[Congressional Record Volume 149, Number 47 (Monday, March 24, 2003)]
[Senate]
[Pages S4323-S4324]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




            INDIAN HEALTH AMENDMENT TO THE BUDGET RESOLUTION

  Mr. DASCHLE. Mr. President, through treaties and Federal statute, the 
Federal Government has promised to provide health care to American 
Indians and Alaska Natives. Sadly, we haven't come close to honoring 
that commitment. Tomorrow, I intend to offer an amendment to the budget 
resolution to rectify this situation.
  The IHS is the only source of health care for many Indians, and is 
required to provide that help and that support, yet funding has never 
been adequate.
  The chronic underfunding has grown even worse in recent years, as 
appropriations have failed to keep up with the steep rise in private 
health care spending.
  While per capita health care spending for the general U.S. population 
is about $4,400, the Indian Health Service spends only about $1,800 per 
person on individual health care services. The Government also spends 
considerably less on health care for Indians that it spends for 
Medicare beneficiaries, Medicaid recipients, and veterans.
  This level of funding is woefully inadequate to meet the health care 
needs of Native Americans--who have a lower life expectancy than other 
Americans, and disproportionately suffer from a number of serious 
medical problems. Indians have higher rates of diabetes, heart disease, 
sudden infant death syndrome, and tuberculosis. There is also a great 
need for substance abuse and mental health services.
  More funds are needed at the IHS to provide necessary health care 
services to Indians.
  The current shortage of funds has startling and disturbing results. 
Native Americans are often denied care that most of us would take for 
granted and, in many cases, consider essential. They can be required to 
endure long waits before seeing a doctor and may be unable to obtain a 
referral to see a specialist. As incredible as this may seem, many 
Indians and Alaska Natives seeking health care are subject to a literal 
``life or limb'' test; that is unless their life is threatened or they 
risk losing a limb, their care is postponed. Others receive no care at 
all.
  This rationing of care means that all too often Indians are forced to 
wait until their medical conditions become more serious--and more 
difficult and costly to treat--before they may have access to health 
care. This is a situation none of us would find acceptable. Yet today 
this is the reality in Indian country.
  Last year, Gregg Bourland and Harold Frazier, then the chairman and 
vice chairman of the Cheyenne River Sioux Tribe, sent a letter to the 
IHS. This is how they describe the situation in Eagle Butte, SD:

       In January and February 2002, the Eagle Butte Service Unit 
     on the Cheyenne River Sioux reservation has been swamped with 
     children with Influenza A, RSV [Respiratory Syntactical 
     Virus], and one fatal case of meningitis. There are only 
     three doctors on duty, one Physician Assistant, and one Nurse 
     Practitioner. The only pediatrician is the Clinical Director 
     who will not see any patients, even though there is a serious 
     need for the services of a pediatrician.
       Several of these children have presented with breathing 
     problems, high fever, and severe vomiting. The average 
     waiting time at the clinic has been four and six hours. The 
     average time at the emergency room is similar. Most babies 
     have been sent home without any testing to determine what 
     they have and with nothing but cough syrup and Tylenol. In at 
     least three cases, the baby was sent home after these long 
     waits two or more times with cough syrup, only to be life-
     flighted soon thereafter because the child could not breathe.
       The children were all diagnosed by the non-IHS hospital 
     with RSV [Respiratory Syntactical Virus]. No babies have died 
     yet, but the Tribe sees no justification for waiting until 
     this happens when these viruses are completely diagnosable 
     and treatable.

  It is absolutely unacceptable to put the lives of these children at 
risk. And we can do something to help. On more than one occasion, I 
have heard horror stories of pregnant mothers delivering children in 
circumstances that no expectant mother or child should have to endure.
  For example, right now the service unit at Eagle Butte in South 
Dakota does not have an obstetrician. The Eagle Butte service unit is 
funded at 44 percent of the need calculated by the Indian Health 
Service. The facility has a birthing room and 22 beds, but there are 
only two to three doctors to staff the clinic, hospital and emergency 
room. Naturally, as a result, many children and expectant mothers do 
not receive the care they need and deserve. Due to budget constraints, 
the IHS policy is to allow only one ultrasound per pregnancy. The 
visiting obstetrician is available only every couple of weeks.
  The story of Brayden Robert Thompson points out how dangerous this 
situation is. On March 3, 2002, Brayden's mother was in labor with a 
full-term, perfectly healthy baby. Brayden's umbilical cord was wrapped 
around his neck, but, without ultrasound, that went undetected. The 
available medical staff didn't know what to do about his lowered 
heartbeat, abnormal urinalysis or the fact that his mother was not 
feeling well. Despite the symptoms, IHS refused to provide an 
ultrasound or to send her to Pierre to see an obstetrician. Bryden was 
stillborn.
  This tragic death was completely preventable, but tough choices are 
being made every day at IHS facilities throughout the country because 
there simply isn't enough money to provide the care that every American 
deserves.
  The Pine Ridge Indian reservation in my State of South Dakota built a 
beautiful new hospital and health care center. In many ways, they are 
equipped to provide state-of-the-art, coordinated care. But they cannot 
retain healthcare professionals because of low payment schedules and 
inadequate training opportunities for local people.
  Their shiny new labor and delivery rooms, surgery rooms and even 
dental

[[Page S4324]]

chairs stand empty, and individuals on the reservation are forced to 
travel long distances to receive these vital services. This also is the 
case on the neighboring Rosebud Indian reservation.
  But this is not solely an Indian issue. It affects surrounding rural 
community hospitals, ambulance services, and other health care 
providers who work with IHS. For example, the Lake Andes-Wagner 
ambulance district in northeastern South Dakota is facing financial 
disaster, in part because they have not been reimbursed properly by the 
Indian Health Service.
  This ambulance service offers emergency transport for citizens of 
Charles Mix County and Yankton Sioux tribal members, since the Wagner 
IHS hospital cannot afford to operate its own service. If this 
ambulance service shuts down, what will these residents--Indian and 
non-Indian--do when they face an emergency?
  Bennett County Hospital in the southwestern part of South Dakota is 
located between the Pine Ridge and Rosebud Indian reservations, and 
suffers similar IHS reimbursement problems, as do other non-IHS 
providers in South Dakota and throughout rural America.
  From 1998 to 2001, the most recent year for which IHS has data, IHS 
contract denials have increased 75 percent.
  In his budget request for the next fiscal year, the President 
requested only $1.99 billion for clinical services for Indians. This 
represents only a small increase over what the President requested for 
fiscal year 2003, and virtually no increase over what was finally 
included in the omnibus appropriations bill. We can and must do better.
  The amendment I am proposing would increase funding for clinical 
services by $2.9 billion over the President's request for fiscal year 
2004. It is the minimal amount that is necessary to provide basic 
health care to the current IHS user population. The full cost over the 
next 10 years would be $38.7 billion. The amendment also devotes an 
equal amount to deficit reduction, all offset by a corresponding 
decrease in the top tax rate reduction.
  The amendment is cosponsored by Senators Inouye, Bingaman, Dorgan, 
Murray, Wyden, Johnson, Leahy, Cantwell, Reid, Kennedy, and Lieberman. 
It is also supported by a wide range of health organizations, native 
and non-native.
  This budget resolution is a test of this Nation's priorities. Some 
will say that it doesn't matter, that it is purely symbolic. But the 
whole point of the budget resolution is to establish an enforceable 
fiscal framework and make room in our budget for needs that we believe 
are worthy or our national attention.
  I know there are some in this body who honestly believe that it is 
more important to accelerate huge tax cuts for our Nation's wealthiest 
citizens than to provide Native Americans the health care they have 
been promised but denied. Some defend that position by saying that 
someday, somehow, these Native Americans will benefit from the tax cuts 
extended to others, that the benefit will ``trickle down'' to them as 
well. It is their right to take that position, but they could not be 
more wrong.
  A woman going into labor cannot wait for economic benefits to trickle 
down to her.
  A child in respiratory distress cannot wait either. How is it 
possible that we can afford to delve deeper into debt to fund 
additional tax cuts for those doing relatively well in this country, 
but we cannot afford to dedicate a small fraction of that amount to 
fund the most basic health care services for some of the poorest people 
in America, today?
  We must not tolerate this situation.
  The problem is real; the solution is simple. Give the Indian Health 
Service the funds it needs to provide Native Americans the health 
benefits they were promised.
  I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Burns). The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. GRAHAM of South Carolina. Mr. President, I ask unanimous consent 
that the order for the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Chambliss). Without objection, it is so 
ordered.

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