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Submission For The Record of Grand Traverse Band of Ottawa and Chippewa Indians

WRITTEN STATEMENT OF ALVIN V. PEDWAYDON, TRIBAL CHAIRMAN, GRAND TRAVERSE BAND OF OTTAWA AND CHIPPEWA INDIANS TO THE DEPT OF VETERANS AFFAIRS BEFORE THE SUB-COMMITTEE HEALTH COMMITTEE ON VETERANS’ AFFAIRS,
U.S. HOUSE OF REPRESENTATIVES;
EXAMINATION OF RURAL AND NATIVE AMERICAN VETERANS’
ACCESS TO HEALTH CARE - AUGUST 27, 2014

My name is Alvin Pedwaydon and I am the Chairman of the Grand Traverse Band of Ottawa and Chippewa Indians (GTB or Grand Traverse Band). I am a Vietnam-era veteran and a resident of Northwest Michigan who has directly encountered healthcare issues, both as a provider in my capacity as Chairman of Grand Traverse Band, and as a recipient as a veteran and tribal member. Grand Traverse Band has 4,100 members or which 1,500 reside in rural Northwest Michigan. My testimony reflects both my position as Chairman of GTB and my individual position as a Vietnam-era veteran and resident of rural Northwest Michigan.

Grand Traverse Band has a storied and turbulent history of military service against and for the United States. Based on our sovereign status as an Indian Nation, like other Indian Nations in the United States, we have fought against the United States and we have fought for the United States. The last hostile encounter between GTB and the United States was the war of 1812; and our resistance to the United States’ attempted Indian removal of our ancestors to Kansas and Oklahoma in the 1830s and 40s.  Our ancestors have nevertheless willingly and gratefully served with honor in the United States armed forces since the Civil War. Members of our Tribal Council, for example, have great-great grandparents who were participants in Company K, Michigan Ottawa Indian Sharpshooters, a total Ottawa Indian Company from our area that fought on the Union side in the Civil War. Our ancestors have also served proudly and honorably in World War I and II, Korea and Vietnam, Gulf (Operation Desert Storm) and the Iraq and Afghanistan wars. GTB also honors its members who participated in the “Siege of Wounded Knee” in 1973 as warriors for Indian Country.

It is this historical complex relationship between Indian Tribes and the United States that defines the scope of our healthcare problems as manifested in our healthcare delivery systems. The history of federal Indian law and the relationships of the Tribes to the United States is a quagmire of complexity that represents both the pain and promise of federal Indian law and our historical relationship with the United States. Clearly Indian Tribes want to maintain their sovereign status as indigenous inhabitants to this continent and we have fought ferociously over the years to maintain this sovereign status. The United States has recognized this sovereign status in the implementation of a complex federal statutory system of federal domestic services.  

In the area of healthcare we must content with the Indian Self-Determination and Educational Assistant Act (ISDEA); the Indian Healthcare Improvement Act; and services offered to veterans under Veterans Administration (VA) delivery systems. The Indian Healthcare Improvement Act (IHCIA) achieved permanency status in the landmark legislation, the Patient Protection and Affordable Care Act (ACA), signed by President Obama in March of 2010. We applaud this permanency and recognition of tribal sovereign status in the ACA. The defining concept of the ISDEA and the IHCIA is self-determination for Indian Tribes. We administer a comprehensive and expensive healthcare delivery system for our tribal members in Northwest Michigan. Indeed, we are probably the second biggest healthcare payor and provider in Northwest Michigan. The defining characteristic of ISDEA and IHCIA is administration by the tribes under a well-defined self-governance concepts and processes that have had the opportunity to develop detailed and complex federal regulations governing healthcare delivery to tribal members. In a thumbnail, those regulations consist of approximately 1,000 pages of CFR regulations, or more appropriately, digital screen images, which the tribes have had the opportunity to implement and develop by negotiated rule-making.

By any measure of modern bureaucracy, both the ISDEA and IHCIA have been a resounding success nationwide for Indian Country. We still argue with the Health and Human Services Department (HHSD) over the scope of the costs and associated indirect costs, but the Tribes have generally prevailed on the merits in requiring HHSD to fully fund indirect costs. We are now confronting and coordinating a MOU agreement with the VA to deliver reimbursement costs for eligible veterans who access our tribal healthcare system. This effectively melds two systems of healthcare delivery, and as expected, we have had problems in fully implementing all of the VA eligible activities into our existing Indian healthcare system.

In particular, the VA system does not have statutory authority similar to the HHSD that permits an Indian tribe to negotiate a 638 self-governance contract under ISDEA to ultimately culminate in a totally administered tribal program. We would suggest that such statutory authority would provide opportunities for Indian tribes and the VA to work out alternative delivery systems for rural-based Indian veterans. Presently, the VA uses an MOU agreement on the model of a “one size fits all” regardless of the individual circumstances of the demographic picture of the service population. For example, it has been GTB’s experience that it is cost-effective for us to bring dental and eye care services directly in-house at our healthcare clinic, but that it is not cost-effective to bring auditory services in-house. Therefore, our service population generally has quick turn-around time for dental and eye care services and delayed service for auditory benefits.

In my own personal experience, because of the remoteness of our location and the necessity of my application to go through a centralized processing VA system, I had to wait eight months to receive my hearing aid. In my position as Tribal Chairman, a very public position, this was extremely frustrating and detrimental to me in effectively administering my office, which requires participation in public meetings. I would suggest that VA statutory authority to negotiate with a Tribe, beyond a simple MOU agreement for direct in-house service, might be a solution for rural Native veterans who do not have access to a VA hospital but do have access to an Indian health clinic.

We applaud the efforts of the VA to have a tribal liaison office and we would suggest that VA services follow the Indian Health Services to have native-specific care modalities, like the Indian Health Service and tribal clinics. Currently, the VA does not make any concessions in services to Native-based beliefs. Though the VA is subject to Indian preference hiring, the VA has not implemented an active Indian preference hiring system for our area. Finally, because of the last decade of war, we unfortunately have a whole generation of wounded warriors suffering from PTSD. This population should receive special attention by the VA and the focus for rural Native Americans should be on establishing pilot PTSD programs for rural Native Americans directly serviced by existing Indian healthcare clinics.

I want to thank you for this opportunity to present these views of the Grand Traverse Band and my personal experience individually and to personally commend you for taking the time to address this important issue for rural Native American veterans and their healthcare.