[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 2047 Introduced in Senate (IS)]








109th CONGRESS
  1st Session
                                S. 2047

                    To promote healthy communities.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           November 17, 2005

Mr. Obama (for himself and Mrs. Clinton) introduced the following bill; 
     which was read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
                    To promote healthy communities.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Healthy Communities Act of 2005''.

SEC. 2. FINDINGS.

    Congress finds as follows:
            (1) Environmental quality is a leading health indicator. An 
        estimated 25 percent of preventable illnesses worldwide can be 
        attributed to poor environmental quality.
            (2) Many diseases are caused or exacerbated by 
        environmental hazards, including cancer, heart disease, asthma, 
        birth defects, behavioral disorders, infertility, and obesity.
            (3) Of the chemicals produced in the United States annually 
        in quantities greater than 10,000 pounds, only 43 percent have 
        been tested for their potential human toxicity and only 7 
        percent have been studied to assess effects on development.
            (4) Approximately 126,000,000 people in the United States 
        live in areas of non-attainment for pollutants that have 
        health-based standards. In 1997, approximately 43 percent of 
        the population of the United States lived in areas designated 
        as non-attainment areas for established health-based standards 
        for ozone.
            (5) In the United States, air pollution alone is estimated 
        to be associated with 50,000 premature deaths and an estimated 
        $50,000,000,000 in health-related costs annually.
            (6) In children, environmental toxins are estimated to 
        cause up to 35 percent of asthma cases, up to 10 percent of 
        cancer cases, and up to 20 percent of neurobehavioral 
        disorders.
            (7) Almost 400,000 children have elevated blood lead 
        levels. In 2002, researchers reported that 100 percent of 
        childhood lead poisoning resulted from environmental lead 
        exposure. If not detected early, lead poisoning in children is 
        associated with behavioral and learning problems, slowed 
        growth, impaired hearing, and damage to the kidneys, brain, and 
        bone marrow.
            (8) Studies have found that the reduction of blood lead 
        levels in children from 1976 to 1999 led to an economic benefit 
        of approximately $319,000,000,000.
            (9) Elevated lead levels can also harm adults by causing 
        difficulties during pregnancy, high blood pressure, digestive 
        problems, nerve disorders, memory and concentration problems, 
        and muscle and joint pain.
            (10) Minority Americans are at greater risk of exposure to 
        environmental toxins. Research has shown that 3 of every 5 
        individuals of African-American or Latino background live in 
        communities with 1 or more toxic waste sites. More than 
        15,000,000 African-Americans, more than 8,000,000 Hispanics, 
        and about 50 percent of Asian and Pacific Islanders and Native 
        Americans are living in communities with 1 or more abandoned or 
        uncontrolled toxic waste sites.
            (11) Communities with existing incinerators are 
        significantly more likely to have a large percentage of 
        minorities. Communities where incinerators are proposed to be 
        located have minority populations that are 60 percent higher 
        and property values 35 percent lower than other communities.

SEC. 3. ADVISORY COMMITTEE ON ENVIRONMENTAL HEALTH.

    (a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary''), in collaboration 
with the Administrator of the Environmental Protection Agency (referred 
to in this section as the ``Administrator''), shall establish an 
independent, 5-year Advisory Committee on Environmental Health 
(referred to in this section as the ``Committee'').
    (b) Membership.--
            (1) In general.--The Committee shall be composed of members 
        with academic training and practical experience in--
                    (A) the areas of--
                            (i) environmental health and public health;
                            (ii) environmental justice;
                            (iii) community-based participatory 
                        research;
                            (iv) adult and child health and 
                        development;
                            (v) data collection, analysis, and 
                        reporting;
                            (vi) health and health care disparities;
                            (vii) community engagement and 
                        mobilization, including grassroots organizing 
                        and community-level activism in communities 
                        with health disparity populations; and
                            (viii) urban, suburban, rural, and regional 
                        planning; and
                    (B) other areas determined appropriate by the 
                Secretary.
            (2) Term.--Members of the Committee shall serve on the 
        Committee for the life of the Committee.
            (3) Selection.--The Secretary shall appoint members of the 
        Committee from health disparity populations. No candidate for 
        appointment on the Committee shall be asked to provide non-
        relevant information, such as voting record, political party 
        affiliation, or position on particular policies.
            (4) Prohibition against federal employees.--No member of 
        the Committee may be a Federal employee.
    (c) Chairperson.--Members of the Committee shall select a 
chairperson from among the members of the Committee, who shall serve a 
1-year term.
    (d) Meetings.--The Committee shall meet not less frequently than 3 
times per year.
    (e) Duties of the Committee.--The Committee shall review 
environmental health data and studies, as well as Federal environmental 
health research and programmatic initiatives, in order to--
            (1) assess the impact of Federal laws, policies, programs, 
        and practices on environmental health and environmental 
        justice;
            (2) identify and recommend ways to--
                    (A) draft new or modify existing Federal laws 
                needed to improve environmental health;
                    (B) ensure compliance with Federal laws related to 
                environmental health;
                    (C) address gaps in environmental health research 
                or programs at the Federal level, particularly research 
                or programs that address the needs of health-disparity 
                populations;
                    (D) prevent or mitigate harm from Federal policies 
                and federally operated or supported programs and 
                practices, that may adversely affect environmental 
                health and environmental justice;
                    (E) increase coordination and integration of 
                interagency environmental health and environmental 
                justice initiatives; and
                    (F) promote efforts to meet Healthy People 2010 
                goals and objectives relating to environmental health;
            (3) assist in the development of the Environmental Health 
        Report Card;
            (4) assist in the development of the Health Action Zone 
        Program, including identification of eligible communities; and
            (5) conduct other activities at the request of the 
        Secretary.
    (f) Vulnerable Populations.--The Committee shall include specific 
focus on health disparity populations in completion of all duties of 
the Committee.
    (g) Collaboration.--To the extent possible, the Committee shall 
seek input from new or existing Federal committees on environmental 
health and environmental justice issues, including the Federal 
Interagency Working Group on Environmental Justice and the National 
Environmental Justice Advisory Council.
    (h) Public Input.--
            (1) Public notice.--The Chairperson of the Committee shall 
        provide public notice of the availability of draft 
        recommendations not less than 90 days prior to the date of 
        finalization of such recommendations.
            (2) Consideration.--The Committee shall solicit and take 
        into consideration public review and comment on draft 
        recommendations pursuant to this section.
    (i) Personnel.--
            (1) Detail of government employees.--Any Federal Government 
        employee may be detailed to the Committee without 
        reimbursement, and such detail shall be without interruption or 
        loss of civil service status or privilege.
            (2) Staff, information, or other assistance.--The Secretary 
        and the Administrator of the Environmental Protection Agency 
        shall provide to the Committee such staff, information, and 
        other assistance as may be necessary to carry out the duties of 
        the Committee.
    (j) Reports.--On an annual basis, the Committee shall compile and 
submit the Committee's findings and recommendations to the public and 
Congress.
    (k) Federal Response.--Not later than 1 year after the date the 
Committee submits a report under subsection (j), the Secretary and the 
Administrator shall propose a plan to implement relevant 
recommendations of the Committee included in such report.
    (l) Authorization of Appropriations.--There is authorized to be 
appropriated to the Committee such sums as may be necessary to carry 
out the objectives of this section.

SEC. 4. ENVIRONMENTAL HEALTH REPORT CARD.

    (a) In General.--The Director of the Centers for Disease Control 
and Prevention (referred to in this section as the ``Director''), in 
collaboration with the Administrator of the Environmental Protection 
Agency (referred to in this section as the ``Administrator''), shall 
assess and report the environmental health of the Nation and, to the 
extent possible, for each State.
    (b) Environmental Health Report Card.--The Director and the 
Administrator shall prepare an Environmental Health Report Card 
(referred to in this section as a ``Report Card'') for the Nation and, 
to the extent possible, for each State on a biennial basis, that 
includes the--
            (1) potential risk of high or cumulative exposure to 
        environmental toxicants and pollutants--
                    (A) taking into consideration the prevalence and 
                health effect;
                    (B) including those measured in the National Report 
                on Human Exposure to Environmental Chemicals;
                    (C) including those that are man-made, natural, and 
                biogenic; and
                    (D) that are present in the air, water, or soil;
            (2) burden of acute and chronic disease empirically shown 
        to be associated with or exacerbated by exposure to 
        environmental toxicants or pollutants;
            (3) demographic characteristics of populations that are 
        most affected by overexposure to environmental toxicants or 
        pollutants; and
            (4) environmental health resources and initiatives, 
        including national and State health tracking and biomonitoring 
        activities.
    (c) Report.--The Director, in collaboration with the Administrator, 
shall--
            (1) submit each Report Card to Congress; and
            (2) make each Report Card readily available in print and 
        electronically to each State and to the public.
    (d) Adaptable.--Each Report Card shall be able to be adapted by 
local agencies in order to rate or report local environmental quality.
    (e) Consultation.--In developing a Report Card, the Director, in 
collaboration with the Administrator, shall consult with the Advisory 
Committee on Environmental Health established under section 3 and 
incorporate the recommendations set forth by the Committee.
    (f) Updated Report.--Each Report Card that is prepared after the 
initial Report Card shall include trend analysis for the Nation, and, 
to the extent possible, for each State, in order to track progress in 
meeting established national goals and objectives for improving 
environmental health (including Healthy People 2010), and to inform 
policy and program development.

SEC. 5. HEALTH ACTION ZONES.

    (a) Purpose.--The Secretary of Health and Human Services (referred 
to in this section as the ``Secretary''), in collaboration with the 
Administrator of the Environmental Protection Agency, shall establish 
the Health Action Zone Program for comprehensive environmental health 
improvement activities.
    (b) Health Action Zone Program.--
            (1) In general.--The Secretary shall award not less than 10 
        Health Action Zone Program grants to eligible communities each 
        year. The duration of each grant shall be 5 years.
            (2) Eligible communities.--
                    (A) Identification.--The Advisory Committee on 
                Environmental Health, established under section 3, 
                shall identify eligible communities under this section, 
                pursuant to subparagraph (B), and report such 
                identifications to the Secretary and the public.
                    (B) Types of communities.--Eligible communities 
                under this section shall be communities that are most 
                at risk, or at greatest disproportionate risk, for 
                adverse health outcomes from environmental toxicants 
                and pollutants, as measured by--
                            (i) proximity to sites with high levels of 
                        environmental toxicants or pollutants, or high 
                        levels of exposure to environmental toxicants 
                        or pollutants, including those that are--
                                    (I) measured in the National Report 
                                on Human Exposure to Environmental 
                                Chemicals;
                                    (II) man-made, natural, or 
                                biogenic; or
                                    (III) in air, water, or soil;
                            (ii) burden of disease and health 
                        conditions that may be caused or exacerbated by 
                        environmental toxicants or pollutants;
                            (iii) level of community health and 
                        economic resources available; and
                            (iv) other factors determined appropriate 
                        by the Advisory Committee on Environmental 
                        Health.
            (3) Notification.--The Secretary shall solicit applications 
        for Health Action Zone Program grants from communities 
        identified by the Advisory Committee on Environmental Health 
        pursuant to paragraph (2).
            (4) Applications.--
                    (A) In general.--An eligible community that desires 
                to receive a Health Action Zone Program grant shall 
                submit an application to the Secretary at such time, in 
                such manner, and accompanied by such information as the 
                Secretary may require, including a strategic plan 
                described in subparagraph (B) and a description of the 
                community advisory board under subparagraph (C).
                    (B) Strategic plan.--
                            (i) In general.--An eligible community 
                        shall include in an application under 
                        subparagraph (A) a strategic plan that shall--
                                    (I) describe the proposed 
                                activities pursuant to subsection (c);
                                    (II) report the extent to which 
                                local institutions and organizations 
                                and community residents have 
                                participated in the strategic plan 
                                development;
                                    (III) identify State, local, and 
                                private resources that will be 
                                available;
                                    (IV) describe the private and 
                                public partnerships to be used, which 
                                may include partnerships with 
                                community-based organizations and 
                                advocacy groups, institutions of higher 
                                education, federally qualified health 
                                centers, academic medical centers, 
                                hospitals, health plans, public health 
                                departments, elected officials, and 
                                other public and private entities;
                                    (V) identify Federal funding needed 
                                to support the proposed activities; and
                                    (VI) report the baselines, methods, 
                                and benchmarks for measuring the 
                                success of activities proposed in the 
                                strategic plan, including health and 
                                environmental health outcomes and 
                                community engagement and participation.
                            (ii) Technical assistance.--The Secretary 
                        shall provide technical assistance, as needed, 
                        for the development and implementation of 
                        strategic plans in--
                                    (I) the areas of--
                                            (aa) public health;
                                            (bb) environmental health;
                                            (cc) environmental justice;
                                            (dd) community-based 
                                        participatory research;
                                            (ee) health tracking, 
                                        biomonitoring, and other 
                                        relevant exposure technologies;
                                            (ff) health and health care 
                                        disparities; and
                                            (gg) human disease 
                                        genetics; and
                                    (II) other areas determined 
                                appropriate by the Secretary.
                    (C) Community advisory board.--
                            (i) In general.--In order to receive a 
                        Health Action Zone Program grant under this 
                        section, a community shall have a community 
                        advisory board.
                            (ii) Members.--
                                    (I) From community.--The majority 
                                of the members of a community advisory 
                                board under clause (i) shall be 
                                individuals that will benefit from the 
                                activities or services provided by the 
                                grants under this section.
                                    (II) Representatives.--A community 
                                advisory board shall include 
                                representatives from the respective 
                                State health department and county or 
                                local health department, community-
                                based organizations, environmental and 
                                public health experts, health care 
                                professionals and providers, nonprofit 
                                leaders, community organizers, and 
                                elected officials.
                            (iii) Duties.--A community advisory board 
                        shall--
                                    (I) oversee the functions and 
                                operations of Health Action Zone 
                                Program grant activities;
                                    (II) assist in the evaluation of 
                                such activities; and
                                    (III) prepare an annual report 
                                that--
                                            (aa) describes the progress 
                                        towards achieving stated goals; 
                                        and
                                            (bb) recommends future 
                                        courses of action.
    (c) Use of Funds.--An eligible community that receives a grant 
under this section may use the grant funding to--
            (1) promote disease prevention and health promotion, 
        particularly for health disparity populations;
            (2) facilitate partnerships between health care providers, 
        public and environmental health agencies, academic 
        institutions, community based or advocacy organizations, 
        elected officials, professional societies, and other 
        stakeholder groups;
            (3) enhance the local capacity for environmental health 
        data collection and reporting, which may include using 
        information from health tracking and biomonitoring;
            (4) coordinate and integrate economic development, 
        healthcare and social services, transportation, education, 
        community, and physical development plans, as well as 
        policymaking and other related activities at the local level to 
        comprehensively address environmental health concerns;
            (5) mobilize financial and other resources from the public 
        and private sector to increase local capacity to address 
        environmental health issues;
            (6) build upon existing environmental and economic efforts 
        to address contaminated sites through the Department of Health 
        and Human Services, the Environmental Protection Agency, and 
        other Federal and State programs that address public health and 
        the environment;
            (7) identify and assess factors relating to the historical 
        contamination of the community, in order to mitigate ongoing or 
        prevent future occurrences, including examining--
                    (A) the historical use of planning mechanisms such 
                as zoning practices;
                    (B) noncompliance with environmental laws and 
                public health codes; and
                    (C) abuse of extraterritorial jurisdiction or 
                redlining;
            (8) support the training of staff in communication and 
        outreach to the general public, particularly those at 
        disproportionate risk from environmental health hazards;
            (9) assist eligible communities in meeting Healthy People 
        2010 objectives relating to environmental health; and
            (10) aid eligible communities in developing environmental 
        management systems to improve the processes and actions that an 
        organization undertakes to meet its business and environmental 
        goals.
    (d) Planning Grant.--
            (1) In general.--At the discretion of the Secretary, an 
        eligible community may receive a 1-time planning grant to--
                    (A) establish or strengthen State or local 
                partnerships;
                    (B) identify Federal, State, or local resources;
                    (C) research promising health practices and models;
                    (D) develop a strategic plan for community 
                intervention;
                    (E) create necessary data collection systems or 
                linkages to facilitate baseline and follow-up data 
                assessment and evaluation;
                    (F) engage target communities in all planning 
                activities, including formation of a community advisory 
                board; and
                    (G) prepare a Health Action Zone Program grant 
                application.
            (2) Duration.--The duration of each planning grant shall be 
        1 year.
            (3) Eligible communities not receiving planning grants.--An 
        eligible community that does not receive a planning grant under 
        this subsection shall still be eligible to receive a Health 
        Action Zone Program grant under this section.
    (e) Evaluation.--
            (1) In general.--The Secretary, directly or through 
        contract, shall conduct an evaluation of the Health Action Zone 
        Program in order to determine success in achieving the purpose 
        of such program.
            (2) Reports.--Findings from the evaluation under paragraph 
        (1) shall be reported to Congress and the public annually.
    (f) Supplement, Not Supplant.--Grant funds received under this 
section shall be used to supplement, and not supplant, funding that 
would otherwise be used for activities described under this section.
    (g) Priority.--In awarding grants under this section, the 
Secretary--
            (1) shall give priority to communities that do not have 
        sites already listed on the National Priorities List for which 
        remediation activities are actively ongoing, as determined by 
        the Environmental Protection Agency; and
            (2) may give priority to empowerment zones and enterprise 
        communities designated pursuant to section 1391 of the Internal 
        Revenue Code of 1986.
    (h) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $50,000,000 for fiscal year 2006 
and $50,000,000 for each of the fiscal years 2007 through 2010.

SEC. 6. ENVIRONMENTAL HEALTH RESEARCH.

    (a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary''), in collaboration 
with the Administrator of the Environmental Protection Agency, the 
Director of the Centers for Disease Control and Prevention, and the 
Director of the National Institutes of Health, shall expand and 
intensify environmental health research.
    (b) Areas of Focus.--The Secretary shall expand research on the 
following:
            (1) The health effects of environmental toxins, which shall 
        include expansion and intensification of biomonitoring, in 
        order to--
                    (A) monitor the presence and concentration of 
                designated chemicals;
                    (B) measure toxic chemical exposure levels by 
                testing blood, tissue, saliva, exhaled breath, and 
                urine samples from nationwide volunteers;
                    (C) identify the role of genetic and nongenetic 
                susceptibility factors such as underlying disease 
                rates, social demographics, psychosocial factors, 
                community access to nutritional food and opportunities 
                for recreational exercise, and other factors in 
                modifying health outcomes from environmental 
                pollutants; and
                    (D) determine the availability of and compliance 
                with ethical guidelines when collecting samples and 
                conducting research.
            (2) The contribution of differential exposure to 
        environmental toxicants and pollutants to racial, ethnic, age, 
        gender, and socioeconomic position disparities in health.
            (3) The methods to assess the cumulative risk of exposure 
        or cumulative exposure to multiple pollutants from a variety of 
        sources over time.
            (4) The methods and tools to assess overall environmental 
        community health, including--
                    (A) the presence, level, and type of environmental 
                contaminants;
                    (B) the burden of disease and other health 
                conditions;
                    (C) predisposing factors such as race, ethnicity, 
                socioeconomic position, access to healthcare, 
                geography, and cultural practices;
                    (D) available local health care resources; and
                    (E) other factors determined appropriate by the 
                Secretary.
    (c) State Biomonitoring Capacity.--
            (1) In general.--The Secretary, acting through the Director 
        of the Centers for Disease Control and Prevention (referred to 
        in this subsection as the ``Director''), shall provide grants 
        to States to enable the States to develop or expand the 
        capacity of such States to conduct biomonitoring in order to, 
        with respect to environmental toxicants and pollutants--
                    (A) detect and monitor exposure;
                    (B) assess or predict population and individual 
                health risk as a result of exposure;
                    (C) develop and implement interventions to reduce 
                exposure;
                    (D) evaluate the effectiveness of interventions to 
                reduce exposure;
                    (E) monitor trends in exposure over time; and
                    (F) conduct other biomonitoring-related activities, 
                as determined appropriate by the Director.
            (2) Report.--Each State that receives a grant under this 
        subsection shall report to the Director and to the public, 
        information on the biomonitoring findings and activities 
        pursuant to paragraph (1).
            (3) Coordination.--The Director shall ensure, to the extent 
        possible, that each State that receives a grant under this 
        subsection demonstrates the--
                    (A) coordination and integration of biomonitoring 
                activities throughout the State; and
                    (B) interoperability of data collection and 
                reporting systems with neighboring States for the 
                formation of regional networks.
            (4) Technical assistance.--The Secretary, acting through 
        the Director, shall directly or through grants or contracts, or 
        both, provide technical assistance to States in the 
        establishment and operation of the State biomonitoring system, 
        including providing--
                    (A) training for environmental health personnel and 
                for other appropriate personnel to develop 
                environmental health leadership capacity at the State 
                and local level, including investigative, diagnostic, 
                analytical, risk communication, and response and 
                prevention capabilities;
                    (B) assistance in improving relevant regional and 
                State laboratory capacity and other activities to 
                complement State and local investigative capabilities;
                    (C) assistance in establishing a computerized data 
                collection, reporting, and processing system; and
                    (D) any other technical assistance the Secretary or 
                Director determines to be necessary.
            (5) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection $50,000,000 for 
        fiscal year 2006 and such sums as may be necessary for the 4 
        succeeding fiscal years.
    (d) Translation.--The Secretary shall promote translation and 
dissemination of findings to--
            (1) inform the public; and
            (2) facilitate use by States and communities to address 
        environmental health concerns.
    (e) Integration of Efforts.--The Secretary shall incorporate the 
data collected pursuant to this section with existing data collection 
efforts, including the following surveys and registries as appropriate:
            (1) The National Electronic Disease Surveillance System.
            (2) State birth defects surveillance systems.
            (3) Surveillance Epidemiology and End Results and State 
        cancer registries.
            (4) State asthma surveillance systems.
            (5) The National Health and Nutrition Examination Survey.
            (6) The Behavioral Risk Factor Surveillance System.
            (7) The Substance Release/Health Effects Database.
            (8) State blood lead surveillance systems.
            (9) The Hazardous Substances Emergency Events Surveillance 
        System.
            (10) The Health Alert Network.
            (11) The National Hospital Discharge Survey.
            (12) The National Ambulatory Medical Care Survey.
            (13) The National Health Interview Survey.
            (14) The Environmental Public Health Tracking Network.
            (15) The National Report on Human Exposure to Environmental 
        Chemicals.
            (16) Other data and surveillance systems, registries, and 
        surveys as considered appropriate by the Secretary and the 
        Administrator of the Environmental Protection Agency.

SEC. 7. ENVIRONMENTAL HEALTH WORKFORCE DEVELOPMENT.

    (a) In General.--The Director of the Centers for Disease Control 
and Prevention, in collaboration with the Director of the National 
Institutes of Health and national and professional organizations, shall 
expand training and educational activities relating to environmental 
health and environmental justice for health professionals and public 
health practitioners, including those from health disparity 
populations.
    (b) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section such sums as may be necessary.

SEC. 8. DEFINITIONS.

    In this Act:
            (1) Environmental health.--The term ``environmental 
        health'', as defined by the World Health Organization, includes 
        both the direct pathological effects of chemicals, radiation, 
        and some biological agents, and the effects (often indirect) on 
        health and well-being of the broad physical, psychological, 
        social, and aesthetic environment.
            (2) Environmental justice.--The term ``environmental 
        justice'', as defined by the Environmental Protection Agency, 
        includes the fair treatment and meaningful involvement of all 
        people regardless of race, color, national origin, or income 
        with respect to the development, implementation, and 
        enforcement of environmental laws, regulations, and policies.
            (3) Health disparity population.--The term ``health 
        disparity population'' means a health disparity population as 
        described in section 485E(d) of the Public Health Service Act 
        (42 U.S.C. 287c-31(d)).
            (4) State.--The term ``State'' means each of the 50 States, 
        the District of Columbia, the Commonwealth of Puerto Rico, the 
        United States Virgin Islands, Guam, American Samoa, the 
        Commonwealth of the Northern Mariana Islands, the Republic of 
        the Marshall Islands, the Federated States of Micronesia, the 
        Republic of Palau, and any Indian country (as defined in 
        section 1151 of title 18, United States Code).
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