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Veterans Crisis Line Badge

Office of Public and Intergovernmental Affairs

Remarks by Secretary Robert A. McDonald

National Indian Health Board Annual Health Consumer Conference
September 23, 2015

Mr. Lester Secatero, thank you for that introduction and for your leadership of the National Indian Health Board.

Members of the Board, the Executive Committee, and all tribal leaders and elders, thank you for welcoming me.

And my fellow Veterans—who bring such honor to our communities—American Indians, Alaska Natives, everyone, good morning.

My name is Bob.

First, I would again like to publicly share my acknowledgement of the important government-to-government relationship between the United States and Indian Tribes.

At VA, we respect your tribal governments. And we’ll continue to make every effort to respect tribal sovereignty and consult with tribes before we make decisions that may affect tribal governments and tribal citizens.

Further, I want to reiterate my commitment to honoring that relationship and ensuring VA collaborates as equal partners with Indian Country. That’s the same commitment I made last October to the National Congress of American Indians in Atlanta when we talked about taking care of American Indian Veterans, Alaska Native Veterans—all Veterans who have served this country.

Taking care of Veterans is very personal to me. My wife, Diane, and I come from families with strong traditions of military service. Diane’s father was shot down over Europe and survived harsh treatment as a P.O.W. My father served in the Army Air Corps after World War II. Diane’s uncle served in Vietnam, where he was exposed to Agent Orange. He still receives VA care. And today, my nephew has returned from flying missions over the Middle East and commands a fighter squadron in North Carolina.

For myself, I graduated from the United States Military Academy in 1975. My time at West Point and, then, as an Airborne Ranger with the 82d Airborne Division instilled in me strong values and a lifelong sense of duty to country.

Now, nearly four decades later, simple words from West Point’s Cadet Prayer still guide me. That prayer encourages us “to choose the harder right instead of the easier wrong.”

And that’s my commitment to all of you:

  • To always do the right thing for Veterans,
  • To work hard to understand their needs,
  • And to change VA into the Veteran-centric enterprise Veterans have earned and deserve and that meets their needs.

It was during our listening session at last year’s National Congress of American Indians that Mr. Lincoln Bean invited me to Alaska. He wanted me to see and hear first-hand Alaska Native Veterans’ challenges in receiving healthcare. They are living in some of the most remote locations in our country.

So, in August, I headed to Anchorage to meet with the Alaska Native Health Board, the Alaska Native Health Consortium, the Alaska Federation of Natives, and the Southcentral Foundation.

The weather was beautiful, in the mid-60s, not what I remembered from one visit to Alaska under starkly different circumstances—in a winter paradrop during training operations when I was in the 82d Airborne.

While I was there in August, I spent a good deal of time talking with Mr. Bean, Ms. Verné Boerner, and Chairman Robert Clark and his board members and tribal health directors.

I was deeply honored to meet tribal elders and warriors of the Alaska Territorial Guard when I traveled to Kotzebue and Point Hope. Point Hope was just one of many stations of the more than 6,400 Veterans of the Alaska Territorial Guard who served from Koyuk in the east to Wales in the west, and from Golovin in the south to Shishmaref in the north.

Talking to them helped me better understand their challenges.

Tomorrow, to keep the important dialogue between all of you and VA going, senior VA and Indian Health Services Leaders will join you in another listening session. They, too, need and want to hear what’s working for Veterans, and where we need to do better. I encourage every Veteran and Veteran advocate to attend that session.

Stephanie Birdwell, VA’s Director of Tribal Government Relations, will be there. Let me ask Stephanie to stand so I can introduce her. Stephanie and her regional specialists are singularly committed to facilitating VA's Tribal Consultation Policy, increasing access to health care, and promoting economic sustainability. Talk with her tomorrow.

If you miss Stephanie at the listening session or still have questions about anything related to Native American or Alaska Native Veterans, call her at 202-461-7400. I want to make sure your questions are answered so we keep progressing in tangible, relevant ways.

And we are making progress. Let me share where we are in improving outcomes for Veterans in Indian Country.

Since President Obama signed his Memorandum on Tribal Consultation in 2009, VA has worked closely with tribal leaders and other partners on behalf of Native Veterans.

To increase American Indian and Alaska Native Veteran access to care, VA and Indian Health Services (IHS) signed a Memorandum of Understanding (MOU) in 2010. Under this MOU, VA, IHS, and tribal healthcare partners formed joint workgroups focused on improving care coordination, healthcare services, reimbursement, training and cultural competency.

VA also collaborates with tribal and IHS partners to deliver services in or near Indian Country by sharing clinic space and delivering telehealth services in many tribal and IHS clinics.

In 2012, VA and Indian Health Services signed a national reimbursement agreement that allows VA to reimburse IHS for care of eligible Veterans. Today, thanks to the hard inter-agency work of Dr. Yvette Roubideaux and Mr. Robert McSwain at IHS, we have made progress delivering quality health care to American Indian and Alaskan Native Veterans through reimbursement agreements.

And tribal health programs have also been establishing reimbursement agreements with VA. The National Reimbursement Agreement with Indian Health Service consists of 83 implementation plans covering 108 IHS sites. We have 82 reimbursement agreements with Tribal Health Programs. Sixty more are in process.

Altogether, we’ve reimbursed $26 million dollars for direct care to 5,700 eligible American Indians and Alaskan Natives. And we estimate that about 20,000 American Indian and Alaska Native Veterans may benefit from the program.

Because of the rural nature of many tribal lands, since 2009 VA’s Office of Rural Health has provided over $53 million to fund 120 initiatives that served American Indian and Alaska Native Veterans. These are initiatives supporting transportation, mental health care, and telehealth projects that increase access and minimize long travel distances. That’s especially important for aging and chronically ill Veterans.

For the chronically ill, Home-Based Primary Care teams on tribal lands and co-located at IHS hospitals and tribal clinics provide services at home. For instance, in a clinic at the Tuba City Health Care Corporation on the Navajo Nation, VA delivers mental health services to Veterans so they can receive VA services closer to home. In North Carolina, a VA funded Home-Based Primary Care team serves the Eastern Band of Cherokee Indians.

And I’m happy to announce that on August 1st, VA formalized its partnership with the Oneida Nation’s Anna John Resident Centered Care Community. This Oneida-owned and operated nursing home facility has already started to furnish care to eligible VA beneficiaries. And the Anna John Care Community will serve both Native and non-Native veterans.

At VA, we know we cannot serve Veterans in the ways they deserve without the help of the community. And these are the sorts of collaborations and partnerships that can expand Veterans access to their benefits and healthcare.

It was in the wake of the access crisis in Veteran healthcare when I spoke to the National Congress of American Indians last October. I’d only been at VA for about 90 days. But I told the NCAI audience that VA has before it the greatest opportunity we’ve ever had to improve care for Veterans.

And I made a commitment that my sole purpose will be taking advantage of that opportunity by putting Veterans at the center of everything we do at VA.

I said I’d stay on the road listening to members of Congress, to Veterans, to VA employees and their unions, to Veterans Service Organizations, and to many other partners.

Well, it’s been a year.

Last October, I’d visited 35 VA facilities in 19 cities. And just as I said I would, I’ve been on the road. To this point, I’ve visited 115 VA facilities in more than 80 cities—some more than once.

Everywhere I go, I’m listening. I’m listening to you and tribal leaders and our honored Veterans of Indian Country.

And VA is transforming, applying proven customer-service principles from the public and private sectors so we can work as a department to achieve our five main focus areas of our MyVA transformation:

  • First, improving the Veteran experience to be seamless, integrated, and responsive;
  • Second, improving the employee experience, focusing on people and culture to better serve Veterans;
  • Third, improving our internal support services;
  • Fourth, establishing a culture of continuous improvement;
  • And fifth, enhancing strategic partnerships—building vital networks of collaborative relationships across the federal government, across state and local government, and with both non-profit and for-profit organizations.

Let me just say a word about strategic partnerships. They bring incredible power and resources to efforts to make positive changes for Veterans. These are partnerships like those I mentioned with the Navajo Nation, the Eastern Band of Cherokee Indians, and the Oneida Nation.

How powerful are good partnerships? Overall across the Nation since 2009, there’s been a 33 percent reduction in Veteran homelessness, and a 40 percent reduction in chronic homelessness among Veterans.

Ending homelessness is a local effort, so we’re working with over 2,000 partners all over the country. Communities have housed more than 200,000 homeless Veterans—many with family members—and provided services to more than 260,000 homeless or at-risk Veterans. Over 72,500 Veterans were either placed in permanent housing or prevented from becoming homeless—that’s more than 100,000 people when we include Veterans’ family members.

Why? It’s because of strategic partnerships. It’s because of some unprecedented state-wide cooperation and coordination among state government, federal agencies, and community non-profits. Collaboration and good government at the state and local levels drive that kind of success for Veterans. It’s just one way communities care for those “who shall have borne the battle,” and their families.

And we’ve tackled the access problem.

Today, we’re meeting Veterans’ growing demand with more of everything available—more hours, more space, more people, more productivity, more accountability, more transparency, and more choice.

We’ve completed 7 million more appointments this year than last—2.5 million at VA, 4.5 million in the community.

Nationally, we complete 97 percent of appointments within 30 days. We complete 92 percent within 14 days, 88 percent within seven days, and 22 percent same day. Average wait times for completed appointments—four days for Primary Care, five days for Specialty Care, and three days for Mental Health Care.

Overall, VA healthcare providers have increased physician productivity 8 percent—on a healthcare budget increase of just 2.8 percent.

Your VA is working harder. We’re working smarter. We’re making real progress. And that means more and better care for more Veterans.

We still have sizeable challenges. And VA cannot do it alone. We need everyone’s help and support.

To meet the challenges of the 21st century, VA will need adequate funding. This is especially important to this audience since Native people serve the Nation in uniform at higher rates than any other population.

There are over 150,000 Native American Veterans. Nearly 27,000 American Indian and Alaskan Natives are defending our freedom today. They bring great honor to your people, following the path of Native American war heroes who are their forebears.

The President’s 2016 budget request will provide the funding we need: $168.8 billion—$73.5 billion in discretionary funds and $95.3 billion in mandatory funds for benefits programs.

The House-proposed $1.4 billion reduction would mean $688 million less for Veterans’ medical care—70,000 Veterans going without care and a 50 percent cut in construction, despite our aging infrastructure. The Senate’s proposed reduction of $857 million will hurt, too—even as we work together hard to improve care for Veterans.

Veterans need full funding of the President’s 2016 budget request for VA.

Veterans who have preserved our freedom are watching.

Those serving today are watching as the military drawdown continues.

And our young men and women who might choose to serve are watching.

All of them rightly expect the Nation to fulfill our obligations with the same degree of dignity and fidelity with which they put their lives on the line for the Nation.

In closing, let me ask for your help in spreading the word about how VA is changing and about what VA has to offer Veterans. It will take the collaboration and work of VA and every tribal leader and elder to serve our Veterans and honor our Nation’s commitment to them. That means going to the VA or inviting the VA to your communities for out-reach.

Let me ask you to get updates about the economic impact Veterans Affairs resources have in your community. Ask how many VA dollars are going to services and benefits in your tribe’s county. Ask if every resource is getting to Veterans and families in tribal communities. Help us ensure Veterans have the opportunity to receive the care and benefits they’ve earned.

And if you have any questions, or your representatives simply do not know where best to begin, well, call Stephanie 202-461-7400.

Let me hear from you.

Veterans, thank you for your courage, service, and sacrifice.

And everyone here this morning, thank you for sharing your time.