[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.
____________________