[Congressional Record Volume 151, Number 54 (Thursday, April 28, 2005)]
[Senate]
[Pages S4586-S4589]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BINGAMAN:
  S. 972. A bill to designate the Albuquerque Indian Health Center as a 
critical access facility and to provide funds for that Center; to the 
Committee on Indian Affairs.
  Mr. BINGAMAN. Mr. President. I am introducing important legislation 
to address a crisis in the delivery of health care at the Albuquerque 
Indian Health Center, or AIHC, which provides critical primary, urgent, 
and oral health care services to more than 30,000 urban Indians living 
in the Albuquerque area.
  The Albuquerque Indian Health Center serves a large urban population 
with an inadequate funding base and provides contract health care 
funding for a significant portion of the urban Indian population. About 
50 percent of the base appropriation to the Albuquerque Service Unit 
goes to Tribes who are delivering their own health care services. 
However, for AIHC, the demand has not decreased due to the constant 
underfunding of IHS, and AIHC now receives more than $5 million less 
than it did just a few years ago.
  As a result, AIHC is running a severe deficit and the Indian Health 
Service, or IHS, has directed AIHC to begin the process of a reduction 
in force, or RIF, that will result in a significant downsizing of 
clinical personnel and the closure of the urgent care unit which sees 
an estimated 120 patients a day.
  After the RIF is completed, only two physicians will remain available 
to provide services for more than 30,000 Native Americans who utilize 
AIHC as their primary care provider.
  To address this problem, I am introducing legislation today that is 
called the ``Albuquerque Indian Health Center Act of 2005'' and would 
designate AIHC as a ``critical access facility'' for the region with 
additional funding of $8 million to address the shortfall and allow 
AIHC to be restored as a comprehensive ambulatory care center for urban 
Indians in the region.
  Prior to the introduction of this legislation, I have individually 
and jointly with the entire New Mexico congressional delegation made 
appeals to the Indian Health Service and to Department of Health and 
Human Services Secretary Mike Leavitt to use any authority they have to 
transfer funding to AIHC to alleviate this critical problem. 
Congressman Udall and I also sent a letter to Governor Bill Richardson 
on ways that we can work together with the State to improve the 
situation at AIHC.
  I ask unanimous consent that these letters be printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                                  U.S. Senate,

                                Washington, DC, December 15, 2004.
     Dr. Charles Grim,
     Director, Indian Health Services, U.S. Department of Health 
         and Human Services, Rockville, MD.
       Dear Dr. Grim: I recently had the opportunity to meet with 
     the CEO of the Albuquerque Indian clinic and other IHS staff. 
     It was alarming to hear that the roughly 23,000-25,000 urban 
     Native Americans that currently access their health care at 
     the Albuquerque Indian Health Center (AIHC) are at risk of 
     losing this access because the AIHC is experiencing 
     significant budget shortfalls. Since 1998, the AIHC has had 
     to significantly reduce services from a 24 hour-7 day a week 
     operation down to Monday through Friday 8:00 am-4:30 pm. 
     Access to services that concentrated on diabetic care, 
     behavior health and eye care has been severely restricted.
       The AIHC is projecting a $5 million deficit for fiscal year 
     2005. The current FY 2005 operations budget (hospital and 
     clinic funds) is about $5.4 million, yet current FY 2005 
     expenses are estimated at $10 million. Moreover, 
     approximately $4 million of the $5.4 million is still subject 
     to tribal transfer through Public Law 93-638. Indian Self-
     Determination Act. In an attempt to avoid a large deficit and 
     prepare for future transfers of funds from IHS to tribes, 
     AIHC officials have been forced to make a decision to 
     immediately reduce current services and downsize clinical 
     personnel.
       It is my understanding that beginning on January 1, 2005 
     the AIHC will be closing its urgent care services unit. It is 
     estimated that 100-120 Native American patients are seen on a 
     daily basis through urgent care. With nearly 70% of the 
     25,000 Native American users of the AIHC uninsured, IHS 
     estimates that this closure will put 17,000 urban Native 
     Americans at risk of losing access to healthcare services. 
     Furthermore, I have been informed that a second phase has 
     been proposed which will be to downsize the number of 
     physicians, nurses, pharmacists, and other allied personnel. 
     The annual 90,000 visits will be cut to 30,000, thus 
     decreasing third party billing by more than two thirds. The 
     AIHC anticipates that once the downsizing is complete, at 
     best, there will be two physicians onsite, Monday through 
     Friday, 8:00 am to 4:30 pm, who absolutely will not have the 
     capacity to provide services to 25,000 urban Native 
     Americans.
       I am asking that you consider reprogramming FY 2005 funding 
     increases in the amount of $13 million to the AIHC. $5 
     million will be needed to first stabilize services and the 
     remaining $8 million will then be used to increase services. 
     The $13 million is based on ``Level of Need Funding'' 
     criteria established by the IHS in 2002 to address 60% of the 
     needs of Native American population.
       I appreciate your time and consideration of this matter. 
     Should you have any questions or require further information 
     please feel free to contact Bruce Lesley in my Washington DC 
     office at 202-224-5527 or Danny Milo in my Albuquerque office 
     at 505-346-

[[Page S4587]]

     6601. I look forward to working on a positive solution to 
     this with you.
           Sincerely,
                                                    Jeff Bingaman,
     U.S. Senator.
                                  ____



                                Congress of the United States,

                                Washington, DC, December 22, 2004.
     Dr. Charles W. Grim, D.D.S., M.H.S.A.,
     Director, Indian Health Service, Rockville, MD.
       Dear Dr. Grim: We are writing in support of the request by 
     the Albuquerque Service Unit to shift funding within IHS to 
     the Albuquerque Indian Health Center (AIHC) and to seek 
     funding from other sources within HHS.
       The AIHC provides health care services to about 25,000 of 
     the 47,000 urban Indians living in Albuquerque, including 
     primary, urgent, and dental care. Because of a projected 
     deficit of $5 million in Fiscal Year 2005 and substantial 
     deficits in years thereafter, the urgent care center is set 
     to close on February 1, 2005. Without additional funding, 
     urban Indians in the Albuquerque metro area will lose access 
     to the AIHC for urgent care forcing them to visit non-IHS 
     facilities in the community or not seek urgent care when 
     needed. It is estimated that at least 17,000 urban Indians in 
     Albuquerque utilize urgent care services at the AIHC each 
     year.
       The current FY 2005 AIHC operations budget is about $5.4 
     million, yet FY 2005 expenses are estimated at $10 million 
     with the current level of services. About $4 million of the 
     $5.4 million budget is still subject to tribal share transfer 
     through Public Law 93-638, the Indian Self-Determination Act. 
     In an attempt to avoid a large deficit and to prepare for 
     future transfers of funds from IHS to tribes, AIHC officials 
     made the decision to close the urgent care center and 
     downsize clinical personnel beginning February 1.
       Since 1998, the AIHC has had to significantly reduce 
     services from a 24-7 operation down to Monday through Friday 
     8:00 AM to 4:30 PM. Access to services that concentrated on 
     diabetic care, behavioral health, and eye care has been 
     severely restricted. With the recent announcement of the 
     impending closure of the urgent care unit, walk in/same day 
     appointments wil1 no longer be accepted and patients will be 
     required to have an appointment to access outpatient 
     services. Since the positions of 40 physicians, nurses, 
     pharmacists, and staff will be eliminated, the availability 
     of appointments will be restricted due to the limited number 
     of physicians remaining. This will cause delays in treatment 
     and compromise the health of individuals. While we are asking 
     for a short-term influx of available dollars to keep the 
     urgent care center open, the gradual dwindling of services 
     provided at the AIHC is a systemic problem that must be 
     addressed.
       The 2000 census showed that about 60% of all Indians live 
     off of tribal land. Urban Indian health, however, only 
     comprises about 1% of the IHS budget. The deficit of the AIHC 
     is indicative of a much larger problem, a general deficiency 
     in funding for urban Indian health. We look forward to 
     working with you to address this larger problem. Our long-
     term goal is to secure a stable, reliable, and adequate 
     funding stream to the AIHC to fully meet the health care 
     needs of the urban Indian population in Albuquerque. Any 
     suggestions you have to help us meet this goal would be 
     appreciated.
       The financial stability of the Albuquerque Indian Health 
     Center and affiliated health clinics are vitally important to 
     providing access to health care for Indians, particularly 
     urban Indians in Albuquerque, and for the broader health care 
     system in our community. We look forward to your response in 
     this urgent matter.
           Sincerely,
     Pete V. Domenici,
                                                     U.S. Senator.
     Jeff Bingaman,
                                                     U.S. Senator.
     Heather Wilson,
                                               Member of Congress.
     Tom Udall,
                                               Member of Congress.
     Steven Pearce,
     Member of Congress.
                                  ____

                                          Department of Health and


                                               Human Services,

                                  Rockville, MD, January 21, 2005.
     Hon. Jeff Bingaman,
     U.S. Senate,
     Washington, DC.
       Dear Senator Bingaman: I am responding to your December 15. 
     2004, letter regarding the Albuquerque Indian Health Center. 
     The Albuquerque Service Unit is in a unique situation. It 
     serves a large urban population with a minimal funding base 
     and provides contract health care funds for approximately 30 
     percent of the urban population, including eligible Navajo 
     patients. This is compounded by the transfer of approximately 
     50 percent of the base appropriation to Tribes in the service 
     unit who are administering their own health care delivery 
     programs. To meet these fiscal constraints, the service unit 
     and the Albuquerque Area Indian Health Service (IHS) must 
     deliver care based on the funds available; unfortunately, 
     this requires the downsizing of the health services program 
     and a reduction-in-force.
       Reprogramming IHS funds is not viable for two reasons. 
     First, there arc no contingent funds available in our Agency. 
     Second, reprogramming appropriations for Tribal health to a 
     largely urban population requires a mechanism to transfer 
     these funds to Title V of Public Law 94-437 for urban 
     Indians. This would necessitate extensive Tribal 
     consultation, which would be very time-consuming and not meet 
     the immediate need.
       I have directed the Albuquerque Area Office and Service 
     Unit to: (1) downsize and implement the reduction-in-force; 
     (2) maximize their efforts to increase third-party revenue at 
     the service unit, including developing alternate billable 
     services; (3) work with the State of New Mexico and other 
     agencies and Tribes to develop alternatives to care for the 
     large metropolitan population in Albuquerque; and (4) discuss 
     fiscal support from the Navajo Area IHS. I am confident that 
     the Area Office and the service unit will explore all 
     opportunities to provide the highest quality health care to 
     this population.
       Thank you for your concern and your continued support of 
     our efforts to provide quality health care to our Indian 
     people.
           Sincerely yours,
                                                 Charles W. Grimm,
                                                           D.D.S.,
     Assistant Surgeon General, Director.
                                  ____

                                          Department of Health and


                                               Human Services,

                                  Rockville, MD, January 21, 2005.
     Hon. Heather Wilson,
     House of Representatives,
     Washington, DC.
       Dear Ms. Wilson: I am responding to your December 22, 2004; 
     letter supporting the need for funds to continue services at 
     the Albuquerque Service Unit. I agree that short-term support 
     is needed, but more importantly, a long-term solution to meet 
     the health needs of a rapidly growing ``urban'' population in 
     the Albuquerque metropolitan area is a more complex issue.
       The Albuquerque Indian Hospital has undergone several 
     changes in the scope of services. The number of inpatient 
     beds was reduced. Inpatient services were suspended and 
     evening and weekend clinics were eliminated. We are also 
     planning to limit services to appointments only with a 
     minimal number of hours for non-appointed services (``walk 
     ins'') and to initiate a substantial reduction-in-force 
     (RlF). These changes have been the result of the transfer of 
     over 60 percent of the hospital's Federal funds to Tribal 
     programs under Public Law (P.L.) 93-638 and an increase in 
     the number of uninsured patients residing in the Albuquerque 
     metropolitan community.
       The hospital needs a minimum of $5 million to maintain 
     services through this fiscal year. Permanently reprogramming 
     the IHS appropriation is not a viable option because of 
     limited funds throughout our system to deliver health care 
     services. The transfer of funds that may be available for 
     Tribal shares under P.L. 93-638 to support services to a 
     largely urban population would require extensive, time-
     consuming Tribal consultation. The Albuquerque Area Office 
     has presented to the members of the University of New Mexico 
     (NM) Clinical Operations Board, the possibility of a 
     partnership among the University of NM Health Sciences 
     Center, the State of NM, the Tribes, and the IHS Area. This 
     concept is currently being discussed with Tribal and State 
     officials and leaders in the Albuquerque metropolitan Indian 
     community.
       Mr. James L. Toya, Director, Albuquerque Area IRS, will 
     continue to explore all opportunities for resource 
     development, plan downsizing services at the Albuquerque 
     Hospital, and implement the RIF. In addition, local 
     partnership agreements are currently being developed.
       Thank you for your concern and continued support to our 
     efforts to provide quality health care to our Indian people.
           Sincerely yours,
                                                 Charles W. Grimm,
     D.D.S., Assistant Surgeon General, Director.
                                  ____



                                                  U.S. Senate,

                                 Washington, DC, February 2, 2005.
     Mr. Michael O. Leavitt,
     Secretary, U.S. Department of Health and Human Services, 
         Washington, DC.
       Dear Secretary Leavitt: During our recent meeting in 
     December, I had the opportunity to talk to you about the 
     crisis that the Albuquerque Indian Heath Center (AIHC) is 
     currently facing. The AIHC provides healthcare services to 
     roughly 23,000-25,000 urban Native Americans. Unfortunately, 
     there is a projected $5 million deficit for FY05. I have 
     recently been informed by Dr. Charles Grim that he has 
     directed the Albuquerque Area office and service unit to 
     downsize and implement a reduction in force. (RIF).
       Since 1998, the AIHC has had to significantly reduce 
     services from a 24 hour 7-day a week operation to Monday 
     through Friday 8:00 am-4:30 pm. Because of the 
     administration's under funding of IHS, once again, the AIHC 
     is being forced to ``downsize'' its operations which will 
     have significant effect on the urban Indian population. This 
     downsizing will force the AIHC to close its urgent care unit, 
     which sees an estimated 100-120 Native American patients a 
     day. With nearly 70% of the 25,000 Native American users of 
     the AIHC uninsured, this closure will cause 17,000 urban 
     Indians to lose access to their healthcare services. 
     Furthermore, last week the Indian Health Service took its 
     first steps toward their reduction in force which will result 
     in the elimination of 40 position at the AIHC. There are 
     currently 140 employees at the center of whom only 14 are 
     physicians. It is my understanding that 5 of these 14 
     physicians will be ``RIFed'' which will leave the AIHC with 
     only 9 physicians (4 family practice, 2 pediatricians, and 4 
     specialists) to treat an estimated population of 23,000-
     25,000 patients.
       On December 15, 2004 I sent a letter to Dr. Grim asking him 
     to consider reprogramming

[[Page S4588]]

     FY05 funding in the amount of $13 million. Of this $5 million 
     would be used to stabilize services and the remaining $8 
     million would be used to increase services. Dr. Grim 
     responded to my letter saying that ``reprogramming IHS 
     funding is not viable'' due to the fact that ``there are no 
     contingent funds available to our Agency.'' I am now 
     requesting that you consider reprogramming Department of 
     Health and Human Services (HHS) funds to Indian Health 
     Service in the same amount for the specific purpose of 
     treating the urban Indian population through the Albuquerque 
     Indian Health Center.
       It is important for Department of Health and Human Services 
     to understand and acknowledge that urban Indians throughout 
     the country are falling through the cracks and that urban 
     Indian clinics are being grossly underfunded. For many years 
     there has been a quiet migration of Indians from reservations 
     to cities. In fact more Native Americans live in cities now, 
     making it important that IHS programs cater to Indian Country 
     which extends beyond borders of the reservations and into 
     urban settings. According to a study done by the Kaiser 
     Family Foundation ``about 46% of IHS resources are allocated 
     to IHS facilities, 53% to tribally operated facilities, and 
     only 1% to urban Indian programs''. These numbers clearly 
     indicate that urban IHS facilities lack the financial 
     resources necessary to carry out their services.
       Nationwide there are an estimated 1.6 million federally-
     recognized Native Americans through IHS, as well as Tribal 
     and urban Indian health programs. Of this number, the 2000 
     census data reveals that a little over half this population 
     identify the themselves as living in metropolitan/urban 
     areas, in which Albuquerque has the 7th highest urban Indian 
     population. A recent U.S. Commission on Civil Rights (USCCR) 
     report estimates that the Department of Health and Human 
     Services (HHS) per capita health spending for all Americans 
     is at $4,065, while IHS spent about $1,914 per person and 
     average spending on Navajo patients is $1,187. The United 
     States Government has historical and legal responsibility to 
     provide adequate healthcare for the Native American 
     population and ensure that access to these services are not 
     lost; with these cuts and drastic under funding the 
     government is shirking its responsibility.
       Thank you for your prompt consideration of this matter. 
     Should you have any questions or require further information 
     please feel free to contact Bruce Lesley in my Washington, DC 
     office at 202-224-5527 or Danny Milo in my Albuquerque office 
     at 505-346-6601. I look forward to working with you on 
     finding a solution to this matter. Best wishes.
           Sincerely,
                                                    Jeff Bingaman,
     U.S. Senator.
                                  ____

                                               Secretary of Health


                                           and Human Services,

                                   Washington, DC, March 24, 2005.
     Hon. Jeff Bingaman,
     U.S. Senate,
     Washington, DC.
       Dear Senator Bingaman: I enjoyed our discussion a few 
     months ago, and am pleased to respond to your letter 
     regarding the reduction in available funding for the 
     Albuquerque Indian Health Center (AIHC) in Albuquerque, New 
     Mexico.
       I share your concerns regarding the impact of reducing 
     staff and services at the AIHC. The AIHC has experienced 
     funding decreases in recent years due to Tribes exercising 
     their rights under the Indian Self-Determination and 
     Education Assistance Act (ISDEAA) to operate their own health 
     programs. Under the ISDEAA, the IHS is required to transfer 
     dollars from services it provides directly to eligible 
     American Indians and Alaska Natives (AI/ANs) to Tribes which 
     apply, and are approved, to compact or contract for services 
     they provide to their members. The Department of Health and 
     Human Services does not have authority to reprogram funds 
     from other appropriation accounts to the Indian Health 
     Services account where the AIHC is funded.
       I assure you the IHS continues to partner with other 
     community providers in the Albuquerque area to maximize all 
     resource opportunities for AI/ANs who may still use the 
     center's services. Options being explored include: continued 
     provision of same day appointments, increased collaboration 
     with the University of New Mexico and the Salud managed care 
     organization to enroll more patients in the ``University of 
     New Mexico Cares'' program, maximizing third party 
     collections by increasing access to individuals who may be 
     eligible for Medicaid or Medicare, and improving 
     transportation options to other IHS funded facilities. 
     Additional options for the Albuquerque Indian community 
     include applying for other HHS grant programs including the 
     Health Resources and Services Administration's (HRSA) Sec. 
     330 Community Health Center Program grants, and exploring the 
     Substance Abuse and Mental Health Administration's (SAMHSA) 
     grant opportunities. I want to assure you that HHS staff will 
     provide technical assistance in the grant application process 
     to potential grantees.
       I am hopeful that these options will result in significant 
     assistance to AI/ANs in the Albuquerque area. Thank you for 
     your concern and continued support of HHS efforts to provide 
     quality care to American Indians and Alaska Natives. Please 
     call me if you have any further thoughts or questions.
           Sincerely,
     Michael O. Leavitt.
                                  ____

                                                   March 15, 2005.
     Hon. Bill Richardson,
     Governor of New Mexico,
     State Capitol, Santa Fe, NM.
       Dear Governor Richardson: As you are aware, the Albuquerque 
     Indian Health Center (AIHC) is facing a crisis that threatens 
     the health and well-being of 23,000 urban Indians in 
     Bernalillo County and surrounding areas. Although there have 
     been a number of efforts that we have supported to increase 
     the Indian Health Service (IHS) budget, those efforts have 
     been defeated in the Congress during the past few years. 
     Consequently, funding for the AIHC has dropped from $13 
     million to just $5 million in recent years.
       Although New Mexico's congressional delegation is working 
     together to secure a solution at the federal level, we wanted 
     to encourage you to have your Administration help AIHC in the 
     interim to improve third-party collections.
       For example, as an IHS facility, care delivered to Medicaid 
     beneficiaries at AIHC is reimbursed with 100% federal 
     financing. Thus, we would ask that the Human Services 
     Department (HSD) work closely with Maria Rickert, Chief 
     Executive Officer of AIHC, to determine if: (1) Medicaid 
     reimbursement for services delivered by AIHC could be 
     improved; (2) the State Medicaid program can do more with 
     respect to providing for eligibility workers at AIHC; and, 
     (3) there are other options to help AIHC address its funding 
     problem and protect critical health services for the urban 
     Indians in the Albuquerque area.
           Sincerely,
     Jeff Bingaman,
                                                      U.S. Senator
     Tom Udall,
     U.S. Representative.
                                  ____

                                              State of New Mexico,


                                       Office of the Governor,

                                                   April 25, 2005.
     Hon. Pete V. Domenici,
     U.S. Senator, Hart Senate Office Building, Washington, DC.
     Hon. Heather Wilson,
     Member of Congress, Cannon House Office Building, Washington, 
         DC.
     Hon. Steve Pearce,
     Member of Congress, Longworth House Office Building, 
         Washington, DC.
     Hon. Jeff Bingaman,
     U.S. Senator, Hart Senate Office Building, Washington, DC.
     Hon. Tom Udall,
     Member of Congress, Longworth House Office Building, 
         Washington, DC.
       Dear Senators Domenici and Bingaman and Representatives 
     Wilson, Udall and Pearce: Thank you for your recent letters 
     expressing your concerns regarding the Albuquerque Indian 
     Healthcare Center (AIHC). Clearly, we all share the same 
     commitment to improve the delivery of health care services to 
     our Native American constituencies. Therefore, I hope that 
     you will strongly advocate for increased funding for the 
     Indian Health Service (IHS) during the appropriations 
     process.
       Providing adequate healthcare services to our Native 
     American citizens is a federal responsibility yet the Indian 
     Health Service (IHS) has only received minimal increases in 
     funding, such as a mere 2 percent increase this year. 
     Properly funding the IHS ensures that the Native American 
     population in New Mexico as well as across the country 
     receives the vital healthcare services to which they are duly 
     entitled.
       On the State level, my administration has committed 
     resources to address the healthcare needs of Native 
     Americans. Unfortunately, the New Mexico Legislature did not 
     pass House Bill 521 this past session, letting it sit idle 
     after passage in its first committee. However, I signed into 
     law nearly $2 million in funding for Native American 
     healthcare projects in New Mexico, including the construction 
     of healthcare facilities in Indian Country, the provision of 
     ambulatory services in Albuquerque, and healthcare services 
     at UNM Hospital for Native American patients.
       In addition my administration has provided the following 
     support, which includes but is not limited to:
       The New Mexico Human Services Department (NMHSD) through 
     the Medical Assistance Division is providing outreach to 
     eligible Native American children to get them enrolled with 
     Medicaid.
       NMHSD is providing valuable technical assistance to the 
     AIHC through training and billing resources in order to 
     maximize Medicaid reimbursement. After working with AIHC and 
     reviewing the Medicaid claims, it was determined that there 
     are no outstanding claims and AIHC is receiving reimbursement 
     at the maximum level possible as an outpatient facility.
       The State Coverage Initiative has been funded in New Mexico 
     and will be implemented effective July 1, 2006. It may be 
     possible for AIHC to receive payments for services provided 
     to this population.
       During the State fiscal year 2004, there were 4,549 
     American Indian Medicaid recipients in the fee-for-service 
     program who received outpatient services at AHIC for a total 
     reimbursement of about $2 million dollars. Sixty-five percent 
     of those recipients were under 21 years of age.
       The Presumptive Eligibility/Medicaid On-Site Application 
     Assistance (PE/MOSAA)

[[Page S4589]]

     program has worked well for Indian communities. PE/MOSAA 
     certified workers are located at IHS and tribal health care 
     facilities, tribal schools, and other tribal health and 
     social services departments and with NMHSD's Income Support 
     Division offices.
       As a pilot project, NMHSD recently stationed an eligibility 
     worker at the Gallup Indian Medical Center. As a regional 
     referral center, the Gallup Service Unit (including Tohatchi 
     Health Center, and Ft. Wingate Health Center) provides 
     services to about 800 patients per day.
       New Mexico cannot nor should not bear sole responsibility 
     for funding healthcare services that fall within the ambit of 
     the federal trust relationship with Indian tribes and 
     pueblos. To this end, I appreciate your collective efforts to 
     garner support on the federal level to keep AIHC afloat.
       I also appreciate Senator Bingaman's efforts to address 
     these issues in his legislation that would fulfill the 
     funding needs for AIHC as well as clarify the 100 percent 
     match in Medicaid for urban Indians. I suggest that you 
     direct your staff to review the Bingaman legislation and 
     strongly consider supporting his efforts to assist the AIHC 
     and urban Indians.
       If I can assist the Congressional Delegation in its efforts 
     to advocate for increased federal funding for IHS and 
     specific assistance for AIHC please do not hesitate to call 
     upon me. Again, thank you for your letters and I look forward 
     to working with all of you to improve and expand health care 
     services to our Native American residents in New Mexico.
           Sincerely,
                                                  Bill Richardson,
     Governor.
                                  ____

  Mr. BINGAMAN. Included in that is a statement by Governor Richardson 
expressing his strong support for the legislation I am introducing 
today.
  Unfortunately, the options that Secretary Leavitt outlined in his 
response will only provide limited help in alleviating this crisis. It 
is for that reason that I introduce this emergency funding legislation 
today.
  Fundamentally, while AIHC does face a unique situation because the 
Albuquerque metro area has experienced a significant increase in its 
urban Indian population from surrounding tribes and individuals from 
tribes across the Nation, the most significant underlying problem is 
that the entire Indian Health Service is horribly underfunded.
  In fact, funding for Native American health care is a national 
travesty. Over the years, funding for IHS has not kept pace with 
medical inflation and population growth As a result, IHS services are 
seriously underfunded, and patients are routinely denied care. For many 
critical services, patients are subjected to a literal ``life or limb'' 
test; their care is denied unless their life is threatened or they risk 
immediate loss of a limb. Care is denied or delayed until their 
condition worsens and treatment is costlier or, all too often, comes 
too late to be effective. Federal per capita funding for Indian health 
is only $1,914, about half the allotment of Federal per capita funding 
for health care for Federal prisoners.
  Former HHS Secretary Tommy Thompson traveled to the Navajo 
Reservation last year and saw this problem first-hand and vowed to 
fight for increased funding for tribal health care. Unfortunately, the 
administration has proposed a rather modest increase of less than 2 
percent for IHS in fiscal year 2006. Yet again, IHS funding will not 
come close to keeping pace with medical inflation which is growing at 
double-digit levels in the private sector.
  On a per capita basis, it is even worse because HHS's own budget 
documents indicate that IHS will have to serve over 29,000 new people. 
Furthermore, although urban Indians represent around half of all Native 
Americans in the country, urban Indian health programs receive less 
than 1 percent of all IHS funding and those funds are literally frozen 
at $33 million nationwide.
  This is both unacceptable and unsustainable.
  In addition to supporting budget and appropriations amendments time-
and-time again over the years that unfortunately have failed in Senate 
votes, including an amendment by Senator Conrad to the budget 
resolution this year, I successfully offered amendments last session of 
Congress to the Medicare prescription drug bill to provide Indian 
Health Service units to get better prices through the contract health 
services program and to allow IHS to bill for the full array of 
services in the Medicare program.
  In the coming weeks, I will also be introducing two pieces of 
legislation to both improve health services generally for urban Indians 
and to also improve the delivery of health care for Native Americans in 
the Medicaid and State Children's Health Insurance Program, or SCHIP.
  In the short-term, however, we need passage of this critical and 
urgent legislation to save the health services provided by the 
Albuquerque Indian Health Center that are being threatened. I urge its 
immediate passage.
  I ask for unanimous consent to print a copy of the legislation in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                 S. 972

       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 ``Albuquerque Indian Health 
     Center Act of 2005''.

     SEC. 2. CRITICAL ACCESS FACILITY FUNDING.

       (a) Definition of Critical Access Facility.--In this 
     section, the term ``critical access facility'' means a 
     comprehensive ambulatory care center that provides services 
     on a regional basis to Native Americans in Albuquerque, New 
     Mexico, and surrounding areas.
       (b) Designation.--The Albuquerque Indian Health Center 
     (also known as the ``Albuquerque Indian Hospital'') is 
     designated as a critical access facility.
       (c) Operations.--
       (1) In general.--The Secretary of Health and Human 
     Services, acting through the Indian Health Service, shall 
     provide funds made available under subsection (d) to the 
     Albuquerque Indian Health Center to carry out the operations 
     of that Health Center.
       (2) Self-determination contracts.--The funds transferred 
     under paragraph (1) shall not be distributed to any Indian 
     tribe under section 102 of the Indian Self-Determination and 
     Education Assistance Act (25 U.S.C. 450f).
       (d) Funding.--
       (1) In general.--On October 1, 2005, out of any funds in 
     the Treasury not otherwise appropriated, the Secretary of the 
     Treasury shall transfer to the Secretary of Health and Human 
     Services to carry out this section $8,000,000, to remain 
     available until expended.
       (2) Receipt and acceptance.--The Secretary shall be 
     entitled to receive, shall accept, and shall use to carry out 
     this section the funds transferred under paragraph (1), 
     without further appropriation.
                                 ______