[Congressional Record Volume 144, Number 29 (Tuesday, March 17, 1998)]
[Senate]
[Pages S2114-S2115]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. McCAIN (for himself, Mr. Campbell, Mr. Inouye, and Mr. 
        Conrad):
  S. 1770. A bill to elevate the position of Director of the Indian 
Health Service to Assistant Secretary of Health and Human Services, to 
provide for the organizational independence of the Indian Health 
Service within the Department of Health and Human Services, and for 
other purposes, to the Committee on Indian Affairs.


           assistant secretary for indian health act of 1998

  Mr. McCAIN. Mr. President, I rise today to introduce legislation to 
redesignate the position of the Director of the Indian Health Service 
(IHS) to an Assistant Secretarial position within the Department of 
Health and Human Services. I am pleased that the Chairman and Vice-
Chairman of the Committee on Indian Affairs, Senator Campbell and 
Senator Inouye, as well as my colleague, Senator Conrad, are joining me 
as co-sponsors of this important legislation. The Senate previously 
approved this legislation in the 103rd session and again considered the 
bill in the 104th session, but we were unable to pass a bill before 
adjournment. We are again pursuing this legislation as the timing for 
enactment could not be more critical.
  Some of my colleagues might be led to believe the standard of living 
for Indian people is improving due to the relatively small economic 
success enjoyed by a few Indian tribes in this country. Nothing could 
be further from reality as the health conditions facing Indian people 
are an endemic crisis.
  Mr. President, Indian reservation areas are among the most 
impoverished areas in our nation, yet remain the least served and the 
most forgotten when it comes to improving health care delivery. 
American Indian and Alaska Native populations are affected by diabetes 
at a rate that overwhelmingly exceeds other national populations. 
Mortality rates for tuberculosis, alcoholism, accidents, homicide, 
pneumonia, influenza and suicides are far higher than all other 
segments of the national population. The number of HIV and AIDS cases 
affecting American Indian communities is increasing at an alarming 
rate.
  The Indian Health Service (IHS) is the lead agency charged with 
providing health care to the more than 550 Indian tribes in this 
country. The IHS currently falls under the authority of the Public 
Health Service within the overall Department of Health and Human 
Services. The Indian Health Service consists of 143 service units 
composed of over 500 direct health care delivery facilities, including 
49 hospitals, 176 health centers, 8 school centers and 277 health 
stations and satellite clinics and Alaska village clinics. This health 
network provides services ranging from facility construction to 
pediatrics, and serves approximately 1.3 million American Indians and 
Alaska Native individuals each year.
  For the past couple of years, the Department has undergone 
reorganizational reforms and removed some of the administrative hurdles 
faced by the IHS Director. I applaud the Secretary

[[Page S2115]]

and the Department for these efforts to prioritize Indian health 
issues. However, I am convinced that we must further institutionalize 
the future of the IHS by allowing the agency to operate at the highest 
levels and by its own authority.
  Mr. President, this bill is more than a symbolic gesture. There are 
several other critical reasons which lead me to believe that this 
legislation is necessary. First, designating the IHS Director as an 
Assistant Secretary of Indian Health would provide the various branches 
and programs of the IHS with a stronger advocacy role within the 
Department and better representation during the budget process. As 
evidenced in the Agency's budget request for FY'99, which represents a 
minimal one percent increase over last year's budget, the ability 
of the IHS to affect budgetary policy is limited.

  Second, I am a strong supporter of the success of tribal governments 
to contract and manage programs through Public Law 93-638, the Indian 
Self-Determination and Education Assistance Act. Through separate 
legislation, Senator Campbell will propose to permanently extend this 
authority to the IHS. Our intent through the 638 law has been to 
devolve the paternalistic federal management of Indian programs and 
place responsibility at the local tribal level where tribes most 
benefit by direct services. This legislation we are introducing today 
is intended to compliment that effort.
  I believe that the IHS would operate more efficiently as an 
independent agency. The IHS is charged with an enormous responsibility 
for Indian country and, therefore, should be afforded direct line 
authority and the ability to operate within its own unique mandates and 
rules. This legislation provides for the appropriate authority for this 
transition, particularly to ensure that the service delivery provided 
to the IHS by other PHS entities, such as the Commissioned Corps, would 
be appropriately addressed. I look forward to working with Secretary 
Shalala on these important matters.
  I am convinced that if the current organizational structure of the 
IHS is maintained, the agency will not be positioned for the long term 
to address the day-to-day health care needs of American Indians. 
Therefore, I believe that the IHS is in dire need of a senior policy 
official who is knowledgeable about the programs administered by the 
IHS and who can provide the leadership for the health care needs of 
American Indians and Alaska Natives.
  Mr. President, this legislation will ensure that health care issues 
facing Indian people are addressed on a par with the rest of this 
nation.
  Mr. President, I ask unanimous consent that additional material be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                      Section-by-Section analysis


       section 1. office of assistant secretary for indian health

       Subsection (a) establishes the Office of the Assistant 
     Secretary for Indian Health within the Department of Health 
     and Human Services.
       Subsection (b) provides that the Assistant Secretary for 
     Indian Health shall perform such functions as the Secretary 
     of Health and Human Services may designate in addition to the 
     functions performed by the Director of the Indian Health 
     Service (IHS) on the date of the enactment of this Act.
       Subsection (c) provides that references to the IHS Director 
     in any other Federal law, Executive order, rule, regulation, 
     or delegation of authority, or any document shall be deemed 
     to refer to the Assistant Secretary for Indian Health.
       Subsection (d) amends Title 5, Section 5315 of the U.S.C. 
     by striking `Assistant Secretaries of Health and Human 
     Services (6)' and inserting `Assistant Secretaries of Health 
     and Human Services (7)'. Subsection (d) further amends 
     section 5316 of Title 5 by striking `Director, Indian Health 
     Service, Department of Health and Human Services'.
       Subsection (e) provides for conforming amendments in the 
     Indian Health Care Improvement Act. Subsection (e) further 
     amends the Indian Health Care Improvement Act, the 
     Rehabilitation Act of 1973, the Federal Water Pollution 
     Control Act, and the Native American Programs Act of 1974 by 
     striking `Director of the Indian Health Service' and 
     inserting in lieu thereof `the Assistant Secretary for Indian 
     Health'.


 section 2. organization of indian health service within department of 
                       health and human services

       Subsection (a) amends section 601 of the Indian Health Care 
     Improvement Act by striking `within the Public Health Service 
     of the Department of Health and Human Services' each place it 
     appears and inserting `within the Department of Health and 
     Human Services', and striking `report to the Secretary 
     through the Assistant Secretary for Health of the Department 
     of Health and Human Services' and inserting `report to the 
     Secretary'.
       Subsection (b) amends the heading of section 601 of the 
     Indian Health Care Improvement Act.
       Subsection (c) provides that nothing in this section may be 
     interpreted as terminating or otherwise modifying any 
     authority providing for the IHS to use Public Health Service 
     officers or employees to carrying out the purpose and 
     responsibilities of the IHS. Subsection (c) further states 
     that any officers or employees used by IHS shall be treated 
     as officers or employees detailed to an executive department 
     under section 214(a) of the Public Health Service.
                                 ______