[Congressional Record (Bound Edition), Volume 149 (2003), Part 16]
[Senate]
[Pages 22462-22470]
[From the U.S. Government Publishing Office, www.gpo.gov]




  DEPARTMENT OF THE INTERIOR AND RELATED AGENCIES APPROPRIATIONS ACT, 
                                  2004

  The PRESIDENT pro tempore. Under the previous order, the Senate will 
resume consideration of H.R. 2691, which the clerk will report.
  The legislative clerk read as follows:

       A bill (H.R. 2691) making appropriations for the Department 
     of the Interior and related agencies for the fiscal year 
     ending September 30, 2004, and for other purposes.

  Pending:

       Reid amendment No. 1731, to prohibit the use of funds for 
     initiating any new competitive sourcing studies.
       Reid amendment No. 1732, to authorize the Secretary of the 
     Interior to acquire certain lands located in Nye County, 
     Nevada.
       Reid amendment No. 1733, to provide for the conveyance of 
     land to the city of Las Vegas, Nevada, for the construction 
     of affordable housing for seniors.
       Daschle amendment No. 1734, to provide additional funds for 
     clinical services of the Indian Health Service, with an 
     offset.

  The PRESIDING OFFICER (Mr. Sununu). The Senator from Montana.
  Mr. BURNS. I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. FRIST. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                           HIV/AIDS In Africa

  Mr. FRIST. Mr. President, last month I had the privilege of traveling 
to the southern African nations of South Africa, Mozambique, Botswana, 
and Namibia, along with five of our colleagues in the Senate. I try to 
visit the continent of Africa at least once a year. Part of the trip is 
generally spent doing medical mission work and part of it doing more 
official business. Over the next several minutes I will reflect a bit 
upon what we learned as a group with my colleagues on the official part 
of the recent trip.
  As in previous trips, I was again struck by the optimism, the 
perseverance, the courage of the people I met on the African continent, 
impressed by their openness, impressed by their warmth, impressed by 
their generosity and by their hospitality.
  The purpose of our mission was very focused and straightforward. It 
was not just going and looking at the countries and getting a feel for 
their governments and overall approach to ruling and to the people 
there but to determine how best the United States, with others, can 
coordinate efforts to fight the global HIV/AIDS pandemic which, as I 
have said many times before, I believe is the greatest humanitarian, 
moral, and public health challenge of the last 100 years.
  Several of my colleagues have already come to the floor and offered 
some of their reflections and impressions on our recent visit to the 
continent. I thank Senators Warner, DeWine, Enzi, Alexander, and 
Coleman for their comments and for joining our delegation to study HIV/
AIDS in Africa, as well as Dr. Joe O'Neill, who is Director of the 
Office of National AIDS Policy, who accompanied us as well. Dr. 
O'Neill, who has vast experience as both a physician and someone who 
has focused on HIV/AIDS, both in the clinic delivering care and in 
terms of education and research, and now public policy, was a 
tremendous resource for us. In addition, it allowed us to integrate our 
ideas on an ongoing basis on this particular trip.
  I thank all of them for their thoughts, their remarks, their 
questions, and comments as we traveled through the southern aspect of 
Africa, as well as their remarks on the floor since.
  In sum, our team had a very productive trip. We met with patients, 
doctors, nurses. We met with community leaders, activists. We met with 
the presidents of the countries and other government officials who have 
been trying to fight and are continuing to fight on the front line this 
deadly epidemic--this group of people all working together from 
different vantage points to bring hope and relief to millions and 
millions of people who are HIV positive, have the manifestations of 
that infection, which is AIDS, a disease today for which we have no 
cure.
  No part of the world has been more affected by HIV/AIDS than southern 
Africa, although we all know that the rate of growth was tremendous in 
Russia and throughout the Caribbean. There are probably more people in 
India than any other country in the world with HIV/AIDS. But in Africa, 
where this disease had its impact initially, we see what indeed can 
happen and is happening to countries throughout the world.
  The story of the impact in Africa needs to be told in a way that 
people understand in order to encourage support of the global community 
in reversing this epidemic. Graca Machel, who is a truly remarkable 
former first lady of Mozambique, told us that because of HIV/AIDS:

       We are facing extinction. We still face the worst of the 
     epidemic.

  Let me repeat:

       We are facing extinction.

  When you hear those words from leaders, from people who are 
intimately involved, and you think of extinction caused by this little 
tiny virus of a people, of a population, of a nation, you realize the 
significance of this huge challenge before us.
  We learned several things. First and foremost, we learned that 
leadership and political will are absolutely critical. It must come 
from the top, but it must occur at every level--vertically, down to the 
most grassroots level. We saw effective, comprehensive responses to 
HIV/AIDS in many parts of Africa. In those areas where it has been most 
successful, there has been a strong political will and leadership. We 
have to start at the very top, with the president or the leader of an 
affected country. And you need to extend down to that local tribal 
leader, the person in a local community or a local village or at the 
tribal level, that person to whom people turn, that person whom people 
trust, that person who, if they articulate the realities, can cut 
through the stigma, which I will come to here shortly.
  In the country of South Africa, we met with community leaders who 
were struggling with the political leaders for years over the 
development of specific response and treatment plans that would save 
thousands of lives with new treatment approaches and mechanisms and 
drugs. A lot of this has come to a head over the last year or 2 years.
  Indeed, until just several weeks ago, the political leadership there, 
I believe,

[[Page 22463]]

had failed to address much of the reality that this little virus causes 
HIV/AIDS, for which we have no cure. In South Africa, the country 
itself, more than 5 million people are infected with the disease, for 
which there is no cure. In contrast to a political will that seems slow 
to come to the surface, you go to Botswana, in Gaborone, where we met 
with President Festus Mogae, who, in an effort to reduce the stigma 
surrounding the virus in the United States and around the world, and in 
Africa as well, publicly had himself tested. That was part of an effort 
to show the importance of testing nationwide, to send a strong signal 
across the country.
  This sort of unambiguous leadership sends a strong message to the 
people. It focuses attention, and indeed it works. As a result of that, 
Botswana is making notable progress in fighting this pandemic and 
bringing understanding, security, and hope to its people. Prevention 
and care must be linked to treatment, and treatment must be preceded by 
testing because you have to make the diagnosis.
  All that sounds straightforward--making the diagnosis so that you can 
have care and treatment. But what is interesting is that 90 percent of 
the people in the world who have the virus don't know they are HIV 
positive, and until you can identify who is positive and who is not, it 
is hard to engage in the specific treatment aspect for that virus.
  What is not quite so intuitive, but absolutely fact, I believe, is 
that testing for the virus can become the cornerstone of prevention of 
the virus. Why? Because testing, because of the great technology today, 
takes us 15 minutes to do--when I was in Africa before, it took about 3 
weeks. In technology there has been great progress. After testing--15 
minutes--the counselor or the person doing the test, at that same 
setting, can have what is called a teachable moment when one can learn 
about HIV and learn how to prevent HIV. If one is HIV positive, they 
can learn how to stop and reduce the spread of HIV/AIDS.
  It is critical. For example, there are 100 people in this body, and 
if they were all HIV positive, only 10 would know. You see, we have a 
lot we need to do in order to at least identify it so that we can 
educate those people who may have HIV/AIDS.
  In Kasane, Botswana, we saw how, using two simple tests, a person can 
be tested in 15 minutes while receiving that counseling in an effort 
called voluntary counseling and testing, VCT. I mention those three 
letters because, as people in this body and our colleagues know more 
and more about the virus and what we can do, you will hear about VCT, 
voluntary counseling and testing. If the individual tested negative at 
that sitting--they don't have HIV--he or she can be counseled as to how 
to avoid that infection. Then that person is encouraged to go home and 
talk to their family about the particular virus and about prevention, 
how to avoid this virus. If the individual tests positive on that 
encounter, they can immediately be exposed to the options for care and 
treatment, if available, as well as contact with peer support groups.
  Botswana is one of the countries we visited where the overall 
sophistication is high. There have been a lot of resources devoted, 
through partnerships to Botswana, and the impact right now is beginning 
to be felt.
  There are no easy answers. This will not be addressed in 1, or 5, or 
10 years. It is going to take 15, 20 years to fully address HIV/AIDS.
  Another important lesson we learned is that we must take steps to 
make treatment widely available. This is something that was, for me, 
really brought out on this particular trip. Even on the trip I took a 
little over a year ago, it wasn't quite as dramatic. But it is critical 
that treatment be made available as widely as possible.
  President Bush's emergency plan for global AIDS calls for 2 million 
people to be on treatment by 2006. That is an ambitious goal. We can 
meet that goal if we focus and make sure that taxpayer dollars we spend 
are directed to proven, robust prevention care and treatment programs. 
There is an unlimited amount of money and resources you can devote. 
People talk $5 billion, or $10 billion, or $15 billion. You can spend 
$100 billion on trying to fight HIV/AIDS.
  I think it is important that we spend our taxpayer dollars wisely, in 
such a way that we know they will have an impact--not just over 6 
months or a year but 2, 3, 4, 5, 10, 20 years. This is a long-term 
commitment and one at which we need to stay in a determined fashion.
  Perhaps the single largest challenge to the HIV/AIDS crisis in 
Africa, through prevention, care, and treatment, is the need to help 
develop the medical infrastructure to deliver health care safely and 
effectively. It is not just in South Africa, it is in the United States 
and every country. It comes down to the fact that it is not just a 
diagnostic kit. You don't just give diagnostic kits to everybody in the 
world and expect everything to fall into place. It means you don't just 
have the drugs, the little vial of drugs, and send it, just as you 
would not send it anywhere in this country or to other countries; you 
would not send it to Africa without making sure it could be 
appropriately stored and appropriately transported, that it could be 
actually delivered to the patient in a secure and safe way. It is 
complicated and frustrating, in many ways, in the United States as 
well. This takes an overall system that we have to continue to develop 
and partner with and contribute to in terms of resources to make sure 
it is fully developed.
  A message we heard again and again was the request for the United 
States to help provide expertise and training. This shortage of trained 
medical and health personnel at Chris Hani Baragwanath Hospital, which 
is the largest hospital I have ever been in or practiced in, in the 
United States or in England--it may be the largest hospital in the 
world. It is in Soweto, South Africa. We had the opportunity to visit 
the wards there and visit with the staff.
  When I close my eyes, I can see the exhausted faces of those nurses, 
the nurse practitioners, and the physicians, as we listened to them 
describe the desperate need for more trained staff--staff who have an 
understanding of HIV-related diseases, the infectious diseases that 
appear when one has this virus, which suppresses or holds down one's 
immune system and thus makes an individual more likely to get different 
infections. They told us about the need for nurses to help do the 
testing and administer the tests and the need for social workers 
because it is not just giving the medicine, the antiretroviral therapy, 
if somebody has HIV/AIDS; it is the care, the nutrition, carrying out 
daily activities of living in South Africa, and thus you need a whole 
cadre of social workers to address the care, as well as the treatment 
aspects of responding to this virus.
  They talked about the need for counselors to teach them how to avoid 
and cope with HIV infection. They talked about the need for 
administrative staff. They look to the United States to help partner to 
provide this trained expertise.
  We learned, in addition, that we must build partnerships. It cannot 
be done by one country, or one organization, or one company; it is 
going to require huge partnerships. That is going to take partnerships 
of government and of the NGOs--nongovernment organizations--religious 
organizations, social organizations, pharmaceutical companies, 
universities, all of which can come together to build these so-called 
capacity needs, to build the effective partnerships to address the 
challenges we have.
  In Botswana, we visited the appropriately named Masa--that means 
``new dawn''--Masa Clinic. Masa is funded by the African Comprehensive 
HIV/AIDS Program, called ACHAP, which also supports the Coping Centres 
for People Living with HIV/AIDS, COCEPWA, and the Botswana Christian 
AIDS Intervention Programme. That sort of partnership, that cross-
fertilization is working.
  The African Comprehensive HIV/AIDS Program is a unique partnership 
that is sponsored in part by the Bill and Melinda Gates Foundation, the

[[Page 22464]]

Merck pharmaceutical company, and the Government of Botswana. It is a 
remarkable program that was launched 3 years ago in July 2000. It is 
providing free antiretroviral treatment, counseling, and care for now 
over 6,000 Africans.
  Patients in the Masa program--it has been fascinating to me--have a 
92- to 100-percent rate of compliance following this prescribed 
treatment/drug program, and that is very high. I think compliance with 
their population in Botswana is equally high to compliance of a similar 
regimen in any western country--in the United States or in Europe. 
People are adhering to that regimen that is laid before them day after 
day. It is truly remarkable.
  The highest compliance rates among western countries is 15 to 20 
percent lower than that particular figure. So when people say, in 
Africa it is hard to pull off these complicated treatment programs, 
that is absolutely wrong. That is just absolutely wrong.
  While we were in South Africa, we visited something I have never seen 
before. We visited the huge gold mining facilities. The one we visited 
was called Anglo Gold, or part of Anglo Gold. They have their own 
hospital to treat their miners. There are about 25,000 employees and 
maybe--they don't really know yet--as many as a third of all those 
employees are HIV/AIDS infected. Again, that is sort of typical. It may 
be less than that; it may be a little bit more, but it is a huge 
number. Therefore, in terms of not just care and compassion but just 
productivity, because you need a healthy workforce, they have a 
wonderful program, a comprehensive program that is involved in 
prevention, care, and treatment at Anglo Gold. They are bringing 
antiretroviral treatment to HIV-infected employees directly.
  We had the opportunity to talk to the employees and the impact that 
is making on their lives and the lives of their families and the lives 
of their extended families in their villages.
  We had the real pleasure of visiting St. Mary's Hospital in Rehoboth, 
Namibia, which is preventing new infections through President Bush's 
Prevention of Mother-to-Child Transmission Program. We have talked on 
the floor a lot about the importance of treating the mother with one 
dose of a drug called Nevirapine--a very inexpensive drug--and then 
treating the baby within the first 24 hours with one dose of 
Nevirapine. It cuts that transmission down at least by 50 percent. That 
particular program is having great success.
  In Windhoek, Namibia, we visited the Bernard Noordkamp Camp Center 
run by the Catholic Church which provides care and nutritional support 
and counseling to hundreds of orphaned children. All of my colleagues 
are familiar with the thousands and thousands of orphans as a result of 
HIV/AIDS, children who have lost their parents to HIV/AIDS. That figure 
will go to 10 million to 14 million over the next 10 years.
  Another point we learned is we must reach people where they live. You 
cannot have a program designed for even one country and have it apply 
to every village in another country. You really need to be able to 
reach people in their own communities.
  Most Africans don't live in the big urban areas and, thus, the 
importance of mobile clinics, going out to the villages, is absolutely 
critical. We saw a lot of creative responses to the problem. It could 
be very resource intensive.
  In Carletonville, South Africa, we saw the mobile clinics, the mobile 
vans with trained personnel and medical gear. These vans drive out into 
the bush to bring that voluntary counseling, treatment, and basic care 
to people who otherwise simply would not have access to the care. There 
is no hospital or the nearest hospital or clinic might be 100 miles 
away, and with most of the people walking, it takes days to reach a 
clinic. It is impractical. These units would be able to identify people 
with serious illness and have them come to the local village clinic or 
the closest village clinic.
  In Kasane, Botswana, we saw a mobile rapid-testing lab that travels 
through that whole Kasane region. By closing the gap between people and 
health care providers in these innovative ways, we strengthen the 
overall capacity to deliver health care to those people to cope with 
HIV/AIDS. That provides a structure which can be replicated throughout 
not just South Africa, Botswana, Namibia, or Mozambique but in other 
areas throughout the continent and, indeed, throughout the world.
  I mentioned this earlier, and this will be one of my final points, we 
learned we absolutely have to address the stigma and discrimination 
that is associated with HIV/AIDS. We have had to address it in the 
United States of America. We continue to address it throughout Africa. 
It is very similar.
  This stigma is a universal barrier. Every African nation we mentioned 
said it is a major challenge. Because of fear and discrimination, 
African women told us again and again they are afraid to get tested out 
of fear of retribution by their husbands. When we talked with African 
men, they said they are afraid to be tested because of their fear of 
discrimination in their workforce or being shunned in their local 
communities or being shunned by their family.
  If you have the stigma, people don't ever make it to the VCT--
voluntary counseling and testing. They want to stay at home even if 
they are sick. They say: I don't want to get tested because if someone 
finds me HIV positive, then I will be discriminated against. So there 
is a huge disincentive to be tested. It makes people reluctant to be 
educated about the virus or even talk about the virus.
  One of the most powerful ways of cutting through this stigma is to 
have the political leaders, the well-recognized leaders of the village 
come forward and say: We have to address it. Why? Because the 
possibility of extinction is actually there.
  To effectively fight AIDS, it is important that people know what 
steps to take. Therefore, we have to reach that teachable moment, but 
to reach that teachable moment, we have to destigmatize. One of the 
real advances that has been made--and most people have been watching 
Bono, who has been here this week and talked to a number of people, and 
who is a very effective voice. He talks passionately about this 
subject. I have had the opportunity to spend a lot of time working with 
him on this terribly important issue. He points out the importance of 
the moral cause and the moral drive in terms of our responsibility, not 
just the United States but as the global community. I think he is right 
on target with that particular message as a global community.
  In our discussions yesterday, we were commenting on the tremendous 
positive change in the believers of the world, in the faith-based 
communities, in the churches, in the mosques, in the temples--in the 
churches broadly. There has been a huge sea change over the last 2 or 3 
years because of the moral necessity, the moral correctness of 
addressing this particular issue.
  That is very important for lots of different reasons. It is important 
for the offering of hope and compassion and caring and treatment and 
support, and it is equally important because, to have the church 
leaders and faith-based leaders stand up repeatedly and say this is an 
important issue, then people listen and people understand. If they hear 
it from their political leaders and they hear it from the church 
leaders, all of a sudden you can start tearing apart this stigma, which 
is the barrier to reversing this pandemic that is upon us.
  Prevention messages must resonate locally. I mentioned Graca Machel, 
the former first lady in Mozambique. She told us of the difficulty of 
discussing HIV/AIDS. She told us of how her Foundation for Community 
Development works with faith-based organizations to reduce that stigma 
of HIV/AIDS. We asked her how specifically they do it, and they do it 
by using well-understood Bible verses and Bible messages that connect 
with people. All of a sudden, through that connection, they take away 
the shame that so often is attached to this stigma and discrimination.

[[Page 22465]]

  She reminded us also of the importance of creating practical messages 
that appeal specifically to men. Right now in the world there are more 
women with HIV/AIDS than there are men, which is interesting. Most 
people would think initially there are a lot more men. The challenge in 
many ways is to reach the men. She is very directly developing specific 
messages that help educate them on the dangers of sexual promiscuity as 
the vehicle of spreading AIDS.
  She also shared her thoughts on the way to use multiple media 
sources--telephone lines, billboards, television, radio--to get the 
message out. She understands that all the knowledge in the world about 
HIV/AIDS is not worth very much unless it reaches the individual 
person.
  In Mozambique, we met the traditional healers from 10 villages. It 
was wonderful for me as a physician to be able to go out in a remote 
part of Mozambique and to have the traditional healers, for whom 
Western medicine is not something they have been exposed to much, and 
who use the traditional healing methods, interested in HIV/AIDS, asking 
the right questions, putting them forward, and then educating people. 
These traditional healers are the ones who give health care today. They 
have relationships like the doctor/patient relationship already with 
their villagers. They help destigmatize and encourage education about 
HIV/AIDS. They are the community leaders.
  We have to prepare for a future without AIDS. The devastation caused 
by AIDS is overwhelming. But we must continue to envision a world 
without HIV/AIDS, especially in countries that have been overtaken and 
are feeling the effects at the individual level, in families, and on 
the economies. Even if we get the disease under some sort of control, 
we need to think ahead and plan for the future.
  In all the countries in Africa that we visited we were met with hope 
for the future, hope for new trade agreements, which we need to work 
on, I believe, aggressively in this country. We heard about the hope 
that trade barriers will fall so economies will improve and jobs will 
open up. We listened and heard and were struck by the hope that they 
have for a prosperous life for their families.
  You have this devastating pandemic, terrible disease affecting the 
continent and individual countries. Yet it always comes back at the end 
of the conversation with a smile and optimism and hope. I think that is 
one of the aspects that attracts me back to that continent again and 
again. We should stand by them, partner with them, and maximize their 
opportunity for growth.
  In closing, I do thank the Ambassadors and staff of each of the 
nations that we visited: Ambassador Cameron Hume in South Africa, 
Deputy Chief of Mission Dennis Hankins in Mozambique, Ambassador Joe 
Huggins in Botswana, Ambassador Kevin McGuire in Namibia, for all of 
their outstanding work, their outstanding support. They opened their 
world to us in a way that we very much appreciate and that we will act 
upon over the coming weeks and months and years. They literally opened 
their homes to our delegation and worked overtime to make our trip a 
success. For that we are grateful. They are a great credit to the State 
Department and to the United States and to the people they represent. 
Those people are the people of the United States of America.
  I have gone on too long. Again, it was a dramatic, important trip for 
Members of the Senate as we look ahead to how best and most wisely 
invest our taxpayers' money, to this huge, bold, initiative, the 
boldest initiative taken in public health by any leader of any country 
ever, the initiative President Bush put forward to fight global HIV/
AIDS with $15 billion over 5 years.
  I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. BURNS. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BURNS. Mr. President, as we move into the debate on the Interior 
appropriations bill, there are still some important amendments that 
have yet to be offered. I understand the minority leader will be here. 
He has a couple amendments. We will lay those down today and talk about 
those. If Members are in town and watching, I suggest they bring their 
amendments down so we can get the list down to where it is manageable 
in the first place so we can complete this appropriations as early on 
Tuesday as we possibly can.
  In the meantime, we will be talking about a lot of very emotional 
issues. When you talk about public lands, everybody becomes a land 
manager. As we debate this, it never ceases to amaze me that we forget 
that there is a lot of knowledge on how to manage lands and the 
resources that we haven't tapped.
  This Saturday, September 20, volunteers across the United States will 
participate in the 10th annual National Public Lands Day.
  This day is coordinated by the congressionally chartered National 
Environmental Education and Training Foundation, in conjunction with 
the Take Pride in America Program.
  By the way, the Take Pride in America Program goes all the way back 
to one of the first programs the Interior Department put in when I 
first came to the Senate.
  These two fine organizations team up in an effort to enhance and 
improve our public lands while promoting awareness of citizen 
stewardship and increasing volunteer opportunities for the public. This 
is an excellent idea. I would like to commend them, as well as the 
70,000 folks across the United States who volunteered last year, for 
their hard work in participating in this task.
  One-third of the total amount of the U.S. land mass is considered 
public lands. Recreational activities on these lands are enjoyed by 
millions of Americans and their families. Glacier National Park alone 
in my State provides recreational opportunity for snow-
shoeing, boating, and horseback riding for nearly 580,000 visitors each 
year.
  By the way, we got good news last night. Maybe some of us are 
watching Isabel. One fellow walked into the office this morning and 
asked, ``Isabel who?'' We will proceed with keeping everything 
operating. But, also, good news is that in Glacier National Park we got 
4 inches of snow last night, and they closed the Going to the Sun 
Highway Road. There are some back here who may not think that is good 
news, but it is awfully good news to us because that means the end of 
the fires.
  Another national park in my neck of the woods is Yellowstone, which 
happens to be the oldest national park in the world, and it is 
sometimes considered the crown jewel of the park system. It is 
implementing a fee-free day in honor of National Public Lands Day.
  As chairman of the subcommittee on Interior appropriations, I would 
like to extend a premature thank you to at least a dozen members of my 
own staff and their friends who are participating in Public Lands Day. 
This wasn't something which I asked them to do.
  I ask unanimous consent that their names be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                       National Public Lands Day

       1. Jodie Peters; 2. Melanie Benning; 3. Angela Schulze; 4. 
     Jennifer O'Shea; 5. Chris Heggem; 6. Ryan Thomas; 7. Bruce 
     Evans; 8. Ginny James; 9. Leif Fonnesbeck; 10. Kassy Hodges; 
     11. Stan Ullman; 12. Jarrod Thompson; 13. Christen Petersen.
  Mr. BURNS. Mr. President, in the East it is a good idea to work on 
public lands, particularly if this storm hits us and we sustain a 
little damage from it. It may be a good time to not only take care of 
our own property but also to volunteer to help clean up those areas of 
public lands that we enjoy.
  This is something we are asking Americans to do, and 70,000 responded 
last year.
  We have a fine group in this area that is going to work along the 
Potomac River shoreline where they will undertake the task of painting 
trash cans, railings, and benches on Hains

[[Page 22466]]

Point Park early Saturday morning. Many in my office are going to 
participate.
  As we look forward to Public Lands Day and Saturday, I encourage 
citizens of this great country to think about Take Pride in America's 
slogan: ``It's your land, lend a hand.''
  I think that is an important message.
  I notice that my good friend from South Dakota, the minority leader, 
is on the Senate floor.
  I yield the floor.
  The PRESIDING OFFICER. The minority leader.
  Mr. DASCHLE. Mr. President, I thank the Senator from Montana who has 
done a great job of working with this legislation once again this year. 
I commend him for his efforts.


                           Amendment No. 1739

  Mr. DASCHLE. Mr. President, I ask unanimous consent that the pending 
amendments be set aside and that amendment No. 1739 be considered.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The legislative clerk will report.

       The Senator from South Dakota [Mr. Daschle] proposes an 
     amendment numbered 1739.

  Mr. DASCHLE. Mr. President, I ask unanimous consent that reading of 
the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

(Purpose: To strike funding for implementation of the Department of the 
Interior's reorganization plan for the Bureau of Indian Affairs and the 
  Office of Special Trustee and to transfer the savings to the Indian 
                            Health Service)

       On page 46, line 7, strike ``: Provided, That'' and insert 
     the following: ``, and of which $79,282,000 (composed of 
     $20,000,000 from administrative accounts for operation and 
     support, $6,346,000 from the trust accountability account, 
     $15,168,000 from the field operations account, and 
     $37,768,000 from the historical accounting account) shall be 
     transferred to the Indian Health Service and shall be 
     available for clinical services: Provided, That none of the 
     funds made available by this Act may be used for the proposed 
     trust reform reorganization of the Bureau of Indian Affairs 
     or the Office of Special Trustee: Provided further, That''.

  Mr. DASCHLE. Mr. President, for over 100 years, the Department of 
Interior has managed for the benefit of Indian people a trust fund 
containing the proceeds from the leasing of oil, gas, land and mineral 
rights on Indian land. Today, far from enjoying a sense of security 
about the investment of these assets, tribal and individual Indian 
account holders cannot even be assured of the accuracy of the balances 
that the Department of Interior claims are in their accounts, and the 
Interior Department's discharge of its trust responsibility is being 
litigated in Federal court.
  There is little disagreement that the Department of Interior's 
stewardship of Indian trust funds has been a colossal and longstanding 
failure. But rather than get directly at the underlying problem, the 
department continues to focus on reorganization of the bureaucracy. 
Adding insult to injury, department officials refuse to collaborate 
with the tribes on a government-to-government basis as the department 
promised.
  It is my strong belief that Congress should not appropriate any 
additional funds for reorganization of the BIA until tribal leaders are 
fully consulted on, and can fully participate in, the design of the 
reorganization plan.
  Many of us received a letter yesterday from the National Congress of 
American Indians suggesting that Congress not fund the department's 
ill-considered reorganization.
  According to NCAI, ``The reorganization, because it is being executed 
in advance of the reengineering of the trust accounting systems, is 
premature, expensive, and will not improve trust management.'' NCAI 
goes on to say that: ``Instead the funding should be directed back to 
basic Indian programs from which the money has been reallocated.''
  I agree with NCAI and the tribal leaders of my State, who are saying 
the same thing. I am, therefore, proposing that we transfer $79 million 
from accounts that would fund a reorganization of the Bureau of Indian 
Affairs to the Indian Health Service.
  We are all painfully aware of the acute human need that exists on the 
Nation's Indian reservations. Education, unemployment programs and 
infrastructure are all underfunded by the Federal Government. But no 
human need cries out more than health care.
  The health care statistics on the reservations of South Dakota, and 
throughout the country, are closer to the statistics of the developing 
third world than they are to the national statistics for the United 
States. Infant mortality rates, diabetes rates, fetal alcohol syndrome 
rates and SIDS rates on the reservations far exceed that of the rest of 
the Nation. Every health barometer calls out for prompt intervention 
and assistance.
  We must increase Federal funding for health care on the reservations. 
It is the key to a better education, which is the key to a more 
productive life.
  Yesterday on the Senate floor I showed my colleagues a chart that 
showed the per capita commitment to health care on the reservations. It 
is exactly one-half the per capita commitment to Federal prisoners in 
the United States today. One-half, about 1,900 versus 3,800. Restoring 
accountability and efficiency to trust management and paying account 
holders what they are owed is a matter of fundamental justice and 
should be a national priority. Nowhere do the principles of self-
determination and tribal sovereignty come more into play than in the 
management and distribution of trust funds and assets clearly owed to 
Indian tribes and their people.
  However, the successful resolution of this challenge, which has 
eluded the reach of administrations of both political parties for 
years, depends on meaningful dialogue and true partnership between the 
Federal Government and Indian people and their representatives. That 
standard is not reflected in the Interior Department's current 
reorganization plan.
  Therefore, when I contrast the relative merits of more funding for 
this reorganization with more funding for health care, it is not a 
close call.
  I urge my colleagues to adopt this amendment transferring $79 million 
from BIA and the Office of the Special Trustee reorganization to Indian 
health care.
  I ask unanimous consent that letters from the National Congress of 
American Indians and the Native American Rights Fund be printed in the 
Record along with a resolution regarding this issue passed by the 
National Congress of American Indians.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                                 National Congress


                                          of American Indians,

                               Washington, DC, September 17, 2003.
     Re DOI Interior Appropriations Request for Historical Trust 
         Accounting and Trust Reorganization.

     Hon. Bill Frist,
     Majority Leader.
     Hon. Conrad Burns,
     Chairman, Subcommittee on Interior Appropriations.
     Hon. Ben Nighthorse Campbell,
     Chairman, Committee on Indian Affairs.
     Hon. Tom Daschle,
     Minority Leader.
     Hon. Byron Dorgan,
     Ranking Member, Subcommittee on Interior Appropriations.
     Hon. Daniel K. Inouye,
     Vice Chairman, Committee on Indian Affairs.
       Dear Senators: It has been over a decade since Congress 
     first ordered the Department of Interior to conduct an 
     accounting for Indian trust funds. Since that time, the 
     Department has spent over 600 million dollars on trust 
     reform, but has yet to produce even one accounting. In the 
     FY2004 Interior Appropriations bill, the Department has 
     requested yet another enormous increase in funding to product 
     a historical accounting and reorganize Bureau of Indian 
     Affairs functions to the Office of Special Trustee, shifting 
     significant amounts of funding away from basic Indian 
     programs.
       The recent U.S. Civil Rights Commission Report, ``A Quiet 
     Crisis: Federal Funding and Unmet Needs in Indian Country'' 
     evaluates the budgets and expenditures of the six major 
     federal agencies responsible for Native American programs. 
     The Commission concludes that significant disparities exist 
     between federal funding of programs serving Native Americans 
     and those serving other Americans. The report finds that when 
     inflation is factored in, funding for many individual 
     programs has decreased.

[[Page 22467]]

       In these days of tight federal budgets and dire needs in 
     American Indian communities, we have to make sure that every 
     federal dollar spent in Indian country is money well spent. 
     We do not believe that the increases requested for historical 
     trust accounting and BIA reorganization meet that criteria.
       The bottom line on historical accounting is that the 
     Department simply has not maintained the records to enable an 
     accurate accounting to occur--it has been demonstrated time 
     and again that a more comprehensive forensic accounting 
     approach is needed. The reorganization, because it is being 
     executed in advance of the reengineering of the trust 
     accounting systems, is premature, expensive, and will not 
     improve trust management. NCAI believes that any trust reform 
     reorganization at the Department should only occur after 
     interested parties--including tribal leadership--collaborate 
     to identify new trust business processes and the 
     organizational structure that should accompany those new 
     processes.
       FY2004 Interior Appropriations should not fund the ill-
     considered historical accounting effort and reorganization. 
     Instead, the funding should be directed back to basic Indian 
     programs from which the money has been reallocated. I have 
     attached NCAI Resolution #PHX-03-040, opposing the 
     Department of Interior's trust reorganization plan and 
     related FY2004 budget request.
       Tribal leaders understand better than anyone that the 
     Bureau of Indian Affairs needs to change, that it has 
     significant difficulty in fulfilling its responsibilities in 
     management of trust funds, and that some of the problems 
     relate to the way that the Bureau is organized. We want to 
     see successful change and improvement in the way the BIA does 
     business. We are not opposed to reorganization per se; we 
     simply want to see it done right. In our view, effective 
     organizational change to effectuate trust reform must contain 
     three essential elements:
       (1) Systems, Standards, and Accountability--a clear 
     definition of core business processes accompanied by 
     meaningful standards for performance and mechanisms to ensure 
     accountability;
       (2) Locally Responsive Systems--implementation details that 
     fit specific contexts of service delivery at the regional and 
     local levels where tribal governments interact with the 
     Department; and
       (3) Continuing Consultation--an effective and efficient 
     means for on-going tribal involvement in establishing the 
     direction, substance, and form of organizational structures 
     and processes involving trust administration.
       These elements are lacking in the current DOI 
     reorganization proposal.
       We are extremely concerned that the lack of definition of 
     the responsibilities and authorities of new OST offices will 
     cause serious conflicts with the functions performed by the 
     BIA Agency Superintendent and/or Indian tribes. The OST was 
     designed by Congress to play an oversight role, but the 
     reorganization would now give the Office both oversight and 
     management responsibilities, a clear conflict. Moreover, we 
     believe that the funding and staff needs to flow directly to 
     the agency and regional levels--not just to new Trust 
     Officers--to address long-standing personnel shortages needed 
     to fully carry out the trust responsibility of the United 
     States. Before DOI begins the process of establishing an 
     entire new mini-bureaucracy, the financial and management 
     impact of such an action must be thoroughly examined by the 
     Congress and by affected tribal governments.
       We fear that the DOI is on the verge of repeating the 
     classic mistake that has ruined the majority of its efforts 
     to reform trust administration in the past. The preoccupation 
     with moving or creating boxes on a chart is the antithesis of 
     how effective organizational change can and should be brought 
     about.
       The Department is headed in the right direction with its 
     reengineering efforts, but the new business processes should 
     be devised through a collaborative process involving both BIA 
     employees and tribal leadership. We must include the input of 
     tribes and BIA employees so that the great numbers of people 
     who must implement changes in trust administration understand 
     and support necessary reforms. Only then, as a final step, 
     can we design an organizational chart to carry out the 
     functions of trust management without creating conflicting 
     lines of authority throughout Indian country. The history of 
     trust reform is filled with failed efforts that did not go to 
     the heart of the problem and do the detailed work necessary 
     to fix a large and often dysfunctional system.
       At this time, Congress should prevent DOI from proceeding 
     with its proposed reorganization plan and focus instead on 
     funding core Indian programs where the need is greatest, and 
     programs such as land consolidation, title and accounting 
     that will in time reduce the cost of trust administration. We 
     believe that this could be accomplished with simple 
     appropriations language such as, ``None of these funds shall 
     be used for the proposed historical accounting and trust 
     reform reorganization of the Bureau of Indian affairs and 
     Office of Special Trustee until the Secretary has completed 
     the ongoing reengineering processes through consultation with 
     the tribes.'' Thank you very much for your interest in our 
     concerns, and for your continued commitment to American 
     Indian communities.
           Sincerely,
     Tex G. Hall.
                                  ____



                                  Native American Rights Fund,

                               Washington, DC, September 17, 2003.
     Hon. Tom Daschle,
     Minority Leader, U.S. Senate,
     Washington, DC.
       Dear Senator Daschle: As counsel for the class in Cobell v. 
     Norton, Civ. No. 96-1285 (RCL), a case was filed on June 10, 
     1996 on behalf of a more than 500,000 individual Indian trust 
     beneficiaries in the Federal District Court for the District 
     of Columbia. I write to clarify the position of the Cobell 
     plaintiffs regarding the use of current appropriations for 
     the historical accounting and reform of the IIM Trust. 
     Specifically, under current circumstances, we have no 
     objection to the use of such appropriations to address the 
     many other pressing needs of Indian Country--including, 
     without limitation, Indian education and health services.
       We do not believe Interior can render a complete and 
     accurate accounting. Nor do we believe Interior can reform 
     the trust without Court intervention. Our view on this matter 
     is reinforced with the knowledge that Interior has wasted 
     nearly $1 billion over the last decade on trust reform and 
     there has been no material improvement of the IIM Trust. In 
     short, until the Court has approved a methodology for the 
     historical accounting and plan for meaningful trust reform--
     issues which have been tried and for which a decision is 
     pending--Interior's record conclusively demonstrates that 
     such funds will be wasted and will certainly not benefit 
     Indian Country.
           Sincerely,
     Keith Harper.
                                  ____


            [From the National Congress of American Indians]

                         Resolution #PHX-03-040


 supporting tribal leaders' involvement in a congressional process to 
  settle trust claims; strongly opposing the department of interior's 
  Indian trust reform reorganization plan and related fy 2004 budget 
   report; creating a tribal leaders workgroup to address both issues

       Whereas, we, the members of the National Congress of 
     American Indians of the United States, invoking the divine 
     blessing of the Creator upon our efforts and purposes, in 
     order to preserve for ourselves and our descendants the 
     inherent sovereign rights of our Indian nations, rights 
     secured under Indian treaties and agreements with the United 
     States, and all other rights and benefits to which we are 
     entitled under the laws and Constitution of the United 
     States, to enlighten the public toward a better understanding 
     of the Indian people and their way of life, to preserve 
     Indian cultural values, and otherwise promote the health, 
     safety and welfare of the Indian people, do hereby establish 
     and submit the following resolution; and
       Whereas, the National Congress of American Indians (NCAI) 
     was established in 1944 and is the oldest and largest 
     national organization of American Indian and Alaska Native 
     Tribal governments; and
       Whereas, the federal government has a longstanding 
     comprehensive trust responsibility to Indian tribes based on 
     treaties, the United States Constitution, federal statutes, 
     executive orders, and judicial decisions; and
       Whereas, the issue of whether the federal government has 
     violated its trust responsibility to Individual Indian Money 
     account holders has been in litigation since 1996, under what 
     is now named the Cobell v. Norton case; and
       Whereas, as one means of dealing with the issues in Cobell 
     v. Norton, the Department of the Interior (DOI) has developed 
     and is implementing a reorganization plan which attempts to 
     diminish and limit the nature of the federal government's 
     trust responsibility; and
       Whereas, the DOI reorganization plan creates a top-heavy 
     bureaucracy which will divert desperately needed funding and 
     resources from regional offices and local agencies, strip 
     important decision-making authority from those offices and 
     agencies, and negatively impact trust fund and trust resource 
     management programs at the local level; and
       Whereas, the DOI has incorrectly asserted that segments of 
     its reorganization plan have the approval of Tribal Leaders; 
     and
       Whereas, the DOI plan in fact ignores and rejects Tribal 
     leaders' core consensus positions, developed at great expense 
     of Tribal time and resources, that trust reform must not 
     negatively affect BIA programs, that it must recognize the 
     comprehensive trust responsibility of the DOI/BIA with 
     enforceable standards for meeting that responsibility, that 
     the BIA must not be arbitrarily split between ``trust'' and 
     so-called ``non-trust'' programs, as every BIA function is a 
     trust function; and that decision-making must take place at 
     the ``lowest'' (agency/region) level possible rather than in 
     Washington, DC; and
       Whereas, the DOI reorganization plan lacks substance and 
     details in the areas of management and delivery of trust 
     services; does not describe the new or improved business 
     processes that will be implemented, lacks any recognition of 
     enforceable standards that will guide the implementation of

[[Page 22468]]

     such processes; does not provide accountability to Congress, 
     the courts, Indian tribes and their members; does not provide 
     for a trust oversight mechanism; and fails to provide any 
     details on how service delivery will be improved at the 
     regional and local levels; and
       Whereas, DOI's FY 2004 budget makes improper requests, and 
     in likely violation of federal law, consolidates authority 
     and funding in OST at the expense of Tribal programs: DOI 
     seeks a $123 million increase for OST, nearly doubling its 
     funding, while, at the same time, seeking a $63 million cut 
     to BIA construction, including a $32 million cut for school 
     construction, as well as an $8 million cut to Indian Water 
     and Claims Settlement funding. Equally disturbing, DOI is 
     seeking a less than one percent (0.3%) increase for Tribal 
     Priority Allocations, funding that flows directly to Tribes 
     for trust programs; and
       Whereas, this attempted reorganization is premature because 
     the ``To-Be'' reengi-
     neering study on how to fix the trust management apparatus 
     has not been completed; and
       Whereas, Tribal leaders strongly oppose the reorganization 
     for the reasons herein described; and
       Whereas, Senators Ben Nighthorse Campbell and Daniel K. 
     Inouye, Chairman and Vice-Chairman of the Senate Committee on 
     Indian Affairs, have written to all Tribal leaders asking for 
     their participation in helping to settle the Cobell v. Norton 
     case and ``reforming the Federal trust management 
     apparatus''; and
       Whereas, the continued litigation will cost many more 
     millions of dollars and take many more years to reach 
     completion, further impeding the ability of the Bureau of 
     Indian Affairs and the Department of Interior to carry out 
     their trust responsibilities to Indian tribes; and
       Whereas, it is in the best interests of Tribes that Tribal 
     leaders participate in the resolution of trust related claims 
     and the development of a workable and effective BIA 
     reorganization plan which incorporates the core consensus 
     positions earlier articulated by Tribal leaders; and
       Whereas, Tribal leaders are willing to discuss the 
     Senators' proposal to achieve a settlement of trust claims 
     and related issues because it focuses on land consolidation, 
     development of settlement legislation, continuation of the 
     effort to reengineer trust management processes, and the 
     reorganization of the BIA in true and meaningful consultation 
     with Tribal leadership;
       Now, therefore, be it Resolved, That the NCAI does hereby 
     strongly oppose the DOI's Indian Trust Reform Reorganization 
     Plan and its related FY 2004 Budget Request; and
       Be it further Resolved, That the NCAI calls upon Congress 
     to immediately halt the reorganization of the Bureau of 
     Indian Affairs until the concerns of Tribal Leaders are fully 
     addressed by a workable and effective reorganization plan, 
     and until the ``To Be'' process, developed through true and 
     meaningful consultation with Indian Tribes, is completed; and
       Be it further Resolved, That the NCAI hereby (1) opposes 
     the FY 2004 proposed $123 million budget increase to OST, (2) 
     supports the restoration of funding for BIA Construction and 
     Indian Water and Claims Settlements, and (3) supports a 
     substantial increase, of at least 4%, for TPA funding; and
       Be it further Resolved, That the NCAI requests a series of 
     hearings before the Senate Committee on Indian Affairs and 
     the House Resources Committee on the BIA reorganization and 
     the DOI's FY 2004 budget request, and that the Tribal Leader 
     witnesses represent direct service, contracting and 
     compacting tribes, all regions, and Tribes with diverse trust 
     holdings; and
       Be it further Resolved, That the NCAI supports the efforts 
     of Senators Campbell and Inouye to help reach a settlement of 
     trust claims and to effectively reform the federal trust 
     apparatus, and encourages the participation of Tribal 
     leaders, individually and through a Tribal Leaders Workgroup, 
     in both these crucial processes; and
       Be it further Resolved, That the President of the NCAI is 
     hereby authorized to take all actions necessary to fulfill 
     this Resolution; and
       Be it finally Resolved, That this resolution shall be the 
     policy of NCAI until it is withdrawn or modified by 
     subsequent resolution.


                             certification

       The foregoing resolution was adopted at the 2003 Mid-Year 
     Session of the National Congress of American Indians, held at 
     the Sheraton Wild Horse Pass Gila River Indian Community, in 
     Phoenix, Arizona on June 18, 2003 with a quorum present.
                                                         Tex Hall,
                                                        President.

  Mr. BURNS. Mr. President, there will be quite a spirited debate on 
this issue. There is no question that we have shortcomings in the 
Indian Health Service. We could use more dollars there. In fact, we 
added dollars this year to that particular item. Was it enough? 
Probably not. But who knows how much is enough, whenever we start 
allotting dollars and we take a look at the challenge we have, 
especially in Indian health care. We know diabetes is one great 
challenge we have on our reservations across this country.
  We should also talk about the merits of the trust reform, too. Number 
one, the administration is talking veto if this amendment is allowed to 
be successful. Number two, it is tied up in court. There are actions 
and proceedings underway. The Senator from South Dakota is exactly 
right. This has spanned the years through all administrations, through 
all Secretaries. They have all been sued and held in contempt of court 
because they did not live up to their responsibilities of managing this 
trust.
  We also have to be concerned about those in Indian country, of the 
thousands and thousands of Native Americans who are denied payment from 
this trust because it is in such a mess. Some reform or some system has 
to be set in place before anything can happen. The plaintiffs now in 
the court action are saying the total payment in the country could be 
as high as $176 billion if we do not fix this system and make it work 
for those who have money due them.
  I imagine that to take the dollars from reform and normal accounting 
procedures and let the new organization proceed with reform so we know 
where we are, what kind of ground we are standing on, and how best to 
get that money to the people to whom it is owed--I don't think this is 
the time to take dollars from that process of reform. We will have a 
spirited debate on this subject.
  The Senator from South Dakota also points out we have two 
shortfalls--that and Indian health. So wherever your priorities are, do 
we take care of the trust so we take care of the financial conditions 
of those folks who have money coming to them or do we put basically a 
pittance of what really the IHS, the Indian Health Service needs. We 
have always covered those needs in the past with more dollars. We have 
added dollars this year. But we will monitor that very closely. I am 
aware of the needs in health care because I have seven reservations in 
the State of Montana and it becomes an issue there.
  I thank the Senator from South Dakota for offering this amendment 
because it points up that we have two places we should be doing better.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from South Dakota.
  Mr. DASCHLE. Mr. President, I don't disagree with most of what my 
friend and colleague from Montana has said. He is trying to do the best 
he can given the allocation he has. I don't deny his responsibility to 
make the decisions as best he can, given the allocation. I didn't vote 
for the budget so I don't feel constrained by those budgetary 
allocation decisions that have been made within the Appropriations 
Committee.
  Let me talk briefly about the two issues the Senator addressed. 
First, with regard to the trust fund. The $79 million is for 
reorganization of the BIA to adapt itself to the policy once the policy 
is implemented. The question I have is, how can you reorganize a 
bureaucracy before you know what that policy is going to be? How can 
you say we are going to put it in this agency or in that department or 
in that bureau or that desk without knowing what the policy is going to 
be? And the policy is being contested. It seems to me we are putting 
the cart before the horse. We need to decide on the policy and then do 
the reorganization. That is what I am saying. Yet there is $79 million 
for the reorganization before we even have a clue what the policy is 
going to be.
  With regard to the Indian Health Service, the President requested 
about $1.9 billion for IHS. The analysis done by independent sources 
has indicated if we are going to do it right, if we are going to 
provide coverage anywhere near the coverage provided to others in the 
rest of the country, we would have to put another $2.9 billion into the 
Indian Health Service budget to reach a per-capita equivalency, that 
parity. But we are not going to do that. We obviously cannot do that. 
We had that debate on the budget resolution. I don't recall what the 
exact number was. We offered an amendment to add about $2.9 billion, 
and that was defeated.

[[Page 22469]]

  What the Senate budget resolution included, and I believe it was the 
amendment of the Senator from Montana, but it could have been someone 
else's, was another $292 million, not the $2.9 billion. We passed that, 
but it was not in the final bill, so that was the subject of the 
amendment I offered last night, an amendment to put that agreed-upon 
$292 million in the appropriations bill. We will have that vote, as 
well.
  We are simply saying we ought to try to begin addressing this 
extraordinary deficiency we have. To say to a Native American, on a 
per-capita basis you are only going to get one-half of what we give our 
Federal prisoners is to defend a disparity that I cannot imagine we can 
defend. I hope first we can commit to the $292 million. But since we 
are not ready to move forward on this BIA-OST reorganization plan that 
really isn't a plan, or to spend the $79 million wisely, I am arguing 
that we are certainly ready to spend it through the provision of Indian 
Health Service clinical services. That is where it ought to go right 
now until we know about trust land policy and how it will be 
implemented and how we reorganize to implement that policy once it is 
decided.
  I thank my colleague. I know there are concerns about the weather. To 
accommodate staff and others I will not belabor this. I appreciate the 
opportunity to offer the amendment and look forward to the debate on 
Monday and the vote on Monday evening.
  I yield the floor.
  Mr. BURNS. I think the minority leader brings up a good number. How 
do you reorganize a bureaucracy? That is always a great challenge in 
this town, especially if you work in Washington, what I refer to as 17 
square miles of logic-free environment.
  There are some folks who want to catch some transportation out of 
town. I will remark what the schedule will be. We will be talking quite 
a lot about wildfires. We have good news: Four inches of snow this 
morning at Glacier National Park and the temperature is dropping down 
now to where we can get our arms around these fires. Nonetheless, it 
did not take away from the devastation those fires brought to the west 
this year and how we manage the dollars it takes to fight those fires. 
And it is every State's responsibility in this Union to respond to a 
national problem.
  If you look just at this year--this did not make great headlines--27 
firefighters died this year in wildfires on national lands--27. And 
789--at last count--homes and other structures were destroyed, and 2.8 
million acres have burned.
  During the recent Labor Day weekend, 25,000 firefighters were still 
working on fires in the West. Now that is subsiding, that is over. Of 
the 2.8 million acres, 600,000 acres are in my home State of Montana.
  What does that mean? That means lives are disrupted and resources 
lost. Tourism was curtailed almost to nothing this year in those 
particular areas that always see high summer tourism activity--Glacier 
National Park, Yellowstone National Park.
  We are going to hear in this debate: Well, maybe we should study it. 
We have enough institutional memory already and data that tell us what 
we are doing wrong. The Forest Service and private foresters were not 
just hired 10 years ago. They have been around a long time. And our 
institutional knowledge of fires goes back to the fires of 1988. That 
was the fire, of course, that destroyed the better part of Yellowstone 
Park.
  So we will have some visuals, and we will try to make the case that 
this is a national problem and it must be solved by national leaders 
representing every State in the Union. Every State in the Union has a 
stake in this because what the Forest Service has done, what the Bureau 
of Land Management has done, is they have raided other accounts to pay 
for their firefighting activities. Now we must replace those dollars. 
If we do not, that affects the Forest Service, BLM, Park Service, and 
U.S. Fish and Wildlife Service in every State.
  So as we move on this issue, I hope the Nation will draw its 
attention to what is the right thing to do because we have an $850 
million problem we must take care of.
  Mr. President, not seeing anyone else on the floor, I suggest the 
absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. DORGAN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                           Amendment No. 1739

  Mr. DORGAN. Mr. President, I rise today to support the amendment 
offered by my colleague, Senator Daschle, to increase clinical services 
in the Indian Health Service. I wish to speak just for a moment about 
the issue I raised yesterday, that there is, in my judgment, a full-
blown crisis on Indian reservations in this country dealing with health 
care, education, and housing, and we are not addressing that crisis the 
way we should.
  I have been pleased to work with my colleague from Montana, Senator 
Burns, who I think does a remarkable job. We have not gotten the 
allocation we really need in order to meet all the obligations we have. 
Included in those obligations, in my judgment, is the obligation to 
fund the Indian Health Service in order to provide the kind of medical 
treatment that is necessary for those who are showing up at the Indian 
health treatment centers.
  I must say, I just recently toured a clinic on the Fort Berthold 
Reservation and talked to doctors, nurses, and health care delivery 
personnel. They are wonderful people, but it is dramatically 
underfunded. The fact is, if you have a heart attack at that Indian 
reservation at 5 o'clock, you are in some trouble because the clinic is 
closed. They do not have the resources to keep it open. If you have a 
heart attack on a Saturday, you are in trouble because you won't have 
access to the health care you need at that point.
  So we need to work on these issues. We need to resolve these issues. 
Some say: Well, why special issues dealing with American Indians? The 
fact is, they were here before we were, first of all. But, second, 
Native Americans in this country have served this country in so many 
ways, so many wonderful ways.
  One Sunday morning, some years ago, I traveled to the veterans 
hospital in Fargo, ND, to present medals that were earned by an 
American Indian. His name was Edmund Young Eagle. I have told my 
colleagues about this, I believe, on one other occasion.
  Edmund Young Eagle was an American Indian, living on the Fort Yates 
Reservation. He was called to serve his country during the Second World 
War. He left and went to serve. He served in Africa and in Europe, 
Normandy. He served this country with great distinction in World War 
II. Then he came back to live on the Indian reservation.
  He never had very much, never married, never earned much income. He 
did not, perhaps, have as much joy in his life as he would have liked. 
Then he developed lung cancer. In his mid seventies, when I met Edmund 
Young Eagle, he was lying in a veterans hospital bed in his pajamas. I 
didn't know it that Sunday morning, but he was about a week from dying. 
He died a week later.
  His sisters had asked me if I could achieve for him the medals he 
earned during World War II that he had never received. And I did. I 
took them to the VA hospital on that Sunday morning. Edmund Young Eagle 
was sick with, as I said, lung cancer. His sisters and the doctors and 
nurses came into the room. We cranked his bed up to a seated position, 
and I pinned those medals on Young Eagle's pajama top.
  He earned those medals fighting for this country in the Second World 
War. He had a very distinguished record. This very sick man, an 
American Indian, said to me that Sunday morning in the hospital that it 
was one of the proudest days of his life, as he sat there in his 
hospital bed wearing his military medals that he had earned serving 
this country.
  If you look at the service given this country by American Indians, 
Native Americans, who have been drafted and then enlisted in massive 
numbers across this country, they have served

[[Page 22470]]

in virtually every conflict, every war with great distinction.
  Go to a pow-wow someday and watch those Native Americans wear their 
uniforms, being part of the American Legion or part of the group in 
that reservation or with that particular tribe that is celebrating 
their service to our country, and you can't help but be enormously 
proud. But when you take a look at other things that are part of the 
culture of their lives, and you see service to their country was one 
part that was very important to them--and they served in higher numbers 
as a percentage of their population than almost anyone in this 
country--most of them, many of them came back to their reservations to 
find there was a crisis in health care, housing, and education.
  My colleague, Senator Daschle, offers an amendment dealing with 
health care. This is not just about veterans. It is about children. It 
is about retired folks. If you tour these Indian reservations and take 
a look at what the Indian Health Service is doing, what the public 
health system is doing, we have some wonderful men and women working 
very hard, long hours, doing the best they can, but the resources don't 
exist to provide the kind of health care for these children and these 
citizens as exists in the rest of the country. It is just plain fact.
  The Indian Health Service has a budget of about $2.5 billion. The 
analysis is they need about $12 billion more. Of course, that is not 
going to happen. This is not some academic debate. This is not about 
theory. This is about people living and dying. This is about life or 
death decisions for a lot of people, especially the more vulnerable in 
that population. I am talking about children.
  You want to hear stories about children who die because of chicken 
pox. We can talk about that on some of these reservations. You don't 
hear that much anymore, people dying of chicken pox.
  The primary health services that are available to American Indians on 
reservations are inadequate. I mentioned yesterday 5,000 people getting 
their dental care from one dentist in a small trailer. That is not 
health care. It doesn't meet the needs of those people on that 
reservation.
  My colleague, Senator Daschle, offers an amendment to try to find 
some additional resources for clinical services. I support that.
  Senator Burns missed what I said about this bill. I said, Senator 
Burns has Indian reservations in Montana and cares a lot about these 
issues. We have done as well as we could given the allocation in this 
bill. I wish we could do more.
  I support this amendment because it will do more. I recognize the 
offset comes from outside the bill, and there is some difficulty with 
that. I think when you are talking about issues of life and death, we 
need to make fit the solution that is necessary to provide the health 
care needed, particularly by these children but also people who are 
more vulnerable.
  Go to an Indian reservation, for example, and talk to people about 
diabetes. You will discover the rate of diabetes on, for example, the 
Fort Berthold Reservation is not double or triple or quadruple the rate 
of diabetes in this country. It is 12 times the rate of diabetes, 12 
times the rate of the American population.
  One day I flew into New Town, ND, with the late Congressman Mickey 
Leland and former Congressman Tim Penny. We held a hearing on the Fort 
Berthold Reservation. We had a range of people talk to us about the 
diabetes epidemic. Go to that reservation today and see the rows of 
people doing renal dialysis to stay alive, go to the diabetes clinic--
which I got funding for--and see what they are doing to try to deal 
with this scourge called the diabetes epidemic.
  There are so many challenges that need to be met and so few 
resources. That is why I fully support this amendment.
  When I walked in the Chamber, my colleague from Montana was speaking 
of forest fires. North Dakota is a State that is ranked 50th among the 
50 States in native forest lands. We are a wonderful State. We cherish 
the trees we have. But we rank 50th among the 50 States. We are not 
affected much by forest fires. We do have some range fires on the 
grasslands. The forest fires, of the type my colleague and his 
constituents face, or the forest fires we have read about in Colorado 
and Arizona and other areas, are devastating events. The fact is, we 
know these events occur. This is not some tsunami or typhoon that 
occurs once every 5 or 10 years. We know these events occur.
  As my colleague said, we ought to provide for the payment for fire 
suppression and firefighting in the budgets that we put together. The 
President ought to do it. He ought to request it, and we ought to fund 
it. It doesn't make sense for us to pretend we are surprised when there 
is a forest fire. We must be the only people surprised. Forest fires 
happen. There is no reason to continue having budgets come down from 
the President that say, let's not adequately fund this so that we can 
borrow money from this, that, and the other place. Then we pretend we 
are shocked when a fire comes around and we have to pay for it. Then we 
try to do some emergency fix someplace. That doesn't make sense to me.
  Forest fires are devastating events. We know they are going to 
happen. We should provide funding for fire suppression activities. 
Hundreds of millions of dollars ought to be in these budgets. My 
colleague from Montana and I are determined to try to make sense of 
this and work with the White House and others to do the right thing. I 
echo his comments about the urgency of doing that.
  I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. BURNS. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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