Rep. Kilmer COVID-19 Town Hall: Achieving Quality Health Care for Native American Communities

Okay. Hello folks. Derek Kilmer here from our nation's capital where it's really muggy but I I wanted to take a moment. you know I have the honor of representing the number of tribes in our region and the key part of my job is just making sure that the government works better for our tribal communities and part of that is making sure that the federal government upholds its treaty and trust obligations and that that that applies to health care too. right now, we know that the Corona virus is unfortunately disproportionately. Communities of color and that includes Native Americans and while Congress has taken some actions to support Native Americans, we know that there's a lot more to do so today. I'm honored to be joined by Esther Lucero, the CEO of the Seattle Indian Health Board, to talk about how we can work together to ensure the federal government steps up and provides adequate health care for Native Americans during this pandemic and into the future. Esther Thank you for being here today. I sure appreciate it. Thank you Representative Kilmer. It's always a pleasure to see you and work with you and just have a dialogue and it's really an honor to be a part of this conversation and it's just to introduce myself. I'm hey everybody. My name is Esther Lucero. I am Danae and Latina and as a representative Kilmer said, I am the CEO for the Seattle Indian Health Board and Representative Arora have to tell you it is a beautiful summer day in Washington and I'm gonna tease you with that just a little bit because. How amazing that is, I have some jealousy. I'll be honest. Yeah. it's a circle of hell in our nation's capital. It turns out they're on a swamp maybe Esther maybe just a level set the conversation can you just maybe take a step back and explain how Native Americans in our region actually get health care. Can you explain that to you? The IHS tribal and urban system of care in the Seattle Indian Health board role and kind of capabilities within that system for folks Absolutely. What's really important to understand is that our health care system is a result of the cessation of land and countless treaties that we're actually negotiated with our tribal communities and the US government and so our Indian Health service system is actually a prepaid benefit from my perspective and so when we talk about the IHS system, that's Indian Health Service system, we talk about the I stands for IHS direct in the T stands for. 638 and you is what we are, which is an Indian Health program. so essentially this system is an extension of tribal sovereignty and we actually as urban and health programs don't exist without tribal sovereignty. So it's very important that we're constantly protecting and uplifting travels sovereignty. Can you talk about some of the challenges that Native American health care had prior to Covid- 19 and and particularly some of the challenges you're seeing through your role with the For Sure, of course, so I think it's no secret that although we created a health care system to serve American Indians, Alaska Natives it is never been appropriately funded. quite frankly, we didn't even add funding until the late 19 seventies to in Indian Health service system. so when you're working within a group underfunded system and you're working with the population that is disproportionately impacted by health disparities That is that is a recipe he made for disaster. Really we're constantly scrambling for resources. We wanna serve our people not only in the Western way, but also from a culturally a- two perspective because we know that we're responsible for creating a safe environment where people can have access to their cultural services as well as you know the the Standard Western health care systems a primary care behavioral health dental those. Of things we also know that our our communities are disproportionally impacted by social determinants of health such as homelessness so in the city of Seattle, if you are American or Alaska Native, you're 10 times more likely to be homeless than any other ethnicity. So imagine that you're already disproportionately impacted by something like diabetes and you don't have a home or you can actually store your insulin in a cool environment. and so that gives you some perspective on what we've constantly been challenged with now in. When the ACA was implemented, there was a true attempt to supplement this grossly underfunded system with Medicaid, but that meant we had a completely transformed our way of knowing and being to be able to leverage third party billing systems. So maybe you jump ahead to you know the state of things under kt. you know, obviously there's been press reports that Native American are more susceptible to covid-. 19 you know what what kind of other health and equities exist and how you talked about the the sort of the federal obligation here, you know, maybe give a sense of where the federal Government's come up short in terms of meeting that obligation I can say, I can speak a little bit to the disproportionate impact so again when you have other health disparities that actually present as risk factors right you're going to see a higher rates of morbidity as a result of acquiring prot. Additionally, we have a multi generational households and so you see you know youth living with their grandparents or sometimes a multifamily households and because it's very difficult to socially distance in those environments. you know the challenges in regards to infection and then again you know being disproportionately impacted by homelessness having access to a high stations or a place to take a shower or wash your hands can also be challenging so I would say that that has definitely been significant in addition to the resources to be able to acquire tests and having systems that you trust to actually receive a test so those things are really important. I would say that from the Cares Act and the response funds, I think that the Indian Health service system actually for us as of Indian health programs, not as as it hasn't been as consistent for travel partners, I know, but we've been able to receive our resources more quickly through the Indian Health service system that we have through other systems that we're part of so that the federally qualified health Center system, for example, that said. Was a very slow response, meaning that we had a hard time getting personal protective equipment and we had to work with whatever system we could and we're making placing orders all over the place to just try to get the supplies that we needed we found that very difficult and it was due to a community leader quite frankly, Louie. I think that you might be familiar with him as a local artist and you know he gave us access to his manufacturer and it was through him and our. That we were able to acquire the P that we needed and I think that that gives an example of you know how resilient we are as American Indian Alaska Native people, the ways that we actually support one another from a community perspective and then that that is a little bit of time so when we started to see some of the resources come through Indian Health Service we were able to sustain ourselves. now, I think another way that the federal government has been challenging for us is the fact that all of the testing was actually originally. On through Fema and then actually working with a local public health authority so like King County Public Health was our public health authority, so it was very difficult to acquire tests unless we are able to do it through them and I think I've said this through media before but one of the stipulations that fame of placed on public health, King County was that once a test was delivered that we had to commit to allowing those results to be given by a National call Center so that. Disrupts the continuity of care the patient provider relationship they also had a very short window timeline for the test to be used, which I found very troubling as well. Fortunately, King County made the right decision here and they removed some of those restrictions so we as Urbana and health program can actually aquire the test and use them in the ways that we need it, but those things have been significant drops and I quite frankly representative. That was really an attempt to control the data right and control the data outcomes so that that's been challenging. you know, I think that you maybe heard the story that we were requesting PE and we actually received a box of body bags That is actually real we had and it's shocking and it's also not the first time it's happened right where we've actually seen the need for supplies and only to be responded. to in that way. Those are the ways that's been challenging for us and then on the positive side, you know our community has been really strong. I mean we've been able to implement a testing site at Auto Club, which is a homeless shelter for American Indians, Alaska Natives. So I've seen the community come together to to get us what we need What's your senses? You've talked to. I mean I know as we've talked to tribes throughout the region I represent you know we've spent a lot of those early months connecting them with the University of Washington and it's testing capacity and you know I I. Like we all became procurement officers trying to figure out how to get access to scarce resources whether it be PE or swaps or what have you is that pretty much the dynamic that you've observed as well? Yes, we originally worked most closely with the University of Washington, also getting resources to lab core so that has been most effective for us. I will tell you that we would prefer to have a testing equipment or analyzing equipment on site which you know. Service did offer, but the machine that they offered us is only it's very limited and it's accuracy so 50 to 90 percent accurate, which means that one in every test that we submit we would have to send in for a confirmatory test, and I think that's something that I've experienced from the federal government a lot. it's almost like we get the second tier of of quality and I would really like to ask that that we change that narrative. you know it was the same like we were sent In 95 masks and so those things are not helpful but we you know we'll continue to have conversations like this and advocate for the things that we need because really, if we could have that rapid turn around, you know within two hours to analyze those tests, we can make a better impact and we can be more consistent with our contact racing. Can you say I want you to double? click on that for a second because it's a question that comes up a fair amount and obviously there's this somewhat competing narrative. Yeah, it was some. Fud by the President's suggestion that you know the reason we have more cases of it is because we test more. It's as though you know, we said we have more cavities because people go to the dentist that doesn't seem to make sense so can can you talk a little bit about the importance of having adequate testing capacity and what that means for Native Americans throughout our region. Sure I will. I also think it's important to note that we host the Urbana and Health Institute, which is one of 12. Epidemiology hunts in the nation and it really is deemed a public health authority through the Indian Health Care Improvement Act and now embedded in the ACA. Now the reason that's significant is because the standardized public health approach would be the test as many people as you possibly can right to to get test out there and to be able to identify who may have been exposed and that's what contact tracing is about so that we can quarantine people quickly and we can identify kind of the hot spots. And that helps us overcome pandemics like this, and we haven't been able to do that. I mean number one because we can't get access to test equipment so we had to roll out testing slowly and now that we actually have access to testing equipment and supplies you know now we're actually trying to draw people in to get test and that's really pretty late in the game. So yeah, I mean this idea that we have whatever the that's absolutely ridiculous and I'm quite frankly we are. Behind and I think that the number of positives in this country really demonstrates that yeah. So you mentioned that Char's Act is something that provided some direct support to the system you know my sense is that was helpful, but there's a lot more to do the House has passed a bill called the Heroes Act, which actually commits more assistance to the Indian Health Service and today to use system you know can maybe speak to why. Additional support is critical what it will mean for patients what it will mean for the quality of care and and what's the consequence of Congress just stops with the Cares Act and fails to provide more relief. Yes, that's correct. I mean, so we have to remember that if this pandemic is actually following you know kind of a standard flu-like cycles. it's likely that we're going to be right back where we were in the fall. and so that means that the cares Act funds that we've been able to use to actually you know. Create a safer environment. I mean we I mean, I can't even tell you how many things we've had to do just to the building to ensure that we are reducing the risk of infection. You know the ways that we've had to take care of our employees and so many people who need leave and you know those types of things. I mean we're fortunate to be an Organization that hasn't had to lay anybody off right so so that's great. The Hero Act on the other hand is looking at like long-term stability as well as. US when we go through that next wave right in the fall and so I think it's really important. but I think that things like a hundred percent fmap in the Heroes Act is very important. you know another for folks who haven't I'm sorry just for folks who haven't followed what Fms is you know so do you wanna explain it or I can I can as well but you wanna just take a second to explain what a map is for folks who are watching. yes, so a hundred percent of them so FM is. It's a match percent so essentially with with communities that have higher acuity needs the federal government has incentive by States to actually work more with those communities so Americans are an Alaskan natives are one of those where we get actually a hundred percent match funds from the federal government that go to the States now right now, only tribes are eligible for a hundred percent of map and Urbana and health programs are not therefore there. Incentive to the States to actually keep our ITU intact, You know IT system of care continuity of care. so that's and so we've been advocating for a hundred percent of for probably the last 15 years because it's one of the ways that we can ensure that our environment is sustainable. So is that helpful. It's a really big deal and it was a big piece of the Heroes Act and something as someone on the Appropriations Committee, something that I've been pushing for to your. are there other components of the hero that that? that you're excited about and maybe you are there are there needs that aren't addressed in the heroes that that that we ought to be thinking about sure, definitely and one of the things I love about the Heroes Act is that there's full support for the tribal epicenters so one of the things even though we deemed public health authorities often times government entities administrative bodies don't treat us as as such so we. Acquiring data and most significantly we've had a very limited resources so we have 12 tribal epidemiology centers in the nation and each one of them functions of a contract. That's about $400000 a year so you can imagine that if we're considered public health authority is like a County public health authority or state public health authority how desperate our budgets look compared to that and so the hero Act there's a significant investment in trie centers. That's fantastic, you know, I think that that's that's something that we've been asking for a while, and I think that's something that can make a significant difference in Indian country for pandemics like this. that's true, you may have heard the buzzer in the background that was votes being called, but I have a little while I will invite people who are watching if they have a question for Esther or for me for that matter, You're welcome to put it in the comment section below we. Have kind of speed round though because boats have been called we did actually get one when we mentioned, we were doing this, we got a question in about the important work that the Seattle Indian Health Board has done actually not related to but related to the issue of murdered and missing indigenous women and girls. Yes, maybe for folks who haven't followed that closely you know, share the important work that you and your team have done. Yeah. so so what I would say about and murdered indigenous women and girls is this is a grassroots effort that's been going on for more than 30 years, and I think that what. Was able to do was call out the data gaps that exist for urban communities. so you know there's 71 percent of all Americans, Alaska Natives that live in urban environments and we too are just proportionately impacted. by you know, murder and going missing and so by calling out those gaps, we've been able to call attention to the issue as a whole and so that's a very important issue for us because our people deserve to live. Healthy thriving lives Sorry, the buzzer has been going off so I muted myself. I think that the building's on fire but it's just telling us to vote and there it goes again. I'm sorry. Yeah. that's okay. I know you know through your leadership. Many of us have been working on this issue. do you wanna talk about the you know the policy response to the issues that you've raised on on that matter of a murdered, missing indigenous women and Sure, I mean this is where I just have to give tremendous kudos to our champions on the Hill. I mean folks like you I think about folks like Mccollum, I think about you know the Senator Lisa Murkowski. I mean this is really become a bipartisan issue and so we've been able to see support in that way. you know both from a funding perspective to address also data accountability for Justice systems. I think that's been. I still would like to see some influence over Faa in the way that those resources are distributed, but I would also say that we've been able to have some policy successes both at the state level and at the local level so I think that this is something that will continue to work on as a whole. I think about somebody like Senator Murray well, you know and when you have that kind of fire behind an issue and and the relationships that that you all have on a Hill I know that we'll be able to. Significant policy change lasting change, I think it's a really important issue, and it's one that demands both attention and action so thank you for your leadership on it. We got another question in Reverend Raine from Gig Harbor said. I'm writing it as your constituents as a person of faith Who's grieved over the historic injustices still experience by Native communities They right-I urge you to take concrete steps to make robust funding for tribes and Native communities a priority in future. Ensuring that tribes can make the best allocation decisions for themselves. they write this includes funding for health resources. Education broadband housing assistance, NS, Nothing can write the historic injustices that are still experience by Native communities and in this time of crisis, everything must be done to ensure that those aren't compounded Thank you for the question. Reverend I will tell you I share your priority the it's something as a member of the Appropriations Committee and I serve on the. And Environment subcommittee, which really oversees a lot of those issues around tribal funding and really trying to turn the dial on this issue when we were working on this before covet, but I think KT is really amplified some of those inequities and some of those injustices that you spoke about. I will also just mention several years ago. I pushed the US Commission on civil rights to look at those injustices. You wrote the and they just produced last year report called the broken Promises report and it really goes issue by issue looking at education looking at things related to economic development health care natural resources criminal Justice, you know really across the board and importantly in my view, I think it really lays out a road map for how Congress can from a funding standpoint. Policy standpoint really take action on addressing those injustices Esther I don't know if you wanna speak at all to the reverence question or I just wanna say thank you for the support. I think that more more of the mainstream society can become aware of these injustices and how they're actually we can solve them. You know if if we have support across the country I also just wanna speak to the broken promises report I think it'. First time I've ever heard of of speaking about the Indian Health Service at full funding right like what would really take to get health care for Americans to full funding if you think about that, I think that the Northwest Portland Indian Health Board put out a number, it was 58 point nine billion to get just a full funding and that investment can actually translate to a reduction in cost in the long term but I would just say yes, Thank you and I always appreciate any community support and raise your high. thanks for Reverend Thank you for writing in with the question. Let me see I think we've got one more question in and and then I may have to go vote let's see sorry. I'm just flipping through I guess the question is are there challenges facing the Seattle don't need any help or a more generally that you know certainly related to but other things that you think folks who are watching ought to be aware of that require more. Both by our constituents and by Congress, yes, absolutely, I think that I think one of the hardest things being an urban Indian Health program is that we're constantly battling to to maintain our cultural integrity. you know because the way that health care systems work now that States have more influence over health systems and now local entities do we have to constantly fight just a part of the that continuity of care. I would say, Additionally another. That the health struggles with and many other community health centers do too is that facilities and infrastructure dollars are very difficult to come by and so we're looking you know buildings and structures that have been here since you know the late 19 sixties early seventies and we have a lot of deferred investments that needs to be addressed so I would just say that those are the things that I feel like people are are not aware of that means something to us and that. That we have a thriving American Indian Alaska Native community here in the King County region. We have a 40000 of us, you know and you know we we we really deserve that benefit that we were promised long ago. How much has you know and I think about the the prior question you know one of the things we've certainly heard from the tribal partners throughout our region. You know we've long dealt with this issue around the digital divide the lack of access to Internet or really slow Internet Obviously you know a whole lot of health care has been trying to lean on telehealth in the in the age of cod, you know and so you combine both the telehealth and the inadequacy of broadband access and it makes you know it. Of those disparities have you observe that through the health board? absolutely, I mean here we are in the Organization. you know we're well equipped with our electronic health record system. We're able to shift quickly to telehealth and even in those moments we still struggle with broadband connections, not always from the Organization but from our relatives that we serve, we call our patients our relatives or our relatives that we serve and being able to get enough broadband to be able to meet with our providers over video. Yes, that's definitely consistently a challenge. I would say for our tribal partners and more remote locations. I mean that's that's always an issue. yeah. and so again, these are things that you don't always think about you know that you need in order to provide quality health services and oftentimes in very limited resources. go into these infrastructure needs. Yes. Another thing we're working on interestingly and importantly included in the Heroes Act as well trying to bridge that bridge that digital so I've just been messaged while we're talking that I have five minutes to make it to the floor. It's about a seven minute walk away. so that's driving. up but I just wanna be the first time I've I've seen you run a run so I it's not graceful but you know I just. Thank you so much not just for taking the time with me and not not just for sharing your perspectives with my constituents but for the extraordinary work that you and your team do I have the honor of getting to a member of the subcommittee. Get to hear your testimony frequently and so effectively and raising so many important issues. I just I feel I just tremendous gratitude to you into your team for the extraordinary. You do excellent, I would say the same to you. okay. Thank you so much take care. Thanks everybody for watching and I'm sorry. we're a little shorter than we intended, but I gotta go vote. Alright. Thanks everybody. Thank you take care. Bye Bye.