[Congressional Record Volume 154, Number 9 (Tuesday, January 22, 2008)]
[Senate]
[Pages S59-S65]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
INDIAN HEALTH CARE IMPROVEMENT ACT AMENDMENTS OF 2007--Continued
The PRESIDING OFFICER. The Senator from Alaska.
Mrs. MURKOWSKI. Mr. President, I wished to echo the comments of my
colleague and my chairman on the Indian Affairs Committee.
Reauthorization of this Indian Health Care Improvement Act is something
that is long overdue. When we sat down as the chairman and vice
chairman of this committee to assess the priorities of the committee,
it was absolutely clear the one thing we could do now to help make a
difference in the lives of American Indians and Alaska Natives was to
improve the health care system, the delivery, and the access.
The last time this was updated, if you will, was 1992. Think about
what has happened in health care and the technologies and the
techniques since 1992. We owe it to our constituents across the
country--not just in Alaska, where we have 225 tribes, but from
California to Maine, from the Dakotas down to Florida--we owe it to all
our constituents to finally see this reauthorization through. We do
acknowledge there are some issues that are as yet unresolved, but it is
not as if we have not had the time to resolve them. The time is now to
make it happen.
I, too, would urge the Senate to work together, as the chairman and I
have, in a very cooperative, very bipartisan manner to figure out how
we move this legislation through the Senate to the House so it is
finally enacted into law.
With that, I yield the floor.
The PRESIDING OFFICER. The Senator from Vermont.
Amendment No. 3900
Mr. SANDERS. Mr. President, I ask unanimous consent that the pending
amendment be set aside so I can send an amendment to the desk, and I
ask for its immediate consideration.
The PRESIDING OFFICER. Without objection, the clerk will report.
The legislative clerk read as follows:
The Senator from Vermont [Mr. Sanders], for himself, Mr.
Obama, Ms. Cantwell, Mr. Kerry, Ms. Snowe, Ms. Collins, Mr.
Sununu, Mr. Menendez, Mr. Leahy, Mrs. Clinton, and Mr.
Kennedy, proposes an amendment numbered 3900.
Mr. SANDERS. Mr. President, I ask unanimous consent that the
amendment be considered as read.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:
(Purpose: To provide for payments under subsections (a) through (e) of
section 2604 of the Low-Income Home Energy Assistance Act of 1981)
At the end of title II, insert the following:
SEC. 2__. LOW-INCOME HOME ENERGY ASSISTANCE PROGRAM.
(a) In General.--There are authorized to be appropriated,
and there are appropriated, out of any money in the Treasury
not otherwise appropriated--
(1) $400,000,000 (to remain available until expended) for
making payments under subsections (a) through (d) of section
2604 of the Low-Income Home Energy Assistance Act of 1981 (42
U.S.C. 8623); and
(2) $400,000,000 (to remain available until expended) for
making payments under section 2604(e) of the Low-Income Home
Energy Assistance Act of 1981 (42 U.S.C. 8623(e)),
notwithstanding the designation requirement of section
2602(e) of such Act (42 U.S.C. 8621(e)).
(b) Designation.--Any amount provided under subsection (a)
is designated as an emergency requirement and necessary to
meet emergency needs pursuant to subsections (a) and (b) of
section 204 of S. Con. Res. 21 (110th Congress), the
concurrent resolution on the budget for fiscal year 2008.
Mr. SANDERS. Mr. President, let me begin by saying this amendment is
being cosponsored by Senators Snowe, Collins, Obama, Cantwell, Sununu,
Menendez, Stabenow, Clinton, Leahy, and Kerry. This amendment, which
would increase LIHEAP funding by $800 million, also has the support of
the National Energy Assistance Directors Association, the National Fuel
Funds Network, the American Gas Association, the National Association
of State Energy Officials, and many other groups.
This amendment is as simple and straightforward as it can be, and
what it is about is that at a time when, as everybody knows, home
heating prices are going through the roof, it is getting colder every
day--it will be below zero in Vermont this week--this amendment would
provide real relief to millions of senior citizens on fixed incomes,
low-income families with children, and persons with disabilities.
Specifically, this amendment would provide $800 million emergency
funding for the Low-Income Home Energy Assistance Program, otherwise
known as LIHEAP. Four hundred million dollars of this funding would be
distributed under the regular LIHEAP formula and the other $400 million
would be used under the contingency LIHEAP program.
Last month, I introduced the Keeping Americans Warm Act to provide $1
billion in emergency LIHEAP funding. I am pleased that this bill has
garnered 26 cosponsors--19 Democrats, 6 Republicans, and 1 Independent.
In addition, as you know, on December 3, 38 Senators cosigned a
letter spearheaded by Senator Jack Reed and Susan Collins to the Labor-
HHS-Education Appropriations Subcommittee Chairman Harkin and Ranking
Member Specter urging the appropriations committee to provide a total
of $3.4 billion in LIHEAP funding.
As you know, there is a lot of discussion right now in seeing that
there be a substantial increase in LIHEAP funding in the economic
stimulus bill that is being talked about, which I certainly support.
I would also like to take this opportunity to commend Subcommittee
Chairman Harkin, Ranking Member Specter, Appropriations Chairman Byrd,
and Ranking Member Cochran for providing a total of $2.6 billion in
funding for LIHEAP in the Omnibus appropriations bill. I understand how
difficult it was to reach a deal on this bill. I appreciate everything
Senator Byrd and others have done for LIHEAP to make sure people in our
country do not go cold.
Unfortunately, this $2.6 billion in funding for LIHEAP, while an 18-
percent increase from last year, is still 23 percent below what was
provided for LIHEAP just 2 years ago. And that 23-percent reduction is
not even adjusted for inflation. I am talking about nominal dollars.
Two years ago, as I think every American fully understands, the price
of heating oil was less than $2.50 a gallon. Today, it is over $3.36 a
gallon. In central Vermont, we have seen prices as high as $3.73 a
gallon for heating oil. This winter, consumers are projected to pay
over $1,800 to heat their homes with heating oil--$1,800 just to stay
warm this winter. This winter, it is projected that consumers will be
paying over $1,600 to heat their homes with propane. Two years ago,
they only paid $1,281.
The skyrocketing prices are already stretching the household budgets
of millions of families with children, senior citizens on fixed
incomes, and persons with disabilities beyond the breaking point. I
cannot tell you--I am sure the situation is not radically different in
Pennsylvania--how many people are telling me that when they see these
heating bills, they cannot believe it. They just do not know how they
are going to stay warm this winter.
Unfortunately, the spike in energy costs is completely eviscerating
the purchasing power of this extremely important program in State after
State. If Congress does not act soon to confront this problem head-on--
and this is a problem which is existing now and will get worse in late
January and in February--I fear for the public health and safety of
many of our most vulnerable citizens.
The point is, we have to act. We have to act. I support any and all
efforts to
[[Page S60]]
expand LIHEAP but, frankly, it will do less good if it is passed in
March or in April than it will if it is passed in January and February.
We need to get the money out to people now so they do not go cold.
According to the National Energy Assistance Directors Association,
due to insufficient funding, the average LIHEAP grant only pays for 18
percent of the total cost of heating a home with heating oil this
winter, 21 percent of residential propane costs, 41 percent of natural
gas costs, and 43 percent of electricity costs this winter. What this
means is that low-income families with kids, senior citizens on fixed
incomes, and others will have to make up the remaining cost out of
their own pockets. As you know, in this country we are looking at some
very rocky economic times. More and more people are unemployed. Poverty
is going up. Where are those people going to get these large sums of
money to stay warm this winter?
In addition, only 15 percent of eligible LIHEAP recipients currently
receive assistance with home heating bills. Eighty-five percent of
eligible low-income families with children, senior citizens on fixed
incomes, and persons with disabilities do not receive any LIHEAP
assistance whatsoever due to a lack of funding. There are many people
all over this country who are eligible for this program who are unable
to get the help they need. In my own State of Vermont, it has been
reported that outrageously high home heating costs, oil costs, are
pushing families into homelessness. In fact, it is not uncommon for
families with two working parents to receive help from homeless
shelters in the State of Vermont because they cannot afford anyplace
else to live during the winter.
This is a national energy emergency which is affecting States all
over the country, certainly not just Vermont. On January 17, 1 day
after the President released $450 million in emergency LIHEAP funding,
the National Energy Assistance Directors Association testified in front
of the Health, Education, Labor and Pensions Committee chaired by
Senator Kennedy. I very much appreciate his holding that hearing in
Boston focusing national attention on this crisis. Here is what the
national energy directors reported. This is what they say:
In Arkansas, the number of families receiving LIHEAP assistance is
expected to be reduced by up to 20 percent from last year if they are
not able to get more funding. Arkansas, 20 percent reduction.
In Arizona, estimates are that they will have to cut the number of
families receiving LIHEAP assistance by 10,000 families as compared to
last year.
In Delaware, the number of families receiving LIHEAP assistance will
be reduced by up to 20 percent. In most instances, your average LIHEAP
grant only pays for about 20 percent of the total cost of heating a
home in Delaware.
During the winter in Iowa, the regular LIHEAP grant has been cut by 7
percent from last year. The average LIHEAP grant in Iowa is $300. Two
years ago, the average grant was $450.
The State of Kentucky can run out of LIHEAP funding as early as next
February.
In Maine, the average LIHEAP grant will only pay for about 2 to 3
weeks of home heating costs in most homes in that State, and I can tell
you that it stays cold for a lot longer than 2 or 3 weeks in Maine, in
New England.
In Massachusetts, the spike in energy costs means that the purchasing
costs for LIHEAP has declined by 39 percent since 2006.
The State of Minnesota can run out of LIHEAP funding as early as
February.
In New York, many households have already exhausted their entire
LIHEAP funding.
While Ohio has seen a 10-percent increase in the number of people
applying for LIHEAP assistance, that State will have to cut back its
regular LIHEAP grant by between 15 to 20 percent.
Rhode Island, Texas, the State of Washington--on and on it goes. The
bottom line is, home heating fuel costs are soaring, and LIHEAP does
not have enough money to take care of the needs of people in State
after State after State.
In the richest country on the face of the Earth, no family, no child,
no senior citizen should be forced to go cold this winter. I am afraid
that unless we act, and act very quickly, that is exactly what will be
happening.
We hear a lot of talking about energy funding around here. Not every
piece of legislation, in fact, is an emergency. This is an emergency.
As we speak tonight, people all over this country do not have enough
money to stay warm. That situation will only get worse. We have to act,
and we have to act now.
Let me again thank the many cosponsors of this legislation. It is
certainly bipartisan. There are cold people in Republican States,
Democratic States, Independent States. We have to act together, and we
have to move as rapidly as we can.
I am offering this amendment now on the Indian health bill. I will
offer it at every opportunity I can. I look forward to working with the
Members of the Senate to see that we do the right thing so that no
American goes cold this winter.
Ms. COLLINS. Mr. President, I wish to discuss funding for the Low
Income Home Energy Assistance Program, commonly known as LIHEAP. LIHEAP
is a Federal grant program that provides vital funding to help low-
income and elderly citizens meet their home energy needs.
Due to record-high oil costs, the situation for our neediest citizens
is especially dire this winter. That is why I have sponsored Senator
Sanders' amendment to increase LIHEAP funding by $800 million.
Nationwide, over the last 4 years, the number of households receiving
LIHEAP assistance increased by 26 percent from 4.6 million to about 5.8
million, but during this same period, Federal funding increased by only
10 percent. The result is that the average grant declined from $349 to
$305. In addition, since August 2007, crude oil prices quickly rose
from around $60 a barrel to nearly $100 a barrel earlier this month, so
a grant buys less fuel today than it would have just 4 months ago.
According to Maine's Office of Energy Independence and Security, the
average price of heating oil in our State is $3.30 per gallon, which is
$1.09 higher than at this time last year.
This large, rapid increase, combined with less LIHEAP funding
available per family, imposes hardship on people who use home heating
oil to heat their homes. Low-income families and senior citizens living
on limited incomes in Maine and many other States face a crisis
situation in staying warm this winter.
The Sanders amendment would provide an additional $800 million as
emergency funding for LIHEAP. The term ``emergency'' could not be more
accurate. Our Nation is in a heating emergency this winter. Families
are being forced to choose among paying for food, housing, prescription
drugs, and heat. No family should be forced to suffer through a severe
winter without adequate heat.
I urge all my colleagues to support the Sanders proposal to provide
vital home energy assistance for the most vulnerable of our citizens.
Mr. SMITH. Mr. President, I rise today to speak in favor of
reauthorizing the Indian Health Care Improvement Act, IHCIA, of which I
am a cosponsor. Like many of my colleagues, I feel that passing this
legislation is long overdue. Since its enactment in 1976, the IHCIA has
provided the framework for carrying out our responsibility to provide
Native Americans with adequate health care. As we know, the act has not
been updated in more than 16 years, despite the growing need among
Native Americans.
We cannot allow the health of Native Americans to remain in jeopardy
for yet another year. The reauthorization legislation is a major step
in addressing the growing health disparities that Native Americans
face. The act makes much needed changes to the way the Indian Health
Service, IHS, delivers health care to Native Americans and is the
product of significant consultation and cooperation with Tribes and
health care providers.
I would like to thank Chairman Dorgan and Vice Chair Murkowski for
their leadership and for building on the momentum from the last
Congress to reauthorize this act.
The IHCIA was last reauthorized in 1992. Now 16 years later, another
reauthorization is necessary to modernize Indian health care services
and delivery and improve the health status of
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Native American people to the highest level possible.
A September 2004 report released by the United States Commission on
Civil Rights gives us a snapshot of the health crises Native Americans
face. Native Americans are 770 percent more likely to die from
alcoholism, 650 percent more likely to die from tuberculosis, 420
percent more likely to die from diabetes, 52 percent more likely to die
from pneumonia or influenza, and 60 percent more likely to die of
suicide.
Also, according to the CDC, American Indians and Alaska Natives, AI/
AN, also have the highest rate of suicide in the 15- to 24-year-old age
group, and suicide is the second leading cause of death among Native
American youth aged 10 to 24. The overall rate of suicide for American
Indians and Alaska Natives is 20.2 per 100,000, or approximately double
the rate for all other racial groups in the United States. Given these
circumstances, the life expectancy for Native Americans is 71 years of
age, nearly 5 years less than the rest of the U.S population.
Many serious health issues affect our Native American population.
Yet, today, funding levels meet only 60 percent of demand for services
each year, which requires IHS, tribal health facilities and
organizations, and urban Indian clinics to ration care, resulting in
tragic denials of needed services. Reauthorization of the act will
facilitate the modernization of the systems, such as prevention and
behavioral health programs for the approximately 1.8 million Native
Americans who rely upon the system. I sincerely hope that we can pass
this legislation and send it to the President for his signature.
Although this bill makes vast and necessary improvements upon current
law, it is not perfect. In my home State of Oregon, as well as in many
other States across the country, there is concern that the current bill
creates inequities among the tribes related to the distribution of
health care facilities funding. Senator Cantwell and I intend to offer
an amendment that we are hopeful can resolve this issue because,
ultimately we must ensure that all tribes are treated equitably.
The current priority system outlined in S. 1200 seems to favor health
facility construction in a few States and will harm Oregon's tribes as
well as many others across the country. Since the original bill was
drafted, the IHS and tribes have worked together to develop a new and
more equitable construction priority system that more fairly allocates
funds across Indian Country. This priority system includes the
development of an area distribution methodology. This proposed
methodology would provide for a portion of facility construction funds
to be used to build health facilities that are not part of the current
facilities priority system. Unfortunately, the language in S. 1200 does
not explicitly account for this agreement made between the tribes and
IHS through the National Steering Committee. Many tribes in Oregon and
around the country have never received any construction funding and are
concerned that the proposed language is outdated and will continue to
cause their facilities to lose priority to the extent that it could be
20 to 30 years until facility upgrades would occur.
I offered an amendment during the May 2007 Senate Committee on Indian
Affairs markup of S. 1200 that would have allowed for a portion of
health facility construction funds to be distributed equitably among
all of the IHS areas for local health facilities projects. I withdrew
my amendment because Chairman Dorgan assured me that he would work with
me to find a suitable compromise before the bill went to the floor.
Since then, I have been working with my colleagues and national tribal
organizations to develop compromise language. Yet, given all of this
effort, some Senators are unwilling to compromise.
Therefore, Senator Cantwell and I intend to offer our amendment which
represents an appropriate middle ground for all tribes. I hope my
colleagues will vote in favor of this amendment, and I look forward to
continuing to work with them to explore other creative ways to identify
approaches that address everyone's interest and ensures that all Native
American Indians receive the health care they need and deserve.
I am pleased to see that the bill contains my legislation, the
American Indian Veteran Health Care Improvement Act. This legislation
would encourage collaborations between the Department of Health and
Human Services, HHS, and the Department of Veterans Affairs, VA,
resulting in greater access to health care services for American Indian
and Alaska Native, veterans of federally recognized tribes. This
legislation also would ensure that these AI/AN veterans eligible for VA
health care benefits delivered by IHS, an Indian tribe, or tribal
organization will not be liable for any out of pocket expenses.
American Indians and Alaska Natives have a long history of exemplary
military service to the United States. They have volunteered to serve
our country at a higher percentage in all of America's wars and
conflicts than any other ethnic group on a per capita basis. As a
result, they have a wide range of combat related health care needs. AI/
AN veterans may be eligible for health care from the Veterans Health
Administration, VHA, or from IHS or both. Despite this dual
eligibility, AI/AN veterans report the highest rate of unmet health
care needs among veterans and exhibit high rates of disease risk
factors.
On February 25, 2003, HHS and the VA entered into a Memorandum of
Understanding, MOU, to encourage cooperation and resource sharing
between IHS and the VHA. The goal of the MOU is to use the strengths
and expertise of both organizations to increase access, deliver quality
health care services, and enhance the health status of AI/AN veterans.
These collaborations are designed to improve communication between the
agencies and tribal governments and to create opportunities to develop
strategies for sharing information services and technology. The
technology sharing includes the VA's electronic medical record system,
bar code medication administration, and telemedicine. Also, the VA and
IHS cosponsor continuing medical training for their health care staffs.
The MOU encourages VA, tribal, and IHS programs to collaborate in
numerous ways at the local level. These services may include referrals
for specialty care at a VA facility, prescriptions offered by the VA,
and testing not offered by IHS.
At the local level, many partnerships are being formed among IHS, the
VA, and tribal governments to identify local needs and develop local
solutions. These may include outreach and enrollment for the VA's
health system, initial screenings, and other health care services. The
anticipated product of these collaborations is to ensure that quality
health care is provided to all eligible AI/AN veterans.
In my State, the Portland VA Medical Center and the Portland Area
Office-IHS are working on a local MOU for the purpose of improving
access to VA health care services for eligible AI/AN veterans. The Warm
Springs Confederated Tribes have been instrumental in developing this
agreement based on the needs of AI veterans on the Warm Springs
Reservation. These veterans often are eligible for health benefits from
both the VA and IHS, and it is their intended purpose to make care more
seamless, thereby improving access and quality.
In November 2001, President George W. Bush proclaimed National
American Indian Heritage Month by celebrating the role of the
indigenous peoples of North America in shaping our Nation's history and
culture. He said, ``American Indian and Alaska Native cultures have
made remarkable contributions to our national identity. Their unique
spiritual, artistic, and literary contributions, together with their
vibrant customs and celebrations, enliven and enrich our land.''
An important part of the overall contribution of AI/AN peoples to our
Nation is the part they play in protecting and preserving our freedoms.
Their contributions to our Armed Forces have been made throughout our
history. I am hopeful that the VA and IHS will continue to work
together to deliver health care services to our Nation's AI/AN veterans
that they so deserve. I look forward to hearing about more of these
partnership projects, and to learn of their successes.
As I mentioned earlier, Native Americans have some of the highest
suicide rates in our Nation. That is why it is so critical that we
increase physical and mental health services to this population and,
ultimately, that we pass
[[Page S62]]
this bill. I am proud to have cosponsored the telemental health
language in this bill. The bill would authorize a demonstration project
to use telemental health services for suicide prevention and for the
treatment of Indian youth in Indian communities. The Indian Health
Service would carry out a 4-year demonstration program under which five
tribes, tribal organizations or urban Indian organizations with
telehealth capabilities could use telemental health services in youth
suicide prevention and treatment.
I also would like to speak to my support of the Urban Indian Health
Program, UIHP. It constitutes only 1 percent of IHS's budget; however,
34 UIH centers provide care for nearly 70 percent of the Native
American population residing in cities. According to the 2000 Census,
nearly 70 percent of Americans identifying themselves as having
American Indian or Alaska Native heritage live in urban areas.
In my home State of Oregon, the Native American Rehabilitation
Association of the Northwest, NARA, an urban Indian health provider,
has been in existence for over 37 years and provides education,
physical and mental health services, and substance abuse prevention and
treatment that is culturally appropriate to Native Americans and other
vulnerable people. NARA is an Indian-owned and operated nonprofit urban
Indian health clinic that annually serves over 4,000 people including
257 tribes and bands, of which 25 percent are from Oregon. NARA's
health clinic delivers health care services to tribal members from over
half of the federally recognized tribes that reside in about 30 States.
Notably, NARA is a grant recipient of the Garrett Lee Smith Memorial
Act, which it uses to serve Oregon's tribes.
The UIHP has been a fixture of the Indian Health Care Improvement Act
since its initial passage in 1976, principally serving urban Indian
communities in those cities where the Federal Government relocated
Indians during the 1960s and 1970s. Notably, the Federal Government
relocated thousands of tribal members to Portland at that time.
Although the UIHP overwhelmingly serves citizens of federally
recognized tribes, it has the authority to serve other Native
Americans, largely those who have descended from the Federal
relocatees. S. 1200 provides a modest expansion of authority for the
UIHP to engage in a wider array of health related programs, consistent
with the many changes that have occurred in health delivery in the
United States since the IHCIA was last reauthorized 16 years ago.
Proposals to eliminate or even limit the UIHP within the IHS would
have far-reaching and devastating consequences. Urban Indian health
clinics report that the elimination of Federal support would result in
bankruptcies, lease defaults, elimination of services to tens of
thousands of Indians who may not seek care elsewhere, an increase in
the health care disparity for American Indians and Alaska Natives, and
the near annihilation of a body of medical and cultural knowledge
addressing the unique cultural and medical needs of the urban Indian
population held almost exclusively by these programs. Notably, Urban
Indian health clinics typically leverage IHS funding 2:1 from other
sources.
Urban Indian health clinics provide unique and nonduplicable
assistance to urban Indians who face extraordinary barriers to
accessing mainstream health care. Many Native Americans are reluctant
to go to health care providers who are unfamiliar with and insensitive
to Native cultures. Urban Indian programs not only enjoy the confidence
of their clients but also play a vital role in educating other health
care providers in the community to the unique needs and cultural
conditions of the urban Indian population. Urban Indian health clinics
also save costs and improve medical care by getting urban Indians to
seek medical attention earlier; Provide care to the large population of
uninsured urban Indians who otherwise might go without care; and reduce
costs to other parts of the Indian Health Service system by reducing
their patient load.
More than 30 years ago, President Ford saw the great need and had the
wisdom to sign into law the Indian Health Care Improvement Act. His
signature was a promise made to American Indians that the Federal
Government would work to improve their health status. That promise is
one that we must not back away from. Reauthorizing this act is a
reaffirmation of that commitment and proves that we understand there is
work yet to be done to further improve Indian health.
Again, I am thankful to Chairman Dorgan and Vice Chair Murkowski for
their leadership and for building on the momentum from the last
Congress to reauthorize the act. I hope that we can swiftly resolve any
remaining issues and get this long-overdue bill signed into law.
I would like to close my statement with a quote from Mourning Dove,
the literary name of Christine Quintasket, a Salish tribal woman from
the Pacific Northwest now recognized as the first Native American woman
to publish a novel (1888-1936). ``Everything on the earth has a
purpose, every disease an herb to cure it, and every person a mission .
. . this is the Indian theory of existence.''
There are indeed cures and treatments for the maladies that
disproportionately afflict Native Americans: diabetes, alcoholism, and
suicide. The purpose and the mission of this bill is to connect those
cures with those who need it the most--those who have sought it the
longest--and through chapters of our history, have a unique claim to
those cures and treatment.
Mr. COCHRAN. Mr. President, I am a cosponsor of the Indian Health
Care Improvement Act, which provides updated objectives and policy for
addressing the health needs of American Indians.
By virtue of many treaties and agreements, the Federal Government has
a trust responsibility--an obligation--to provide a variety of basic
needs, including healthcare.
The Indian Health Care Service estimates that it provides about 60
percent of the health care that is needed in Indian Country: an amount
that is less than half of what we spend on the health care needs of
Federal prisoners. Tribes with the resources, try to make up the
difference. In most cases, the result is an absence of health care.
In my State, the Mississippi Band of Choctaw Indians has improved its
health care and the overall health of its population over the last 30
years. But the sad fact remains that health care on the reservation is
inadequate.
For the 9,600 members of the tribe, there are four doctors. The
hospital has 14 beds. The approximately $8 million the tribe spent last
year is simply not enough to cover the needs of the Choctaw's growing
population.
According to Health Care Financing Review--Summer 2004, Volume 24,
Number 4--the national health care expenditure average cost per person
per year was calculated at $5,440. Using the $5,440 estimate, the
Mississippi Band of Choctaw Indians Health Care System would need over
$48 million dollars to cover the tribe's health care costs.
From fiscal year 2000 to fiscal year 2005, there was a 30.4 percent
increase in the number of patients from the Mississippi Band of Choctaw
Indians who accessed the health care system. During that same time
period there was a 41.4 percent increase in the number of ambulatory
visits.
According to the CDC, 7 percent of Americans have diabetes. In
comparison, 20.5 percent of Choctaws have diabetes, one of the highest
percentages of any tribe in the country. From 2000 to 2005 there was a
62.3 percent increase in the number of patients diagnosed with
diabetes.
My point in telling the Senate these examples is, with adequate
health care, successful preventive care, appropriate facilities, and
more health care professionals, lives would be longer and general
health would improve.
Statistics for other tribes are similar. Some include alarming
incidences of suicide, high infant mortality rates, and practically
nonexistent mental health care.
This bill includes provisions that promote better communication
between tribes and the Indian Health Care Service, in order to ensure
effective administration of the programs meant to assist the well-being
of the American Indian population.
I urge my colleagues to vote for the Indian Health Care Improvement
Act.
(At the request of Mr. Reid, the following statement was ordered to
be printed in the Record.)
[[Page S63]]
Mr. OBAMA. Mr. President, I commend Senator Dorgan and the
Committee on Indian Affairs for their leadership on the long-overdue
Indian Health Care Improvement Act, IHCIA, Amendments of 2007.
The historical treatment of Native Americans is a tarnished mark on
American history. Lawmakers must ensure that this Nation fulfills its
treaty obligations to Native Americans and address the injustices that
continue to be suffered by the first Americans. I am committed to
making sure that Native Americans are treated with respect, dignity,
and equality both now and in the future and to ensure that promises
made by this great Nation are promises kept as well. As such, I believe
it is this country's moral imperative to address the significant health
disparities between Native Americans and the American population as a
whole.
Diabetes is perhaps the most striking example of such health
disparities. American Indians have the highest rate of diabetes in the
world. The American Diabetes Association reports that American Indians
and Alaska Natives are more than twice as likely to be diagnosed with
diabetes as non-Hispanic Whites, and the death rate from diabetes is
three times higher among American Indians and Alaska Natives than the
rate in the general U.S. population. Yet these statistical averages
mask the fact that certain tribal populations are experiencing epidemic
rates of diabetes. About half of adult Pima Indians, for example, have
diabetes. Even worse, on average, Pima Indians are only 36 years old
when they develop diabetes, which contrasts to an average age of 60
years for White diabetics.
Unfortunately, diabetes is not the only health condition that
disproportionately affects American Indians. Death rates from heart
disease and stroke are respectively 20 and 14 percent greater among
American Indians compared to the average U.S. population. We know the
infant mortality rate is 150 percent higher for Indian infants than
White infants. The rate of suicide for Indians is 2\1/2\ times greater
than the national rate, and methamphetamine use has ravaged Indian
reservations all across the country.
Urban Indians are not exempt from these dire health challenges. In
addition to facing higher than average rates of chronic disease and
mental health and substance abuse disorders, urban Indians experience
serious difficulties accessing needed health care services. Given that
over half of the Native American population no longer reside on
reservations, our efforts to improve Indian health and health care must
include explicit focus on the urban Indian population.
For these reasons, I am proud to be an original cosponsor of the
Indian Health Care Improvement Act. Our tribal health care programs
must be modernized and prepared to provide preventive and chronic
disease health care services and to address other key issues such as
access and quality of care concerns. And these activities must be
supported while honoring the principle of tribal sovereignty.
The bill before us would enact much needed advancements in the scope
and delivery of health care services to Native Americans. In
particular, it authorizes a host of new health services, makes crucial
organizational improvements, and provides greater funding for
facilities construction. Through scholarships, investments in
recruitment activities, loan repayment programs, and grants to
institutions of higher education, IHCIA also takes steps to help
increase the number of Native Americans entering the health services
field.
I am especially pleased that the bill addresses well-documented
health problems affecting urban Indian communities as well. This
proposal provides grants and increased aid for diabetes prevention and
treatment, community health programs, behavioral health training,
school health education programs, and youth drug abuse programs in
urban areas.
I trust my colleagues will agree with me on the critical need to
address health disparities facing the Native American community. I urge
the Senate to act quickly to pass this bill.
Mr. McCAIN. Mr. President, today the Senate is considering S.
1200, the Indian Health Care Improvement Act, IHCIA, Amendments of
2007. This bill would reauthorize the IHCIA, the statutory framework
for the Indian health system, which covers just about every aspect of
Native American health care.
I would first like to acknowledge the hard work of Chairman Dorgan
and my other colleagues on the Senate Indian Affairs Committee for
their efforts to bring this important legislation to the floor.
Reauthorization of the IHCIA is critical to the lives of more than 2
million American Indians and Alaska Natives and is long overdue.
The IHCIA expired in 2000, and Indian tribes and health organizations
have been working diligently to see it reauthorized. Seven years ago, a
steering committee of tribal leaders, with extensive consultation by
the Indian Health Service, developed a broad consensus in Indian
Country about what needs to be done to improve and update health
services for Indian people. During the 109th Congress, we made
significant progress towards passing a reauthorization bill.
Unfortunately, the Senate was unable to complete work on that bill
before adjourning last Congress.
I believe now as I did when I served as chairman of the Senate Indian
Affairs Committee during the last Congress that reauthorizing our
Indian health care programs is a top priority for us, and I hope that
the Senate will move a sound comprehensive bill through the legislative
process as quickly as possible. However, there are some key and
troubling differences between the bill pending before the Senate and
the proposal I put forward at the end of the last Congress, S. 4122. In
particular, the new version contains language that would essentially
authorize the Indian Health Service to promote ``reproductive health
and family planning'' services. As my colleagues know, I have had a
longstanding policy against promoting abortion as an acceptable form of
birth control, except in cases of rape and incest. I strongly believe
that society and government have a legitimate interested in protecting
life, born or unborn. Obviously, my thinking on this question applies
to the unborn children of patients to the Indian Health Service. I
cannot in good conscience support the promotion of abortions at
Federally funded IHS facilities or any Federal facilities. I remain
hopeful the bill will be modified to allow me to supports its swift
passage.
I am, however, supportive of the majority of this bill which builds
upon the principles of Indian self-determination. Over the years,
Indian health care delivery has greatly expanded and tribes are taking
over more health care services on the local level. It is our
responsibility to maintain support for these services and promote high
standards of quality health care for IHS and its partner units. Among
the items provided in this bill are provisions exploring options for
long-term care, governing children and senior issues. It also would
provide support for recruitment and retention purposes; access to
health care, especially for Indian children and low-income Indians.
Further, it would provide more flexibility in facility construction
programs, consolidated behavioral health programs for more
comprehensive care, and would establish a Commission to study and
recommend the best means of providing Indian health care.
We must remember that nearly 30 years ago, Congress first enacted the
IHCIA to meet the fundamental trust obligation of the United States to
ensure that comprehensive health care would be provided to American
Indians and Alaska Natives. Yet the health status of Indian people
remains much worse than that of other Americans. They have a shorter
average lifespan, higher infant mortality rate, and a much higher rate
of diabetes than the national average. American Indians and Alaska
Natives are 650 percent more likely to die of tuberculosis, 770 percent
more likely to die of alcoholism, and 60 percent more likely to die of
suicide. The suicide mortality rate among Indian youth is three times
that of the general population.
I have seen the hard reality of these statistics in the families of
Arizona tribes as well as tribes across the Nation. Methamphetamine
addiction, diabetes, alcoholism, and heart disease are epidemics
devastating the Indian people. Our trust obligation dictates we address
these health crises on reservations, and I strongly support actions to
that effect. However, as I stated before,
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using taxpayer money to promote abortion services is something I find
highly objectionable and will vehemently oppose. I strongly urge my
colleagues to support efforts to strike these unacceptable provisions
and enable this bill, which is of critical importance to Indian
country, to be approved.
Mr. SANDERS. I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Mr. THUNE. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. THUNE. Mr. President, is the pending business S. 1200, the Indian
Health Care Improvement Act Amendments of 2007?
The PRESIDING OFFICER. That is correct.
Mr. THUNE. Mr. President, I wish to speak to that legislation. The
Indian Health Care Improvement Act is before the Senate today and
tomorrow and hopefully will be completed, and we will be able to vote
on some amendments and finally get this legislation reauthorized
because it is very long overdue and the need for its completion cannot
be underestimated.
I represent nine tribes in my State of South Dakota, and in any given
year, depending on the year we are talking about, as many as five of
those reservation counties in South Dakota will be in the top 10
poorest counties in America. These are areas in my State that are
struggling in so many different ways where many of the basic services
that those of us who live off the reservations expect on a daily basis
are just not available.
One of the things that is desperately needed is access to health
care, making sure there is quality health care available to people on
the reservations.
The Indian Health Care Improvement Act reauthorization has really
been in the works since 1999-2000. I think the 106th Congress was the
last time this issue was debated. We have been trying since that time
to get this bill on the floor and get it reauthorized. It is a critical
piece of legislation that is so important to the people whom I
represent and to tribes all across this country and to Native American
people.
To give an example of what I am talking about, in South Dakota,
between 2000 and 2005, Native American infants were more than twice as
likely to die as White infants. Nationally, Native Americans are three
times as likely to die from diabetes as compared to the rest of the
population in the country.
In South Dakota, a recent survey found that 13 percent of Native
Americans suffered from diabetes. This is twice the rate of the general
population in which only 6 percent are suffering from diabetes.
An individual who is served by IHS is 6.5 times more likely to suffer
an alcohol-related death than the general population. An individual
served by an IHS facility is 50 percent more likely to commit suicide
than the general population.
I appreciate the time the Senate is taking to debate this bill and
the serious health issues this bill hopes to address and correct. I
especially thank the Indian Affairs Committee for working with me to
help the Yankton Sioux Tribe of South Dakota keep the Wagner emergency
room open. Our delegation from South Dakota has been working for some
time in making sure that members of the Yankton Sioux Tribe have access
to emergency room service 24 hours a day, which is critically
important.
The committee was very helpful in making sure that issue was
addressed in this authorization. I thank them for that help and
appreciate their work in working with us to that end.
I also thank them for the work they have done to ensure that the
Urban Indian Health Program remains a viable and helpful program for
Native Americans who live off the reservation.
I am also a cosponsor of an amendment that has been offered by
Senator Vitter. I reiterate my support for extending the Hyde language
of this bill in preventing Federal funds being spent on abortions,
except in cases where the life of the mother is at stake or in case of
incest or rape.
I also reiterate my support for Senator Bingaman's amendment. I am a
cosponsor of that amendment which will extend Medicare payment rates to
all Medicare providers who accept IHS contracting agreements.
This amendment hopefully will stretch IHS contracting dollars even
further and help reduce, even if it is only in a small way, some of the
shortfalls that currently exist.
This legislation goes a long way in attempting to improve health care
throughout Indian country. However, we have to remember there is still
more, lots more, that we need to do, especially in the area of tribal
justice and law enforcement in order to help improve the lives of
individuals who live on and near Indian reservations throughout the
country.
Last year, I worked hard to improve tribal justice and law
enforcement on Indian reservations, and I look forward to partnering
with my colleagues in the Senate to continue that fight this year to
make sure we have adequate law enforcement personnel, that we have an
adequate number of prosecutors so that when crimes are committed, they
can be prosecuted. But we have to address these very fundamental issues
if we are going to improve the quality of life for people on the
reservations.
As I travel the reservations in South Dakota--and I was at the
Rosebud Indian Reservation just this last week--what strikes me is,
people on the reservations, just as those I represent who live off the
reservations, want the same thing: They want a better life for their
children, for their grandchildren, for future generations. They want to
make sure they have security and there is adequate law enforcement and
they do not have to live in fear when it comes to the issues of crime.
They want to make sure their children have access to quality education
and a responsibility that many of us take very seriously, ensuring and
seeing to it that young people, children on the reservation, have an
opportunity to learn at the very fastest rate possible, to go through
elementary and secondary school and then on to higher education if they
choose to.
A number of the tribal colleges we support in many cases suffer,
again, from a lack of funding. They also have to have basic health care
services, which is what this bill attempts to address. Whether it is in
the area of dental care, whether it is in the area of basic primary
care, speciality care, the IHS facilities on the reservations suffer
from being unable to recruit and retain health care providers. Whether
it is physicians or dentists--and that is an issue we face as well--we
need to make sure we have the right incentives in place to attract
health care providers to serve in reservation areas.
This bill, as it is currently structured, I believe, will help to
address that very basic expectation that all people who live on
reservations have, and that is, when they have a need, they will have
access to quality health care to address those needs.
This bill will be debated again tomorrow in the Senate, probably, I
hope, voted on sometime tomorrow so that we can finally get this
reauthorization bill through. It has been teed up for some time.
I appreciate the work the chairman, Senator Dorgan from North Dakota,
and Senator Murkowski from Alaska, the ranking Republican, have done to
bring this bill to the floor and, as I said before, to work with us on
issues important to South Dakota.
I am also happy to cosponsor a couple of amendments that I hope can
be adopted--the Vitter amendment and, as I said earlier, the Bingaman
amendment, which will help make health care more available and take the
dollars of the IHS and stretch them further when it comes to
contracting services.
I urge my colleagues in the Senate to vote for this bill. This should
be a big bipartisan vote. If anybody cares seriously about improving
the quality of life on reservations in this country and addressing what
are deep economic needs, it starts with some of these very basic
services. It starts with law enforcement security, it starts with
education, and it starts with health care, and I think this bill takes
us a long way in the direction of dealing with the health care issues
that affect so many of our tribes in this country.
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I hope my colleagues in a very big bipartisan way will vote for this
legislation, support it, and hopefully get it signed into law before
this year is out.
Mr. President, I yield the floor, and I suggest the absence of a
quorum.
The PRESIDING OFFICER (Mr. Brown). The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Mr. CASEY. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
____________________