[Congressional Record Volume 167, Number 191 (Monday, November 1, 2021)]
[House]
[Pages H6044-H6046]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                     URBAN INDIAN HEALTH CONFER ACT

  Ms. LEGER FERNANDEZ. Madam Speaker, I move to suspend the rules and 
pass the bill (H.R. 5221) to amend the Indian Health Care Improvement 
Act to establish an urban Indian organization confer policy for the 
Department of Health and Human Services.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 5221

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Urban Indian Health Confer 
     Act''.

     SEC. 2. URBAN INDIAN ORGANIZATION CONFER POLICY.

        Section 514(b) of the Indian Health Care Improvement Act 
     (25 U.S.C. 1660d) is amended to read as follows:
       ``(b) Requirement.--The Secretary shall ensure that the 
     Service and the other agencies and offices of the Department 
     confer, to the maximum extent practicable, with urban Indian 
     organizations in carrying out--
       ``(1) this Act; and
       ``(2) other provisions of law relating to Indian health 
     care.''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentlewoman from 
New Mexico (Ms. Leger Fernandez) and the gentleman from Arkansas (Mr. 
Westerman) each will control 20 minutes.
  The Chair recognizes the gentlewoman from New Mexico.


                             General Leave

  Ms. LEGER FERNANDEZ. Madam Speaker, I ask unanimous consent that all 
Members may have 5 legislative days in which to revise and extend their 
remarks and include any extraneous material on the measure under 
consideration.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentlewoman from New Mexico?
  There was no objection.
  Ms. LEGER FERNANDEZ. Madam Speaker, I yield myself such time as I may 
consume.
  Madam Speaker, H.R. 5221, the Urban Indian Health Confer Act, 
introduced by Natural Resources Chair Raul Grijalva from Arizona will 
require agencies and offices within the United States Department of 
Health and Human Services, or HHS, to confer with Urban Indian 
Organizations, or UIOs, on policies and initiatives related to 
healthcare for American Indians and Alaska Natives.

[[Page H6045]]

  The Indian Health Care Improvement Act established Urban Indian 
Organizations in response to many American Indians and Alaska Natives 
living in urban areas and seeking healthcare. Today, approximately 70 
percent of all American Indians and Alaska Natives live in urban areas.
  The Indian Health Service supports contracts and grants to 41 UIO 
programs that offer medical services ranging from dental care, 
optometry, pharmacy services, and community services, such as alcohol 
and drug abuse prevention, nutrition education, and counseling.
  An urban confer policy at HHS will serve as the preferred method of 
dialogue between the agency and UIOs. Currently, the Indian Health 
Service is the only agency that maintains a legal obligation to confer 
with UIOs. This limited scope serves as a barrier for UIOs to 
communicate with other agencies and offices within HHS.
  During the COVID-19 pandemic, the issues with this limited confer 
policy were, sadly, highlighted. Despite congressional and Tribal 
support for the inclusion of UIOs and the agency's vaccine allocations, 
HHS refrained from initiating communications with them. As a result, 
UIOs were unable to provide input on the vaccine rollout allocations 
until the deadline, which delayed the vaccine's distribution to many 
urban American Indians and Alaska Natives.
  The failure to communicate with UIOs about healthcare policies that 
impact urban Indian communities is inconsistent with the Federal trust 
responsibility and contrary to sound public health policy.
  H.R. 5221 will establish direct lines of communication for UIOs 
across the entire Department and ensure that urban American Indians and 
Alaska Natives are aware of significant healthcare policy changes.
  I want to thank Chair Grijalva for championing this critical 
bipartisan legislation. I am pleased to be a cosponsor of the bill and 
I urge quick adoption. I reserve the balance of my time.
                                         House of Representatives,


                               Committee on Natural Resources,

                                 Washington, DC, October 26, 2021.
     Hon. Robert C. ``Bobby'' Scott,
     Chair, Committee on Education and Labor, House of 
         Representatives, Washington, DC.
       Dear Chair Scott, I write to you concerning H.R. 5221, the 
     ``Urban Indian Health Confer Act.''
       I appreciate your willingness to work cooperatively on this 
     legislation. I recognize that the bill contains provisions 
     that fall within the jurisdiction of the Committee on 
     Education and Labor. I acknowledge that your Committee will 
     not formally consider H.R. 5221 and agree that the inaction 
     of your Committee with respect to the bill does not waive any 
     future jurisdictional claim over the matters contained in the 
     bill that fall within your Committee's Rule X jurisdiction.
       I am pleased to support your request to name members of the 
     Committee on Education and Labor to any conference committee 
     to consider such provisions. I will ensure that our exchange 
     of letters is included in the Committee Report and the 
     Congressional Record during floor consideration of the bill. 
     I appreciate your cooperation regarding this legislation and 
     look forward to continuing to work with you as this measure 
     moves through the legislative process.
           Sincerely,
                                                 Raul M. Grijalva,
     Chair, Committee on Natural Resources.
                                  ____

                                         House of Representatives,


                             Committee on Education and Labor,

                                 Washington, DC, October 21, 2021.
     Hon. Raul M. Grijalva,
     Chairman, Committee on Natural Resources,
     Washington, DC.
       Dear Chairman Grijalva: I write concerning H.R. 5221, the 
     Urban Indian Health Confer Act. This bill was primarily 
     referred to the Committee on Natural Resources, and 
     additionally to the Committee on Education and Labor. As a 
     result of Leadership and the Committee on Natural Resources 
     having consulted with me concerning this bill generally, I 
     agree to forgo formal consideration of the bill so the bill 
     may proceed expeditiously to the House floor.
       The Committee on Education and Labor takes this action with 
     our mutual understanding that by forgoing formal 
     consideration of H.R. 5221, we do not waive any jurisdiction 
     over the subject matter contained in this or similar 
     legislation, and we will be appropriately consulted and 
     involved as the bill or similar legislation moves forward so 
     we may address any remaining issues within our Rule X 
     jurisdiction. I also request that you support my request to 
     name members of the Committee on Education and Labor to any 
     conference committee to consider such provisions.
       Finally, I would appreciate a response confirming this 
     understanding and ask that a copy of our exchange of letters 
     on this matter be included in the Committee Report filed by 
     the Committee on Natural Resources and in the Congressional 
     Record during floor consideration of H.R. 5221.
           Very truly yours,
                                        Robert C. ``Bobby'' Scott,
     Chairman.
                                  ____


                                         House of Representatives,


                               Committee on Natural Resources,

                                 Washington, DC, November 1, 2021.
     Hon. Frank Pallone,
     Chair, Committee on Energy and Commerce,
     House of Representatives, Washington, DC.
       Dear Chair Pallone: I write to you concerning H.R. 5221, 
     the ``Urban Indian Health Confer Act.''
       I appreciate your willingness to work cooperatively on this 
     legislation. I recognize that the bill contains provisions 
     that fall within the jurisdiction of the Committee on Energy 
     and Commerce. I acknowledge that your Committee will not 
     formally consider H.R. 5221 and agree that the inaction of 
     your Committee with respect to the bill does not waive any 
     future jurisdictional claim over the matters contained in the 
     bill that fall within your Committee's Rule X jurisdiction.
       I am pleased to support your request to name members of the 
     Committee on Energy and Commerce to any conference committee 
     to consider such provisions. I will ensure that our exchange 
     of letters is included in the Committee Report and the 
     Congressional Record during floor consideration of the bill. 
     I appreciate your cooperation regarding this legislation and 
     look forward to continuing to work with you as this measure 
     moves through the legislative process.
           Sincerely,
                                                 Raul M. Grijalva,
     Chair, Committee on Natural Resources.
                                  ____

                                         House of Representatives,


                             Committee on Energy and Commerce,

                                 Washington, DC, November 1, 2021.
     Hon. Raul M. Grijalva,
     Chairman, Committee on National Resources,
     Washington, DC.
       Dear Chairman Grijalva: I write concerning H.R. 5221, the 
     ``Urban Indian Health Confer Act,'' which was additionally 
     referred to the Committee on Energy and Commerce.
       In recognition of the desire to expedite consideration of 
     H.R. 5221, the Committee agrees to waive formal consideration 
     of the bill as to provisions that fall within the Rule X 
     jurisdiction of the Committee. The Committee takes this 
     action with the mutual understanding that we do not waive any 
     jurisdiction over the subject matter contained in this or 
     similar legislation, and that the Committee will be 
     appropriately consulted and involved as this bill or similar 
     legislation moves forward so that we may address any 
     remaining issues within our jurisdiction. I also request that 
     you support my request to name members of the Committee to 
     any conference committee to consider such provisions.
       Finally, I would appreciate the inclusion of this letter 
     into the Congressional Record during floor consideration of 
     the measure.
           Sincerely,
                                               Frank Pallone, Jr.,
                                                         Chairman.

                              {time}  1645

  Mr. WESTERMAN. Madam Speaker, I yield myself such time as I may 
consume.
  Madam Speaker, today, the Indian Health Services Urban Indian Health 
Program consists of 41 nonprofit programs nationwide.
  These programs are funded through grants and contracts from the 
Indian Health Service, pursuant to the authorities of the Indian Health 
Care Improvement Act.
  Urban Indian health organizations that participate in the program 
provide services such as information, outreach and referral, dental 
services, primary care services, community health, and other important 
services.
  In 2010, as part of the Patient Protection and Affordable Care Act, 
Congress reauthorized and amended the Indian Health Care Improvement 
Act by adding a requirement that the Indian Health Service confer with 
urban Indian organizations.
  In 2014, the Indian Health Service established a policy to guide when 
the Indian Health Service seeks input from Urban Indian Organizations 
on health policy matters.
  Other agencies within the Department of Health and Human Services 
that serve American Indians and Alaska Natives, such as the Centers for 
Medicare and Medicaid Services, the Centers for Disease Control and 
Prevention, and the Substance Abuse and Mental Health Services 
Administration, and others, do not have policies regarding conferring 
with Urban Indian Organizations.
  Throughout the COVID-19 pandemic, Urban Indian health organizations 
were provided no notice that they were required to make selections for 
COVID-19 vaccine distribution until the day of the deadline imposed by 
an agency.

[[Page H6046]]

This resulted in Urban Indian Organizations struggling to provide 
accurate responses to changing public health decisions for Indians 
living in urban areas.
  This bill would amend the Indian Health Care Improvement Act to 
require all agencies within the Department of Health and Human Services 
to establish an urban Indian organization confer policy.
  I thank the sponsor of this legislation, Chairman Grijalva, and I 
reserve the balance of my time.
  Ms. LEGER FERNANDEZ. Madam Speaker, I yield as much time as he may 
consume to the gentleman from Arizona (Mr. Grijalva), the chairman of 
the Natural Resources Committee.
  Mr. GRIJALVA. Madam Speaker, as stated before, today marks the first 
day of National Native American Heritage Month.
  I want to thank the gentlewoman from New Mexico, the chair of the 
Subcommittee on Indigenous Peoples of the United States, Ranking Member 
Westerman, and Ranking Member Young for putting a package together for 
Congress to vote specifically on significant bipartisan pieces of 
legislation that deal specifically with Indian Country. I think it is 
noteworthy and symbolic, and as you see these pieces of legislation, 
very much necessary. I want to extend my thanks to all of them for 
that.
  While it is a time to celebrate the histories and achievements of 
Native Americans in this country, it is also a time for Congress to 
fully recognize the trust and treaty obligations the U.S. Government 
owes to Tribal governments and to indigenous people in our country.
  Ensuring equity for Tribal healthcare entities is an essential part 
of the Federal trust responsibility, which is the reason that I am 
proud to sponsor H.R. 5221, the Urban Indian Health Confer Act.
  The accessible and culturally competent healthcare services that 
Indian Health Services provides to Tribal communities are critical to 
ensuring their well-being.
  As stated by the chairwoman, over 70 percent of American Indians and 
Alaska Natives began seeking healthcare outside of Tribal jurisdictions 
in our cities and nonreservation communities across this country. Urban 
Indian Organizations, UIOs, were created to fill that gap.
  Today, IHS supports 41 of these programs that offer vital medical 
services, including dental care, mental health support, optometry 
services, and social services, such as nutrition, education, and home 
healthcare.
  Although UIOs have been recognized as critical components of the 
Tribal healthcare system, they continue to experience parity and 
recognition of purpose and the attention that they deserve for the 
services they provide to indigenous people and the family services they 
provide to nonreservation Native people across this country.
  At the Department of Health and Human Services, only IHS maintains an 
obligation to confer with UIOs regarding any healthcare policy changes 
that may affect urban Indian communities. This issue became glaringly 
obvious during the COVID-19 pandemic, when the Department excluded UIOs 
in the vaccine rollout discussions, leaving urban Indian communities 
among the last to receive vaccine allocations through their local urban 
Indian centers.
  As a Member of Congress who represents a UIO, the Tucson Indian 
Center, I am grateful for their essential work to keep Tribal 
communities safe and healthy, especially as we go into a post-COVID-19 
pandemic era.
  H.R. 5221 will establish direct lines of communication between UIOs 
and the Department of Health and Human Services so that UIOs have a 
seat at the table for all relevant Tribal healthcare policy changes.
  Ensuring that UIOs achieve equity at the Department is sound public 
health policy and upholds the U.S. Government's Federal trust 
responsibility to Indian Country. H.R. 5221 represents a much-needed 
change.
  Madam Speaker, I urge the quick adoption of this bipartisan 
legislation.
  Mr. WESTERMAN. Madam Speaker, I am ready to close, and I yield back 
the balance of my time.
  Ms. LEGER FERNANDEZ. Madam Speaker, I want to, once again, thank 
Ranking Member Westerman, as well as Ranking Member   Don Young and 
Chair Grijalva, for bringing forth this legislation. It addresses 
immediately something that we saw that had lingered, but the pandemic 
shown its ugly light on what happens when we let things linger and do 
not deal with them. This legislation fixes that. It highlights the 
importance of communication, of cooperation, and the confer policy that 
must be adopted across all of our agencies, not only at HHS.
  Madam Speaker, I urge my colleagues to support this legislation, and 
I yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentlewoman from New Mexico (Ms. Leger Fernandez) that the House 
suspend the rules and pass the bill, H.R. 5221.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds 
being in the affirmative, the ayes have it.
  Mr. ROY. Madam Speaker, on that I demand the yeas and nays.
  The SPEAKER pro tempore. Pursuant to section 3(s) of House Resolution 
8, the yeas and nays are ordered.
  Pursuant to clause 8 of rule XX, further proceedings on this motion 
are postponed.

                          ____________________