The following are remarks from Kathleen Sebelius, the 21st Secretary of the Department of Health, during President Barack Obama’s fourth annual White House Tribal Nations Conference on December 5.

Good Morning. The Department of Health and Human Services is proud to be partners with you in working to open new doors of opportunity across Indian country.

During a recent visit to tribal communities in South Dakota, I saw some great examples of our work together.

At Sinte Gleska University on the Rosebud Sioux Indian reservation, I met young people served by a unique children’s mental health program that blends Western and traditional Lakota cultural approaches to healing.

I met students at the Red Cloud Indian School on the Pine Ridge Indian reservation where the Administration is supporting a Lakota Language Program which teaches the Lakota traditions through a rich K-12 curriculum.

And I met community members who had begun to eat healthier and increase their physical activity with support from the Special Diabetes Program for Indians.

There are rich partnerships like these all across Indian country. And they are giving more First Americans reason to feel hope for the future instead of despair.

To be sure, we face incredibly persistent challenges today: high unemployment, energy costs, suicide, chronic disease and federal resources stretched thin.

But I also know that smart investment has allowed us to make real progress. Programs like those I visited in South Dakota were made possible by a strong collaboration between tribes and the Obama Administration.

They are also part of something bigger happening across Indian country.

When President Obama took office, he recognized that we needed more than a series of individual success stories. We needed a comprehensive approach. And if you look back over the last four years, you can begin to see what that has meant for Indian country.

Four years ago, the Indian Health Service [IHS] had a budget of $3.8 billion. Today, it’s 29 percent larger at $4.3 billion.

Four years ago, the Contract Health Service budget was $579 million. In most places, IHS could fund only life or limb referrals. Today, the Contract Health Service budget is $843 million, a 46 percent increase that has allowed many more patients to get the referrals they need.

And it’s not just the budget.

Four years ago, the reauthorization of the Indian Health Care Improvement Act was hopelessly stuck in Congress. Today, after more than a decade of trying, it has been permanently authorized. The Indian Health Service is here to stay. The law also means that tribes can get coverage for their employees through the Federal Employees Health Benefits Program. More than 10,000 are already enrolled.

And by approving every single Tribal Facility for the National Health Service Corps, we’re bringing more providers to communities in need. As you know this is a program that says to doctors, nurses, and dentists: “If you go practice in an underserved community, we’ll give you a scholarship or help pay your loans.” Four years ago, because of the complicated certification process, fewer than 60 IHS and tribal facilities were eligible for Corps members. Today, there are 587.

I am also proud to say that after close consultation with tribes, the VA and IHS will announce a national agreement [December 6] for the VA to reimburse IHS for the direct care it provides veterans. This agreement includes the outpatient all-inclusive rate that tribes preferred. Implementation will begin soon at federal sites. This agreement will make it easier for tribes to enter their own agreements with VA for the health services they provide.

Now at HHS, the well-being of the American Indian and Alaska Native people is a priority that extends beyond the IHS to reach every operating division and program office. We recognize that giving people the opportunity to thrive requires more than just access to quality care. It also comes from investing in whole families and strong communities.

Four years ago, American Indian and Alaska Natives in the foster care and child welfare system had to go through large state programs and outside groups. Today, we have created a process for tribes to operate their own Title IV-E programs. The Port Gamble S’Klallam Tribe was the first. And right now we continue to process additional agreements with other tribes.

Four years ago, we were seeing a steady decline in the number of children in Head Start who spoke a tribal language at home. Today, we’re using Head Start’s new performance standards to begin integrating tribal language and culture into their classrooms and curricula.

Four years ago, tribal nations were largely on their own in the ceaseless fight against alcohol and substance abuse. Today, our department has a dedicated office working with tribes as they develop detailed action plans and coordinate resources from across the federal government.

All of this progress is built on a strong foundation of consultation. And we’ve made progress here too.

Four years ago, HHS had an outdated consultation policy on its books. Today with your guidance it has been updated, and seven agencies within the department have their own new or updated consultation policies. Our new department-wide policy calls for us to regularly evaluate our progress. So we recently sent each of you a letter asking for your input. And I look forward to your perspective.

Four years ago, our department’s leadership was receiving irregular updates about its work in Indian country—often only when there was a crisis to solve. Today, our senior leaders and I meet regularly with the Secretary’s Tribal Advisory Committee or STAC—the first cabinet level committee of its kind. And we have charged the STAC not only with addressing today’s biggest problems but also with making the most of tomorrow’s opportunities.

One of the biggest of those opportunities is our ongoing work to implement the Affordable Care Act. We need your help to make sure people are taking advantage of the law which includes many important benefits for American Indians and Alaska Natives.

It puts in place new rules prohibiting insurers from imposing lifetime dollar limits on your benefits. Young adults who would otherwise be uninsured, can now stay on their parents insurance until they turn 26. And key preventive services like diabetes screening and mammograms, now cost nothing out of pocket for most people in private plans and elders on Medicare.

In 2014, more of Indian country’s most vulnerable may be covered by Medicaid. States will receive federal funding assistance to extend their programs to uninsured adults with incomes below 133 percent of the Federal Poverty Level. That’s about $15,000 a year for an individual and $31,000 for a family of four.

At the same time, new competitive insurance marketplaces will allow hundreds of thousands of American Indians and Alaska Natives to purchase quality, affordable health coverage for the first time.

But we need your partnership to educate tribal communities about the law’s new benefits and protections—and to identify everyone who is eligible and help them enroll.

And together, we need to hold our partners in the states accountable. Last year, I wrote a letter to governors reiterating my full commitment to strong government-to-government relationships with tribes. And I will continue to remind states that they must consider tribes full partners during the design and implementation of any programs that use HHS funds.

Looking back, it’s clear that we are in a much better place today than we were four years ago. But the time is now to look forward.

The journey ahead will not be easy. But it is possible to envision an Indian country four years from now where everyone has access to the quality care they need to get healthy and stay well; where more children have the chance to follow his/her dreams; and where every community can protect its culture and traditions while creating new opportunities for work and growth.

We can fulfill that great promise by continuing our work together. We have made great progress, but we have much more work to do. And this Administration is committed to working hand-in-hand with you to improve lives for the better in Indian country.”