[Congressional Record Volume 166, Number 214 (Thursday, December 17, 2020)]
[House]
[Pages H7245-H7247]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              {time}  1430
  DEEMING AN URBAN INDIAN ORGANIZATION AND EMPLOYEES A PART OF PUBLIC 
                             HEALTH SERVICE

  Mr. GALLEGO. Madam Speaker, I move to suspend the rules and pass the 
bill (H.R. 6535) to deem an urban Indian organization and employees 
thereof to be a part of the Public Health Service for the purposes of 
certain claims for personal injury, and for other purposes, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 6535

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. DEEMING AN URBAN INDIAN ORGANIZATION AND EMPLOYEES 
                   THEREOF TO BE A PART OF THE PUBLIC HEALTH 
                   SERVICE FOR THE PURPOSES OF CERTAIN CLAIMS FOR 
                   PERSONAL INJURY.

       Title V of the Indian Health Care Improvement Act (25 
     U.S.C. 1651) is amended by adding at the end the following:

     ``SEC. 519. DEEMING AN URBAN INDIAN ORGANIZATION AND 
                   EMPLOYEES THEREOF TO BE A PART OF THE PUBLIC 
                   HEALTH SERVICE FOR THE PURPOSES OF CERTAIN 
                   CLAIMS FOR PERSONAL INJURY.

       ``Section 102(d) of the Indian Self-Determination and 
     Education Assistance Act shall apply--
       ``(1) to an Urban Indian organization to the same extent 
     and in the same manner as such section applies to an Indian 
     tribe, a tribal organization, and an Indian contractor; and
       ``(2) to the employees of an Urban Indian organization to 
     the same extent and in the same manner as such section 
     applies to employees of an Indian tribe, a tribal 
     organization, or an Indian contractor.''.

     SEC. 2. DETERMINATION OF BUDGETARY EFFECTS.

       The budgetary effects of this Act, for the purpose of 
     complying with the Statutory Pay-As-You-Go Act of 2010, shall 
     be determined by reference to the latest statement titled 
     ``Budgetary Effects of PAYGO Legislation'' for this Act, 
     submitted for printing in the Congressional Record by the 
     Chairman of the House Budget Committee, provided that such 
     statement has been submitted prior to the vote on passage.
  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Arizona (Mr. Gallego) and the gentleman from Virginia (Mr. Wittman) 
each will control 20 minutes.
  The Chair recognizes the gentleman from Arizona.


                             General Leave

  Mr. GALLEGO. Madam Speaker, I ask unanimous consent that all Members 
may have 5 legislative days in which to revise and extend their remarks 
and include extraneous material on the measure under consideration.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Arizona?
  There was no objection.
  Mr. GALLEGO. Madam Speaker, I yield myself such time as I may 
consume.
  Madam Speaker, H.R. 6535, the Coverage for Urban Indian Health 
Providers Act, is a bipartisan bill authored by myself and 
Representative Markwayne Mullin of Oklahoma.
  This bill would uphold our trust responsibility, provide long-overdue 
parity to the Indian Health System by extending Federal Tort Claims Act 
coverage to urban Indian organizations, and direct their scarce 
resources to saving lives instead of bureaucratic overhead.
  This broadly supported policy change was also included in the 
President's fiscal year 2021 budget proposal.
  As part of our trust and treaty responsibilities, the U.S. Government 
has a legal responsibility to provide healthcare to Native Americans 
and Alaska Natives. Congress created the Indian Health System to carry 
out this obligation.
  The Indian Health System is made up of the Indian Health Service; 
Tribal health programs; and urban Indian organizations, known as UIOs.
  UIOs play a pivotal role in upholding the trust responsibility by 
providing culturally competent care to the over 70 percent of American 
Indians and Alaska Natives who live in urban areas, like my district in 
Phoenix, Arizona.
  However, despite the pivotal role they play, UIOs are the only branch 
of the Indian Health System that are not currently eligible for 
liability coverage under the Federal Tort Claims Act, known as FTCA.
  As a result, each UIO is forced to spend up to $250,000 per year on 
individual medical liability policies. If we pass this bill today, that 
quarter of a million dollars will instead be spent directly on patient 
care and the resources these clinics need to fight COVID-19. That is 
why passing H.R. 6535 is especially critical now, in the midst of a 
pandemic that has hit Native populations the hardest, and UIOs have 
been disproportionately the ones servicing them and also hit hard.
  This year, over 80 percent of UIOs have cut services due to the 
resource shortages they are experiencing, and at least three have had 
to shut their doors during the first wave of the pandemic. Cuts to 
services are devastating for the vulnerable Native communities and the 
UIOs that serve them. I know because I have heard from my constituents 
what a critical role UIOs, like Native Health of Phoenix, play in the 
daily lives of urban Indians.
  From free food deliveries during the pandemic to seniors and low-
income families, to COVID testing, primary care, and social services, 
UIOs and their staffs are pillars of the communities they serve and 
they save lives.
  These heroic frontline staffs should not be singled out for exclusion 
from coverage under FTCA merely due to which part of the Indian Health 
System they serve in. Passing H.R. 6535 would immediately make these 
health providers eligible for FTCA coverage, and it would create a 
financial lifeline for these cash-strapped health clinics serving on 
the front lines of the pandemic.
  I urge my colleagues to support frontline health workers, support 
Native communities, and support upholding our trust responsibilities by 
voting ``yes'' on this bill.
  Madam Speaker, I reserve the balance of my time.
  Mr. WITTMAN. Madam Speaker, I yield myself such time as I may 
consume.
  Madam Speaker, H.R. 6535 would amend the Indian Health Care 
Improvement Act to extend Federal Tort Claims Act coverage to urban 
Indian

[[Page H7246]]

organizations, or UIOs. It would do so by deeming the UIOs and their 
employees part of the Public Health Service.
  Currently, urban Indian health organizations need to purchase 
liability insurance with resources that could be better utilized to 
expand services to Native Americans. The rising costs of liability 
insurance and the general cost of providing healthcare services 
adversely impact the ability of UIOs to provide needed services. As a 
result, services are often substantially reduced or certain types of 
staff are eliminated.
  The Indian Health Service deems UIOs an integral part of the Indian 
healthcare system. They provide high-quality, culturally relevant 
healthcare and are often the only healthcare providers readily 
accessible to urban American Indian and Alaska Native patients.
  While there is general agreement and support that Federal Tort Claims 
Act protections should be extended to UIO health facilities, I am 
disappointed that the majority failed to consider technical amendments 
provided by the Department of Health and Human Services.
  Requests to address these legitimate concerns were dismissed shortly 
after Chairman Grijalva of the Natural Resources Committee agreed to 
keep working on the legislation before it would be considered on the 
House floor. These technical changes would improve the legislation, 
which may now face an uncertain future in the Senate. That 
shortsightedness only hurts the very Native Americans that this bill is 
trying to help.
  Madam Speaker, I yield back the balance of my time.
  Mr. GALLEGO. Madam Speaker, I urge my colleagues to support this 
legislation, and I yield back the balance of my time.
  Mr. CASE. Madam Speaker, I rise in support of H.R. 6585 with deep 
reservations.
  I support the substance of the measure as addressing key concerns for 
American Indians and Alaska Natives. My grave concern is with the 
inexplicable omission of Native Hawaiians as indistinguishably 
indigenous peoples of this country to be treated and included the same.
  I spelled out my concerns at length in a submission to the record of 
my Committee on Natural Resources on this measure and I include in the 
Record my statement:

     U.S. House Committee on Natural Resources:
     July 29, 2020 Full Committee Markup on H.R. 6535:
     Additional Remarks for the Record:
     U.S. Congressman Ed Case:
       Chairman Grijalva, Ranking Member Bishop and fellow 
     Committee members, I respectfully submit these additional 
     remarks for the record on H.R. 6535, introduced by my friend 
     and colleague on the Committee, Mr. Gallego, also Chair of 
     the Committee's Subcommittee on Indigenous Peoples of the 
     United States on which I am also honored to serve.
       H.R. 6535, considered and unanimously reported by this 
     Committee on July 29, 2020, would extend federal tort claims 
     coverage for certain personal injury claims to urban Indian 
     organizations by deeming them part of the Public Health 
     Service, similar to current coverage provided to Indian 
     tribes, tribal organizations, Indian contractors and 
     employees. I fully endorse this measure and was pleased to be 
     able to support it in both Subcommittee and full Committee.
       However, I must register my deep concern that Native 
     Hawaiian Health Care Systems (NHHCS) have not also been 
     extended the same coverage in this measure or otherwise. 
     Although there are legitimate procedural and related non-
     substantive reasons for not including them in this specific 
     vehicle, I wish to affirm for the record that this is clearly 
     unfinished business that should and must be remedied by this 
     Committee and Congress at the earliest opportunity.
       The current federal tort claims coverage extends to many 
     health care providers serving American Indian and Alaska 
     Native individuals in the Indian Health Service (IHS) and 
     tribal facilities as part of the undertakings and obligations 
     of our country to our indigenous peoples. Whole segments of 
     our indigenous populations depend on these providers for 
     their health needs, in particular primary and preventive 
     care. The practical effect of covering these critical 
     organizations under the Federal Tort Claims Act (FTCA) is to 
     simplify the processing and resolution of medical malpractice 
     and other personal injury claims against the organization, 
     which expedites settlement of legitimate claims and decreases 
     administrative and related expense burdens, thus enabling 
     providers to deliver more extensive and better service to 
     their communities.
       FTCA coverage has extended for decades to the IHS and 
     tribal organizations including indigenous-focused federally 
     qualified health centers (to include Native Hawaiian 
     Community Health Centers (NHCHC).) However, for reasons that 
     reflect simple omission rather than any other explanation, 
     urban Indian organizations and NHHCS, first established under 
     the Native Hawaiian Health Care Improvement Act of 1988, are 
     not currently covered under the FTCA. This bill would correct 
     that as to urban Indian organizations but not NHHCS.
       There is no policy or functional differentiation among 
     urban Indian organizations, NHHCS, tribal organizations and 
     NHCHC in FTCA coverage, nor between NHHCS and urban Indian 
     organizations. Both urban Indian organizations and NHHCS are 
     devoted to the same needs for the same reasons as the others. 
     In fact, in Hawai'i, where we have the largest population of 
     Native Hawaiians of any state but relatively few Native 
     Americans and Alaska Natives, our NHHCS actually contract 
     with the IHS to provide our own and visiting Native Americans 
     and Alaska Natives with reduced cost health care and payer of 
     last resort services (and at actual costs that far exceed the 
     contracted amounts).
       Moreover, in the public health context, there is every 
     reason for Native Hawaiians to seek the same benefits as 
     afforded to other indigenous organizations under FTCA 
     coverage. Even aside from COVID-19, Native Hawaiians suffer 
     from the shortest life expectancy of the major ethnic groups 
     in Hawai'i due to underlying medical conditions such as 
     diabetes, coronary heart disease and asthma. With higher 
     unemployment rates, Native Hawaiians are in particular need 
     of the culturally relevant, lower cost health care options 
     offered by Native Hawaiian-focused organizations like NHHCS. 
     All this has been worsened by COVID-19, which has inflicted 
     some of the highest infection and mortality rates on Native 
     Hawaiian/Pacific Islander communities nationwide. The 
     extension of FTCA to NHHCC is just one of many initiatives 
     that can make a real difference in ensuring NHHCS can 
     continue to serve their own populations in these times of 
     great challenge and need.
       During my Subcommittee on the Indigenous Peoples of the 
     United States' July 19, 2020 hearing on H.R. 6535, I asked 
     IHS Director RADM Michael D. Weahkee whether there was any 
     policy reason to differentiate between NHHCS, urban Indian 
     organizations and other tribal health care providers in FTCA 
     coverage. Director Weahkee responded: ``In one of my roles as 
     Indian Health Service Director, I serve as the Vice Chair of 
     the Interdepartmental Council on Native American Affairs at 
     the Department of Health and Human Services, and that 
     responsibility extends not only to our American Indian and 
     Alaska Native populations, but also to our Native Hawaiian 
     and Pacific Islanders, and so in that chair I would see the 
     same advantage toward Native Hawaiian programs as I discussed 
     here today for our American Indian urban Indian 
     organizations.'' Further, the Congressional Budget Office 
     previously reviewed similar legislation, the Native Hawaiian 
     Health Care Improvement Reauthorization Act of 2003, and 
     determined there was no appreciable cost to the federal 
     government.
       Aside from these bill specifics, I ask this Committee to 
     understand and appreciate my Native Hawaiian community's goal 
     of extending FTCA coverage to NHHCS, and its great concern at 
     being excluded from H.R. 6535, as not just a policy 
     inconsistency but in a much broader context. To repeat, 
     Native Hawaiians are the indigenous peoples of our country to 
     the same degree and extent as other indigenous peoples. As 
     such, the United States has undertaken a similar special 
     trust responsibility to Native Hawaiians dating back to 
     Hawaii's entry into the United States as a territory in 1900, 
     and continuing through the seminal century-old Hawaiian Homes 
     Commission Act of 1920 and some 150-plus more Native Hawaiian 
     federal statutes and equally if not more numerous specific 
     regulations, administrative actions and other initiative 
     since including the Native Hawaiian Education Act and Native 
     Hawaiian Health Care Improvement Act. This is not a new or 
     questionable relationship in any way and has the same long 
     and often difficult history as other indigenous peoples.
       Notwithstanding, Native Hawaiians have faced decades of 
     being overlooked, ignored and excluded in our federal 
     initiatives to fulfill our country's trust responsibilities 
     to our indigenous peoples. It has proven too easy to ask 
     Native Hawaiians to just wait while we take care of another 
     indigenous concern first, while too often the wait has not 
     materialized into any later action. So please understand that 
     when Native Hawaiians express great concern over exclusion 
     from a seemingly straightforward bill like H.R. 6535, their 
     skepticism, apprehension and distrust has deep roots that 
     transcend this specific bill.
       Chair, Ranking Member and Committee colleagues, I 
     personally appreciate your consideration of my additional 
     remarks on behalf of our country's vital Native Hawaiian 
     community, and hope that I have provided you with some 
     broader appreciation of why we believe that inclusion of 
     NHHCS in FTCA coverage as is provided for virtually all other 
     indigenous health care organizations is so important. I look 
     forward to working with your and our like-minded colleagues 
     to achieve such inclusion in other appropriate vehicles.
       Mahalo nui loa (thank you very much).
       I fully expect that further measures I am asked to support 
     of benefit to American Indians and Alaska Natives will 
     include Native Hawaiians.
       Thank you.
  The SPEAKER pro tempore. The question is on the motion offered by

[[Page H7247]]

the gentleman from Arizona (Mr. Gallego) that the House suspend the 
rules and pass the bill, H.R. 6535, as amended.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

                          ____________________