[Congressional Record Volume 145, Number 11 (Friday, January 22, 1999)]
[Senate]
[Pages S900-S902]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. McCAIN (for himself, Mr. Inouye, and Mr. Conrad):
  S. 299. A bill to elevate the position of Director of the Indian 
Health Service within the Department of Health and Human Services to 
Assistant Secretary for Indian Health, and for other purposes; to the 
Committee on Indian Affairs.

[[Page S901]]

           assistant secretary for indian health act of 1999

 Mr. McCAIN. Mr. President, I rise to introduce legislation 
that will establish the Director of the Indian Health Service within 
the Department of Health and Human Services as an Assistant Secretary 
for Indian Health. My colleagues, Senators Inouye and Conrad, are 
joining me in this effort as original co-sponsors. I am pleased to note 
that Congressman Nethercutt from Washington introduced companion 
legislation on the House side.
  Last year, we came very close to successful passage of this same 
bill, but the legislative clock expired. It is our hope that we can 
move this legislation forward expeditiously this year as this bill 
enjoys widespread support from Indian tribes nationwide and the 
Administration.
  The history of this legislation spans back several years. Every year, 
the Congress deliberates on how best to raise the standard of health 
care for all Americans. Yet, in nearly every debate, the health care 
needs of Indian people are either marginalized or ignored. The need for 
this legislation arose out of the continuing frustration expressed by 
the tribes that their health concerns were not adequately addressed 
under the existing administrative policy and budgetary processes.
  As the primary health care delivery system, the Indian Health Service 
is the principal advocate for Indian health care needs, both on the 
reservation level and for urban populations. More than 1.3 million 
Indian people are served every year by the IHS. At its current 
capacity, the IHS estimates that it can only meet 62 percent of tribal 
health care needs. The IHS will continue to be challenged by a growing 
Indian population as well as an increasing disparity between the health 
status of Indian people as compared to other Americans. Thousands of 
Indian people continue to suffer from the worst imaginable health care 
conditions in Indian country--from diabetes to cancer to infant 
mortality. In nearly every category, the health status of Native 
Americans falls far below the national standard.
  The purpose of this bill can be simplified to three primary needs. 
Indian people desire a stronger leadership and policy role within the 
primary health care agency, the Department of Health and Human 
Services. The Assistant Secretary for Indian Health will ensure that 
critical policy and budgetary decisions will be made with the full 
involvement and consultation of not only the Indian Health Service, but 
also the direct involvement of the Tribal governments.
  Second, the enactment of this legislation is consistent with the 
unique government-to-government relationship between federally 
recognized Indian tribes and the federal government. This legislation 
is long overdue in bringing focus and national attention to the health 
care status of Indian people and fulfilling the federal trust 
responsibility toward Indian tribes.
  Finally, passage of this legislation is critical as the Congress is 
set to deliberate several pieces of Indian health policy. 
Reauthorization of the Indian Health Care Improvement Act and 
development of legislation to permanently extend tribal self-governance 
authority to tribes will be vital components of Indian health care in 
the future. Implementation of this bill is intended to support the 
long-standing policies of Indian self-determination and tribal self-
governance and assist Indian tribes who are making positive strides in 
providing direct health care to their own communities.
  At this critical time, 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. We continue to pursue passage of 
this legislation as many believe that the priority of Indian health 
issues within the Department should be raised to the highest levels 
within our federal government.
  I look forward to working with my colleagues on both sides of the 
aisle to ensure prompt passage of this legislation. I ask unanimous 
consent that the full text and section-by-section analysis of this bill 
be included in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                 S. 299

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

     SECTION 1. OFFICE OF ASSISTANT SECRETARY FOR INDIAN HEALTH.

       (a) Establishment.--There is established within the 
     Department of Health and Human Services the Office of the 
     Assistant Secretary for Indian Health in order to, in a 
     manner consistent with the government-to-government 
     relationship between the United States and Indian tribes--
       (1) facilitate advocacy for the development of appropriate 
     Indian health policy; and
       (2) promote consultation on matters related to Indian 
     health.
       (b) Assistant Secretary for Indian Health.--In addition to 
     the functions performed on the date of enactment of this Act 
     by the Director of the Indian Health Service, the Assistant 
     Secretary for Indian Health shall perform such functions as 
     the Secretary of Health and Human Services (referred to in 
     this section as the ``Secretary'') may designate. The 
     Assistant Secretary for Indian Health shall--
       (1) report directly to the Secretary concerning all policy- 
     and budget-related matters affecting Indian health;
       (2) collaborate with the Assistant Secretary for Health 
     concerning appropriate matters of Indian health that affect 
     the agencies of the Public Health Service;
       (3) advise each Assistant Secretary of the Department of 
     Health and Human Services concerning matters of Indian health 
     with respect to which that Assistant Secretary has authority 
     and responsibility;
       (4) advise the heads of other agencies and programs of the 
     Department of Health and Human Services concerning matters of 
     Indian health with respect to which those heads have 
     authority and responsibility; and
       (5) coordinate the activities of the Department of Health 
     and Human Services concerning matters of Indian health.
       (c) References.--Reference in any other Federal law, 
     Executive order, rule, regulation, or delegation of 
     authority, or any document of or relating to the Director of 
     the Indian Health Service shall be deemed to refer to the 
     Assistant Secretary for Indian Health.
       (d) Rate of Pay.--
       (1) Positions at level iv.--Section 5315 of title 5, United 
     States Code, is amended--
       (A) by striking the following:
       ``Assistant Secretaries of Health and Human Services 
     (6).''; and
       (B) by inserting the following:
       ``Assistant Secretaries of Health and Human Services 
     (7).''.
       (2) Positions at level v.--Section 5316 of title 5, United 
     States Code, is amended by striking the following:
       ``Director, Indian Health Service, Department of Health and 
     Human Services.''.
       (e) Duties of Assistant Secretary for Indian Health.--
     Section 601(a) of the Indian Health Care Improvement Act (25 
     U.S.C. 1661(a)) is amended--
       (1) by inserting ``(1)'' after ``(a)'';
       (2) in the second sentence of paragraph (1), as so 
     designated, by striking ``a Director,'' and inserting ``the 
     Assistant Secretary for Indian Health,''; and
       (3) by striking the third sentence of paragraph (1) and all 
     that follows through the end of the subsection and inserting 
     the following: ``The Assistant Secretary for Indian Health 
     shall carry out the duties specified in paragraph (2).
       ``(2) The Assistant Secretary for Indian Health shall--
       ``(A) report directly to the Secretary concerning all 
     policy- and budget-related matters affecting Indian health;
       ``(B) collaborate with the Assistant Secretary for Health 
     concerning appropriate matters of Indian health that affect 
     the agencies of the Public Health Service;
       ``(C) advise each Assistant Secretary of the Department of 
     Health and Human Services concerning matters of Indian health 
     with respect to which that Assistant Secretary has authority 
     and responsibility;
       ``(D) advise the heads of other agencies and programs of 
     the Department of Health and Human Services concerning 
     matters of Indian health with respect to which those heads 
     have authority and responsibility; and
       ``(E) coordinate the activities of the Department of Health 
     and Human Services concerning matters of Indian health.''.
       (f) Continued Service by Incumbent.--The individual serving 
     in the position of Director of the Indian Health Service on 
     the date preceding the date of enactment of this Act may 
     serve as Assistant Secretary for Indian Health, at the 
     pleasure of the President after the date of enactment of this 
     Act.
       (g) Conforming Amendments.--
       (1) Amendments to indian health care improvement act.--The 
     Indian Health Care Improvement Act (25 U.S.C. 1601 et seq.) 
     is amended--
       (A) in section 601--
       (i) in subsection (c), by striking ``Director of the Indian 
     Health Service'' both places it appears and inserting 
     ``Assistant Secretary for Indian Health''; and
       (ii) in subsection (d), by striking ``Director of the 
     Indian Health Service'' and inserting ``Assistant Secretary 
     for Indian Health''; and
       (B) in section 816(c)(1), by striking ``Director of the 
     Indian Health Service'' and inserting ``Assistant Secretary 
     for Indian Health''.
       (2) Amendments to other provisions of law.--The following 
     provisions are each amended by striking ``Director of the 
     Indian

[[Page S902]]

     Health Service'' each place it appears and inserting 
     ``Assistant Secretary for Indian Health'':
       (A) Section 203(a)(1) of the Rehabilitation Act of 1973.
       (B) Subsections (b) and (e) of section 518 of the Federal 
     Water Pollution Control Act (33 U.S.C. 1377 (b) and (e)).
       (C) Section 803B(d)(1) of the Native American Programs Act 
     of 1974 (42 U.S.C. 2991b-2(d)(1)).
                                  ____


                      Section-by-Section Analysis

       Subsection (a) provides that the Office of Assistant 
     Secretary for Indian Health is established within the 
     Department of Health and Human Services.
       Subsection (b) requires that the Assistant Secretary for 
     Indian Health shall perform functions designated by the 
     Secretary of Health and Human Services in addition to the 
     functions of the Director of Indian Health. The Assistant 
     Secretary for Indian Health shall report directly to the 
     Secretary of HHS and shall also consult with the Assistant 
     Secretary of Health and other Assistant Secretaries on all 
     matters pertaining to Indian health policy.
       Subsection (c) provides that any references to the Director 
     of Indian Health Service 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)(1) 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)(1) further 
     amends 5316 of title 5 by striking ``Director, Indian Health 
     Service, Department of Health and Human Services.''
       Subsection (d)(2) abolishes the position of the Director of 
     Indian Health Service.
       Subsection (e) amends section 601 of the Indian Health Care 
     Improvement Act, 25 U.S.C. 1661, and other Acts by deleting 
     all provisions referring to the ``Director'' or ``Director of 
     Indian Health Service'' and inserting in lieu thereof ``the 
     Assistant Secretary for Indian Health.''
       Subsection 601 of 25 U.S.C. 1661(a), as amended by 
     subsection (b), is further amended by striking the term 
     limits for the Assistant Secretary for Indian Health.
                                 ______