[Congressional Record Volume 155, Number 149 (Thursday, October 15, 2009)]
[Senate]
[Pages S10493-S10494]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DORGAN (for himself, 
        Mr. Reid, Ms. Murkowski, 
        Mr. Udall of New Mexico, 
        Mr. Whitehouse, Mr. Johnson, Mr. Tester,  Mr. Akaka, 
        Mr. Conrad, Mr. Begich, 
        Mr. Franken, Mr. Burris, 
        Mr. Inouye, Ms. Stabenow, 
        Mr. Udall of Colorado, and Ms. Klobuchar):
  S. 1790. A bill to amend the Indian Health Care Improvement Act to 
revise and extend that Act, and for other purposes; to the Committee on 
Indian Affairs.
  Mr. DORGAN. Mr. President, today I introduced the Indian Health Care 
Improvement Reauthorization and Extension Act of 2009. We face a bona 
fide crisis in health care in our Native American communities, and this 
bill is a first step toward fulfilling our treaty obligations and trust 
responsibility to provide quality health care in Indian Country. I 
introduce this bill on behalf of myself, Leader Reid and Senators 
Murkowski, Udall of New Mexico, Begich, Franken, Whitehouse, Inouye, 
Akaka, Johnson, Tester, Conrad, Burris, Stabenow, Udall of Colorado, 
and Klobuchar.
  As Chairman of the Senate Committee on Indian Affairs, I have again 
made health care a top priority for the Committee this Congress. Native 
Americans suffer staggering health disparities due to an outdated, 
strained and underfunded health care system. We have a federal health 
care system for Native Americans that is only funded at about half of 
its need. Clinician vacancy rates within this system are high and 
misdiagnosis is rampant. Only those with ``life or limb'' emergencies 
seem to get care. Native Americans die of tuberculosis at a rate 600 
percent higher than the general population, suicide rates are nearly 
double, alcoholism rates are 510 percent higher, and diabetes rates are 
189 percent higher than the general population.
  These numbers are appalling and represent Third World conditions 
right here in the U.S.
  I have heard the heartbreaking stories about the lack of health care 
on our Native American reservations: people like Ta'shon Rain 
Littlelight, Jami Rose Jetty, Russell Lente and Avis Little Wind, who 
likely still would be living today had they had access to adequate 
health care. Our Federal system has failed them and so many other 
Native Americans. We owe our First Americans something better, and the 
bill I introduced today with my colleagues will provide a better 
system.
  For over a decade, Indian Country has asked Congress to reauthorize 
and amend the Indian Health Care Improvement Act, P.L. 94-437. The 
National Steering Committee for Reauthorization, National Congress of 
American Indians, National Indian Health Board, and other Native 
American health advocates have been dedicated to improving the health 
care available to Native Americans across the country. I too am 
committed to ensuring the United States fulfills its trust 
responsibility to provide decent health care to the Native Americans.
  Last Congress, the Senate passed the Indian Health Care Improvement 
Act Amendments of 2008, which would have brought needed improvements to 
the Native American health care system. The bill passed by an 
overwhelming 83 to 10 vote. This was the first time in almost 17 years 
that the Senate considered and passed a Native American health care 
bill. Ultimately, the bill failed to be considered in the House of 
Representatives. My colleagues and I remain committed to getting a bill 
enacted into law.
  In July, I developed a Native American health concept paper which was 
sent out to Indian Country for comments. I and the Committee on Indian 
Affairs held many listening sessions and meetings with many Native 
Americans around the country to discuss the concept paper. In addition, 
the Committee has held five hearings focused on Native American health 
issues this Congress. The Committee has worked to compile the feedback 
received from the concept paper and other meetings to develop the 
Native American health bill I introduced today.
  Similar legislation has been considered in the 106, 107, 108, 109, 
and 110 Congresses. Today, my colleagues and I put forward a Native 
American health bill for the 111 Congress which builds on the work of 
prior Congresses, but goes beyond to include innovative solutions and 
reforms for the Native American health care system.
  I would like to highlight some of the important updates the Indian 
Health Care Improvement Reauthorization and Extension Act of 2009 will 
bring to

[[Page S10494]]

the Native American health care system.
  Perhaps most importantly, the Native American health bill permanently 
reauthorizes all current laws governing the Native American health care 
system. This means that once this bill is passed, Indian Country will 
never again have to wait nearly 20 years for a reauthorization of the 
Indian Health Care Improvement Act.
  This bill also authorizes long-term care services, including hospice 
care, assisted living, long-term care and home- and community-based 
care. Current law does not allow for these services to be provided by 
the Indian Health Service or tribal facilities. Although some areas of 
Indian Country are merely focused on addressing life or limb medical 
emergencies, other areas are in need of long-term care. Thus, I believe 
they should be authorized.
  In addition, the bill establishes mental and behavioral health 
programs beyond alcohol and substance abuse, such as fetal alcohol 
spectrum disorders, child sexual abuse and prevention treatment 
programs. The mental health needs in Native American communities extend 
beyond alcohol and substance abuse, in fact over \1/3\ of the health 
care needs in Indian Country are related to mental health. The 
comprehensive mental and behavioral health programs established as a 
result of this bill will bring necessary care and resources to Native 
Americans.
  In order to address the tragic level of youth suicide, the bill 
includes behavioral health provisions solely focused on preventing 
Native American youth suicide. The youth suicide rate in Indian Country 
is 3.5 times higher than the general population. Earlier this year, I 
chaired an Indian Affairs hearing to draw attention to this important 
topic.
  The bill also incorporates many new ideas aimed at improving the 
access to health care available to Native Americans. The bill 
authorizes projects which will incentivize tribes to use innovative 
facilities construction which save money and expand the health care 
services available to Native American communities. For example, these 
projects include the use of modular component facility construction and 
mobile health stations.
  Modular component health facilities can be built at often one-third 
the cost and a fraction of the time of a typical health facility. In 
addition, mobile health stations will allow for Native Americans in 
rural areas without a hospital, increased access to specialty health 
services like dialysis, same-day surgery, dental care, or other 
services. Currently, there is an estimated $3 billion backlog for 
maintenance, improvement and construction of Native American health 
care facilities. In addition, the average age of an Indian Health 
Service facility is 33 years, as compared to 7 years in the general 
population. These innovative health care facilities will go a long way 
in this disparity and improving access to health care for Native 
Americans across the country.
  The Native American health bill establishes a health delivery 
demonstration project. This project provides for convenient care 
services, which could be offered in local grocery stores and other 
venues, to make health care more available to Native American 
communities. The health delivery demonstration project authorizes the 
Indian Health Service to consider other innovative health delivery 
models, like community health centers, and other models which will 
increase access to health care services.
  I want to end by saying the need for health care is not new for 
Indian Country. Nowadays, the need for national health care reform is 
front page news, but our Native Americans have long been in need of 
health care reforms. Therefore, I intend to offer this Native American 
health bill as an amendment to any national health care reform bill 
considered on the Senate floor.
  I want to thank all the Native American health advocates who assisted 
us in the development of this crucial piece of legislation. The Federal 
Government signed the dotted lines years ago, and today, we make an 
important step towards finally fulfilling those obligations.

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