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S. Hrg. 103-483, Pt. 1 Senate Hearings Before the Committee on Appropriations ^ Y 4. AP 6/2: S, HRC. 103-483/ PT.l Departnent of the Interior and Reli. Department of the Interior and Related Agencies Appropriations '''='«?1%%, JUi & ®54 Fiscal Year 1994 103d CONGRESS, FIRST SESSION H.R. 2520 PART 1 (Pages 1-1588) DEPARTMENTOFAGRICULTURE DEPARTMENTOF ENERGY DEPARTMENTOFHEALTHANDHUMANSERVICES DEPARTMENTOFTHEINTERIOR SMITHSONIANINSTITUTION DEPARTMENT OF THE INTERIOR AND RELATED AGENCIES APPROPRIATIONS FOR HSCAL YEAR 1994 HEARINGS BEFORE A SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS UNITED STATES SENATE ONE HUNDRED THIRD CONGRESS FIRST SESSION ON H.R. 2520 AN ACT MAKING APPROPRIATIONS FOR THE DEPARTMENT OF THE IN- TERIOR AND RELATED AGENCIES FOR THE FISCAL YEAR ENDING SEPTEMBER AND FOR OTHER PURPOSES 30, 1994, PART 1 (Pages 1-1588) Department of Agriculture Department of Energy Department of Health and Human Services Department of the Interior Smithsonian Institution Printed for the use of the Committee on Appropriations U.S. GOVERNMENT PMNTING OFFICE 6»-€17cc WASHINGTON : 1994 ForsalebytheU.S.GovernmentPrintingOffice SuperintendentofDocuments,CongressionalSalesOffice,Washington,DC 20402 ISBN 0-16-044102-1 COMMITTEE ON APPROPRIATIONS ROBERT C. BYRD, WestVirginia, Chairman DANIEL K. INOUYE, Hawaii MARK O. HATFIELD, Oregon ERNEST F. HOLLINGS, South CaroUna TED STEVENS, Alaska J. BENNETT JOHNSTON, Louisiana THAD COCHRAN, Mississippi PATRICKJ. LEAHY, Vermont ALFONSE M. D'AMATO, New York JIM SASSER, Tennessee ARLEN SPECTER, Pennsylvania DENNIS DeCONCINI, Arizona PETE V. DOMENICI, New Mexico DALE BUMPERS, Arkansas DON NICKLES, Oklahoma FRANK R. LAUTENBERG, New Jersey PHIL GRAMM, Texas TOM HARKIN, Iowa CHRISTOPHER S. BOND, Missouri BARBARA A. MIKULSKI, Maryland SLADE GORTON, Washington HARRY REID, Nevada MITCH McCONNELL, Kentucky J. ROBERT KERREY, Nebraska CONNIE MACK, Florida HERB KOHL, Wisconsin CONRAD BURNS, Montana PATTY MURRAY, Washington DIANNE FEINSTEIN, California James H. English, StaffDirector Mary S. Dewald, ChiefClerk J. Keith Keiwedy, Minority StaffDirector Subcommittee on Department of the Interior and Related Agencies ROBERT C. BYRD, WestVirginia, Chairman J. BENNETT JOHNSTON, Louisiana DON NICKLES, OUahoma PATRICK J. LEAHY, Vermont TED STEVENS, Alaska DENNIS DeCONCINI, Arizona THAD COCHRAN, Mississippi DALE BUMPERS, Arkansas PETE V. DOMENICI, New Mexico ERNEST F. HOLLINGS, South CaroUna SLADE GORTON, Washington HARRY REID, Nevada MARK O. HATFIELD, Oregon PATTY MURRAY, Washington CONRAD BURNS, Montana Professional Staff Sue Masica Rusty Mathews Kathleen Wheeler Administrative Support Ellen Donaldson (II) CONTENTS Tuesday, April 20, 1993 Page DepartmentofHealth and Hiunan Services: PublicHealth Service: Indian Health Service 1 Tuesday, May 4, 1993 Smithsonian Institution 73 Thursday, May 6, 1993 Department ofthe Interior: Acting Assistant Secretary for Fish and Wildlife and Parks 163 Tuesday, May 11, 1993 Departmentofthe Interior: BureauofIndianAffairs 323 National Indian GamingCommission 411 Wednesday, May 12, 1993 DepartmentofEnergy: OfBce oftheAssistant Secretary for Energy Efficiency and RenewableEnergy 459 Wednesday, May 19, 1993 Departmentofthe Interior: U.S. Fish andWildlife Service 679 Tuesday, May 25, 1993 Departmentofthe Interior: Biu-eau ofLandManagement 935 Wednesday, May 26, 1993 DepartmentofAgriculture: ForestService 1123 Tuesday, June 8, 1993 Departmentofthe Interior: OfBce ofthe Secretary 1389 Tuesday, June 15, 1993 DepartmentofEnergy: OfBceofthe Secretary 1507 an) DEPARTMENT OF THE INTERIOR AND RELAT- ED AGENCIES APPROPRIATIONS FOR FIS- CAL YEAR 1994 TUESDAY, APRIL 20, 1993 U.S. Senate, Subcommittee of the Committee on Appropriations, Washington, DC. The subcommittee met at 3:33 p.m., in room SD-116, Dirksen Senate Office Building, Hon. Harry Reid presiding. Present: Senators Reid, Murray, Nickles, Stevens, Domenici, and Bums. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Indian Health Service statementofmichele.lincoln,actingdirector accompanied BY: DUANEJEANOTTE,ACTINGDEPUTYDIRECTOR MILBURNH. ROACH, EXECUTIVEASSISTANTTOTHE DIRECTOR DR. PHILLIP SMITH, ASSOCIATE DIRECTOR FOR HEALTH PRO- GRAMS ADM. WILLIAM PEARSON, ASSOCIATE DIRECTOR FOR ENVIRON- MENTALHEALTHANDENGINEERING GEORGE BUZZARD, ASSOCIATE DIRECTOR FOR ADMINISTRATION AND MANAGEMENT BUDGET REQUEST Senator Reid. The subcommittee will come to order. This is the first hearing of the Interior subcommittee on the fiscal 1994 budget, which was formally submitted only 12 days ago. In total for the programs under the subcommittee's jurisdiction, the President has requested $13.5 billion, an increase of $1 billion over last year's level, or about 8 percent. Before anyone gets too excited, though, about these increases, it should be realized that the 602(b) allocation provided to the subcommittee will ultimately determine the funding levels for these programs. For the first time in several years the Interior subcommittee could be faced with a situation where its' allocation requires reduc- tions to the President's budget, rather than increases. (1) Many agency budgets, including this one, are rededicated to maintaining the existing program base by scaling back on new construction. The theme this year appears to be one of operational re- sponsibility, namely, that funds should be allocated to address more adequately the needs of existing facilities and existing programs before imposing new operational requirements. Turning to the matter before us, this is the time scheduled to re- view the Indian Health Service budget. This afternoon testif3dng is Mr. Mike Lincoln, Acting Director ofthe Indian Health Service. In the fiscal year 1994 budget the request for the Indian Health Service is $1,880,120,000. This is an increase of almost $22 million compared to last year's enacted level. Included in the fiscal year 1994 proposal is $22 million cat- egorized as the Indian health portion ofthe President's investment initiative. The investment funds for the Indian Health Service will be used to help maintain the current level of services provided to Indian Health Service hospitals and tribal and Indian Health Service clinics throughout Indian country. In addition, the budget attempts to maintain current services through a transfer of funds from the facilities account to the services account. For the first time in a long time the Indian Health Service budget does not assume third party fee collection—s that are far in excess ofrealistic expectations for the current year and I appreciate that. Nor does it propose that these funds be redirected from their au- thorized purpose to the conduct of ongoing programs. For that the administration is to be commended. The total level of third party collections assumed for this budget is $138 million, the same as the current estimate for 1993, and con- sistent with the actual collection level experienced in 1992. Mr. Lincoln, your complete statement will be included in the record. I invite you to summarize your remarks so that we can proceed directly to the questions. Also, because this is your first time testifying before the subcommittee your biographical sketch will be included in the record as well, ana I have reviewed that and am impressed with it. I would then ask that you summarize your statement so we can get on to the questions unless. Senator Murray, do you have any statement? Senator MURRAY. I do not have an opening statement. I am de- lighted to be a part ofthis hearing. Senator. It is a very important item for the people in the State ofWashington. Senator Reid. Please proceed, Mr. Lincoln. STATEMENT OF MICHEL E. LINCOLN Mr. Lincoln. I am accompanied today by Dr. Phillip Smith, As- sociate Director for the Office of Health Programs; Adm. Bill Pear- son, who is the Associate Director for the Office of Environmental Health and Engineering; Mr. Howard Roach, who is Executive As- sistant to the Director ofthe Indian Health Service. Senator Reid. I thought it wasjust a few weeks ago but it's been 1 year ago. Mr. Roach. It has been 1 year ago. Mr. Lincoln. Duane Jeanotte is the current Director of the Bil- lings area; and Mr. George Buzzard, is the Associate Director for the Office ofAdministration and Management. The $1,880 billion budget that we have submitted to the Con- gress reflects the President's policy ofinvesting in health care services on behalfofAmerican Indian and Alaskan Native people. As you noted in your opening comments this year we were very straightforward about presenting the Medicare and Medicaid pro- jected collections and how those collections would be used. Indeed, we anticipate collecting approximately $120 million in Medicare and Medicaid and those funds will be used to continue to maintain and correct deficiencies associated with the Joint Com- mission on Accreditation for Health Care Organizations; $18 million will be collected from private insurance and those funds will be used to address the need for additional services in the Indian Health Service. The goal of the Indian Health Service, as stated many times, is to raise the health status of Indian people to the highest level pos- sible. To carry out this mission the Indian Health Service has four subgoals and they are important because they dictate our work in the Indian Health Service. The first goal is to assist Indian tribes in developing their health programs; the second is to facilitate and assist Indian tribes in ob- taining and using the health resources available through Federal, State, and other local programs; the third is to provide comprehen- sive health services; and, fourth, the Indian Health Service serves as the principal Federal advocate for American Indians and Alas- kan Natives in health matters. There are approximately 1.3 million Indian people served by the Indian Health Service this past fiscal year and we anticipate the same amount ofpeople being served in fiscal year 1993. In addition to the 1.3 million Indian people served directly by the Indian Health Service, there are an additional 900,000 Indian people who live off reservation in urban areas and these individuals are served by a modest but very important program that is funded through the Indian Health Service to urban Indian organizations throughout this country. Tribal governments, the Indian Health Service program, and urban Indian organizations provide an unprecedented, comprehen- sive scope of preventative, clinical, curative, and rehabilitative services. This community-based primary care program consists of community health services, maternal and child health services, women's health programs, alcohol and substance abuse programs, diabetes care, and environmental health services. And, unlike many other health delivery systems, we are involved in the construction of hospitals, the construction of quarters necessary to staff those hospitals and, perhaps most importantly, we are involved in the construction of water and sanitation projects throughout this country. It is unique that in a single agency this scope ofservices be provided to a given people. It is necessary to support an infrastructure when providing this wide scope ofservices. To that end the Indian Health Service main- tains a management information system that not only counts the number of people served and what services are provided to those individuals, but also aides us in determining whether or not the health status of a people is actually improved. Mortality and mor- bidity information is critical to understanding the mission and to documenting whether or not the Indian Health Service is carrying out its mission. The Indian Health Service operates 42 hospitals, 65 health centers, and numerous other health stations. Through those facilities and with the people in those facilities approximately 65,000 inpatient admissions were provided. The average length of stay for a hospital admission in the Indian Health Service is approximately 4.1 days per admission. So one can see that approximately 260,000 inpatient days were provided through Indian Health Service facilities. In addition to that almost 4 million ambulatory care visits were provided. This is only part of the story, though. This is a tri-partite effort to provide health care to Indian people. The Alaskan Native Amer- ican Indian people and tribes and organizations also operate 8 hospitals and 93 health centers, 172 Alaskan village clinics as a partner in delivering health care to the Indian people. These programs, these tribally managed programs, in 1991 provided almost 7,000 inpatient admissions and 1.1 million outpatient visits. This tribal health delivery system now operates about 35 percent ofthe Indian Health Service clinical program. The third partner in this effort to provide health services to In- dian people is urban Indian organizations, as I mentioned before. There are 34 Indian organizations throughout this country which operate 28 health centers and 6 community outreach programs. Numerous services and activities are provided to Indian people who have relocated to urban areas for various reasons throughout the last 20 to 30 years. An integral part ofthe Federal and tribal program is the contract health services program. This is a program where services are purchased in support of the direct care program or services are purchased that cannot be provided in the Indian Health Service or tribal facilities. In this regard approximately 17,000 admissions were purchased through the private marketplace by the Indian Health Service and 154,000 outpatient visits. Likewise, the tribal health programs purchased approximately 4,500 admissions through the private marketplace and 167,000 outpatient visits. We know of no other health care organization that accomplishes such a wide array of activities and operations and program ele- ments within a single agency. As the result ofthese Indian Health Service and tribal and urban program efforts, I believe the health ofthe Indian people continues to improve. The Indian Health Service and its tribal counterparts and its urban counterparts have made significant strides in reducing early and preventable deaths. Indeed, there is a metamorphism occurring, an evolution occurring, Mr. Chairman, as the health problems that are affecting Indi- ans, which in the past 20 years have been infectious communicable diseases, have now become chronic behavioral diseases. The infant mortality has been reduced dramatically over the last 20 years.