Legislature(2019 - 2020)CAPITOL 106
02/11/2020 08:00 AM House TRIBAL AFFAIRS
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| Presentation: Alaska Tribal Health Compact | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
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+ teleconferenced
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| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
HOUSE SPECIAL COMMITTEE ON TRIBAL AFFAIRS
February 11, 2020
8:02 a.m.
MEMBERS PRESENT
Representative Tiffany Zulkosky, Chair
Representative Bryce Edgmon, Vice Chair
Representative John Lincoln
Representative Chuck Kopp
Representative Dan Ortiz
Representative Dave Talerico
MEMBERS ABSENT
Representative Sarah Vance
COMMITTEE CALENDAR
PRESENTATION: ALASKA TRIBAL HEALTH COMPACT BY NATASHA SINGH~
TANANA CHIEFS CONFERENCE
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
NATASHA SINGH, General Counsel
Tanana Chief's Conference
Fairbanks, Alaska
POSITION STATEMENT: Offered a presentation on The Alaska Tribal
Health Compact.
VERNE BOERNER, President and CEO
Alaska Native Health Board
Anchorage, Alaska
POSITION STATEMENT: Provided information and responded to
questions during the presentation on The Alaska Tribal Health
Compact.
ACTION NARRATIVE
8:02:25 AM
CHAIR TIFFANY ZULKOSKY called the House Special Committee on
Tribal Affairs meeting to order at 8:02 a.m. Representatives
Lincoln, Ortiz, Kopp, Talerico, and Edgmon were present at the
call to order. Representative Vance arrived as the meeting was
in progress.
^PRESENTATION: ALASKA TRIBAL HEALTH COMPACT
PRESENTATION: ALASKA TRIBAL HEALTH COMPACT
8:03:04 AM
NATASHA SINGH, General Counsel, Tanana Chief's Conference,
offered a presentation on The Alaska Tribal Health Compact
(hereafter the ATHC or "the compact"). She thanked the
committee for having been invited to educate the Alaska State
Legislature on the history and opportunities in tribal
compacting. Ms. Singh informed the committee that she is
originally from Stevens Village, Alaska, but resides in
Fairbanks, Alaska, where she raises her family and works for
Tanana Chiefs Conference (TCC), a tribal health and social
services consortium that provides services to Alaskans living in
Interior villages and to tribal members living in Fairbanks.
MS. SINGH related that TCC is one of the 25 co-signers of the
compact, which she stated is likely the most successful compact
in the history of the Indian Self-Determination and Education
Assistance Act of 1975 (ISDEAA). She explained the reason she
said the ATHC is the most successful compact is because severe
health disparities are being reversed for Alaska Native people
in one of the most remote and rural areas of the country, and
this is happening while the AHTC is suffering significant
underfunding by the U.S. Congress.
MS. SINGH imparted to the committee that the Alaska Tribal
Health System ("the system") is made possible because of the
compact, an agreement between the federal government and the
Alaska Tribal Health entities. She added that the compact is
successful because tribal leaders are the decision-makers,
planners, and strategists in the implementation of their own
health care. She stressed that, rather than being race-based,
this is a government-to-government relationship between the
federal government and tribes. The reason for this, she
explained, is that the compact is built on the Federal Trust
Responsibility created through treaties signed with tribal
governments.
MS. SINGH went on to say that before the compact, chronic
underfunding, extremely rural nature of villages, and, most
importantly, the absence of locally driven decision making
resulted in a lack of quality provided by the Indian Health
Service (IHS) [an agency of the US Department of Health and
Human Services]. She added that Lower 48 tribes were also
experiencing similar outcomes from IHS, so in 1988 Congress
passed the ISDEAA amendments. Whereas the original ISDEAA
provided the necessary authority for tribes to enter into
agreements that carry out the responsibilities of the federal
government, these 88 amendments addressed inflexible bureaucracy
and federal inefficiencies, and increased the tribe's ability to
redesign and tailor services to the specific needs of their
communities.
MS. SINGH imparted to the committee that agencies and
bureaucracies resist the implementation of self-determination,
despite proven success, and legislative support is continually
needed to fully implement the intent of the ISDEAA. She added
that, soon after the amendments to the ISDEEA were passed,
Alaska was offered an IHS demonstration project. Alaska tribes
and health entities quickly joined together to create a multi-
party compact consisting of all those that wanted to join,
something that had never been done through IHS. With the
support of the Alaska area IHS office and the determination of
tribal leaders, the ATHC was created in 1994.
8:07:35 AM
MS. SINGH went on to say that compacting is just one choice the
ISDEAA provides for self-determination; the other option being
to assume operations of a federal program. Furthermore, she
added that self-determination contracts require less in-depth
planning to begin the tribal assumption of operations, but that
those contracts also provide for less flexibility and local
control over how a program is implemented.
MS. SINGH informed the committee that compacting on a federal
level requires tribes to initiate a planning phase to assume
operations of a federal program and to prove financial stability
of the tribe. This longer process allows tribes to have more
flexibility in how the programs are designed and implemented,
and ultimately allows for more local control of funding and
program outcomes. The true beauty of compacting, according to
Ms. Singh, is the fact that tribal leaders have full authority
to decide for themselves the best way to address their own
health care needs. Ms. Singh emphasized that [in compacting] a
tribe is forced to be accountable for its own people. As such,
TCC answers to its tribes continually throughout the year. The
tribes, split into six sub-regions, are met with twice per year.
Tribes are met with upon request in their own village or in
Fairbanks, and all tribes are brought together to meet twice
yearly.
MS. SINGH informed the committee that at all meetings tribes are
able to take formal action, through resolutions or motions, to
direct TCC. The tribes also contribute to and oversee
implementation of TCC's strategic plan. The boss of the
thousand employees at TCC is elected by the tribe and serves
three-year terms: this is tribal accountability through self-
determination. Through the ATHC, the health care information is
owned by the tribe; therefore, practices can be changed,
programs redesigned, and services, functions, and activities
augmented to best fit regional needs. At a TCC meeting, she
explained, if there is an issue with service delivery, tribes
can explain their plan for redesign, and staff will move
accordingly. If a program is not properly funded, the tribe is
allowed the flexibility to reallocate funds and cobble together
funding streams as the tribe sees fit. Ms. Singh mentioned that
the state of Alaska could learn from this manner of conducting
business.
MS. SINGH went on to say that the AHTC does have some strings
attached: co-signers are obligated to provide an annual single
organization-wide audit as prescribed by the Single Audit Act
(SAA) of 1984. The secretary of the U.S. Department of Health
and Human Services submits a report to the Senate Committee on
Indian Affairs and the House Natural Resources Committee
detailing the level of need that is underfunded. The boards at
TCC are well educated in the audit process and take pride in the
lack of findings, she added, and robust accounting divisions
often include an internal auditor who triple-checks that the
little money received from the federal government is spent
properly. Ms. Singh let the committee know that currently there
are over 25 diverse co-signers, and that financially the co-
signers are also very different, ranging from small, community
health aid programs under 60,000, to a large statewide medical
center and environmental health program with over 2,000
employees. Co-signers, the IHS, and partners make up the ATHS,
which is rooted in community and tribally driven.
8:12:17 AM
MS. SINGH informed the committee that the system consists of
community clinics, sub-regional services, regional services, and
statewide services and is interconnected through sophisticated
patterns of referrals in its primary mission of improving the
health status of Alaska Native people. As a co-signer, TCC
relies on the "common" ATHC, a perpetual agreement that sets the
general terms of the nation-to-nation relationship between the
United States and the Alaska tribes as it relates to the
implementation of health care services. All the co-signers
under the compact speak with one voice when they negotiate; in
order to do this, all final, common decisions affecting the
ATHC, whether they regard resource distribution or others, are
made through the consensus process with tribal representatives
of the co-signer.
MS. SINGH added that once the co-signer agrees, a strict
protocol of negotiation rules govern the annual negotiation
process. The negotiations are a time when the parties are able
to discuss, update, and make changes to four key documents: the
ATHC itself, which is a perpetual document amended as needed,
but not necessarily every year; the funding agreements, which
can be multi-year or amended at each annual negotiation, and
usually include a highly individualized scope of work as is
common in other individual provisions; the funding tables, also
known as "Appendix A" to the funding agreement, which provide
the beginning funding amounts for each annual funding period,
and in which funding allocations for each co-signer are re-
calculated based on the approved Alaska tribal share
distribution formula and co-signer selections for retained
services and buy-back services from the IHS; and, last, the
continuing services agreement, another sort of appendix to the
funding agreement and an annual description of the scope and
extent of services which will continue to be provided by the IHS
office in Alaska.
8:15:18 AM
MS. SINGH said the negotiations have been built on a foundation
of good faith, trust, and government-to-government relationship.
The shared goals of negotiations, as well as the shared goals of
the nations, according to Ms. Singh, include being prepared and
sharing information early and often so parties are able to stay
transparent and honest with each other, as the continued
relationship between the parties is just as valuable as the
outcome of the negotiations. When these rules are not enough
for a successful negotiation, the ISDEAA provides for the
backbone of the ATHC. With the ATHC's current language, IHS has
a clearer understanding of its legal mandates. When they do not
have a clear understanding, the tribes will point them in the
right direction. Because of ISDEAA, the ATHC, and the ATHS, Ms.
Singh shared with the committee, smiles of children in rural
Alaska are improving. Because of the dental health aid therapy
program, children in rural Alaska are cavity-free.
MS. SINGH went on to say that these achievements by ATHS, made
possible because of the compact, have been done without tribes
and tribal health entities being required to waive their
sovereign immunity. Tribes and co-signers of ATHC are deemed by
ISDEEA to be a part of the public health services for purposes
of coverage under the Federal Tort Claims Act (FTCA), including
medical malpractice claims. Ms. Singh encouraged the Alaska
Legislature to study the ISDEEA as a possible method for
providing similar coverage for state compacters. Ms. Singh
closed by stating that tribes are amazing entities when given
the authority and trust to address their own issues.
8:18:08 AM
REPRESENTATIVE EDGMON asked Ms. Singh her thoughts on using the
ISDEEA model with regard to public safety.
8:18:39 AM
MS. SINGH answered that it made sense, and referenced a report
by twelfth Assistant Secretary of the Interior for Indian
Affairs' Kevin Washburn, in which he determined that compacting
and self-determination for public safety is the next logical
step in tribal self-determination and it is how we can actually
impact other social health barriers such as education and child
protection.
8:19:46 AM
REPRESENTATIVE EDGMON followed up by asking whether the auditing
process, with its different components of regional and sub-
regional, is more involved than a normal auditing process in
which there would be essentially one round.
8:20:22 AM
MS. SINGH replied that she wished she could take committee
members through TCC's accounting division and administration so
they could see the internal controls they have in place to
protect the tribal resources and ensure that they are being used
in the proper way. She added that if it were not the federal
government, the SAA, or the ISDEEA that required them to have
such strict internal controls, it would be the tribe itself that
would require them as such.
8:21:35 AM
CHAIR ZULKOSKY asked Ms. Singh to remind the committee what the
four key documents are over which the co-signers negotiate.
8:21:52 AM
MS. SINGH replied that the compact is about 25 pages and lays
out the fundamentals and what is being done for the ATHS. The
actual funding agreement lays out exactly what services TCC
provides to Interior Alaska, she continued, which is very
different from what the Arctic Slope Native Association (ASNA)
provides, because instead of having the ability to redesign
programs, they lay out, in agreement form, what the services
are. After all the tribes at negotiations compact the common
documents, individual funding agreements are negotiated. Ms.
Singh pointed out the importance of the funding tables'
"Appendix A," which deals with the complex funding formulas tied
to many different departments within the U.S. Department of
Health and Human Services, which impact everyone differently
throughout the state: TCC, she noted as an example, is one of
the only regions that doesn't have a hospital.
8:24:15 AM
MS. SINGH informed the committee that TCC funding goes to
Fairbanks Memorial Hospital, which serves the tribe. The
funding "bucket," she continued, is very important to TCC. She
added that often negotiations happen internally between tribes
first, and it's a real awesome demonstration in self-
determination in that tribes sit down and negotiate between
themselves first, and sometimes with not much funding there
isn't much disagreement over who gets the pennies, but when
there is new funding available, complex negotiations take place.
Ms. Singh related that the next step is to determine how funding
will be distributed. Finally, there's the continuing service
agreement: even though the tribes in Alaska have taken over 90
percent of the health care services, there are some residual
services the Alaska area [IHS] still provides, and the
continuing service agreement lays out what those are. She
offered as an example the tribes' takeover of the Village Public
Safety Officer Program (VPSO). There would still be some
administrative oversight that the state would provide, she
acknowledged: on the IHS side is a chief medical officer who
oversees the health aide certification and the manuals; that
officer also sits on the board to ensure compliance on the
federal side.
8:26:59 AM
REPRESENTATIVE KOPP said that he appreciated Ms. Singh's
comments about compacting public safety, and that he thought the
entire VPSO program budget was about $11 million dollars total
within the Department of Public Safety (DPS). He asked Ms.
Singh whether she knew the total value of the ATHC.
8:27:32 AM
MS. SINGH replied that she didn't know, but that the question
could possibly be answered by Verne Boerner from the Alaska
Native Health Board (ANHB), the next testifier, who would get
into more details of economic impacts.
8:27:52 AM
REPRESENTATIVE KOPP posited that the total value of the ATHC is
actually in the billions and that he was certain it could manage
a $1 million dollar program.
8:28:15 AM
CHAIR ZULKOSKY said that Representative Kopp's point was well
taken. She then asked Ms. Singh to revisit the portion of her
statement regarding sovereign immunity with regard to the
federal government's coverage of tribes and tribal consortiums'
liabilities.
8:28:33 AM
MS. SINGH replied that ATHC employees are covered under the
Federal Tort Claims Act (FTCA), a statute which provides tort
coverage to federally employed medical providers. Because of
this, she added, TCC does not need to waive their sovereign
immunity. If an issue comes up and someone is questioning
medical malpractice, TCC works with federal attorneys and
investigators, who do a thorough review of the case file.
Certain protocols must be abided by in order to keep tort
coverage intact in these cases, and federal attorneys represent
the tribal entities if a lawsuit arises. She added that in the
11 years she has been at TCC they have not reached this point.
She then postulated that after a thorough review, the number of
lawsuits would be remarkably low.
8:30:53 AM
CHAIR ZULKOSKY asked Ms. Singh to speak to the committee about
the importance for Alaska tribes of keeping sovereign immunity
intact and what it means in terms of recognition, and how that
relationship has been able to be maintained through the ATHC.
8:31:27 AM
MS. SINGH related that, just like the state of Alaska wants to
protect itself from being sued, the public interest in
government is more important than a private interest in a
lawsuit. Every time someone is sued, she added, it is because
they have waived their sovereign immunity. It's the same with
tribes: the government can't be totally torn down through an
individual lawsuit. She provided the following example: there
is a small grant from the state of Alaska for $100,000 for
weatherization of homes. A request is made to waive immunity
for all programs in order to receive said grant, and then
something happens in the implementation of the grant and there
is a liability lawsuit. According to Ms. Singh, it's not worth
the risk, especially to a small village whose entire operation
could shut down. She urged the committee to do away with the
waiving of sovereign immunity in broad strokes because it's not
worth it if it's for something much greater than what is being
given.
8:35:09 AM
CHAIR ZULKOSKY checked that Ms. Singh was saying it came down to
tribes being asked to waive a disproportionate amount of risk
and responsibility for a value and return that's not providing
such broad benefits to the communities that the tribes are
serving.
8:35:41 AM
MS. SINGH agreed with the summary.
8:36:00 AM
VERNE BOERNER, President and CEO, Alaska Native Health Board,
began by imparting to the committee that she lives in Anchorage
but that her heart and home were in Kiana, Alaska, and that she
is Inupiaq and enrolled in a Native village of Kiana.
Referencing Ms. Singh's presentation, Ms. Boerner mentioned the
information the committee had been given regarding the work,
relationships, and mechanisms of the compact, and let them know
that she would provide impact information on how the compact has
shaped the ATHS and its impact on the state of Alaska. The
compact also had its twenty-fifth anniversary last year, showing
the strength of the compact and the resilience of its member
organizations to work for the betterment of all Alaska Natives
and American Indians in Alaska. The compact has also
strengthened the work of the ATHS, Ms. Boerner added. She
imparted that Alaska tribes are unmatched nationally in the
realization of the level of self-determination and self-
governance.
MS. BOERNER, as Ms. Singh had pointed out, Ms. Boerner informed
the committee that the 229 federally recognized tribes in Alaska
operate via a single compact agreement while maintaining each
tribe's and its respective tribal organization's right to
exercise sovereignty and negotiate individual agreements. Ms.
Boerner related that the compact's innovative system was created
out of necessity to provide health care and public health
services to now more than 177,000 Alaska Natives and American
Indian people, and the entirety of the 229 federally recognized
tribes. The ATHS, the largest health care system in the state
and one of the largest in the country, is a vital part of many
communities, for whom tribal health programs are the only access
point of care, Ms. Boerner said, adding that many centers have
become dually funded community health centers providing care to
thousands of non-Alaska Natives and American Indians.
8:39:58 AM
MS. BOERNER explained that in 2012 a special relationship was
forged with the Alaska Veterans Affairs (VA), extending the VA's
footprint from six points of access to care to over 200,
reaching across the entire state and providing access to care
for Alaska veterans both Native and non-Native, many of whom had
not had access to care in decades. Due to its service
population and statewide reach, the ATHS represents a large part
of Alaska's economy, Ms. Boerner pointed out. The ANHB
commissioned an economic impact study in 2017 and found that the
system was 5 percent of the entire Alaska economy. The health
system is a larger sector of the economy than the retail trade,
the construction industry, the professional business and
technical service sector, all arts and entertainment, all
manufacturing, the information sector, utilities, and
agriculture and forestry sectors.
MS. BOERNER relayed that he tribal health system generated
18,000 jobs for Alaskans and contributed a total economic output
of $2.4 billion in the state, Ms. Boerner explained. This can
be broken down into economic sectors, she continued: the ATHS
spent approximately $63.4 million on travel and lodging alone in
2017; it also spent 64.6 million in capital expenditures that
year, which is approximately one third of the proposed fiscal
year 2021 (FY 21) state capital budget and was at the time about
50 percent of the FY 2018 capital budget. As a part of the
APHS, the ATHS has served as a pillar for the state's economy
and as a partner with the State of Alaska as it pursues policy
and health care coverage. The system helps the State of Alaska
provide adequate health care statewide in its most remote
corners and is an active partner in the public and emergency
health response system, Ms. Boerner imparted. This partnership
has not only generated net economic impact for the state, but it
has also helped produce massive savings to the state budget in
the form of federal Medicaid offset.
8:43:04 AM
MS. BOERNER added that the ATHS has helped the state budget a
total of $152 million dollars, Ms. Boerner explained. That
includes savings of $72.6 million in FY 19 alone, she added.
Currently the state expects to save $104 million through tribal
health programs in FY 21. Because ANHB is Alaska-based, -owned,
and -operated, the ATHS can work with the state to achieve these
types of savings. The compact has made all of this possible
through the realization of self-determination and self-
governance of Alaska tribes, she reiterated. When governance is
returned to the tribes and tribal leaders, they can make
decisions which will produce the best outcomes for the people,
something that is also true as a part of the Federal Trust
Responsibility, which underpins the ATHC.
MS. BOERNER surmised that with nearly half the tribes in the
United States [in Alaska], if the State of Alaska would embrace
the sovereignty of the tribes as partners, much could be done to
benefit from the Federal Trust Responsibility. The health
board's partnership with the state is already yielding
substantial savings for the state as a whole, and the tribes
have proven to be good stewards of the board's resources.
Tribes in Alaska have the largest businesses in the state, are
the largest and best employer, and have designed national,
award-winning, and internationally recognized programs, said Ms.
Boerner. She wrapped up by adding that the ATHS invests in
Alaskans and in Alaska.
8:45:19 AM
REPRESENTATIVE EDGMON asked Ms. Boerner to speak about the
compliance aspect with which the health care system is involved,
with specific attention to the audits.
8:46:32 AM
MS. BOERNER replied that there are a number of different ways in
which compliance issues are measured, and that many of the
board's systems are dually funded and have multiple funding
sources. The various funding sources also have different
requirements, she added, so many board facilities are also
community health centers which go through an accreditation
process and have to meet reporting requirements in order to be
become eligible to receive the funding. Some tribal health
organizations have to do as many as six different types of
audits and reporting in a year. Ms. Boerner said the board has
been working with the federal government to try to streamline
some of the reporting requirements, but the board's programs are
well documented and reported on as far as compliance issues are
concerned.
8:48:08 AM
REPRESENTATIVE EDGMON replied that, being a member of a tribe
himself, he was intrigued that there are the normal channels of
compliance through government regulators, but also the
compliance of measuring up to what the people expect. He added
that the latter level of compliance, informal as it might be,
could easily be at the top of the list: being answerable to the
people is a really important connection.
8:48:50 AM
MS. BOERNER answered Representative Edgmon that she agreed
completely; the most stringent and selective compliance
requirement does come through the people, and that is one of the
beauties of self-determination and self-governance.
8:49:22 AM
CHAIR ZULKOSKY asked Ms. Boerner to speak to how cost savings
are realized; not in terms of displacement of particular line
items of state or federal spending, but how the compact has been
able to improve outcomes as well as save dollars.
8:50:33 AM
MS. BOERNER stated that the numbers she gave are actual numbers
of the portion that the federal government reimburses the state
through the Medicaid program. For services provided to tribal
members through the ATHS, the state is able to claim 100 percent
of those costs and be reimbursed fully by the state. She
imparted that there are also a number of other cost savings that
come from developing a statewide system like the ATHS given the
vastness of Alaska: being able to establish referral patterns
and relationships and developing telehealth. The system as a
whole is able to benefit from economies of scale, she added.
One great example of the benefits and the savings to the state,
she imparted, is the relationship with the Alaska VA, which
started in 2012. Prior to 2012, veterans had six points of
access to care in the state and they were largely centered in
urban areas; much of the state was not covered and veterans were
not able to access care.
MS. BOERNER explained that after the tribal share agreements
were entered into, the VA extended its footprint all across the
state to over 200 facilities and for the first time in decades
veterans, Native and non-Native alike, were able to access care.
The board was working with the VA to help encourage enrollment
of benefits: there are an estimated 70,000 to 90,000 veterans
in the state of Alaska and only about 35,000 of those have
enrolled with the VA, Ms. Boerner shared. This is another
economic driver in being able to provide these services within
the state as opposed to sending veterans out of state for care,
she added.
8:53:42 AM
REPRESENTATIVE LINCOLN asked Ms. Boerner to highlight any
programs or technological innovations that took place within
tribal health.
8:54:08 AM
MS. BOERNER replied that she would highlight the development of
the community health aide program. She related that her own
grandmother was one of the first-generation community health
aides in the state, and that that program has allowed community
members to be trained and provide culturally relevant care to
communities across the state, even in the smallest villages.
The health aide program is currently being implemented in the
Lower 48, she added, and is an evidence-based program that shows
and demonstrates that community members are able to get access
to care and interventions earlier. The model has been utilized
in other parts of the world and was a precursor to the dental
health aide therapist program that was implemented and designed
in New Zealand following the community health aide program that
was also brought home to Alaska.
MS. BOERNER said from this same model, the behavioral health
aide program has also been developed. Alaska and the tribal
health system have been leaders in developing telehealth across
the nation, she went on to say, and partnerships with the
Federal Communications Commission (FCC) extend access to care
via telehealth visits, which save $850 per visit. Award-winning
programs such as the Nuka System of Care (also known as "Nuka")
have also been highlighted and implemented in the Lower 48 with
other tribes. The National Health System (NHS) in the United
Kingdom has also shown interest in Nuka.
8:58:18 AM
CHAIR ZULKOSKY asked Ms. Boerner to speak to the ground rules
aspect when it came to establishing such a successful compact.
8:59:22 AM
MS. BOERNER replied that the agreements between the tribes are a
product of many, many hours of work and negotiations between the
tribes, and that ground rules come from a basis of consensus.
Early on in the negotiations process, tribes would remain
together into the wee hours of the morning and just have enough
time to return to their lodgings and shower and come back to the
table to continue the process, she explained. Putting the 229
tribes together in unison speaking with the federal government
really lifts the voice together, she added.
9:01:45 AM
MS. SINGH advised that ground rules are important because
process is important. Because TCC relies so heavily on the IHS
to provide information and updates, it's very important that all
deliver their summation in a timely manner, she explained. When
ground rules were developed, an improvement in process was seen,
she added.
9:04:08 AM
REPRESENTATIVE LINCOLN said that if he remembered correctly, the
federal government initially was going to contract with a
limited number of tribal organizations in the state, but the
tribal community throughout the state came together and said
that rather than just work with one or two tribes they should
all work together and use that one opportunity to grow that into
one compact instead.
9:04:47 AM
MS. SINGH confirmed this and said TCC was offered by IHS one
agreement in the state of Alaska. Even though a compact had
never been done before, it made more sense than fighting over
it. Being able to visit other IHS regions around the country
and the challenges they face not being within a larger tribal
system, she explained, confirmed that the decision by going with
one compact was the right one, and that progress has come out of
the unification.
9:06:41 AM
MS. BOERNER added that one other benefit to having the single
compact is the fact that by having it, the board is able to
create institutional memory. Ms. Boerner related anecdotally
that a tribe in Arizona had made some inroads but not as swiftly
as were made by the tribes in the compact due to the Arizona
tribe's multiple changes in leadership. Institutional memory
survives various changes in governance itself, she added.
9:08:19 AM
REPRESENTATIVE KOPP remarked that every tribe is able to do an
individual compact under the law, but he wondered whether it had
happened anywhere else.
9:10:10 AM
MS. BOERNER replied that there have been some great
collaborative efforts throughout the Lower 48 but not a single
compact. The Northwest Portland Area Indian Health Board
(NPAIHB) has 46 federally recognized tribes in Washington,
Oregon, and Idaho; they have created the NPAIHB and have been
able to put forward as a tribal organization a unified position
on various health issues affecting those 46 federally recognized
tribes, but it's not the same as in the compact, as each NPAIHB
tribe enters into its own separate compact with the federal
government, whereas the ATHC speaks as one voice.
9:11:47 AM
CHAIR ZULKOSKY summed up that effectively, Alaska is the only
state in the nation with both the tribal representation and the
economic impact, and the scopes have worked in the size and
breadth and complexity of its type within the compact in the
country.
9:12:10 AM
MS. BOERNER agreed with this summation.
9:12:57 AM
ADJOURNMENT
There being no further business before the committee, the House
Special Committee on Tribal Affairs meeting was adjourned at
9:13 a.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| Alaska Tribal Health Compact Amended and Restated October 1 2010.pdf |
HTRB 2/11/2020 8:00:00 AM |
Alaska Tribal Health Compact |
| ATHC Negotiation overview.pdf |
HTRB 2/11/2020 8:00:00 AM |
Alaska Tribal Health Compact |
| ATHC Negotiations Process.pdf |
HTRB 2/11/2020 8:00:00 AM |
Alaska Tribal Health Compact |
| Differences Between Title I Contracting and Title V Compacting.pdf |
HTRB 2/11/2020 8:00:00 AM |
Alaska Tribal Health Compact |