Madam Chair, my time is up, but it looks to me like what you are giving us is a wake up call about a crisis that is not 10 years from now; it is right now.

Would it be fair to say they need to be managed?

99 percent of all the revenue coming into the Federal Government... is going to go back out in two categories: interest on the Federal debt and mandatory payments on entitlements.

So you are talking--just to begin with, you are saying the Affordable Care Act needs to be reformed----

I most certainly appreciate you taking the time to hold today's field hearing in South Dakota where our tribal members are all too familiar with the failures of the Indian Health Service.

We're talking about improving accountability at IHS.

the chronic failures of the IHS, failures that, frankly, are just unacceptable

I think my legislation deals in changing the contracting process, which I think needs to happen.

The mismanagement of fiscal stability that is lacking in the area and the agency have just completely eliminated my confidence in the agency.

I wanted to acknowledge Congresswoman Noem for alleviation of the employer mandate from the tribes.

I believe that IHS should get out of the hospital business. I think they're terrible at it. I don't think they know what they're doing.

I want everyone to know, and I want you to know that we're obviously aware that there are people scared of retaliation.

I'll just close with this, that I also understand that IHS relies on a Norwegian accrediting body, DNV GL, to maintain your accreditation at some of these hospitals throughout the region...

We found that the agency is devoid of transparency and openness.

The medical care that we receive at IHS in the Great Plains region is like getting health care in a third-world country.

IHS has not been forthcoming about changes.

I'd also like to thank Senator Thune and Congresswoman Kristi Noem for their tireless work to address the problems plaguing IHS.

leadership starts at the top, and if IHS leaders are a barrier to delivering quality care, then they should look for another job