“Whether it’s improving health care or making our economy more innovative, the policies we craft must include the voices and perspectives of Native Americans.”

As prepared for delivery.

“I want to start off by thanking President Harvier, the Tribal council, and the entire Salt River Pima – Maricopa Indian Community for hosting the Committee, and Representative Schweikert for bringing us to Arizona.  

“This is the first Ways and Means hearing on sovereign Tribal land in our Committee’s 235-year history. It’s an honor to be able to make this history in the chamber where this community exercises its right to self-governance.

“We are here in Arizona to strengthen our government-to-government relationship and affirm our commitment to help Tribal communities prosper. Whether it’s improving health care or making our economy more innovative, the policies we craft must include the voices and perspectives of Native Americans.

“I have the honor of representing southern Missouri, which is one of the most rural areas in the entire country. It’s a region filled with hard working families who do right by their neighbors. It’s also a region where many folks struggle to make ends meet. Though the experiences of rural communities and Tribal communities are not the same, I see similarities between some of the broad challenges they both face.

“Native American Tribes face unfair double standards in solving those challenges. The Committee has been focused on policies aimed at strengthening Tribal families, particularly in the areas of child welfare, adoption, and child support. 

“Tribal child support agencies, unlike state agencies, are not allowed to garnish past-due child support from tax refunds. As we heard at a Committee hearing last fall, it makes it more difficult for parents to take care of their children. 

“Tribes face unique challenges when it comes to administering federal child welfare programs. Native American children, constituting just 1 percent of the total child population in the United States, are disproportionately represented in foster care placements, accounting for 2.7 percent of placements. Collaboration between state agencies and Tribes is necessary to ensure culturally appropriate interventions and placements within their communities to protect vulnerable children and keep families together whenever possible. 

“One area that unites both rural and Tribal communities is the health care crisis. There are simply not enough doctors, nurses, or sites of service. As a result, rural Americans have a 43 percent higher mortality rate compared to Americans living in cities and suburbs, and Native Americans have a 33 percent higher mortality rate. Those are tragic facts that show more work needs to be done to solve this crisis. 

“The Committee is focused on working toward a future where every individual can access health care in the community where they live and work. 

“Part of the challenge is getting more doctors to practice in rural and Native American communities. When doctors complete their residency in a rural community, they are six times more likely to set down roots and practice. This week, our Committee voted to guarantee that recent Medicare-funded residency slots promised to rural hospitals are actually filled by truly rural hospitals. This is just a first step, and the Committee will make further improvements to the Graduate Medical Education program to secure the physician workforce for rural Americans. At the same time, we should look at how to help grow the health care workforce serving Native American communities as well.

“Patients also need open hospitals and quick emergency services in their area. Your Congressman, David Schweikert, has been a champion in Congress for preserving health care for every family. Just two days ago, the Committee passed his bill that allows Medicare patients to continue to use telehealth and provides critical funding for small hospitals and emergency services across the country, including right here in the East Valley. 

“Looking at the future, we must use every tool we have to end the health care crisis in underserved communities. For example, a competitive tax code will help businesses innovate and produce the next generation of life-saving drugs and medical products. Next year, the tax cuts passed under President Trump that fueled innovation and made American businesses more competitive will expire. We must find ways to build on the success of those tax cuts.

“I want to thank the witnesses for taking time to be with us today. 

“We also want to hear from everyone in the audience as well. There will be clipboards passed out for everyone to share with us your concerns and ideas. We will enter those into the official hearing record and take those back with us to Washington as we consider how to empower Native American and rural communities.”