[Congressional Record Volume 154, Number 31 (Tuesday, February 26, 2008)]
[Senate]
[Pages S1150-S1158]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
INDIAN HEALTH CARE IMPROVEMENT ACT AMENDMENTS OF 2007
The ACTING PRESIDENT pro tempore. Under the previous order, the
Senate resumes consideration of S. 1200, which the clerk will report by
title.
The assistant legislative clerk read as follows:
A bill (S. 1200) to amend the Indian Health Care
Improvement Act to review and extend that act.
Pending:
Vitter amendment No. 3896 (to amendment No. 3899), to
modify a section relating to limitation on use of funds
appropriated to the Service.
Dorgan amendment No. 3899, in the nature of a substitute.
Smith amendment No. 3897 (to amendment No. 3899), to modify
a provision relating to development of innovative approaches.
Murkowski (for DeMint) amendment No. 4015 (to amendment No.
3899), to authorize the Secretary of Health and Human
Services to establish an Indian health savings account
demonstration project.
Murkowski (for DeMint) amendment No. 4066 (to amendment No.
3899), of a perfecting nature.
The ACTING PRESIDENT pro tempore. The Senator from North Dakota.
Amendment No. 3896
Mr. DORGAN. Mr. President, I believe by previous unanimous consent
the Senate will now consider the Vitter amendment.
The ACTING PRESIDENT pro tempore. The Senator is correct. There are 2
minutes of debate equally divided.
The Senator from Louisiana.
Mr. VITTER. Mr. President, I strongly urge all of my colleagues to
support this mainstream amendment. The Vitter amendment codifies the
Hyde amendment and simply says in Indian health care no taxpayer funds
will be used to support abortions, with the normal exceptions of the
Hyde amendment.
Up to now, this has been the practice and the law, but only because
the Indian health care law points to whatever the current
appropriations language is on the subject in Labor, Health, and
Education. And so it is a very tenuous policy that is subject to change
and a vote and a change in policy every year.
This amendment will solidify that policy. It will put the Hyde
amendment in permanent Federal authorization law with regard to the
Indian health care act, just as was done decades ago in the Defense
authorization bill. It is a solid mainstream amendment, and I urge
support from both sides of the aisle.
The ACTING PRESIDENT pro tempore. The Senator from North Dakota.
Mr. DORGAN. Mr. President, this is not a debate about whether Federal
dollars should be used for abortion services. Current law already
prohibits that. I oppose Federal funding for abortions, and I have
supported the Hyde provision. But the Vitter amendment is completely
unnecessary.
First of all, we have a provision in the underlying bill that relates
to the Hyde provision that applies to all other appropriations bills.
But I do want to say this: This is not a mainstream amendment that
everybody is clear about. In fact, there is a provision in this
amendment on page 2, section B. I don't know what it means, and I don't
think Senator Vitter knows what it means. There have been no hearings,
no discussion, yet onward through the fog on amendments like this.
The fact is, we ought to have a hearing, but there has been no
hearing. I don't understand what section B means, nor does the author,
I believe.
Having said all that, again, this is not a debate about whether
Federal dollars should be used for abortion services. Current law
already prohibits the use of Federal funds for abortion services, and
the underlying bill contains a provision that relates to current law
and continues the same policy.
The ACTING PRESIDENT pro tempore. All time has expired. The Senator
from Louisiana.
Mr. VITTER. I ask unanimous consent for 30 additional seconds.
Mr. DORGAN. I will agree, provided I am allowed 30 additional seconds
following Senator Vitter.
The ACTING PRESIDENT pro tempore. Without objection, it is so
ordered.
Mr. VITTER. Mr. President, I do this to ask the distinguished Senator
about the provision he is talking about. Maybe we can have a discussion
about it rather than him vaguely alluding to it without pointing out
the language and claiming nobody knows what it means.
Mr. DORGAN. Well, Mr. President, the appropriate place for that kind
of discussion would have been a congressional hearing. That is where
you discuss what provisions mean and how they are written.
The provision reads: As to provide or pay any administrative cost of
any health benefits coverage that includes coverage of an abortion.
I don't understand what that means with respect to facilities or
other issues. There are a series of issues that relate to that. And
that is not, incidentally, just codifying the Hyde amendment, as the
Senator alleges. This provision doesn't exist with the Hyde amendment.
This is something the Senator conceived of and added.
My point is, it ought to be the subject of a hearing. We don't
disagree on the issue of Federal funding for abortion. We agree on
that. But the Senator has mischaracterized his amendment.
Mr. VITTER. Reclaiming my remaining time, that was language I pointed
out to the distinguished Senator 3 weeks ago when I introduced my
amendment and we discussed it. So I think it is a little disingenuous
to bring it up at this point.
Mr. DORGAN. And, Mr. President, he indicated when he pointed it out
to me that this is why it was different than the Hyde amendment, which
doesn't point to what he claims today.
The ACTING PRESIDENT pro tempore. The question is on agreeing to the
amendment.
Mr. VITTER. I ask for the yeas and nays.
The ACTING PRESIDENT pro tempore. Is there a sufficient second? There
appears to be a sufficient second.
The clerk will call the roll.
[[Page S1151]]
The assistant legislative clerk called the roll.
Mr. DURBIN. I announce that the Senator from New York (Mrs. Clinton),
the Senator from Connecticut (Mr. Dodd), and the Senator from Illinois
(Mr. Obama) are necessarily absent.
Mr. KYL. The following Senators are necessarily absent: the Senator
from Texas (Mr. Cornyn), the Senator from Arizona (Mr. McCain), and the
Senator from Virginia (Mr. Warner).
Further, if present and voting, the Senator from Texas (Mr. Cornyn)
would have voted ``yea.''
The ACTING PRESIDENT pro tempore. Are there any other Senators in the
Chamber desiring to vote?
The result was announced--yeas 52, nays 42, as follows:
[Rollcall Vote No. 30 Leg.]
YEAS--52
Alexander
Allard
Barrasso
Bayh
Bennett
Bond
Brownback
Bunning
Burr
Byrd
Casey
Chambliss
Coburn
Cochran
Coleman
Corker
Craig
Crapo
DeMint
Dole
Domenici
Ensign
Enzi
Graham
Grassley
Gregg
Hagel
Hatch
Hutchison
Inhofe
Isakson
Johnson
Kyl
Landrieu
Lugar
Martinez
McConnell
Murkowski
Nelson (NE)
Pryor
Reid
Roberts
Salazar
Sessions
Shelby
Smith
Stevens
Sununu
Thune
Vitter
Voinovich
Wicker
NAYS--42
Akaka
Baucus
Biden
Bingaman
Boxer
Brown
Cantwell
Cardin
Carper
Collins
Conrad
Dorgan
Durbin
Feingold
Feinstein
Harkin
Inouye
Kennedy
Kerry
Klobuchar
Kohl
Lautenberg
Leahy
Levin
Lieberman
Lincoln
McCaskill
Menendez
Mikulski
Murray
Nelson (FL)
Reed
Rockefeller
Sanders
Schumer
Snowe
Specter
Stabenow
Tester
Webb
Whitehouse
Wyden
NOT VOTING--6
Clinton
Cornyn
Dodd
McCain
Obama
Warner
The amendment (No. 3896) was agreed to.
Mr. DORGAN. I move to reconsider the vote and to lay that motion on
the table.
The motion to lay on the table was agreed to.
Amendment No. 3897
The ACTING PRESIDENT pro tempore. There will now be 2 minutes of
debate equally divided in relation to amendment No. 3897.
The Senator from Oregon.
Mr. SMITH. Mr. President, 8 years ago, Congress asked the Indian
Health Service and the tribes to revise a failed system for allocating
facilities funding. The compromise they reached may amount to nothing
without this amendment. That is why I feel so strongly about it. It is
not only about one region or group of regions; this amendment is about
holding true the government-to-government relationship the United
States holds with all tribes. I ask my colleagues to support the
amendment to ensure that all Native Americans receive the health care
they need and deserve.
Members should know it is unlikely that Native Americans in their
States are receiving construction funding for Indian Health Service
facilities. All this does is say to the Indian Health Service: Come up
with a formula that is fair. Otherwise, your State, the tribes you
represent, will receive nothing.
Mr. BINGAMAN. Mr. President, I rise in opposition to Senator Smith's
amendment, No. 3897, to the Indian Health Care Improvement Act, S.
1200, and urge my fellow Senators to vote against this amendment.
This amendment would expressly authorize the Secretary of Health and
Human Services, HHS, to utilize a new ``area distribution fund''
methodology to allocate Indian Health Service, IHS, health care
facilities construction, HCFC, funding.
This approach could result in critical projects that are on the
current IHS HCFC priority list from receiving funding. These projects
have been waiting for many years, and in some cases decades, to receive
funding. Furthermore, section 301 of the underlying bill, which the
Smith amendment would amend, represents the results of hours of
bipartisan negotiations on this issue throughout the last 2 years.
While I understand Senator Smith's desire to provide a possible avenue
for his tribes to receive funding, this amendment would undo the very
delicate compromise that was reached in the underlying bill.
According to the IHS staff briefings, the entire concept of an area
distribution fund does not guarantee that all IHS service areas receive
HCFC funding; instead, it creates a new criterion that must be used to
determine IHS HCFC funding priorities. The current criteria utilized by
IHS are focused on directing funding to the IHS areas in most need,
where IHS patients are most isolated and least likely to have access to
care. This geographic criterion does not represent good policy but
simply an attempt to spread the very paltry funding provided for IHS
HCFC projects even more thinly based on location instead of need.
Instead of playing games with the distribution formula, we in Congress
should be working to ensure that there is adequate funding for IHS HCFC
projects so that the current backlog is addressed and new projects from
throughout the country may be added.
I note that Navajo Nation also strongly opposes this amendment. The
following discussion provides a summary of their concerns.
I. CONGRESS SHOULD LEAVE THE CURRENT LANGUAGE OF SECTION 301 AS
CONTAINED WITHIN H.R. 1328 AND S. 1200 UNCHANGED
The current language of section 301 ``grandfathers'' in
those health facility projects that have completed phase one
and two of the current health care facilities construction
priority system, and places them on the construction priority
list upon enactment of the Indian Health Care Improvement
Act.
The following projects have completed phase one and two of
the current health facilities construction funding process:
Winslow Dilkon, AZ, Pueblo Pintado, NM, Bodaway-Coppermine,
AZ, Gallup Indian Medical Center, NM, Alamo, NM, Albuquerque,
NM, Ft. Yuma, AZ, Rapid City, SD, Sells, AZ, Crown Point, NM,
and Shiprock, NM. These projects should not be penalized for
following the rules by eliminating the old process and
instituting a new ill-defined funding system.
II. A LACK OF CONGRESSIONAL FUNDING CREATED CONTROVERSY OVER
DISBURSEMENT OF HEALTH FACILITIES CONSTRUCTION DOLLARS
According to the Conference Report for H.R. 2466, the
fiscal year 2000 Interior appropriations bill, the managers
recognized the need for a ``base funding amount'' for
facilities: ``Given the extreme need for new and replacement
hospitals and clinics, there should be a base funding amount,
which serves as a minimum annual amount in the budget
request.'' Unfortunately, the managers' intent was never
fulfilled, and funding levels have dropped consistently for
several years. Congressional funding for health care
facilities construction has decreased from a high of
$134,300,000 in fiscal year 1993 to $13 million in fiscal
year 2007.
Given the limited amount of funding, tribes are now
competing over an ever-decreasing pool of money for tribal
health facilities.
III. THE CURRENT SYSTEM RIGHTLY HONORS FUNDING FACILITIES BASED UPON A
VOLUME OF SERVICES
Most of the health facility projects on the current
priority list have been in the planning process for 20 to 30
years. These projects have done all that is asked of them
including adapting to any new requirements imposed on them
midway through the planning process.
The current health facilities construction priority system
prioritizes projects based on several relevant factors such
as volume of services provided; square footage needs; size;
age; condition of existing facilities; demographics;
population density; isolation; and distance to inpatient,
outpatient, and alternative facilities.
The current priority system favors providing health
facility construction dollars to those facilities that will
provide a large volume of services over 10 years. For
example, if a facility will serve 90,000 patient visits a
year, calculated over 10 years, then this amount would total
900,000 patient visits in a 10 year period. The current
system favors providing a volume of services that provides
the most access to health care by the largest pool of people
and need.
On the other hand, any system that distributes funding
based upon equal distribution among the Indian health care
regions could not provide a sufficient volume of services
because some regions have larger native populations with less
access to health care than others. In other words, fewer
people would be provided health care by more facilities.
Keeping the current priority system would provide certainty
and reinforce the work put into developing existing health
facility projects.
IV. DO NOT AUTHORIZE A VAGUE CONCEPT
There is currently no consensus as to the meaning or impact
of an area distribution fund. In fact, the Federal
Appropriation Advisory Board, the workgroup created by the
IHS to evaluate various facilities construction funding
schemes, did not define the area
[[Page S1152]]
distribution fund. It is at best only a concept without a set
methodology, structure, or any idea of what effects such a
change may have on the current funding system. Randall
Gardner, Acting Director of the IHS Office of Environmental
Health and Engineering, OHE, has referred to the area
distribution fund as only a concept in need of further
evaluation. It would be the height of irresponsibility for
Congress to replace a known system with the uncertainty of a
concept without further investigation.
V. THE ISSUE IS ABOUT ACCESS TO HEALTH CARE AND NOT WHETHER TO BUILD
ANOTHER HOSPITAL
Some groups have argued that their IHS service areas have
not received much needed health facility funding. However,
the statistics, when weighed against isolated areas like
Sells and the Navajo Nation, do not support the need for
another hospital in, for example, the Portland, California,
Bemidji, or Nashville service areas. According to the IHS,
the Portland area has 218 hospitals providing health services
to 157,000 tribal members.
The California, Bemidji, and Nashville areas are similarly
situated with respect to health care. In fiscal year 2001,
California tribal health programs had 119,362 registered
users with 69,238 active users served by 438 hospitals. The
Bemidji area comprising Wisconsin, Minnesota, and Michigan,
is made up of 34 tribes with 90,000 individual patients
served by 494 hospitals. Finally, the Nashville area, which
is the largest service area, has a native population of
45,000 Indian people with access to over 1,000 hospitals.
However, the Navajo Nation area, which is as large as West
Virginia, has 238,515 users living on, or near, the
reservation with access to only 6 hospitals. That is 1
hospital for every 39,753 users. The need for more health
care facilities within the Navajo Nation area is clear.
Further, IHS statistics show that while the Portland,
California, Bemidji, or Nashville service areas have not
received any health facility construction dollars, the native
people in these areas have always had access to superior
health care. All Native Americans living within IHS areas
also do not receive health facility dollars receive contract
health care dollars that cover expenses incurred at non-IHS
facilities.
The current priority system rewards basic health care
access over building redundant hospitals in areas with many
non-IHS facilities that can provide much needed health care
services. Building another hospital in the Portland,
California, Bemidji, or Nashville service areas when the
Navajo Nation and other IHS area have significant unmet needs
is redundant and inefficient use of federal funds.
VI. CONCLUSION
The current HCFC system now provides funding to ensure
that large populations without access to nearby hospitals
receive health care facilities funding. The area distribution
fund concept has yet to be established with any certainty as
to its meaning or impact. A new ill-defined system should not
replace the existing priority system without some study.
Authorizing such a concept without investigating thoroughly
the overall effect of such a dramatic change to how IHS
health care facilities funded would be irresponsible.
The ACTING PRESIDENT pro tempore. The Senator from North Dakota.
Mr. DORGAN. Mr. President, I share the frustration of the Senator
from Oregon, but I must oppose the amendment. We have a backlog of $3
billion in facilities. If the Secretary chooses to establish what is an
area distribution fund, moneys would be taken from the priority list.
Many of the tribes on that list have waited a long time for funding for
facilities. If the Secretary begins to take money from that priority
list and does an area-wide distribution, it would be a serious problem.
I want to work with the Senator from Oregon. We desperately need new
and improved facilities. We need more money addressed to that. He is
raising the right question. I happen to believe it is the wrong answer.
I regretfully will vote against it.
Mr. SMITH. I ask for the yeas and nays.
The ACTING PRESIDENT pro tempore. Is there a sufficient second?
There is a sufficient second.
The question is on agreeing to amendment No. 3897. The clerk will
call the roll.
The bill clerk called the roll.
Mr. DURBIN. I announce that the Senator from New York (Mrs. Clinton),
the Senator from Connecticut (Mr. Dodd), and the Senator from Illinois
(Mr. Obama) are necessarily absent.
Mr. KYL. The following Senators are necessarily absent: the Senator
from Texas (Mr. Cornyn), the Senator from Arizona (Mr. McCain), and the
Senator from Virginia (Mr. Warner).
Further, if present and voting, the Senator from Texas (Mr. Cornyn)
would have voted ``yea.''
The ACTING PRESIDENT pro tempore. Are there any other Senators in the
Chamber desiring to vote?
The result was announced--yeas 56, nays 38, as follows:
[Rollcall Vote No. 31 Leg.]
YEAS--56
Akaka
Alexander
Bennett
Biden
Bond
Boxer
Brownback
Byrd
Cantwell
Casey
Chambliss
Cochran
Coleman
Collins
Corker
Craig
Crapo
Dole
Durbin
Ensign
Feingold
Feinstein
Gregg
Hatch
Hutchison
Isakson
Kennedy
Kerry
Klobuchar
Kohl
Landrieu
Lautenberg
Levin
Lincoln
Lugar
McConnell
Menendez
Murkowski
Murray
Pryor
Reed
Reid
Roberts
Schumer
Shelby
Smith
Snowe
Specter
Stabenow
Stevens
Sununu
Vitter
Voinovich
Whitehouse
Wicker
Wyden
NAYS--38
Allard
Barrasso
Baucus
Bayh
Bingaman
Brown
Bunning
Burr
Cardin
Carper
Coburn
Conrad
DeMint
Domenici
Dorgan
Enzi
Graham
Grassley
Hagel
Harkin
Inhofe
Inouye
Johnson
Kyl
Leahy
Lieberman
Martinez
McCaskill
Mikulski
Nelson (FL)
Nelson (NE)
Rockefeller
Salazar
Sanders
Sessions
Tester
Thune
Webb
NOT VOTING--6
Clinton
Cornyn
Dodd
McCain
Obama
Warner
The amendment (No. 3897) was agreed to.
Mr. DORGAN. Mr. President, I move to reconsider the vote and move to
lay that motion on the table.
The motion to lay on the table was agreed to.
Amendment No. 4015 Withdrawn
The ACTING PRESIDENT pro tempore. There will now be 2 minutes of
debate in regard to amendment No. 4015.
Mr. DORGAN. Mr. President, we have reached agreement, and I ask
unanimous consent that amendment No. 4015 be withdrawn.
The ACTING PRESIDENT pro tempore. Without objection, it is so
ordered.
Amendment No. 4066
Mr. DORGAN. Mr. President, we have also been in discussions with
Senator DeMint, and we are prepared--and I believe it has been agreed
to on both sides--to accept amendment No. 4066 without debate. I ask
unanimous consent that the amendment be adopted.
The ACTING PRESIDENT pro tempore. Is there objection?
Without objection, it is so ordered.
The amendment (No. 4066) was agreed to.
Mr. CONRAD. Mr. President, I want to join my colleagues in strong
support of the Indian Health Care Improvement Act. Today has been a
long time in coming. I want to particularly recognize the work of my
friend Senator Dorgan, the chairman of the Indian Affairs Committee. We
would not be here today without his dedication and persistence.
In 2004, the U.S. Commission on Civil Rights issued a report on the
Native American health care system. One item in the report struck a
very somber note with me. The report notes that as early as 1926 the
adequacy of the delivery of health care to Native American was formally
questioned by the government. In response, a report was issued 2 years
later that sparked a host of statements by the Federal Government that
the health status of Native Americans was ``intolerable.''
Unfortunately, the Commission notes that much of the 1928 report
remains true today. It is indeed sad that in the 21st century Native
Americans still do not have the access to and quality of health care to
which they are entitled.
As my colleague from North Dakota has so poignantly illustrated time
and time again, there is a health care crisis in Indian country. Native
Americans are 200 percent more likely to die from diabetes, 500 percent
more likely to die from tuberculosis, 550 percent more likely to die
from alcoholism, and 150 percent more likely to die from accidents.
Suicide is the second-leading cause of death for Native American
adolescents, 2\1/2\ times the national average. Native Americans have a
life expectancy nearly 6 years less than the rest of the U.S.
population.
That is unacceptable. And it is why it is so important that we pass
the reauthorization of the Indian Health Care Improvement Act.
[[Page S1153]]
More than 1.8 million Native Americans and Alaska Natives rely on the
Indian Health Service for health care. Since the act was first
authorized in 1976, the ways in which health care is delivered in this
country have changed enormously. The bill before us helps meet the
contemporary needs of Indian country.
I believe that the inability of many Indian people to receive
preventive and nonemergency care is one of the reasons why there are
such significant health disparities that exist between Native Americans
and the rest of the U.S. population. In North Dakota, when the IHS
clinic closes at 5 p.m. on the weekdays and is closed on the weekends,
many go without care. I am pleased the bill before us addresses this
challenge by establishing grants for demonstration projects including a
convenient care services program to expand the availability of health
care. It also has a renewed emphasis on disease prevention and health
promotion.
The bill also takes important steps to provide training and
incentives to increase the number of health care professionals in
Indian country, especially Native health care professionals who
understand the unique conditions facing their own communities and can
provide care with greater cultural awareness. At the University of
North Dakota, three programs authorized by the Indian Health Care
Improvement Act--the Quentin N. Burdick Indians Into Medicine, Indians
Into Nursing, and Indians Into Psychology Programs--are recruiting
increasing numbers of Native Americans into medical professional
programs. Graduates of these programs are making a real difference
throughout Indian country, and I am pleased these successful programs
are continued in the bill.
It also includes much needed provisions to address the youth suicide
crisis that exists throughout Indian country by authorizing grants to
deliver more counseling and suicide prevention services to tribal
communities.
Finally, I am pleased my amendment to increase the use of video
service delivery to assist in the outreach and enrollment of individual
Indians in Medicare and Medicaid was incorporated into the managers'
amendment. Remote video access to government services has all the
benefits of face-to-face communication, without the costs and
difficulties associated with traveling long distances from rural and
remote reservations. To date, video service delivery has allowed for
more than 300 completed applications for benefits, more than double
what would be expected through conventional delivery methods. My
amendment will allow for the expansion of this successful effort to
other reservations across the country.
We have been working on reauthorization of the Indian Health Care
Improvement Act for a number of years. I think Native Americans have
waited long enough and it is time we deliver them this bill which
begins to reverse the disparate health disparities that exist.
I do not expect that we will be able to solve all of the health care
challenges that exist in Indian country with this one bill, but I
expect that we will be able to make substantial progress in addressing
some of the most pressing needs and creating a stronger system for the
future.
Again, I want to recognize the extraordinary work of Senator Dorgan
in delivering a truly bipartisan bill that meets the urgent health care
needs of Native Americans in North Dakota and across the country. I
urge my colleagues to support this bill.
Mr. LEVIN. Mr. President, today the Senate will pass the Indian
Health Care Improvement Act of 2008. This bill would reauthorize and
modernize the Indian Health Care Improvement Act which funds and
authorizes health care services and programs to Native American Indians
and Alaska Natives and reaffirms our commitment to ensuring that we
meet our treaty and legal obligation to provide these communities with
access to quality health care.
Reauthorizing the Indian Health Care Improvement Act has been long
overdue. The last time the Congress reauthorized the Indian Health Care
Improvement Act was in 1992, and this act has been up for
reauthorization since 2001. The Indian Health Service has not been
updated for far too long. As health care evolves and improves programs
must be modernized to reflect new advances in the health care system.
The Indian Health Care Improvement Act has not been modernized since
1992, 16 years ago, and is falling behind. We have a trust
responsibility to provide health care to Native American Indians and
Alaska Natives. We have not met that responsibility.
The disparities that exist between Indian communities and other
Americans are overwhelming. The life expectancy for Indians is almost 6
years less than the rest of this country's population and the suicide
rate is 2.5 times higher than the national average. Death due to
alcoholism or tuberculosis is more than 600 percent more likely; and,
Indians are 318 percent more likely to die from diabetes. These
statistics are unacceptable and we need to continue to ensure that we
close the gap.
The passage of this bill brings us one step closer to ensuring that
the Indian Health Service is adequately funded and that programs to
address the health care needs of these communities are available.
Mr. FEINGOLD. Mr. President, I am pleased to support final passage of
the Indian Health Care Improvement Act Amendments of 2007. This bill is
long overdue, and I hope that House works expediently to move this bill
forward so that we can get this bill to the President and signed into
law.
Throughout the Senate's work on this bill, I have been impressed with
the bipartisan work that Senator Dorgan and the Senate Indian Affairs
Committee have put into moving this bill forward. It was not any easy
process, but I commend the committee for its ongoing dedication to
significant consultation with Indian Country in drafting this bill and
seeing it through to completion.
There are significant unmet needs in Indian Country throughout this
Nation, and addressing the unmet health care needs ranks as one of the
most significant problems that we must address. The Federal Government
has a longstanding and well-established trust responsibility with
regard to American Indian affairs, and this trust responsibility
extends to providing good health care to communities throughout Indian
Country.
For too long, the Federal Government has not lived up to its Federal
trust responsibility commitments, but I hope that passage of this
legislation will set the Federal Government on a course toward better
supporting the needs of our American Indian communities, whether they
be health care, education, or housing needs. While this bill is a vital
step in the right direction, we need to follow through with fiscally
responsible increased funding for the important programs authorized in
this legislation.
This bill has the support of tribal governments throughout the United
States, including the 11 tribes in my State of Wisconsin. I have heard
from a number of constituents in Wisconsin about the need to pass this
bill this year. The improvements that the legislation will make to
various Indian Health Service programs including clinical programs on
the various reservations throughout the State and urban Indian programs
in Milwaukee and Green Bay are significant, and it is my hope that this
bill will help improve the quality of health care provided to American
Indians living throughout Wisconsin.
Health care is consistently the No. 1 issue that I hear about all
over my home State of Wisconsin. When I hold my annual townhall
meetings across the State, many people come to tell me about problems
with our overall health care system, and data shows us that these
problems are often most acutely felt in Indian Country. Lack of access
to good health care is a problem that disproportionately affects
American Indians throughout the United States. According to recent
studies, American Indians and Alaska Natives are 200 percent more
likely to die from diabetes, more than 500 percent more likely to die
from alcoholism, and approximately 500 percent more likely to die from
tuberculosis.
Some may doubt whether this legislation is needed or whether it will
really help improve the lives of Americans. The staggering statistics
that highlight the health care disparities faced by American Indians
show just how imperative it is that we pass this legislation, which is
long overdue. These statistics also help illustrate the vast
[[Page S1154]]
amount of work that remains to be done to improve the quality of health
care in American Indian communities beyond passage of this legislation.
Nevertheless, this bill takes an important first step toward addressing
these health care disparities through the many reforms it makes to
Indian health care programs. For example, modernizing Indian Health
Services programs through this legislation will help to address the
diabetes and suicide crises that exist on reservations--just two
examples of the many health care issues that impact the daily lives of
American Indians across the country.
Reauthorization of this bill will help encourage health care
providers to practice at facilities in Indian Country and encourage
American Indians to enter the health care profession and serve their
communities. Recruiting talented and dedicated professionals to serve
in IHS facilities, whether urban or rural, is a key challenge facing
many tribal communities in Wisconsin and around the country. I hope
these provisions will help bring additional dedicated doctors, nurses,
and other health care professionals to our tribal populations.
This bill also reauthorizes programs that assist urban Indian
organizations with providing health care to American Indians living in
urban centers around the country. The Urban Indian Health Program
represents a tiny fraction of the Indian Health Services budget, but
the small amount of resources given to the urban programs provides
critical health services to those Indians living in urban areas.
Contrary to what some people may think, the majority of American
Indians now live in urban areas around the country, including two urban
areas in my State--Milwaukee and Green Bay. Throughout our Nation's
history, some American Indians came to urban centers voluntarily, but
many were forcibly sent to urban areas as a result of wrongheaded
Federal Indian policy in the 1950s and 1960s and have since stayed in
urban areas and planted roots in these communities.
As a result of this movement to urban centers, Congress created the
urban Indian program in the late 1970s to address the growing urban
Indian population around the country. The Federal Government's
responsibility to American Indians does not end simply because some
American Indians left their ancestral lands and moved to urban
locations--particularly when some of them had little choice in the
matter.
While this legislation takes important steps toward improving urban
Indian health care programs, we need to do much more to support these
urban programs, including fighting for increased appropriations. I have
been disappointed that the President has proposed zeroing out the urban
Indian program in past budgets, and unfortunately, the President's
budget request for fiscal year 2009 is no different. As in years past,
I have joined with my colleagues to urge the Senate to restore funding
for urban Indian programs to the Federal budget for fiscal year 2009,
and I hope this year the Senate can also provide a much-needed boost in
funding for the urban Indian programs.
I voted for an amendment offered by Senators Smith and Cantwell that
would permit, but not require, the Secretary of HHS to create an area
distribution fund to allocate funding resources for IHS facilities
construction to all 12 of the IHS service areas. I have heard a lot of
concern from tribes in my State of Wisconsin about the way that
construction facility funds are allocated and the fact that certain IHS
service areas, including the Bemidji region covering Wisconsin, do not
fare well under the current system. I recognize that there needs to be
an overall boost in the appropriations for IHS facilities construction
to help tribes currently on the construction priority list as well as
those tribes that cannot even get on the current list, and I look
forward to supporting fiscally responsible efforts to boost funding for
various IHS programs, including this one. But in the meantime, we
should explore opportunities to address innovative solutions to this
problem, and this amendment takes a reasonable approach to addressing
this problem. Any efforts to create an area distribution fund should
involve significant consultation with tribes throughout Indian Country,
and I am pleased this amendment makes clear that such consultation
would be required.
I also voted for amendment 4032, offered by the Senator from
Oklahoma, because it is critically important that sexual assault
victims be able to find out whether they have been exposed to HIV.
However, I am concerned about the way that the amendment was drafted.
If there is a conference on this bill, I would urge conferees to
consider making this provision consistent with the existing provision
governing the testing of defendants in Federal cases, 42 U.S.C. section
14011, or at a minimum to clarify how it would relate to that law. I
also would urge them to ensure that the new provision complies fully
with the requirements of the fourth amendment.
Mr. President, Indian Country has made many compromises in order to
move this bill forward, and passage of this bill is long overdue. The
Senate's actions today mark an enormous victory for Indian Country, and
I hope that the House will quickly take this bill up so that we can get
this bill signed into law by the President this year.
This bill takes concrete and positive steps toward addressing some of
the health care needs facing American Indian communities around the
country, and I look forward to working with my colleagues to build on
this legislation in the coming months and years. Challenges facing
American Indians throughout the United States extend beyond health care
issues into issues of improving economic development, educational
opportunities, and affordable and safe housing opportunities, and I
hope we can continue to work together in a bipartisan way to pass other
important measures this year. Together, tribal nations throughout all
our States can work closely with the Federal Government to address the
vast array of these unmet needs. Passage of the Indian Health Care
Improvement Act Amendments of 2007 today provides an important
foundation going forward, and it is up to all of us to see that this
foundation is strengthened in the coming months and years.
Mr. DORGAN. Mr. President, I wish to take a few minutes to talk about
the vote we had earlier today on an amendment offered by Senator Vitter
to the Indian Health Care Improvement Act. Senator Vitter described his
amendment, which was adopted by the Senate, as codifying a longstanding
policy that prohibits Federal funds from being used to pay for
abortions.
I agree that Federal funding should not be used to pay for abortions.
I have always supported the existing funding prohibition known as the
Hyde amendment that has been added in the appropriations process every
year since 1976.
That being said, I opposed Senator Vitter's amendment because the
amendment would only codify the Hyde amendment with respect to the
Indian Health Service. I think we should apply the same standard to all
Federal health programs and not set up a separate standard that only
applies in Indian Country.
Mr. DORGAN. Mr. President, the next vote will be a vote on final
passage. I will take just 30 seconds.
I do want to say that Senator Murkowski has helped get us to this
point in a very significant way. As to Senators Baucus, Grassley,
Kennedy, Enzi, Kyl--and especially Senator Reid, who allowed us to
spend time on the floor on this bill--and the 31 cosponsors of the
legislation, I thank all of them.
I thank Allison Binney, the majority staff director, and David
Mullon, the minority staff director, and the really talented group of
staff members who worked very hard on this legislation. I say a hearty
thank-you to them.
Mr. President, I ask unanimous consent that a list of all their names
be printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
Indian Affairs (Democratic staff)
Allison Binney (Staff Director), Ted Charlton, Cindy Darcy,
Heidi Frechette, John Harte, Tracy Hartzler-Toon, David
Holland, Jerci Powell (intern), Eamon Walsh, Rollie Wilson.
Indian Affairs (Republican staff)
David Mullon (Staff Director), Megan Alvanna-Stimpfle, Jim
Hall, Rhonda Harjo, Gerald Moses, Jonathan Murphy.
Finance Committee (Senator Baucus' staff)
Catherine Dratz, Michelle Easton, Deidre Henry-Spires,
Richard Litsey, David Schwartz, Russ Sullivan.
[[Page S1155]]
Finance Committee (Senator Grassley's staff)
Becky Schipp, Rodney Whitlock.
Democratic Policy Committee (DPC)
Kory Caro, Liz Engel, Ryan Mulvenon.
HELP Committee (Senator Kennedy's staff)
David Bowen, Caya Lewis, Lauren McFarran, Peter Romer-
Friedman, Tanchia Terry, Portia Wu.
HELP Committee Staff (Senator Enzi's staff)
Greg Dean, Shana Christup, Katherine McGuire, Randy Reid
(Senator Enzi's Legislative Director), Amy Shank.
Senator Reid's Leadership staff
Carolyn Gluck, Kate Leone, Darrel Thompson, Marcela Zamora.
Senator Kyl's staff
Jennifer Romans.
Mr. DORGAN. It has been 8 years now that we should have advanced this
legislation to improve Indian health care, and after 8 long years we
finally have it done--at least through the Senate after this final
passage vote. I say thanks to all of my colleagues for their patience
and also their help.
I yield the floor to Senator Murkowski.
The ACTING PRESIDENT pro tempore. The Senator from Alaska.
Ms. MURKOWSKI. Mr. President, I, too, want to thank so many who have
done so much to advance this legislation. Very rarely do we see an
opportunity for Indian bills of any nature to receive floor time, so I
want to thank all our colleagues to be able to debate this very
important issue with them.
I thank especially Chairman Dorgan for his leadership on this
legislation. He has mentioned so many who have participated throughout
the years, including the staffs, but we also need to recognize the
leadership of the former chairman, Senator Ben Nighthorse Campbell,
and, of course, Senator McCain, Senator Dorgan, Senator Inouye--so many
who have done so much.
I also want to acknowledge the National Tribal Steering Committee for
their efforts--great tribal leaders coming together to advance this
very important legislation.
I have a long list of thank-yous, but truly it has been a great
effort, and we appreciate the leadership on both sides in advancing
this legislation.
The ACTING PRESIDENT pro tempore. The majority leader is recognized.
Mr. REID. Mr. President, the one thing both of these Senators did not
mention is the wonderful work they have done. The chairman and ranking
member of the Indian Affairs Committee were able to reach out to
Members on both sides of the aisle. This is truly a bipartisan piece of
legislation. Is it everything we wanted? Is it everything they wanted?
No. But it is a good piece of legislation. For the Indians around
America today, it is a really bright day. So I appreciate the good work
of Senators Dorgan and Murkowski, who have done very good work.
Mr. President, I am happy to yield to my friend.
The ACTING PRESIDENT pro tempore. The Republican leader is
recognized.
Mr. McCONNELL. Mr. President, let me add my congratulations to
Senator Dorgan and particularly Senator Murkowski for their excellent
work in putting together this very important piece of legislation. I
commend them both for outstanding work.
The ACTING PRESIDENT pro tempore. The majority leader is recognized.
Order of Procedure
Mr. REID. Mr. President, I ask unanimous consent that notwithstanding
the previous order, the Senate recess from 12:30 to 2:25 p.m. for the
weekly caucus lunches; that at 2:25 p.m. the Senate begin the 20
minutes of debate prior to a vote on the motion to invoke cloture on
the motion to proceed to S. 2633 as provided under the previous order,
with all other provisions of the previous order remaining in effect;
further, that if cloture is not invoked, the next rollcall vote on the
motion to invoke cloture on the motion to proceed to S. 2634 occur at 4
p.m, with the Senate in a period of morning business until 4 p.m., with
the time equally divided and Senators permitted to speak up to 10
minutes each.
So, Mr. President, because of problems that sometimes come here with
scheduling, we are going to bifurcate, but it will only be for about 50
minutes. We will have about 50 minutes of morning business until the
vote at 4 o'clock. I appreciate everyone's cooperation.
The ACTING PRESIDENT pro tempore. Is there objection?
Without objection, it is so ordered.
Under the previous order, the Dorgan substitute amendment, as
amended, is agreed to.
The amendment (No. 3899), as amended, was agreed to.
The ACTING PRESIDENT pro tempore. The question is on the engrossment
and third reading of the bill.
The bill was ordered to be engrossed for a third reading and was read
the third time.
The ACTING PRESIDENT pro tempore. The bill having been read the third
time, the question is, Shall it pass?
Mr. DORGAN. Mr. President, I ask for the yeas and nays.
The ACTING PRESIDENT pro tempore. Is there a sufficient second?
There appears to be a sufficient second.
The clerk will call the roll.
The legislative clerk called the roll.
Mr. DURBIN. I announce that the Senator from New York (Mrs. Clinton),
the Senator from Connecticut (Mr. Dodd), the Senator from Connecticut
(Mr. Lieberman), and the Senator from Illinois (Mr. Obama) are
necessarily absent.
I further announce that, if present and voting, the Senator from
Connecticut (Mr. Lieberman) would vote ``yea.''
Mr. KYL. The following Senators are necessarily absent: the Senator
from Texas (Mr. Cornyn), the Senator from Arizona (Mr. McCain), and the
Senator from Virginia (Mr. Warner).
Further, if present and voting, the Senator from Texas (Mr. Cornyn)
would have voted ``yea.''
The ACTING PRESIDENT pro tempore. Are there any other Senators in the
Chamber desiring to vote?
The result was announced--yeas 83, nays 10, as follows:
[Rollcall Vote No. 32 Leg.]
YEAS--83
Akaka
Alexander
Barrasso
Baucus
Bayh
Bennett
Biden
Bingaman
Bond
Boxer
Brown
Brownback
Bunning
Burr
Byrd
Cantwell
Cardin
Carper
Casey
Chambliss
Cochran
Coleman
Collins
Conrad
Craig
Crapo
Dole
Domenici
Dorgan
Durbin
Ensign
Enzi
Feingold
Feinstein
Grassley
Hagel
Harkin
Hatch
Hutchison
Inouye
Isakson
Johnson
Kennedy
Kerry
Klobuchar
Kohl
Kyl
Landrieu
Lautenberg
Leahy
Levin
Lincoln
Lugar
Martinez
McCaskill
McConnell
Menendez
Mikulski
Murkowski
Murray
Nelson (FL)
Nelson (NE)
Pryor
Reed
Reid
Roberts
Rockefeller
Salazar
Sanders
Schumer
Shelby
Smith
Snowe
Specter
Stabenow
Stevens
Tester
Thune
Voinovich
Webb
Whitehouse
Wicker
Wyden
NAYS--10
Allard
Coburn
Corker
DeMint
Graham
Gregg
Inhofe
Sessions
Sununu
Vitter
NOT VOTING--7
Clinton
Cornyn
Dodd
Lieberman
McCain
Obama
Warner
The bill (S. 1200), as amended, was passed.
(The bill will be printed in a future edition of the Record.)
Mr. DORGAN. I move to reconsider the vote, and I move to lay that
motion on the table.
The motion to lay on the table was agreed to.
Mr. REID. Mr. President, the Senate has taken an important step today
by passing S. 1200, the Indian Health Care Improvement Act Amendments
of 2007.
I am now pleased to join the other 30 cosponsors of this legislation
in sending it to the House for their consideration.
When signed into law, this legislation will:
increase and improve recruitment and retention programs for
Indian health professionals;
improve communicable and infectious disease monitoring and
provide for more research on issues unique to those living on
reservations;
improve and expand diabetes screening and treatment
programs;
expand programs to prevent domestic violence, sexual abuse,
and substance abuse, in Native American communities;
incorporate and encourage the use of technology in
delivering health care services and
[[Page S1156]]
providing treatment, which is so important to our rural
Indian communities;
and encourage States to increase outreach to Indians to
help them to enroll in Medicaid and SCHIP programs.
This legislation is supported by a broad, bipartisan coalition, those
in Indian Country, and many organizations that advocate for eliminating
disparities in health care.
I would like to take this opportunity to acknowledge the support and
leadership of particular Senators and their staffs.
The bill managers have been strong and articulate advocates for the
bill, and shown great flexibility.
I commend Senator Dorgan and his staff, particularly Allison Binney,
Cindy Darcy, Heidi Frechette and Ben Klein.
I commend Senator Murkowski and her staff, including David Mullon and
Nathan Bergerbest.
I commend Senator Baucus, and his staff, particularly David Schwartz
and Richard Litsey; and Senator Grassley and his staff, including
Rodney Whitlock, who have insisted on improvements in the
administration of Indian health programs.
I commend Senator Kennedy and his staff, particularly Caya Lewis, and
Senator Mike Enzi and his staff, including Randi Reid, Shana Christrup,
Greg Dean and Amy Shank, who helped us negotiate many difficult issues.
On my staff and part of the Democratic leadership team, I commend
Kate Leone, Carolyn Gluck; Kory Vargas Caro, Elizabeth Engel, and Ryan
Mulvenon.
I want to say a special word of thanks to Tracy Hartzler-Toon, who
has worked tirelessly for over a year to help make today possible.
She has served me, the Indian Affairs Committee, and the Senate very
well. And most importantly, she has served the residents of Indian
Country exceedingly well.
I also thank my colleagues, the Republican leader, Senator McConnell,
and his health policy advisor, Megan Hauck, and Senator Jon Kyl, and
particularly Jennifer Romans, for their agreement and commitment to see
that this bill finally received its due consideration.
Lastly, I want to acknowledge the support of the late Senator Craig
Thomas of Wyoming. Before he passed away last year, his leadership on
the Indian Affairs Committee was helpful in bringing the Senate to this
moment.
With the help of so many, both in the Capitol and around the country,
we have taken an important step toward providing Indian Country some of
the health care services that many in the rest of this Nation have
enjoyed for years.
I urge the House to take quick action on H.R. 1328, the companion
bill to what we passed today, so we can get this important legislation
to the President's desk and make these services a reality.
The ACTING PRESIDENT pro tempore. The Senator from North Dakota.
Mr. DORGAN. Mr. President, I wish to say a few words about this vote,
and then I am going to ask unanimous consent that Senator Murkowski be
recognized, then Senator Enzi, Senator Feingold, and Senator Boxer. I
believe Senator Enzi is going to ask for 10 minutes, Senator Feingold
20 minutes, and Senator Boxer 15 minutes. I ask by unanimous consent
that be the order.
The ACTING PRESIDENT pro tempore. Without objection, it is so
ordered.
Mr. DORGAN. Mr. President, I will take a couple of additional minutes
to say how pleased and proud I am that we have passed by a very wide
margin the first improvement in Indian health care since 1992. These,
after all, are the first Americans. They were here first. We signed
treaties with them, we took their land, we put them on reservations,
made promises, and we have a trust responsibility. We said ``we
promise.'' The fact is, we have not kept those promises for a long
time, especially with respect to Indian health care.
Finally, at long last, this Congress--and thanks to Senator Reid and
all the folks who allowed this to be on the floor of the Senate for the
time that it was--we finally have made some progress, the first time
since 1992 that we have reauthorized the Indian Health Care Improvement
Act. This is a big deal. This will save lives. We have more steps to
take. The House has a bill with which it has to deal. It will, and we
will be in conference, and finally we will be able to have a bill
before the President of the United States for his signature in this
year.
I have spoken at length. I know people are tired of hearing me. The
Presiding Officer is from Montana. He and I held a hearing on the Crow
Indian Reservation in Montana. We heard an earful about Indian health.
I have held listening sessions around the country in different States
with Indian tribes. I cannot tell you the number of stories I have
heard that had me going away from these meetings shaking my head
wondering: What on Earth can we do to fix this situation? How much will
it take for us to fix this situation?
I recall a grandmother on the Crow Reservation, MT, standing up with
a beautiful picture of her 5-year-old granddaughter who had died. After
essentially a rather lengthy story, she asked: How do you justify this,
a young girl spending the last 3 months of her life in unmedicated pain
because the health care system does not work for that young girl? The
stories go on and on.
I am convinced we must do better, and I am determined and it was my
priority when I became chairman of this committee to finish this job. I
know Ben Nighthorse Campbell worked hard on it, and Senator McCain,
when he was chairman of the committee, worked hard on it. Finally,
Senator Murkowski and I made it a priority for this committee to say:
We have to fix this situation. This is not some option. The promise of
health care means if we do not keep this promise, people will die. I
have named some of those people, some of them children.
We have to do better. And this vote today, a very significant vote in
the Senate, an overwhelming vote, 90 percent of the Senate saying we
agree, let's fix it, that is something I think is going to be
unbelievably welcome news to American Indians all across this country
today. It has been a long time coming, 16 years, but finally--finally--
we made progress, and I believe this progress will save lives.
Mr. President, I thank Senator Murkowski who has been an enormous
partner in trying to get this bill completed. As I close, I will
mention our staff director, Allison Binney, also Ted Charlton, Cindy
Darcy, Heidi Frechette, John Harte, Tracy Hartzler-Toon, David Holland,
Jerci Powell, Eamon Walsh, and Rollie Wilson on our side; and David
Mullon, staff director on the minority side, Megan Alvanna-Stimpfle,
Jim Hall, Rhonda Harjo, Gerald Moses, Jonathan Murphy, and so many
others.
Those people I have named have worked a lot. They worked behind the
scenes, long hours, late at night, and on weekends to help make this
possible. I say a heartfelt thanks to them for their wonderful work.
I yield the floor.
The ACTING PRESIDENT pro tempore. The Senator from Alaska.
Ms. MURKOWSKI. Mr. President, I rise to recognize the passage of the
Indian Health Care Improvement Act. I again thank the majority leader
and minority leader for committing floor time for this bill. Rarely
have Indian bills received time on the Senate floor, but this is one
that is very important to the well-being of our country's Native people
that the attention it has been given by the Senate is more than
justified.
I thank my colleagues for their commitment in considering this
legislation, addressing the issues, and supporting our efforts to
improve health care services for American Indians and Alaska Natives.
As with many bills, the provisions fall under more than one
committee's jurisdiction. The Committee on Indian Affairs, on which I
serve as the vice chairman, has shared this bill with the Finance and
HELP Committees, and both of these committees have worked in earnest to
assist us in crafting a bill to carry the Indian health care system
into the 21st century.
I am fortunate to have a chairman on the Indian Affairs Committee--
Senator Dorgan--with whom I share a close working relationship. We both
have significant populations of Native people in our States with
similar issues and challenges in many areas such as health care,
education, housing, economic development and transportation.
[[Page S1157]]
We have had numerous opportunities to work together in our committee,
particularly on youth suicide prevention and treatment and
telemedicine. I truly appreciate his persistence and dedication in
advancing this bill.
Senators Grassley and Baucus have also worked with us closely to
advance this measure through the Finance Committee last year which
reported the bill out favorably in both the 109th and 110th Congresses.
I also wish to recognize their staff Rodney Whitlock, Becky Shipp, and
David Schwartz, who worked so closely with the Indian Affairs staff on
this bill.
Likewise, Senator Enzi, in his capacity as chairman and now as
ranking member of the HELP committee--worked very diligently on this
legislation to refine key pieces of the legislation during the 109th
Congress and again this year. Greg Dean, Shana Christrup, Randi Reid
and Amy Shank devoted countless hours of work with the Indian Affairs
Committee to work out issues, which I appreciate. I especially
appreciate the leadership and commitment of Senator Kyl. He has one of
the largest Indian populations in his State. His commitment to Indian
issues was reflected by his continued involvement and that of his
staff, Jennifer Romans, in working out issues to advance this bill.
We must not forget that this bill reflects the work of our dear
colleague and my predecessor, the late Senator Craig Thomas, who held
the reins as vice chairman last year. He eagerly pursued efforts to
improve health care services for all American Indian communities,
including those in his home State of Wyoming on the Wind River Indian
Reservation, and it is most fitting that we will honor his work with
the passage of this bill. I pointed out on the floor yesterday, in the
109th Congress, Senator McCain made a great effort to reauthorize the
act in his role as chairman of the Indian Affairs Committee. Before
that, Senator Campbell, who also served as chairman of the Indian
Affairs Committee, carried this legislation since the 106th Congress as
the original sponsor, along with Senator Inouye, until Senator
Campbell's retirement in 2004.
Between Chairmen Campbell and McCain in the 108th and 109th
Congresses, there were 8 hearings on the reauthorization, including
joint hearings with the HELP Committee and with the House Resources
Committee.
Our efforts had also great help from my good friends Senators
Stevens, Domenici, Smith, Cochran, Hatch, and Thune. These Senators
have been long-time friends of our country's Native people, and I want
to acknowledge their dedication in promoting American Indian and Alaska
Native health.
The Republican staff of the Senate Committee on Indian Affairs has
waited a long time for this day to come. David Mullon, the Republican
staff director and chief counsel, and Rhonda Harjo, the deputy chief
counsel, came to the committee during Senator Ben Nighthorse Campbell's
tenure.
Rhonda Harjo has been the lead Republican staff member of the
committee for Indian Health Care Improvement Act reauthorization since
2003. Indian country takes pride in her devotion to the betterment of
her Native people and I share that pride today.
I also wish to acknowledge the efforts of Jim Hall and Jon Murphy and
two Alaskans who recently joined the committee--Gerald Moses and Megan
Alvanna-Stimpfle--in preparing this bill for floor consideration.
I also acknowledge the tireless efforts over the past 8 years of the
Indian tribal and health care leaders and advocates across the U.S. in
helping develop the legislative proposal which served as the basis for
this bill. In particular, the National Tribal Steering Committee,
consisting of tribal leaders and Indian health representatives, brought
together the diverse interests of over 560 tribes across the country to
a consensus on this very important measure.
That is no small task and it was handled dutifully by the cochairs of
the National Tribal Steering Committee, Chairman Buford Rolin of the
Poarch Band of Creek Indians in Atmore, Alabama, Rachel Joseph, former
Chairwoman of the Lone Pine Paiute-Shoshone Tribe, in Lone Pine,
California, and staff, Kitty Marx from the National Indian Health
Board.
Three key Alaska Native leaders played significant roles on the
National Tribal Steering Committee: Sally Smith, the chairman of the
National Indian Health Board and the Bristol Bay Area Health
Corporation; Don Kashevaroff, the president of the Seldovia Village
Tribe and chair of the Tribal Self-Governance Advisory Committee; and
Valerie Davidson from the Alaska Native Tribal Health Consortium. I
appreciate their leadership and thoughtful consideration in the
development of this legislation.
A lot of good work went into this bill and our efforts should not go
in vain. I look forward to working with my House colleagues and getting
this bill on to the President's desk for signature.
Mr. President, we had a brief opportunity to express our thanks to
those who have worked so hard on the reauthorization of the Indian
Health Care Improvement Act. Again, my sincere thanks and gratitude to
Chairman Dorgan for all that he has done.
This is a good day for Indian country, for Alaska Natives who are
just waking up back home right now. They are going to wake up to news
that they have been waiting to hear for a good decade: that finally we
have advanced the Indian Health Care Improvement Act. We have taken
that step. We recognize this is not the end-all and be-all in terms of
providing for the health care needs of American Indians and Alaska
Natives. We know we need to do more, and we are challenged to do that.
We talked about the funding issue and how we must make that next step
to make sure it is not just what we put in the authorization, but we
back that up with the dollars for the programs.
We have a long way to go, but I think we have made a very significant
step today. I am proud of the work of my colleagues today and those who
came before us on this very important issue.
``Exxon Valdez'' Oilspill
Mr. President, I wish to take a few minutes this morning to talk
about tomorrow because tomorrow the United States Supreme Court will
hear the appeal of the ongoing litigation between ExxonMobil and
commercial fishermen and other plaintiffs whose livelihoods were
negatively impacted, devastated, in fact, by the 1989 Exxon Valdez
oilspill. The Exxon Valdez ran aground on Bligh Reef at 12:04 a.m. on
March 24, 1989. It spilled 11 million gallons of oil--this is about the
same size as 125 Olympic-sized swimming pools--directly into Prince
William Sound in Alaska. The oil from the spill migrated several
hundred miles from Bligh Reef and polluted roughly 1,300 miles of
Alaskan shoreline. There were 11,000 square miles of ocean that were
ultimately affected by this spill, which is believed to be the worst
oilspill worldwide with respect to environmental damage.
Regrettably, the spill area is still affected some 19 years later. In
2001, the National Oceanic and Atmospheric Administration studied the
shoreline of Prince William Sound for any remaining effects of the
spill. Scientists reviewed 91 sites within Prince William Sound and
found that 58 percent of these locations were still polluted by oil.
Again, this is 19 years after the fact. Some estimates note that
beaches and streams in this area are still polluted with over 25,000
gallons of oil.
Of course, the fisheries in Prince William Sound were affected. The
herring fishery in this area experienced a dramatic decrease in the
years immediately after the 1989 spill. As of 2007, the herring fishery
had not improved to the pre-1989 levels. Another example is what has
happened with the value of the fisheries permits in this part of the
State. In 1988, a fishing permit in Prince William Sound was worth
$400,000. As of 2004, the value of each such permit was less than
$70,000, a drop of more than 82 percent.
There was a class action jury trial held in Federal court in
Anchorage, AK, in 1994. The plaintiffs at that time included over
30,000 commercial fishermen, among those whose livelihoods were gravely
affected by the disaster. The jury awarded $5 billion in punitive
damages to the plaintiffs. This punitive damage award has been on
repeated appeal by ExxonMobil since that time. On December 22, 2006,
the Ninth Circuit Court of Appeals reduced the punitive damage award to
$2.5 billion. In early 2007, ExxonMobil petitioned the Ninth Circuit
for a rehearing en banc. Within a few months, the Ninth Circuit denied
[[Page S1158]]
this petition and ExxonMobil appealed to the Supreme Court.
Unfortunately, in this intervening time period, with years and years of
litigation bringing delay in resolution, we have had several thousand
plaintiffs pass away since this litigation began.
Due to the limitations in admiralty law with respect to the recovery
of compensatory damages, many Exxon Valdez plaintiffs were not able to
recover the financial losses they sustained in the aftermath of this
spill. So the punitive damages that are under consideration by the
Supreme Court will provide them that level of compensation.
Once the Supreme Court decided to hear this case, I joined with
Senator Stevens and Representative Young in submitting an Alaska
congressional delegation amicus brief to the U.S. Supreme Court. In
that brief, we argue that the award of punitive damages in this case of
reckless and wanton conduct by Exxon not only is permissible under the
Clean Water Act, but it is supported by Federal maritime law. Only
punitive damages will provide those who were harmed--and who continue
to be harmed--with the justice and the fair compensation they deserve.
This litigation needs to end. Nineteen years is far too long for
these plaintiffs to wait to be compensated for their loss of income. I
am hopeful that the Supreme Court will rule in favor of the plaintiffs
in this case, and I, along with so many Alaskans, look for a final
resolution to this great tragedy that occurred to us as a State some 19
years ago.
Mr. President, I yield the floor.
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