will also say. There are no funds. We all know this and all wish it weren't so. But it is. One of the suggestions I would offer is to allow for a more creative methodology by which construction costs and operating expenses could be scored by Congress for budget considerations.

We have presented Congress with several suggestions that would allow us to build our much needed facilities now and provide the services that the facilities would offer. We have suggested leaseback arrangements, bonding opportunities, third party billing and revenue sharing arrangements, public-private partnerships -- and all have been rejected because of federal budget scoring. While the budget scoring continues, our people continue to suffer from neglect.

Rigid budget scoring methods have repeatedly denied us a chance to provide the services we need now. It seems to many of us that the federal trust responsibilities require scoring solutions to procure these needed facilities and services. Innovative public-private partnerships, long-term leaseback arrangements and flexibility in government bond policy all must be re-examined.

None of us here believe for an instant that there is federal money available to meet the current health care needs in Indian country. We urgently need a federal budget policy that says "here's how to do that" rather than "no you can't do that!" I urge you to work with us to develop a creative scoring system and deliver the health services and facilities that are needed now. It is the minimum that we can do.

We would like to be partners with you in these efforts and look forward to that opportunity. On behalf of all the members of my Tribe who have sent me here to address you, thank you for this opportunity.