Lisa Murkowski

I am going to continue to place a priority from a budget perspective.

What's the rationale for not funding the Small Ambulatory Clinic Program?

We included $15 million in the omnibus for the Small Ambulatory Clinic Program.

I told them it's great to get that building, but you have to have the staffing that goes with it.

Let me ask about staffing packages. Again this is kind of an annual question for me, just making sure that we're tracking.

I would suggest that this is one of those issues that we need to engage as many of you within the agency that are involved from a policy perspective.

So what you're telling me now is that with the 2018 funds, $11 million total, $6 million is going to go to the Village Built Clinic (VBCs), $5 million then to these 105(l)s, but that is just a drop in the bucket in terms of what we may be…

So if something is not done, what would you propose that we do?

Let me ask what that good solution might be because it's my understanding that the budgetary impact of this decision nationwide is going to blow things out of the water.

As I understand the budget proposal, it effectively overrides the 105(l) with this 'notwithstanding' clause that would make these lease payments entirely discretionary within the agency, effectively overturning the Maniilaq decision.

Let me raise the issue that I raise every year, Village Built Clinics.

I just wanted to make sure because we would completely erode the underpinnings of how we provide for healthcare in these villages if we didn't have CHAP.

As you know, we have broadband in Alaska that is spotty at best.

It seems to me that you have acknowledged that this is a valuable program; we need to do a little bit better job with regards to the data.

I worry that as we're making headway, that we're going to cut back on the funding and we're going to lose that.

This is something that I'm working with Senator Smith on the Indian Affairs Committee, behavioral health funding.

In Alaska, I'm told that when it comes to suicide rates amongst young Alaska Native males, we're 10 times the national average.

When we say $150 million if the Department of Health and Human Services determines that they're going to shift this over here in the IHS account, to me that's not acceptable.

I think we all recognize, as you say, the sobering statistics, the sobering reality that far too many of our Native people around the country face, whether in Montana, New Mexico, or Alaska. It is not acceptable.

We don't want to have a silo, separate, program that looks at our prescriptions.

Certainly, IHS shares the concern about the opioid epidemic.

I want to assure you that it's a misnomer that IHS is not supportive of reporting to PDMP.

I understand they're coming along, but my information is that IHS has been resistant to participate.

We're a pretty clear example of you have an IHS facility, you've got an emergency room out in the Mat-Su Valley, you've got a clinic, you've got a VA, a Community Based Outpatient Clinic (CBOC) that's there, and you could literally have an…

If we are dealing with a level of addiction that is debilitating to our communities, it makes it really hard to focus on a job, it makes it hard to focus on raising your kids, and it makes it hard to focus on education.