NIHB Testifies before House Veterans' Affairs
Health Subcommittee on Health Care Access for Native Veterans
October 30, 2019

NIHB Testifies before House Veterans' Affairs
Health Subcommittee Hearing

On Wednesday, October 30, 2019, the National Indian Health Board (NIHB) testified before the House Veterans' Affairs Subcommittee on Health regarding health care needs for the nearly 146,000 American Indian/Alaska Native (AI/AN) Veterans in the country. Testifying on behalf of NIHB was Andrew Joseph Jr., Immediate Past Board Member-at-Large and Portland Area Representative.

The hearing represents the first time in decades that Congress has held a hearing specifically to examine issues related to health care access for AI/AN Veteran issues within both the Department of Veterans' Affairs (VA) and the Indian Health Service (IHS).

In his testimony, Mr. Joseph spoke on the dual responsibility for the federal government to provide health care services to AI/AN Veterans: one obligation specific to the federal trust responsibility for health services for all AI/ANs, and one obligation specific to their service in the Armed Forces.

"Our People serve in the military at higher rates than any other ethnicity in America. We continue to hold up our end of the bargain," Mr. Joseph said, highlighting the need for the VA to hold up its end of the bargain by honoring the federal trust responsibility for health.

While NIHB and several subcommittee members expressed disappointment that Secretary Wilkie, IHS Principal Deputy Director RADM Weahkee, and other federal leadership were not present, the hearing provided an invaluable opportunity for Tribes to advocate for AI/AN Veterans. Andy Joseph, Jr. made the following recommendations to the VA in his testimony:

Mr. Joseph also made the following recommendations to Congress:

  • Congress should enact Advance Appropriations for IHS and other Indian programs, which the Veterans' Health Administration receives.
  • Congress should exempt AI/AN veterans from VA co-pays and deductibles.
  • Congress should establish parity between VA and IHS in funding and technical assistance for Health Information/Technology system modernization efforts.
  • Congress should enact H.R. 2791 to establish a Tribal Advisory Committee at the VA.

NIHB Vice Chairman and Chief of the Valdez Tribe, William Smith, testified on behalf of the Alaska Native Health Board. Chief Smith spoke on the mental health needs of AI/AN Veterans and on the ongoing impact of use of Agent Orange during the Vietnam War, in which Chief Smith served. "If we built a memorial wall to those harmed by Agent Orange in Vietnam, it would be ten times as high," he said. Chief Smith also spoke at length about the need for IHS and the VA to "tear down their walls" and work collaboratively to address the health care needs of AI/AN Veterans.

In addition to Mr. Joseph and Chief Smith, other panelists on the AI/AN panel included:

  • Kevin J. Allis, CEO, National Congress of American Indians
  • Sonya M. Tetnowski, Vice President, National Council of Urban Indian Health
  • Marilynn Malerba, Chief, Mohegan Tribe of Connecticut; Chair, Indian Health Service Tribal Self-Governance Advisory Committee

Panelists also discussed the need to comprehensively address ongoing issues in health care access for Native Veterans living in urban areas, including by ensuring Urban Indian Organizations (UIOs) are including in the revised Memorandum of Understanding (MOU) between the VA and IHS.

Following the AI/AN panel, representatives from the Veterans' Health Administration (VHA) and IHS testified before the committee. Representative Ruben Gallego (D-AZ), asked the VHA representative, Deputy Under Secretary for Health for Community Care Dr. Kameron Matthews, if charging AI/AN Veterans co-pays constituted a breach of the federal government's responsibility to Tribes. Dr. Matthews pledged to examine possible paths forward on the issue.

Representative Gallego also discussed legislation he introduced yesterday that would exempt Native Veterans from copays. That bill, which NIHB has endorsed, H.R. 4908 - Parity in Access to Care Act - would amend Title 38 of the United States Code to prohibit the collection of copays from Native Veterans in recognition of the federal trust responsibility for health.

Chairwoman Brownley (D-CA) asked the federal representatives about Tribal consultation on the MOU between the IHS and VA. Dr. Thomas Klobuchar, Executive Director of the Office of Rural Health at the VA, responded that the two biggest issues raised during consultation were inclusion of Urban Indian Health Organizations and clarification on the referral process involving Purchased/Referred Care from IHS at VA facilities.

NIHB will continue to advocate for legislation that will promote the highest health status and outcomes for all Native Veterans, and is actively working to ensure that Tribal leaders and AI/AN Veterans are leading the discussions on the revised IHS and VA MOU.

Click here to read the testimony NIHB submitted to the Subcommittee.

Click here to watch a recording of the hearing.

For any questions on health care issues pertaining to AI/AN Veterans, please contact NIHB Deputy Director of Congressional Relations, Shervin Aazami, at

Andy Joseph, Jr., Immediate Past Member-at-large & Portland Area Representative for NIHB, testifies to the House VA Subcommittee on Health regarding unmet health care needs for the nation's 146,000 AI/AN veterans.
NIHB Board member Chairman William Smith speaks on behalf of the Alaska Native Health Board regarding mental health needs for AI/AN veterans.

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