[Congressional Record (Bound Edition), Volume 154 (2008), Part 1]
[Senate]
[Pages 470-498]
[From the U.S. Government Publishing Office, www.gpo.gov]




         INDIAN HEALTH CARE IMPROVEMENT ACT AMENDMENTS OF 2007

  The PRESIDING OFFICER. Under the previous order, the Senate will 
proceed to the consideration of S. 1200, which the clerk will report.
  The legislative clerk read as follows:

       A bill (S. 1200) to amend the Indian Health Care 
     Improvement Act to revise and extend the act.

  Mr. DORGAN. Madam President, this is a piece of legislation we have 
reported out of the Committee on Indian Affairs in the Senate. Senator 
Murkowski, the vice chair, and I have worked hard on these issues. We 
have also made some changes since reporting the bill out of the 
Committee on Indian Affairs and will offer a substitute that will be 
cosponsored by both of us. We are now clearing that substitute, and I 
will, at the appropriate time today, I hope, offer the substitute 
version.
  Some might wonder why there is a separate Indian health care bill, 
and

[[Page 471]]

the answer is relatively simple: because this country has a trust 
responsibility--a trust responsibility that has grown over a long 
period of time and has been reaffirmed by the Supreme Court, affirmed 
by treaties with various Indian tribes--a trust responsibility to 
provide health care for Native Americans.
  The last comprehensive reauthorization of the Indian Health Care 
Improvement Act was 15 years ago in 1992. The act itself has been 
expired for the last 7 years, and it is long past the time for this 
Congress to reauthorize this program. Even though the act has expired, 
the Indian Health Service continues to provide Indian health care, 
despite not having a current authorization. But with advances in 
medicine and in the delivery and in the administration of health care, 
we need to finally pass this reauthorization and give the Indian 
population of this country the advantage of the expansions we will do 
in this reauthorization bill.
  This legislation reflects the voices and the visions of Indian 
Country. It also responds to a number of concerns that have been raised 
by others, including the administration. The enactment of this 
reauthorization has been the top priority of myself and the vice chair 
of the committee, Senator Murkowski. I also wish to say the former vice 
chair of the committee, the late Senator Craig Thomas from Wyoming, at 
the start of this Congress, worked very hard on this legislation and 
cared very deeply about it. We bring this to the floor, remembering the 
work of Senator Thomas and recognizing his important work.
  I wish to describe the need for the legislation as I begin before I 
describe the legislation itself. I have in the past couple weeks done 
some listening tours on Indian reservations, particularly in North 
Dakota, and we heard and saw many examples of deplorable conditions in 
Indian health care. It is true there are some health care providers in 
the Indian Health Service that are making very strong efforts to do the 
best they can, but they are overburdened and understaffed, underfunded. 
I wish to give some examples of that.
  I wish to show a picture--a photograph, rather--of someone I have 
shown to the Senate before. This is a woman on the reservation in North 
Dakota, the Three Affiliated Tribes near New Town, ND. Her name is 
Ardel Hale Baker. Ardel Hale Baker has given me consent to use her 
image. She had chest pains that wouldn't quit. Her blood pressure was 
very high. So they went to the Indian health clinic, and she was 
diagnosed as having a heart attack. The clinic staff determined she 
needed to be sent immediately to the nearest hospital 80 miles away. 
She told the staff she didn't want to go in an ambulance because she 
knew she would end up being billed for the trip, and she didn't have 
the money. So she signed a waiver declining the ambulance service, but 
the Indian Health Service said you have to take it anyway. We have 
diagnosed a heart attack happening here. You have to take the 
ambulance.
  She arrived at the hospital and Ardel Hale Baker at the hospital was 
being taken out of the ambulance and transferred to a hospital gurney. 
As this woman, having a heart attack, was transferred to the hospital 
gurney, a nurse saw a piece of paper taped to her thigh and the piece 
of paper taped to her thigh was a piece of paper that was notifying the 
health care provider there wasn't going to be any money for this 
patient. The nurse asked this woman who was then having a heart attack 
what the envelope was. She pulled the envelope that was taped to her 
leg off her leg and asked: ``Mrs. Baker, is this yours?'' When they 
looked at the paper, here was the document. The document was from the 
Department of Health and Human Services, attached by the folks on the 
Indian reservation, taped to her leg as she left to be put in the 
ambulance, and it says:

       Understand that Priority 1 care cannot be paid for at this 
     time due to funding issues. A formal denial letter has been 
     issued. If and when funds become available, the health 
     service will do everything possible to pay for Priority 1 
     care.

  What this means is this--contract health care, which cannot be 
delivered on the reservation. This reservation has a clinic. It is open 
from 9 until 4 every day, 5 days a week. It is not a hospital, it is a 
clinic. For health care that cannot be delivered at that clinic, you 
have to refer the patient somewhere else. But that has to be paid for 
with contract health care funds, and they run out very quickly.
  We had one reservation tell us they were out of health care contract 
money in January, 4 months into the fiscal year. On this reservation, 
they say don't get sick after June because the contract health care 
money is gone. This poor woman was loaded onto a hospital gurney with a 
piece of paper taped to her leg, saying to the hospital that if you 
admit her, understand that the Indian Health Service will not pay. This 
woman must pay. Obviously, this woman had no money. It was a way to say 
to the hospital that if you admit this patient, you are on your own.
  Well, I visited a Sioux reservation at Standing Rock, the McLaughlin 
Indian Health Center, a couple of weeks ago. The Standing Rock 
Reservation clinic sees 10 patients in the morning and 10 in the 
afternoon. I believe they only have a physician assistant there. The 
reason given in the memorandum about the 10 and 10 was the clinic had 
only one medical provider and patients signed up in the morning. 
Anybody arriving after the quotas were made were turned away.
  Harriet Archambault received her last prescription for serious 
hypertension and stomach medication on October 25, 2007. As the 
medicine ran out, she attempted five times to sign up at the clinic, 
leaving home early in the morning, driving 18 miles to the clinic but 
arriving too late each time. Her name was not on the top 10. She 
couldn't wait at the clinic for a possible opening because she provided 
day care for three of her grandchildren. So her medication ran out.
  In a conversation with her sister prior to her death, she said: What 
do I have to do, die first before I finally get my medication? She 
tried five times to drive the nearly 20 miles to the clinic, and five 
times failed and never got her medicine, and she died a month later, 
November 27, 2007. Her husband told that story because he wants us to 
understand that delivery of health care is about life and death.
  I have shown a photograph to my colleagues. I wish to do so again. It 
is a photo of a precious young lady who died, Ta'shon Rain Littlelight. 
I was at the Crow Indian Reservation in Montana when I met the 
grandmother of Ta'Shon Rain Littlelight. This was a beautiful 5-year-
old girl. She loved to dance. This was traditional dance regalia, and 
she loved to go to dance contests. Ta'Shon Rain Littlelight died. Here 
is how she died. Her grandmother and mother and aunt told me she died, 
with the last 3 months of her life in unmedicated, severe pain. She 
went back and back and back to the Crow Tribe's Indian Health Service 
clinic for health problems. They began treating her for depression. 
Depression. During one of the visits, one of the grandparents of 
Ta'Shon said: Well, she has a bulbous condition on her fingertips and 
toes. That suggests there may be a lack of oxygen to the body, or 
something is going on. Can't you check that? Ta'Shon was treated for 
depression.
  Finally, one day, August 2006, she was rushed from the Crow clinic, 
where she had gone once again to the St. Vincent Hospital in Billings, 
MT. The next day she was airlifted to the Denver Children's Hospital 
and was diagnosed with untreatable, incurable cancer. She lived for 3 
more months after the tumor was discovered in what her grandmother said 
was unmedicated pain. She died in September 2006. Her parents and 
grandparents asked the question: If Ta'Shon's cancer had been detected 
sooner, would this child perhaps have lived?
  When diagnosed with terminal illness, the one thing Ta'shon Rain 
Littlelight wanted to do was see Cinderella's castle, so Make-a-Wish 
sent her to Orlando. But the night before she was to see the castle, in 
the hotel room in Orlando, she died in her mother's arms.
  The question is, for a young girl such as Ta'shon Rain Littlelight, 
should she

[[Page 472]]

have had the same opportunity in health care others have? Is this what 
we are willing to accept? Not me. This problem has a human face. I 
could tell a dozen more stories similar to Ardel Hale Baker and Ta'Shon 
Rain Littlelight.
  I sat on Indian reservations for a total of probably six hours 
listening to stories about Indian health care. Let me talk about the 
statistics, if I might.
  For tuberculosis, the mortality rate for American Indians and Alaskan 
Natives is seven times higher than the American population as a whole.
  For alcoholism, the mortality rate is six times higher.
  For diabetes, it is not double but triple--three times higher.
  Twenty percent of American Indians and Alaskan Natives over age 45 
have diabetes. There are reservations in my State where they estimate 
over 50 percent of the adults have diabetes.
  American Indians and Alaskan Natives have higher rates of sudden 
infant death syndrome than the rest of the Nation.
  Injuries are the leading cause of death for Native Americans ages 1 
to 44. Injuries include pedestrian accidents, vehicular accidents, and 
suicides.
  The cervical cancer rate for Indians and Alaskan Natives is four 
times higher than the rest of the population.
  The suicide rate for American Indians and Alaska Natives between ages 
15 and 34 is triple the national average. For Indian teens in the 
northern Great Plains, it is 10 times the national average.
  I have shown my colleagues a photograph of Avis Little Wind. Avis 
Little Wind is a young teen who died. Avis Little Wind's relatives gave 
me permission to use her photograph. This is a 14-year-old girl who lay 
in bed in a fetal position for 90 days and then killed herself. Her 
sister had taken her life 2 years previous. Her dad had taken his life. 
For 90 days, somehow, everybody missed little Avis. The school missed 
wondering what happened. She lay in bed for 90 days and then took her 
life because she felt there was no hope and no help.
  On that reservation, I went and met with the tribal council, school 
administrators, and her classmates to try to find out how does a kid, 
age 14, fall out of everyone's memory and everyone's vision? What I 
have discovered is there are a lot of issues, but there was not any 
kind of health care treatment available for a young girl, age 14, who 
had these kinds of problems. Even had there been health care available, 
there would not have been a car to drive her there. There is a basic 
lack of transportation. Aside from the fact they don't have the 
capability to provide the necessary health care treatment that is 
necessary to intervene, we have to do better. We have a responsibility 
to do better.
  I wish to address the question of why it is our responsibility. Why 
is the plight of Native Americans a responsibility to the Federal 
Government? The simple answer is we are bound to follow the law set 
forth in the Constitution, in treaties, and in the laws of our land. We 
are bound to follow the trust responsibility that has been imposed on 
us by the Constitution, the rulings of the Supreme Court, and by 
treaties.
  Now, our predecessors long ago negotiated treaties with Indian tribes 
in which we received, as a Nation, hundreds and hundreds of millions of 
acres of Indian homeland to help build this great Nation of ours. In 
return for the enormous cessions of land by the Indians, our country 
promised certain things. We promised to provide things such as health 
care, education, and the general welfare of Native Americans.
  This chart I am going to show you shows a provision from one of those 
treaties, and there are a lot of them, most of them broken by our 
country. This is with the northern Cheyenne and Arapaho. It says:

       The U.S. hereby agrees to furnish annually to the Indians 
     who settle upon the reservation a physician.

  It says we have your land and we are going to give you a reservation, 
but we also understand our responsibility, and we will provide health 
care. We have failed miserably to hold up our end of the bargain.
  This bill doesn't provide health care for Native Americans simply 
because it is the moral and right thing to do. It is, certainly. It is 
a bill that requires us to keep our word. It is an active step to 
fulfill our responsibility, our end of the bargain, struck by our 
predecessors a long time ago.
  In addition to the treaty obligations, the U.S. obligations to Indian 
tribes are set forth in hundreds of U.S. Supreme Court cases and 
Federal statutes.
  I wish to especially refer to the next chart. In 1831, the U.S. 
Supreme Court, in an opinion by Chief Justice John Marshall, recognized 
a general trust relationship between the United States and Indian 
tribes. He held that the United States assumed a trust responsibility 
toward the tribes and their members. He explained the United States not 
only has the authority to deal with Indian tribes and their members, 
but also the responsibility and obligation to look after their well-
being.
  In describing Indian tribes as ``domestic dependent nations,'' he 
also established the relationship in that ruling between the United 
States and tribes as similar to one between ``a ward to his guardian.''
  Now, at the time, these Supreme Court decisions were used by the 
United States to justify our actions toward the Indians, such as 
forcing Indians from homelands and placing them on reservations. But we 
cannot now ignore these court decisions merely because we are doing a 
poor job of fulfilling our obligation.
  At the time of the Supreme Court's decision I described, the United 
States, through the Department of War, was already providing health 
care services to Indians on reservations. That practice began in 1803 
and the United States has been providing such health care for over 200 
years.
  One of the initial reasons for providing health care on reservations 
was because we were the ones who were transmitting diseases to Indian 
nations and forcing them into environments where diseases would 
prevail. That became evident in 1912 when then-President Taft sent a 
special message to Congress summarizing a report that documented the 
deplorable health care conditions on Indian reservations.
  In 1913, the Public Health Service reached a similarly distressing 
conclusion about the health of Native Americans. The Snyder Act was 
passed in 1921--I am providing the history so people understand what is 
the context of health care for Indian nations--one of many laws passed 
by the Congress over the last 100 years to try to address the health 
disparities between American Indians and the rest of our society: The 
Snyder Act of 1921, Indian Health Facilities Act of 1957, Indian Self-
Determination of 1975, and the Indian Health Care Improvement Act of 
1976 as it was amended in 1992.
  President Nixon, in 1970, said in a message to the Congress:

       The special relationship between Indians and the Federal 
     Government is the result of solemn obligations which have 
     been entered into by the United States Government. Down 
     through the years through written treaties . . . our 
     Government has made specific commitments to the Indian 
     people. For their part, the Indians have often surrendered 
     claims to vast tracks of land. . . . In exchange, the 
     Government has agreed to provide community services such as 
     health, education and public safety, services which would 
     presumably allow Indian communities to enjoy a standard of 
     living comparable to that of other Americans. This goal, of 
     course, has never been achieved.

  That is in 1970 from the President of the United States, describing 
our responsibility.
  Let me talk just for a moment about the proposed legislation, having 
described the reason for us to bring a piece of legislation to the 
floor of the Senate.
  We know--and it has been like pulling teeth to find this out--we know 
there is full-scale health care rationing on Indian reservations. It 
should be front-page headline news in all the biggest newspapers in the 
country, but it is not. If it was happening elsewhere, it would be 
front-page headlines, but it is not now.
  Forty percent of health care needs of Native Americans are not being 
met. We meet 60 percent of the health care

[[Page 473]]

needs; 40 percent are unmet. So it is rationed, and that is why Ardel 
Hale Baker, having a heart attack, is wheeled in to a hospital with a 
piece of paper taped to her leg saying: ``This isn't going to be paid 
for.'' It is health care rationing, there is no other way to describe 
it, no soft way to put a shine on it. It is health care rationing. It 
shouldn't happen, and I think it is an outrage, because it is happening 
on Indian reservations. It is seldom covered by the 24/7 news hour, but 
it should be, because it is a scandal. I hope this is the first step to 
begin addressing it.
  This legislation will be described by some who come to the floor of 
the Senate as not enough. I agree with that assessment. This is a first 
step, at last, at long last, that should have been done a decade ago. 
It is a first step in the right direction, but it is a first step as a 
precursor to real reform because we need reform.
  This is a reauthorization 10 years after it should have been done. We 
are reauthorizing and expanding programs that I will describe, but we 
need to do much more. When we move this legislation through the Senate, 
through the House, and it is signed by the President, I intend, with 
the Indian Affairs Committee, to begin immediately with new and more 
aggressive reforms, and it is urgent we do so.
  This bill expands the types of cancer screenings that are available 
to American Indians. It expands the types of communicable and 
infectious diseases that health programs can monitor and prevent beyond 
tuberculosis, which now is the emphasis, to include any disease. It 
expands the recruitment and scholarship programs and authorizes nurses 
currently serving in the Indian Health Service to spend time teaching 
students in nursing programs. These are critical programs, given that 
there is a 21-percent vacancy rate for physicians in the Indian Health 
Service, and the entire Nation faces a shortage of nurses.
  There is a new program in this legislation dealing with teen suicide 
on Indian reservations. I held hearings on this subject. We have worked 
for legislation that will provide screenings and mental health 
treatment, and we begin to address those issues with this legislation.
  Treatment for diabetes: We held a hearing to examine the threat of 
diabetes to the health of American Indians. It is an unbelievable 
threat. Diabetes emerges as the most serious and devastating health 
problems of our time, and nowhere in this country is it worse than on 
Indian reservations. It affects the Indian population in a dramatic 
way.
  I ask any of my colleagues, if they wonder about that, go to a 
reservation and see if they have a dialysis unit, and watch the people 
in the dialysis unit getting dialysis, some having lost limbs, having 
one leg cut off, another leg cut off, still trying to stay alive. The 
ravages of diabetes is an unbelievable scourge in Indian country. It is 
a serious problem for our entire country, but nowhere is it worse than 
among American Indians. In some communities, the prevalence reaches 60 
percent of adults. In the 14-year period from 1990 to 2004, the 
diabetes rate among Indian kids 15 to 19 years old increased 128 
percent.
  We expand and enhance the current diabetes screening program. We 
direct the Secretary to establish an approach to monitor the disease, 
provide continuing care among Native Americans, and authorize the 
Secretary to establish a dialysis program to treat this threatening 
disease.
  Health service to Native American veterans: It is well documented 
that there is no population in this country that has participated with 
greater distinction or in greater numbers per capita serving in this 
Nation's military than Native Americans--none. Many Indians served in 
World War I even before our Nation recognized Indians as citizens of 
our country. Think of that, we had American Indians sign up to fight 
for this country when they were not yet considered citizens of this 
country.
  I was checking recently, and 1962 was the last time when a State 
finally passed legislation allowing Indians to vote in the State. Think 
of that, go back to 1961 and understand, there were places in this 
country where American Indians were not allowed to vote in State 
elections. And until the early part of the last century, they were not 
considered citizens. Yet they were signing up to go to war for this 
country, to fight for this country.
  I attended a ceremony on the Spirit Lake Reservation a few months ago 
and passed out medals--Silver Stars, a lot of medals--to three soldiers 
who are now elderly men who served this country in the Second World War 
with unbelievable valor, had fought all around this world for this 
country and earned these medals--Silver Star, Purple Heart, and various 
others. They were enormously proud of their country.
  Go to a reservation and find out what percent of the population of 
eligible adults sign up to serve in the military on an Indian 
reservation and you will be surprised. There is no group of Americans 
who signs up in bigger numbers to serve this country in the military.
  Senator Murkowski and I have a provision in this bill that deals with 
health services to Native American veterans. More than 44,000 American 
Indians out of a total Native American population of less than 350,000 
at that point served in World War II. Think of that. Out of a 
population of 350,000, 44,000 of them served in the Second World War.
  We had a ceremony in this Capitol Building, honoring the Code Talkers 
who played a significant role in intercepting and deciphering the codes 
used by the Nazis. We gave the Congressional Gold Medal to those Native 
American Code Talkers.
  We direct the Secretary of Health and Human Services to provide for 
the expenses incurred by any eligible Native American veteran who 
receives any medical service that is authorized by the Department of 
Veterans Affairs and administered at an Indian Health Service or tribal 
facility. We want the Indian Health Service to be able to get the 
funding to provide that health care.
  This bill also provides a provision dealing with domestic violence. 
My colleague, Senator Murkowski from Alaska, was particularly 
instrumental in this provision. We held a hearing to examine the causes 
of and solutions to stopping violence against Native American women.
  We received testimony that more than one in three American Indian and 
Alaska Native women will be raped or sexually assaulted during their 
lifetime. That is pretty unbelievable. We received reports of rapes 
that were not investigated. We received reports of circumstances where 
there isn't even the basics, just a rape kit available to take 
evidence.
  We have included in this legislation some approaches that I think 
will be very helpful: Community education programs related to domestic 
violence and sexual abuse, victim support services and medical 
treatment, including examinations performed by sexual assault nurse 
examiners, and a requirement for rape kits. I think we have made 
significant progress. I thank Senator Murkowski for her special 
interest in that section of the bill as well.
  Finally, we have a section of the bill that deals with convenient 
care service demonstration projects. The reason for that is I don't 
want to see the rest of the country move toward convenient care, walk-
in clinics with long hours, 7 days a week, only to have Indian 
reservations be out there with these clinics that serve at times that 
are not very convenient.
  I have a photograph of a clinic I visited last week on the New Town 
Reservation. They are open, I believe, from 9 a.m. until 4 p.m., 5 days 
a week. Good for them. They take an hour off for the noon hour, by the 
way, and close it. I think it is 9 a.m., maybe 8. This is the Minne-
Tohe Health Center, of the Three Affiliated Tribes. I visited there 
within the last week or so. They are open 6 or 8 hours a day, take an 
hour off for lunch and close it down. If at 5 o'clock in the afternoon, 
you are having a heart attack there, you are in trouble. If it is 
Saturday and you have a bone fracture, you are in trouble, because you 
are 80 miles from the hospital in Minot, ND.

[[Page 474]]

  My point is, why not develop a model care system of convenient care 
clinics open long hours, 7 days a week? Let's extend the opportunity 
for real health care on Indian reservations.
  We have done a lot of other things in this legislation, including 
establishing the framework for the next approach on reforming this 
system completely, and that is the establishment of a bipartisan 
commission on Indian health care which will study the delivery of this 
system and recommend approaches that we will begin working on 
immediately in the Indian health care area in our committee.
  I have described a number of items that are not positive, and I will 
later today describe some good news, because there are some positive 
things going on. One of the Indian reservations I visited in the last 
week has an Indian health care clinic that is dramatically underfunded. 
The tribal council voted to take $500,000 of the funds that belong to 
the tribal government and move it to try to support that clinic. That 
is good news. Good for them. That takes a lot of courage and 
commitment.
  There are good things happening, and I am going to talk about that a 
little later today.
  The fact is, we have a desperate situation with respect to health 
care in the Indian nation, and it cannot continue. We cannot allow it 
to continue. In the name of children who should not have died--Avis 
Little Wind or Ta'Shon Rain Littlelight or others--we cannot allow this 
to continue to happen. This country is better than that.
  I close by quoting Chief Joseph of the Nez Perce Tribe, located in 
what is now Idaho. Chief Joseph, one of the great Indian leaders, was 
pretty upset about a lot of things. Here is what he said about broken 
promises:

       Good words do not last long unless they amount to 
     something. Words do not pay for my dead people.
       Good words cannot give me back my children. Good words will 
     not give my people good health and stop them from dying.
       I am tired of talk that comes to nothing. It makes my heart 
     sick when I remember all the good words and all the broken 
     promises.

  This legislation on the floor of the Senate is not just some other 
bill. This is a step toward the completion of promises that have been 
made, not ``we hope to help you,'' but promises--promises that have 
been made in treaties, promises that have to be kept as a result of a 
trust responsibility that exists with American Indians.
  To make the case finally, let me say this: There is a chart that 
shows how much we spend per person on health care, and that chart 
describes something I think all need to know about the commitment of 
Congresses and Presidents for a long period of time.
  This chart shows we have a responsibility to provide health care for 
Federal prisoners. We incarcerate them because they committed a crime, 
and we stick them in prison. But in their prison cell, we have a 
responsibility for their health care. That is our job, and we meet that 
responsibility.
  We also have a responsibility for health care for American Indians, 
because of a trust responsibility and because of treaties we signed 
after we expropriated massive amounts of their land. We don't meet that 
responsibility. In fact, this chart shows that we spend almost twice as 
much per person providing health care for incarcerated Federal 
prisoners as we do providing health care for American Indians. That is 
why little 5-year-old Ta'Shon Rain Littlelight dies, because she 
doesn't have the same access to health care that the rest of us do. It 
is why when a woman goes to the doctor, the doctor shows up at our 
committee and testifies, saying: You know, a woman came to me who had 
been to the Indian Health Service doctor. She had a knee so bad--it was 
bone on bone--it was unbelievably painful. He said it was the kind of 
knee that, if it belonged to somebody in my family or yours, we would 
get knee replacement surgery. We would have to get knee replacement 
surgery because we wouldn't be able to live with it that way. You can't 
live with that kind of pain. But she told me she went to Indian Health 
Service, and they told her to wrap the knee in cabbage leaves for 4 
days and it would be okay. Wrap the knee in cabbage leaves. This is a 
knee which we would get replaced, yet this Indian woman is told to wrap 
it in cabbage leaves.
  Are we meeting our responsibility? People are dying. Forty percent of 
the health care need is unmet. I have described the conditions that 
exist in these health clinics and on reservations. The answer is, we 
are not meeting our responsibility, and at least from my standpoint, 
and I believe I speak for the vice chair, though she will speak for 
herself, it is past time, long past the time when this country should 
keep its promise.
  Chief Joseph is long gone, but that doesn't mean we don't have a 
responsibility to keep our promise to the first Americans. They were 
here first. To this point, we have had all kinds of circumstances over 
many years of pushing them to reservations after we took their land, 
then pushing them off the reservation and saying they had to go to the 
city. So they got a one-way bus ticket and were told: By the way, we 
want you to mainstream, to get you off this reservation. So they got a 
ticket and were sent to the city, and then we decided that was wrong, 
and we brought them back.
  What has been happening in this country in public policy dealing with 
American Indians is unbelievable, and it has to stop. Let us meet our 
responsibility, keep our promises, and provide decent health care to 
the people who were here first. That is what this bill does.
  This bill is just a step in the right direction, and it will be 
followed by significant reform. When we do that, I will feel that, 
finally, at long last, this country has kept an important promise to 
those who were here first.
  Mr. President, I yield the floor.
  Mr. GREGG. Mr. President, I ask unanimous consent to speak briefly at 
this point. I ask unanimous consent that at the completion of the 
remarks of the Senator from Alaska I be recognized for up to 10 
minutes.
  The PRESIDING OFFICER (Mr. Salazar). Without objection, it is so 
ordered.
  The Senator from Alaska.
  Ms. MURKOWSKI. Mr. President, I so appreciate the passion and the 
advocacy of my colleague, the Senator from North Dakota, and working 
together on the Indian Affairs Committee on an issue in which I think 
both of us believe very strongly. Both of us believe in the commitment 
we have to the American Indians and the Alaska Natives, particularly 
insofar as providing them with a level of access to health care. That 
commitment is one that in far too many areas we have failed, and that 
is why it is so important that we are able to advance, as the first 
legislation of this new year, the Indian Health Care Improvement Act of 
2007.
  We just celebrated the birthday of Martin Luther King, and as a 
nation we think about that time in our history when we were not proud 
of how we treated one another based on color of skin and ethnicity. We 
know that in many parts of this country, we still have far to go, but 
we are making progress. Yet, as we look to how the American Indians, 
the Alaska Natives, and so many in our Native communities have been 
treated when it comes to the basics in health care, that is an area 
where I think we need to look very critically and say we can and we 
must do more.
  When I first became the vice chair of this committee, Chairman Dorgan 
and I sat down, and he said to me: Lisa, what are your priorities for 
the Indian Affairs Committee? What is it that you would like to see 
advanced? He told me what his priorities were. It is awfully nice being 
able to walk into that new relationship and agree that the most 
important thing we could do was to work together in a bipartisan effort 
to advance legislation that has been working through the process for a 
number of years, for a number of Congresses, and to successfully move 
that through the Congress.
  We have worked on this bill through three committees of 
jurisdiction--the Indian Affairs Committee, the Finance Committee, and 
the HELP Committee--before finally bringing this here to the Senate 
Floor. I believe this

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legislation brings new hope for Indian health. It represents a step 
forward, a step toward the goal of providing our first Americans with 
health care that is on par with other Americans. It is not the end-all 
and be-all, but it is a first step, and I am encouraged that we have 
the opportunity to produce this legislation in support of that goal.
  As my colleague has noted, this day has been far too long in coming. 
Efforts to enact comprehensive reform for the Indian Health Care 
Improvement Act began in 1999. This act was extended for 1 year back in 
2001 through legislation introduced by Senator Thune when he was a 
Member of the House of Representatives. Since then, the Indian Affairs 
Committee has shepherded several reauthorization bills through multiple 
Congresses, through multiple hearings, through multiple markups, but it 
has yet to be reauthorized despite the very good efforts of a great 
many.
  This bill would reauthorize and would amend the Indian Health Care 
Improvement Act and applicable parts of the Indian Self-Determination 
and Education Assistance Act, as well as the Social Security Act.
  The Indian Health Care Improvement Act provides a basic framework for 
delivery of health care services to American Indians and Alaska 
Natives. As Senator Dorgan has indicated, this is a Federal 
responsibility arising from the Constitution, arising from the treaties 
and from Federal court cases.
  The act itself, first enacted back in 1976, was last comprehensively 
reauthorized in 1992. Think about the status of health care back in 
1992 and what has changed. Certainly, in my State of Alaska, we have 
been able to do so much more in our remote areas because of what we are 
able to do through Telehealth. Well, back in 1992, I can guarantee you 
we were not doing then what we are doing now. It is so vitally 
important that we provide for this authorization to update a system by 
passing this bill.
  We recognize there are still some outstanding issues that need to be 
resolved. I would like to think they are not central parts to this 
bill, and I am very confident we can deal with them if our colleagues 
work with us in the same very bipartisan way that we on the committee 
have done to advance this.
  Now, Chairman Dorgan has given good background in terms of an 
overview, the need for reauthorization, and he has highlighted it with 
stories that touch our hearts, as they should. I wish to elaborate a 
little bit further on the legislation, how it developed, and give that 
overview as well as some of the key improvements we have in S. 1200.
  To really understand the framework of the Indian health care system 
under this act, you have to keep in mind that there is very significant 
interplay between this act and the Indian Self-Determination and 
Education Assistance Act. The Indian Self-Determination and Education 
Assistance Act provides the process whereby Indian tribes and the 
tribal organizations contract or compact to take over administration of 
programs from the Indian Health Service. It is the interplay between 
these two statutes that provides a great deal of the backdrop for many 
of the principles that underlie this reauthorization.
  The act essentially governs programs for the recruitment and 
retention of Indian health professionals, for health promotion and 
disease prevention, for facilities, urban Indians, and a comprehensive 
behavioral health system. The act also governs important authorizations 
which increase access to care where there is third-party reimbursement. 
It also sets forth the administrative organization for the Indian 
Health Service. Finally, it contains reporting requirements and other 
regulatory authority for the Secretary of the Department of Health and 
Human Services.
  The bill is intended to improve Indian health care in three areas: 
First, by increasing access to health care; second, by updating the 
authorized services and programs; and third, by facilitating innovative 
financing systems to help support Indian health.
  So let's talk about the increase in access to care. In Alaska, we are 
talking about access to care all over the State. Geographically, as you 
know, we are very large, populations are very small, and providers are 
very limited. And this is throughout all systems, not necessarily just 
the Indian Health Service. This legislation includes programs to 
increase outreach and enrollment in Medicare, Medicaid, and SCHIP. We 
need to have aggressive outreach in order to ensure that the Native 
people who are eligible for these programs participate in them and so 
that they can navigate through a relatively challenging enrollment 
process.
  We recognized the critical importance of the Medicare, the Medicaid, 
and the SCHIP programs for Indian patients. There was an Indian woman 
by the name of Ski who lives in southwestern Oklahoma. Along with her 
husband, she takes care of her three grandchildren and her great-
granddaughter. About 4 years ago, Ski's doctor, after checking her x 
rays, found a large spot on her lungs. They also diagnosed her with 
thyroid cancer. Sadly, though, the IHS Contract Health Service, which 
is intended to provide for the kind of specialty care Ski needed, 
notified her that the funds aren't available to pay for it. This is 
very similar to some of the stories my colleague has mentioned.
  Without this additional care, Ski, who is the primary caregiver for 
her grandchildren and great-grandchild, wondered if she would be around 
to watch her children and great-grandchild grow up. Fortunately, Ski 
won't have to face the prospect of living without health care because 
she did receive it--not through the Contract Health Service but through 
Medicare. It was these resources which allowed Ski to undergo the 
biopsy which ruled out lung cancer and to see a pulmonologist and 
receive testing on a regular basis for the pulmonary fibrosis she was 
eventually diagnosed to have. She had complete removal of her cancerous 
thyroid and since that time has been able to receive the follow-up 
treatments, the testing, and the examinations, all of which we know are 
very costly but which Medicare helped to cover so that Ski can continue 
her life raising her family.
  She is fortunate and, unfortunately, somewhat of a rarity. Many 
Indian patients do not have Medicare or Medicaid to help them even 
though they may be eligible. In the legislation we have, S. 1200, it 
will help those Indian patients in accessing Medicare, Medicaid, and 
SCHIP through the outreach and the enrollment programs as well as other 
means.
  Now, accessing third-party reimbursement also helps Indian health 
providers. The Makah Tribe is a good example of why we should include 
the provisions to assist tribes in participating in Medicare, Medicaid, 
and SCHIP. The Makah Tribe is in Washington State, and they are located 
on a very picturesque 44-square-mile Indian reservation filled with 
rich forests, wildlife, birds, and plant life--a very beautiful area.
  From their home, tribal members can cross the Strait of Juan de Fuca 
and during the summers go fishing or boating in the Pacific. Although 
their home is a place of amazing beauty, it is also a very remote part 
of the State which presents some daunting challenges to the delivery of 
health services to the tribal members.
  It has been reported that the tribe operates a small ambulatory 
clinic with over 2,000 users and only two doctors. Due to the 
remoteness of the clinic, the tribe has difficulty recruiting health 
care professionals, including dentists.
  Over 70 miles away you have the nearest town with a full-service 
hospital, Port Angeles. But those 70 miles can be treacherous to 
negotiate. It is a winding road, a difficult road. There are several 
instances when the road has been washed out by storms, leaving no 
access to or from the reservation.
  So there is no surprise that Port Angeles, being a larger town and a 
more accessible town, has salaries that are more attractive than the 
reservation.
  The Makah Tribe administers the health care services through a self-
governance compact for which the tribe should receive contract support 
costs.

[[Page 476]]

However, those contract support costs do not cover all of the indirect 
costs of health care services. So this impacts the tribe's ability to 
provide for competitive salaries and to provide for that full array of 
health care services. But despite all of those challenges, the Makah 
Tribe has remained resourceful. They are in the process of improving 
their third-party reimbursements, in particular the Medicare Part B 
access for eligible people on the reservation.
  It is these additional reimbursements that assist the tribe in 
essentially hedging against the insufficient contract support costs. So 
when you hear of situations like what we are seeing with the Makah, 
recognize this legislation will serve to benefit the tribal health 
providers as well as the Indians who are served by allowing for, again, 
the additional reimbursement for improving access to care.
  The legislation will also improve access by removing barriers to such 
enrollment such as the waivers of Medicaid copays and allowing the use 
of tribal enrollment documentation for Medicaid enrollment. These are 
very important to provisions in this legislation. I hope we will hear 
more of the good stories, the stories like Ski's, rather than the very 
damning stories we hear of the system currently.
  Now, in updating health care services in Native communities, the bill 
establishes permanent authority for home and community-based services, 
and these are services which have been operating in the State of Alaska 
with very impressive results.
  I mentioned just a few minutes ago Alaska's size. Many know Alaska 
Natives have to travel enormous distances away from their home 
communities to obtain any level of specialized care. Some people think 
we make this map up, just to show Alaska's shape over the continental 
United States--but this is actually true to size--the State of Alaska 
does stretch from just about Florida into Arizona and beyond, from 
Canada down to the southern area. Geographically, we are huge.
  We have another chart that indicates how the distances for an 
individual coming from, let's say, Unalaska down here where Arizona is 
on the map. Unalaska is not only our State's largest fishing port, it 
is the largest, in terms of volume of fish, fishing community in the 
United States of America.
  For an individual who is coming from Unalaska, which just has a small 
clinic, to come to Anchorage, which is where all of the points converge 
in the middle of the map, it is the equivalent of essentially going 
from Arizona to Kansas for your medical appointment to come to the 
Alaska Native Medical Center where you can see a specialist.
  To give another example, the residents of Barrow, at the northern 
most part of the State, also have to travel to Anchorage to obtain 
specialty medical services in the Alaska Native Medical Hospital. That 
is the distance of coming from the Canadian border down to Kansas for 
medical services.
  If you are coming out of the southeastern part of our State, in many 
of our island communities, again, you are moving from essentially 
Alabama or Florida into Kansas. The distances we deal with to provide 
access to care are realities for us in the State that other people 
cannot relate to.
  We are not talking 100 miles, we are talking several hundred miles. 
When you put it in context that way, you recognize it is not just the 
time and the distance traveled, but it is the expense and the distance 
traveled.
  Mr. President, as I was mentioning the distances that we deal with, I 
mentioned the time to travel, the expense to travel, but think about 
the situation if perhaps you are elderly, you are ill, or perhaps you 
do not know what is wrong, and you have to leave your village to go to 
our cities, our largest cities, which is very intimidating for many of 
our Alaska Natives in the first place.
  They are away from their family, they are away from their community 
members, they are away from their traditional foods, they are away from 
their traditional activities. Many of our elders do not speak English, 
so they are coming into town where the language is different. Think 
about how well you would heal or how well you would feel in truly a 
strange and foreign place like this.
  Well, the Yukon-Kuskokwim Health Corporation located out in Bethel, 
Alaska, in western Alaska, decided this is unacceptable, to have to 
pull everybody from the villages so far away. And they developed a 
village and a regional service structure to help the elders, to help 
the Alaska Native patients with chronic diseases to continue living in 
their homes or in their community rather than being sent hundreds of 
miles away to receive special nursing care.
  It was their pilot program to take over all home and community-based 
care in their region, which resulted in a reduction in service waiting 
time for the disabled and the elders in the region and truly improved 
the patients' health status level. This legislation may enable other 
tribal programs around the country to also engage in home and 
community-based care which would allow Indian patients to remain in 
their homes rather than face a lengthy hospital stay or nursing home 
stay in a distant and, again, a strange location.
  Our legislation also consolidates and coordinates the various tribal 
health programs into a more comprehensive approach. As we well know, 
alcohol and drug abuse among many of our Native communities, and 
methamphetamine abuse, has reached epidemic proportions in some 
communities.
  We had a gentleman, the former chairman of the Northern Arapahoe, Mr. 
Richard Brannan. He testified before our joint hearing before the 109th 
Congress, and then again during the 110th, and told us truly a heart-
breaking story of the tragic and painful and terrible unnecessary death 
of a beautiful little Indian girl at the hands of methamphetamine-
addicted individuals.
  Chairman Brannan sought our help in providing both prevention and 
treatment for the drug and alcohol addictions that ravage Native 
communities. I am pleased that this bill will authorize such assistance 
and more to help prevent these tragedies from happening to other Indian 
children.
  Now, also during the committee hearing on the methamphetamine plague, 
we received testimony from tribal leaders about the devastation this 
terrible drug has brought to their communities. Kathleen Kitcheyan, the 
former tribal chairwoman of the San Carlos Apache Tribe in Arizona, 
described a very personal loss, a tragic loss of a grandson to drugs. 
And she stated that on her reservation, they have methamphetamine users 
who are as young as 9 years old.
  Think about what is happening to our children. Think about drug abuse 
and the addictions. But to know that children as young as 9 years old 
are being made the victims, we should all be alarmed when we hear 
stories like this. And what is equally horrifying are the residual 
effects of methamphetamine abuse on children. The former chairwoman 
testified how babies were being born on the reservation, born addicted 
to methamphetamine, with physical deformities. She stated that on her 
reservation a 22-year-old methamphetamine user tried to commit suicide 
by stabbing himself with a 10-inch knife. So many terrible stories. 
There were 101 suicide attempts on her reservation during the year 
2004, 101 attempts that were directly related to meth.
  Now, I have described that we are seeing methamphetamine users as 
young as 9, but it also afflicts the middle-aged as well as the 
elderly. Once meth has taken hold, few can escape without considerable 
help. The Indian Health Service estimates it takes well over 60 days in 
treatment programs in order to overcome these addictions. So just 
separating a methamphetamine addict from the drug for a period of a few 
weeks or even a month is not nearly enough to provide effective 
treatment, not nearly enough to break the addiction. The 
methamphetamine addicts need the long-term treatment necessary to allow 
their mental and their physical state to heal and to recover.
  For the children, the IHS has 11 federally funded youth regional 
treatment

[[Page 477]]

centers with 300 beds overall. In addition, there are an estimated 47 
or perhaps 48 tribal and urban residential programs for adults. One 
program, the Native American Rehabilitation Association in Portland, 
OR, which is an urban Indian facility, can also house the patient's 
family so the patient can also receive the very necessary family 
support during the recovery.
  These programs authorized under the Indian Health Care Improvement 
Act, and more importantly the Indian and Alaska Natives who are 
suffering from meth addiction, will benefit from the updates to the 
behavioral health program in this bill.
  Now, we heard from Chairman Dorgan that the Indian health system is 
funded at approximately 60 percent of the need. And with the new health 
hazards, whether it is methamphetamine or whatever the hazard is, that 
face our Native communities, we have to be innovative in finding 
solutions and resources in building upon the foundations that are set 
forth in the Indian Health Care Improvement Act.
  This legislation will establish the Native American Wellness 
Foundation, a federally chartered foundation to facilitate mechanisms 
to support but not supplant the mission of the Indian Health Service. 
It is modeled after legislation which passed the Senate in the 108th 
Congress. I am pleased to say we will have an opportunity to advance it 
in this legislation as well.
  I wish to mention two key provisions that have been briefly 
mentioned. This is regarding the issue of violence against Native 
women. In the substitute we hope to advance later, we will provide for 
authorization of prevention and treatment programs for Indian victims 
and the perpetrators of domestic and sexual violence. We will also 
provide critical incentives for Indian health providers to obtain 
certification and training as sexual assault nurse examiners or in 
other areas to serve victims of violence. Both these provisions build 
upon very important work this Congress did in the Violence Against 
Women Act, by addressing some of the systematic shortcomings to improve 
prosecutions, such as forensic examinations. I will speak on this a bit 
later.
  One of the things we heard in testimony before the committee was that 
in many of our IHS facilities, they did not have rape kits available. 
They could not collect the forensic evidence. If you don't have the 
evidence, you cannot proceed with prosecution. When you hear stories 
such as this and ask for confirmation that, in fact, this is the 
situation, that we simply don't have the kits available--it is 
confirmed--it is no wonder women feel helpless in even seeking 
assistance after a violent act such as a rape. In addition, simply not 
having the training for the nurses at the clinics, these are areas of 
critical shortcomings and ways we can help to make a difference.
  There are many good things in this bill, but I do wish to impress 
upon Members this is truly a national bill. It works to benefit Indians 
and Indian health programs in communities across the spectrum. I have 
mentioned that it has been a product that has been in the works for 
years, a very determined effort on the part of Native health leaders 
truly from all corners of our Nation. There are over 560 Indian tribes 
in this country, with 225 of those tribes in Alaska alone. Our Indian 
tribes and Indian health care system span the Nation from Maine to 
Florida, California to Washington, and, of course, to Alaska up North. 
According to recent information from IHS, over 1.6 million American 
Indians and Alaska Natives receive services in this system at over 600 
facilities. These facilities are all over the board, in terms of what 
they can provide, ranging from inpatient hospitals, general clinics, 
and health stations.
  There are some that look beautiful and there are some that you look 
at and say: We can do far better.
  I mentioned earlier many Natives in the State travel into Anchorage 
from outlying areas to receive care at the Alaska Native Medical 
Center. As you can see behind me, it is a large, beautiful facility. It 
is designed to provide for that advanced level of care and specialty 
for Alaska Natives from around the entire State. But as one travels 
away from Anchorage, and you get off the road system out into the bush, 
the facilities vary in size and certainly in service and are certainly 
much more modest. We have a picture of the clinic in Atka, AK. It is a 
little rough around the edges, certainly, but they are able to provide 
for the basic needs in that region. I checked to identify some of the 
other challenges the folks in Atka face, in terms of their costs. This 
is a village where gas is selling for $5.09 a gallon, and home heating 
oil is going for $4.99 a gallon.
  We have a picture of the clinic at Arctic Village which is located 
more in the central or interior part of the State. I checked with them 
this weekend on the price of gas per gallon. It is 7 bucks a gallon. 
Their home heating oil costs are $6.36 a gallon. So it is expensive to 
live out there. It is expensive to heat your home. When you are ill or 
need help, this clinic is where you go in Arctic Village.
  We know the need is extensive. The Indian health care system has to 
provide everything from basic medical to dental to vision services and 
medical support systems. It has to include the laboratory, nutrition, 
pharmaceutical, diagnostic imagining, medical records. Obviously, they 
are not providing that there at Arctic Village.
  Senator Dorgan had mentioned the history of the Indian health care 
system. I will not take the time today to speak to that. I do, before 
taking a break, wish to take time to talk about some of the updates to 
the current Indian health care system we have in this legislation. As I 
mentioned, there have been enormous changes to the medical system since 
the last reauthorization of the Indian Health Care Act in 1992. So in 
order to update and provide for an improvement in the overall status of 
the American Indian and Alaska Native health and well-being, we have to 
make sure our facilities access is better.
  Chairman Dorgan mentioned some of the health statistics and mortality 
rates we see among American Indians and Alaska Natives. We know these 
populations are dying at higher rates than others within the U.S. 
population. On tuberculosis, for American Indians and Alaska Natives 
the rate is 600 percent higher; alcoholism, 510 percent higher; 
diabetes, 229 percent higher; unintentional injuries, 152 percent 
higher; homicides, suicides higher. The statistics are all so troubling 
as we look to what we are providing and whether we are seeing 
improvement.
  As I say that, we have seen some gains. With passage of the Indian 
Health Care Improvement Act of 1976, there were some pieces of good 
news insofar as decreases in mortality rates over the past 35 years. 
The average death rate from all causes for the American Indian and 
Alaska Native population dropped 28 percent between 1974 and 2002. We 
have seen gastrointestinal disease mortality reduced. Even though the 
death rate for Indians is 600 percent higher than the rest of the 
United States, we have seen tuberculosis mortality reduced 80 percent, 
and cervical cancer mortality has been reduced. Infant mortality has 
been reduced 66 percent. We are seeing good news there. The problem is, 
we started at such high levels. So, the statistics are still 
unacceptable.
  In addition, we have population growth and economic factors which are 
creating strong pressure on American Indian and Alaska Native 
communities and their health care facilities. From 1990 to 2000, the 
population grew at a rate of 26 percent among the American Indian and 
Alaska Native populations. Compared to the total U.S. population, it 
grew by 13 percent. But we know the health care funding for Native 
people simply has not kept up with the expanding population and 
inflation.
  This effective reduction in health care funding creates our current 
health status level. We see the survival rate improving, but all we 
need to do is look at the charts, look at the statistics. We know 
Indians and Alaska Natives still suffer disproportionately from a 
number of health problems. We know, for instance, in the area of 
diabetes, the rates are unacceptably high. While we recognize the 
Indian Health Service is

[[Page 478]]

trying to get this diabetes crisis under control--they are providing 
diabetes care to greater numbers of Native people than ever before, and 
we see some success--is it adequate? Is it sufficient?
  Another area where we are seeing some success is in the area of 
vaccinations. We are getting higher vaccination rates for adults over 
65. These have been instrumental in helping with some of our health 
statistics. Screenings, such as for fetal alcohol syndrome, have been 
helping to reduce the burden of preventable disease.
  One of the aspects we face in increasing efficiencies within the 
delivery of the health care system, we know we have to use new 
technologies, new techniques, and these are contemplated and outlined 
in many areas of the legislation before us. I will go back to Alaska as 
an example of a State that faces very unique challenges in providing 
for quality health care to the residents in rural Alaska. The majority 
of the 200 rural Alaska Native villages are not connected to a road 
system. We don't have the roads. We are 47 out of 50 in ranking of 
States for the number of road miles, but we rank first out of 50 for 
overall land mass. We simply don't have a road system to speak of in 
much of Alaska. When you don't have a road system, you fly. We fly in 
small bush planes. During the summer months, we rely on skiffs and 
riverboats to get around. But for the most part, we fly. It is not 
luxury travel. It is a basic need.
  From the chart I have behind me, you can't see the names of all the 
towns there, but it is there to demonstrate what we deal with as a 
State. When you look at the IHS budget in Alaska, you may be surprised 
to see the travel budgets are unusually large, oftentimes larger than 
staff budgets. That gets people's attention. Are we going out to 
conferences? No. This is how we get around in the State of Alaska and 
how we move our patients, those who need to get to that medical 
specialist. We move them by airplane. Up in the north there you see a 
community of Barrow. Nuiqsut is a small village outside of Barrow. They 
have a small clinic. Barrow has a larger one. But in order to receive 
any level of specialty care, an Alaska Native would have to fly about 
700 miles south to Anchorage to the Alaska Native Medical Center. The 
cost of that particular flight is $1,100 for that person coming out of 
Nuiqsut.
  Over to the west, out on St. Lawrence Island, an individual who is 
ill in Savoonga and needs to come into Anchorage for medical care is 
going to pay about $1,000. This is round trip, not that that makes it 
any better.
  Down south of Anchorage, off of Kodiak Island--and if you look at the 
red lines, it looks as if it must be much closer to Anchorage and 
therefore less costly--if you are coming from Old Harbor on Kodiak 
Island, your airfare is going to be about $1,350 round trip to get you 
to and from.
  So when we factor in the budgets of doing business, travel costs are 
enormous. This is all about access. We also recognize it is not just 
the cost. Oftentimes during the winter--this time of year--travel is 
shut down completely. For some of our communities, because of weather 
conditions, fuel barges have not been able to get into the community, 
and they have had to fly fuel in to provide for the diesel generation 
that provides the power in these villages.
  Whether it is the ice, the wind, the snow, oftentimes it is just too 
dangerous to make the trip into town. Blue Cross has estimated that it 
is 300 times more expensive to operate a hospital or a clinic in Alaska 
than it is in the continental United States. These are the expenses we 
deal with.
  In the last 10 years, we have seen access to medical specialists and 
health care improve. Working with my colleague, Senator Stevens, we 
have seen a revolution in terms of how health care is delivered to our 
rural villages with the development of an advanced telehealth network. 
With 99 percent of the telehealth initiative coming from IHS funding 
and managed by the Alaska Native Tribal Health Care Consortium, the 
Alaska Federal Health Care Partnership is a collaboration with the 
Department of Veterans Affairs, the Department of Defense, and the U.S. 
Coast Guard. They teamed up together to develop the Alaska Federal 
Health Care Access Network. They developed a special telehealth cart, 
and they deploy these carts to small villages in rural Alaska. They are 
able to provide a very wide variety of clinical services, including 
cardiology, community health aid training, dental and oral health, 
dermatology, ear, nose and throat care, as well as emergency room 
services.
  They had a demonstration cart here a couple years back to just kind 
of show us what it is they were doing. I had just come off a trip up 
north, and I was due to fly again very soon. My ears were all plugged 
up. I said: Well, show me how this works. Just standing right there, 
they put a little monitor in my ear, and they were talking to a doctor 
in Anchorage. He said: You just have a little inflammation there. You 
are fine to fly.
  What we are able to do with telehealth is to connect many of our 
Alaska Natives in a very cost-effective way for them to have access to 
qualified health care specialists without necessarily leaving their 
village.
  We continue to evaluate the cost savings we are seeing as a 
consequence of this telemedicine. The preliminary data suggests that 37 
percent of the time, telemedicine prevented the need for a patient and 
family escort to travel. That saved an estimated $4.4 million in travel 
costs. So if you can save $4 million in travel, because we have the 
technology in front of us, it is a savings for all of us.
  Tribal health providers in Alaska with their Federal counterparts 
have been extremely innovative in addressing the unique health care 
challenges of our State. The Alaska Federal Health Care Access Network 
has been working with the IHS service areas to expand quality and 
affordable health care to American Indians across the United States.
  The new opportunities, such as expanded telehealth, found in S. 1200 
serve important purposes in promoting good investments. Indian tribes 
and tribal organizations have performed admirably in developing their 
health care services and facilities. These types of efforts should be 
rewarded and encouraged by passage of this bill.
  There are some other items I would like to speak to, and I may come 
back to them at another point in time. But before I conclude for now, I 
want to mention the importance of the program in the sanitation 
facilities area.
  I could probably stand all day justifying the need for the 
reauthorization, but one area that has been demonstrated to be one of 
those very important functions in reducing health disparities is the 
Sanitation Facilities Program. This program governs the construction, 
operations, and maintenance of sanitation facilities providing clean 
water and sanitary disposal systems to Indian and Alaska Native 
communities.
  For us in Alaska, the issue of sanitation is one we have been 
struggling with for far, far too many years. One in three families--one 
in three families--in rural Alaska has no sanitation facilities. We are 
not talking about upgraded sanitation facilities; we are saying no 
sanitation facilities. What we have in many of our villages, still, 
unfortunately, is a system we refer to as the honey-bucket system. It 
is not a very refined system. In fact, it is a system that, for those 
of us in the State, we look at with shame and say: For Alaska Natives, 
for Alaskans to have to rely on this as their sanitation system is 
offensive. It is close to Third World conditions, and here we are in 
the United States of America, and you have a system where human waste 
is collected in a bucket and hauled outside and dumped in a collection 
facility. In some areas, it is less than a collection area; it is 
dumped in a lagoon. You can walk through some of these communities, and 
you have waste that is spilled along the wayside.
  I have in the Chamber this picture of these two little Native boys. 
It is like the equivalent of taking out the trash--taking out the honey 
bucket. If you do not think this does not contribute to some of our 
health issues in rural Alaska, you have not looked at the facts.

[[Page 479]]

  In testimony before the committee, we had Steven Weaver. He is from 
the Alaska Native Tribal Health Consortium. Steve Weaver has been very 
instrumental working with us in order to eliminate the honey bucket. 
But he spoke at that hearing to the challenges families face in 
communities without sanitation facilities. He said: Other folks in 
America have the convenience of running water and inside flushing 
toilets, but in too many of our Native communities we have to haul the 
clean water into the homes and then haul the honey buckets out of the 
homes as part of the household chores, part of the daily living.
  I was in a community several years back and visited the health clinic 
there. It was a very small health clinic. It was one of the villages 
that still do not have running water. There was a honey bucket in the 
corner of the health clinic. When you think about the need for 
sanitation, particularly in your clinic, and you realize there is no 
running water and the human waste must be discarded by walking it out 
the door, the health consequences in communities without running water, 
without sewer are very real.
  The Alaska Native Tribal Health Consortium reported that infants in 
communities without adequate sanitation are 11 times more likely to be 
hospitalized for respiratory infections in comparison to all U.S. 
infants and 5 times more likely to be hospitalized for skin infections 
than those in communities with adequate sanitation.
  We have about 6,000 homes without potable water, about 18,650 homes 
that need improvements or upgrades for water, sewer, or solid waste.
  This legislation, S. 1200, will maintain the Sanitation Facilities 
Program. For us in a State such as Alaska, this is vitally important.
  Mr. President, at this time I am prepared to defer to Senator Gregg. 
He has been waiting some time. I do have additional comments I will 
make throughout the day, but I yield the floor at this time.
  The PRESIDING OFFICER. The Senator from New Hampshire.
  Mr. GREGG. Mr. President, I ask unanimous consent that Senator 
Stevens be recognized for up to 10 minutes following my remarks.
  The PRESIDING OFFICER. The Senator from North Dakota.
  Mr. DORGAN. Mr. President, is the request for a presentation on the 
bill without amendment?
  Mr. GREGG. Mr. President, I have no knowledge of what the request is 
other than a request for 10 minutes of remarks.
  Mr. DORGAN. Mr. President, I will agree to that request with the 
understanding it is on the bill without an amendment. I would also like 
to add to the request that Senator Bingaman be recognized to offer an 
amendment immediately following the presentation by Senator Stevens.
  The PRESIDING OFFICER. Is there objection to the request, as 
modified?
  Without objection, it is so ordered.
  The Senator from New Hampshire.
  Mr. GREGG. Mr. President, I wish to speak on a subject which is not 
related to this bill. I congratulate the managers for bringing this 
bill forward.


                            Stimulus Package

  Mr. President, the subject I rise to speak about is one that is 
fairly topical to today's events, obviously, with what is happening in 
the international markets and in the stock market and with the Federal 
Reserve System, and that is the issue of how we as a Congress should 
proceed relative to what has been called a stimulus or growth proposal.
  I want to put down what I would call a red flag of reason, let's call 
it, as we move forward on this stimulus package. Let's first understand 
what the problem is we are confronting.
  The economy has a serious overextension of credit. This overextension 
of credit occurred because, as often occurs, there was a period of 
exuberance in the credit markets.
  Now, I have had the good fortune to be involved in Government and in 
the private sector for a number of years, and I have seen this type of 
situation arise at least two major times during my career, once when I 
was Governor of New Hampshire. What happens is people who make loans 
suddenly find they have a lot of cash available to them to make loans, 
and they go out and start making loans based on speculation that it can 
be repaid rather than on the capacity of the individual they are 
lending the money to to repay it or based on speculation that the 
collateral for that loan will always maintain its value as originally 
assessed when, in fact, that collateral may be overstated.
  This usually comes at the end of what is known as a business cycle, 
when basically you have a lot of people out there who probably have not 
been through a downturn before in their lives who basically put out 
credit at a rate that is irrationally exuberant--to use the terms of 
Mr. Greenspan on another subject of the late 1990s bubble--and as a 
result, credit is put out that, in this instance, was put out at a rate 
and to individuals who basically did not have the capacity to repay it 
under the terms of the credit, and with collateral that did not support 
it.
  This exuberant expenditure of credit or promotion of credit was 
compounded by the fact that we had an inverted pyramid created. That 
item of credit, that loan that was made, which was made on collateral 
which didn't support it and which was made to an individual who 
probably didn't have the ability to repay it under the terms that it 
was made on, that item was then sold and it was sold again, and then it 
was turned into some sort of synthetic instrument which was multiplied 
and created more sales of the item. So you have basically an inverted 
pyramid, where that initial loan, which had problems in and of itself 
on the repayment side and on the collateral side, was compounded by a 
reselling of the loan over and over again in a variety of different 
markets and through a number of different instruments, which 
essentially exaggerated the implications that that loan should not be 
repaid. So that is what has happened. The loans can't be repaid, in 
many instances, or the collateral isn't there, in many instances, so 
these loans start to get called and they start to be foreclosed on. 
Because they can't be repaid, the lenders find themselves in a 
situation where they have to obtain liquidity from somewhere else. So 
they start to contract their lending to basically people who can repay 
because they must maintain a strong balance sheet, they must maintain 
their capital reserve, and as a result it feeds on itself and you have 
a liquidity crisis.
  That is a classic business cycle. It is a classic end to a business 
cycle, and that is what we are in today. It is unfortunate and it 
causes great personal harm and trauma and it obviously disrupts the 
economy and people and it affects people's lives. People are damaged by 
this. Its roots basically go to the fact that there were people lending 
money to people who should not have been lent money under the terms 
they were lent it without the collateral they needed for support.
  So how do we react to that? How do we keep that from snowballing into 
a massive slowdown in the economy or a possible potential recession? 
Well, the discussion is to stimulate the economy through some sort of 
fiscal policy and the Federal Government taking action--what is known 
as fiscal policy. There is also, of course, the monetary side. Today 
the Federal Reserve cut the rates by 75 basis points, and as a result, 
the market reacted, although it was hugely down when they started. I 
haven't looked at it recently. I don't know that it reacted in a 
positive way to that cut in rates.
  On the fiscal side, there is a lot of discussion about stimulating 
the economy. I guess my red flag of reason I am putting out here is, if 
we are going to stimulate the economy through fiscal policy, let's at 
least do it correctly. Let's not do it in a way that damages the 
economy or the future or that basically gets you a short-term political 
headline but doesn't get you the impact you need, which is to help 
people through a difficult economic period.
  The proposals which are out there, most of which I have seen, have 
fallen into two categories. One is stimulate the economy by giving 
people money to spend and the other is to stimulate the

[[Page 480]]

economy through energizing small business and large business to invest 
in economic activity. The problem we have with a stimulative event, 
which is basically giving people $100, $200, $300, $400, whether you 
give it to them directly or whether you give it to them through the tax 
laws, is that money will be spent, but does it stimulate our economy? I 
am not so sure. So much of the product we buy in America today, that we 
consume in America today is produced outside the United States: Maybe 
it stimulates the Chinese economy, but I am not so sure it stimulates 
our economy. What may be raising the Chinese economy may raise the 
national economy and that helps us out, but as a practical matter, I am 
not sure it gets a big bang for the bucks expended, and, most 
importantly, what happens when you take that sort of action is you 
borrow this money. This money doesn't appear from nowhere that you are 
going to put out into the marketplace and say: Here, American citizen, 
we are going to return you X dollars through a direct payment--probably 
an inverted tax payment of some sort, for people of low income who 
aren't basically paying taxes are going to get some sort of payment; 
middle-income people will get a lesser payment or some marginal 
payment. That money has to be borrowed. That money gets borrowed from 
our children. The practical effect of borrowing that money, if it is a 
$150 billion one-time event, is it compounds because there is interest 
on top of that and it grows into a lot more money. Then our children 
and our children's children end up having to pay it back. So do you get 
the value? Is there a value there that is large enough to justify 
putting this debt on our children's backs for this type of stimulus 
event? I think we have to look at that very seriously.
  There are proposals out there that we should essentially waive the 
Social Security payment, for example; that we should say we are not 
going to require people to make their Social Security withholding 
payment for 1 month or 2 months or whatever the number would be that we 
would settle on. That, as a policy matter, has very serious 
implications for our children and our children's children. Essentially, 
the Social Security system is supposed to be an insurance system, where 
you as a working American pay into the system so when you retire, you 
have paid into the system money which is then returned to you through 
Social Security payments for your retirement. It is and historically 
has been viewed as an insurance policy approach, with the Federal 
Government managing the insurance. Yes, nobody is going to argue the 
fact that the Social Security system in the outyears does not have the 
resources to repay the liabilities that are on the books. That is a big 
issue for us and it is a function of the retirement of the baby boom 
generation. But you only radically, quite honestly, aggravate that 
problem by borrowing from the Social Security Administration to 
essentially fund the short-term fix of a stimulus package.
  First, you have created a brandnew event, which has never happened in 
my knowledge, of taking Social Security dollars and moving them over 
for the purposes of an expenditure which is a day-to-day operation of 
Government expenditure. You are basically formally saying the Social 
Security dollars which are paid in, in taxes, can be used for something 
other than the purposes of creating obligations which will be paid back 
in the form of retirement payments. You are saying Social Security 
dollars will go directly--without any obligation being shown on the 
Social Security balance sheet--will be taken off the Social Security 
balance sheet and put directly into the day-to-day operation of 
Government for the purposes of paying people a stimulus event of $500 
or $600. The implications of that are huge, from a public policy 
standpoint.
  We are basically totally readjusting our approach as a nation toward 
Social Security. You are basically saying Social Security is a dollar 
in, dollar out purpose, with absolutely no fund and that there is no 
offsetting balance being set up for Social Security payments, which is 
used later to pay down the Social Security responsibility. That is a 
terrible precedent. It may be a theoretical debate, but it is one heck 
of a big precedent to create that sort of new paradigm relative to 
Social Security.
  Again, what do you get for it? You get a momentary stimulus which may 
or may not help our economy, because as we all know, most of that 
consumer event is going to occur with the purchase of products produced 
outside the country, to a large degree, and you don't get any long-term 
action which is essentially going to improve the financial viability of 
the Social Security system. In fact, you significantly aggravate it 
because, again, you compound that event, and compounding interest has 
an amazing effect in the area of what will end up as the total cost of 
that one-time event. Ask the notch babies about that. So this is a 
policy choice which I think would be truly destructive to the 
historical role of Social Security in our Government and would be 
equally probably nonproductive as a stimulus to our economy and 
probably do more damage than good.
  There is also the proposal that we extend unemployment insurance for 
another 2 weeks, 3 weeks, 4 weeks. Well, that has some arguably 
positive benefits if you are into a recession, but we are not in a 
recession. We have essentially what has historically been deemed full 
employment in this country, which is we are at about 5 percent of 
unemployment. When you extend unemployment and you have full 
employment, you are basically creating an atmosphere where people who 
are on unemployment have no incentive to go out and find a job, even 
though there may be a job available because you are at pretty much a 
full economy. So are you being destructive to the system or are you 
actually reducing productivity to the system when you make that choice? 
I would say that is a very debatable issue and one which needs to be 
looked at before we take this action.
  I understand that politically it is a great press release: We are 
going to extend unemployment for 2 weeks for people who are out of 
work. Yes, that is a great press release, but if you have earned 
literally at full employment, which is where we appear to be right now, 
or pretty close to it, then to extend unemployment at this time could 
be counterproductive, significantly counterproductive to keeping the 
economy going, because it would not allow people to go out and find 
jobs for whom jobs may be available.
  Now, if we do move into recession, which is----
  The PRESIDING OFFICER. The Senator from New Hampshire has used his 
allotted 10 minutes.
  Mr. GREGG. I ask unanimous consent for an additional 5 minutes.
  Mr. DORGAN. Mr. President, Senator Stevens is to be recognized 
following Senator Gregg and then Senator Bingaman, both of whom I 
believe are here. Certainly, if the Senator wishes I would not object, 
but both I think have been waiting for some period of time on the bill.
  Mr. GREGG. I appreciate that, and I will try to make this brief and 
wrap up in less than 5 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. GREGG. So we have that issue, which is fairly significant. The 
real goal of a stimulus package should be to create an atmosphere where 
we actually improve the underlying pillars of the economy, and that 
means we improve productivity, we improve the incentive of people to be 
productive and go out and create jobs, and that can be done if we need 
to do this, and that is very much an issue--that can be done through 
initiatives which are productive, or which are on the productive side 
of the ledger rather than just on the spending side of the ledger.
  I know, historically, people have said: Well, inject money into the 
economy and that will make it move. That was before we got to an 
international economy, where essentially injecting money into the 
economy so consumers can spend money basically moves the Chinese 
economy, not necessarily ours. What makes much more sense is if we are 
going to inject money into this economy through some sort of Federal 
initiative, we should do it in a way

[[Page 481]]

where we create economic benefit to our economy, by making it more 
productive and thus creating more jobs and creating more incentive for 
entrepreneurs. There are a lot of ways to do that. As we proceed down 
this road to discuss this issue of stimulus, I will continue to discuss 
that point and get specific on ways we could do that.
  So I wished to raise this sort of red flag of reason before we step 
on to this slippery slope of a stimulus package which could easily end 
up being primarily a spending package, for the purposes of addressing 
whatever anybody happens to deem to be a good political spending issue, 
that before we step on that slope, we take a hard look at what we will 
end up with in the way of producing benefit for people today versus 
producing debt that our children will have to repay and maybe 
undermining our economy generally for the long term.
  I yield the floor at this time.
  The PRESIDING OFFICER. The Senator from Alaska is recognized.
  Mr. STEVENS. Mr. President, I am pleased to speak today in support of 
my colleague, Senator Murkowski, and explain my strong support for the 
passage of S. 1200 which will reauthorize the Indian Health Care 
Improvement Act.
  It has been 15 years since the Indian Health Care Act was 
reauthorized and almost 10 years during which reauthorization bills 
were introduced in the Congress but received no action. Great advances 
in the models for the delivery of health care have occurred during this 
time which need to be incorporated into the Indian health care system. 
This bill does that. The health needs of Alaska Natives in our State 
and American Indians throughout the country continue to grow. It is 
important we pass this bill.
  Ten years ago, we opened the Alaska Native Medical Center in 
Anchorage. It is the only tertiary care hospital in the Indian health 
care system. At the same time, we created the Alaska Native Tribal 
Health Consortium, and Alaska Natives took over the management of the 
entire Native health care system in our State.
  I believe much has been done in the last decade. Alaska now has the 
best health care system in the entire country. The reason, in my 
judgment, is that the system is operated by the Alaska Native people, 
who have shaped it to fit their own needs. But Alaska Native health 
leaders across our State have told me again and again that they believe 
this legislation needs to be passed because it contains new provisions 
to aid delivery of health care to the Indian people. It is necessary to 
continue their critically important work.
  This Indian Health Care Improvement Act is a comprehensive bill. 
Every aspect of what it takes to improve a true system of care to the 
Alaska Natives and the American Indians is in this bill.
  The health status of Alaska Natives and American Indians is poorer 
than that of the average American. It is poorer than what the average 
American receives. Many of our people live in remote communities with 
little economic base, high unemployment rates, and low income levels. 
These conditions create a ``perfect storm'' of health care obstacles 
for Alaska Native people. These people must travel farther than others 
throughout our country to receive health care services. They are less 
healthy than the average American, and they have more medical issues 
they face because of the circumstances under which they live.
  In Alaska, many communities are not served by roads. For instance, a 
pregnant woman living in Adak, way out on the Aleutian chain--almost 
1,200 miles from Anchorage--must travel by air to deliver her child. 
She must fly to Anchorage to do that. As she does, she will have flown 
more than 5 hours, and she will be flying on a plane that is only 
available 2 to 3 days a week. As it is almost everywhere in Alaska, the 
weather conditions are really great problems and can delay the start of 
such a trip for a week or more. Of course, all of these concepts 
increase the cost of health care, but it is the availability of health 
care that counts, and it is really difficult for our people to get to 
the areas where health care can be provided to them.
  The Alaska Native Tribal Health Consortium and the Native health 
organizations in our State have worked hard to improve the health 
status of our Native people. Rates for diseases, such as tuberculosis, 
have dropped dramatically, and we have improved access to health care 
and basic public health measures, such as childhood vaccinations, and 
installation of water and sewer systems in rural Alaska has also 
improved our health care. Between 1950 and 2007, Alaska Native life 
expectancy rose from 46 years to 64 years of age. Those are 
improvements brought about by health care.
  However, in Alaska, as in other parts of the country with Indian 
populations, many infectious diseases have increased, and other health 
problems have taken the place of those we have eliminated. Respiratory 
illness outbreaks threaten the lives of Native babies and toddlers and 
fill our hospital beds in the Yukon-Kuskokwim area of our State every 
winter. Noninfectious conditions, such as suicide, violent injury, and 
intentional injury, still plague Alaska Natives at a very high rate. As 
the population ages, rates of cancer, heart disease, and diabetes 
threaten the gains we have made in life expectancy.
  The Alaska Native health system has been innovative and pioneered 
access to and delivery of health services to the Native people in 
Alaska. Yet huge disparities continue to exist. This bill needs to be 
passed and funding increased to address these health disparities to 
save and improve lives in Alaska and to reduce the cost of health care 
throughout our area and Indian Country.
  Title I of this Indian health care bill provides support for Native 
people to receive training as health workers. Each year, Alaska Natives 
and American Indians complete their education, supported in part by 
programs authorized under title I, and return back to their home to 
take positions as nurses, doctors, social workers, behavioral health 
specialists, and administrators--all to improve the health care system.
  The Alaska Community Health Aide Program, which is an important 
example, is an outstanding example of innovation in the delivery of 
health care in remote communities.
  When I came to the Senate, there was hardly any health care in our 
Alaska villages. They received their health care by the wife or a 
spouse of the superintendent of the Indian school or native school, 
calling in to Anchorage, their one central hospital. There were no 
health aides. We created and pioneered the concept of community health 
aides.
  Through the many years since that time, Alaska Native health leaders 
worked with the Indian Health Service to train community members to 
provide tuberculosis treatment during epidemics in Alaska, and the 
program has provided more than 500 community health aides, with all 
levels of health care in over 178 remote villages where there is no 
other type of health care provider.
  Recently, the Community Health Aide Program was expanded by the 
Alaska Native health system, making specifically trained behavioral and 
dental health aides available to people living in villages. Today, 
Alaska's telemedicine system, with installations in 235 sites across 
Alaska, allows the community health aides to have direct access to 
physicians and dentists in regional hub hospitals in Anchorage and 
Fairbanks. They can use telemedicine to contact outside specialists who 
can assist them in the various clinics throughout the country. I will 
speak of a few of these people.
  Jennifer Kalmakof, a community health aide from Chignik Lake, is an 
example of how important the aides are in their communities. Jennifer 
won the 2007 Vaccine Alaska Coalition's Excellence in Immunization 
Award, presented to her at the Alaska Public Health Summit this past 
December. She made it her mission to increase and improve and maintain 
immunizations at the local level. She started her own system to keep 
track of infants,

[[Page 482]]

children, elders, and adults, using her own money to buy tackle boxes 
in which she organized clinic vaccines and kept them in her own 
refrigerator. She pioneered keeping track of the type of assistance 
these people need in terms of immunizations and various types of 
vaccinations.
  Title II of the bill addresses the range of services authorized, 
recognizing the change which has already occurred in our non-Native 
health system, where the emphasis has shifted from health care to home- 
and community-based care--such as provided by the young woman I 
mentioned--especially for long-term care services. All Alaska Natives 
need to have access to these home-based services, and the assisted 
living and nursing homes that recognize the cultural needs of Alaska 
Native elders need to also be available.
  Title III of the bill addresses safe water and sanitation needs. 
There continues to be enormous unmet needs for investment in safe water 
and sanitation systems in Alaska Native communities. Currently, 26 
percent of rural Alaska Native homes lack adequate water and wastewater 
facilities.
  For instance, Andrew Dock lives with his large family in Kipnuk, AK. 
In his household, there are two adults, six boys, and three girls. The 
youngest child is 1, and the oldest is 22. There is no piped-in water 
in this village and not even a central watering point. In the winter, 
water is obtained by chopping ice from tundra ponds with a steel ice 
pick and hauling it to his home in three 30-gallon gray garbage cans in 
a sled pulled by a snow machine. In the summer, he obtains water by 
collecting rainwater from domestic rooftops. It is also possible to 
haul water from a lake at Tern Mountain, which is a 13-mile boat trip. 
Hauling water is a daily chore--one to three trips a day to support 
drinking, cooking, and washing clothes. He hauls over 1,000 gallons of 
water per week to just keep safe water for the Dock household.
  In Kipnuk, sanitation is accomplished by 5-gallon honey buckets in 
each home. I know Senator Murkowski talked about this. Buckets are 
self-hauled twice a day through the living space of the family and 
deposited in a collection hopper nearby. Buckets must be emptied into 
another bucket when they become too full to carry without spilling in 
the home.
  Collection of the hoppers is often delayed, and there can be as many 
as five buckets waiting next to the hopper to be emptied.
  More than 6,000 homes in rural Alaska are without safe drinking 
water, and nearly 14,000 homes require upgrades or improvements to 
their water, sewer, or solid waste systems to meet minimum sanitation 
standards.
  There is also an immense unmet need for health care facilities 
throughout the Indian Health Care system, including in remote parts of 
Alaska. In Barrow, the northernmost point in the United States, $143 
million is needed to build the only hospital in an area the size of 
Idaho. And in Nome, $148.5 million is needed to build the only hospital 
in an area the size of Virginia.
  Other parts of the bill address the ability of native health 
organizations to bill third parties for health care services delivered 
to native beneficiaries also covered under public or private insurance 
programs. These funds provide critical additional funds to make up for 
shortfalls in Indian Health Service funding, including for emergency 
care.
  While the typical emergency response time from emergency 911 call to 
hospital care is generally clocked in minutes, in Alaska it is clocked 
in hours. In 2005, a young man in Bethel, Alaska, was stabbed in the 
stomach during an early morning fight and needed to be air-ambulanced 
to Anchorage, more than an hour away by jet. Due to weather and 
mechanical issues, the patient finally arrived at the hospital in 
anchorage about 7 hours after the first emergency call. A one-way air 
ambulance flight from Bethel to Anchorage costs more than $13,000.
  Finally, the bill addresses behavioral health needs of native people. 
The life expectancy of people with mental health issues is 25 years 
less than those without mental health issues. In Alaska that means that 
while we continue to make strides towards improving life span, we have 
not yet been able to adequately address this issue due to program and 
funding limitations.
  The combination of substance abuse and mental illness is associated 
with much higher rates of multiple diseases and early death. One in 
eleven Alaska native deaths is alcohol-induced, and alcohol was the 
fourth leading cause of death from 1993 to 2002 in Alaska. Alcohol 
contributed to 85 percent of reported domestic violence cases and 80% 
of reported sexual assault cases between 2000 and 2003. Suicide among 
Alaska natives remained steadily at two times the non-native rate in 
Alaska from 1992 to 2000.
  Integrated behavioral health programs can make a difference in this 
picture. Maniilaq, the native health organization in northwest Alaska, 
operates a very successful behavioral health program called the 
Mapsivik Treatment Camp, which provides alcohol treatment for families 
in a remote location. It is a year-round program that integrates the 
family into cultural and behavioral health treatment models. The camp 
has been successful in reducing recidivism and helping to heal whole 
families. And the Raven's Way program operated by the Southeast Alaska 
Regional Health Consortium for adolescents has now graduated more than 
1,000 kids. Many of these graduates have gone on to lead healthier 
lives, become hardworking adults, and some have even become native 
leaders.
  In conclusion, the need to pass this legislation now is clear, and I 
urge my colleagues to support passage of the bill.
  The PRESIDING OFFICER. The Senator from New Mexico is recognized.
  Mr. BINGAMAN. Mr. President, the Indian Health Care Improvement Act 
was first enacted in 1976. It has enabled us to develop programs and 
facilities and services that are models of health care delivery with 
community participation and with cultural relevance.
  We have accomplished a substantial amount under the Indian Health 
Care Improvement Act. American Indians and Alaska Natives today have 
lower mortality rates from diseases, such as heart disease and 
cerebrovascular disease, malignancy, and HIV infection, than they did 
before. Under the Indian Health Care Improvement Act, the infant 
mortality rate has decreased since 1976 from 22 per 1,000 to 8 per 
1,000.
  In spite of the notable improvements, there are still shocking health 
disparities that remain for Indian people. Let me give you some 
examples from my home State of New Mexico.
  First, let me say that over 10 percent of our population in New 
Mexico is American Indians. We have the second highest percentage of 
Native Americans of any State in the country.
  Native American women in New Mexico are three times as likely to 
receive late or no prenatal care compared to national rates. Native 
American New Mexicans are more than three times more likely to die from 
diabetes compared to other New Mexicans. Death rates for Native 
American New Mexicans from motor vehicle crashes are more than double 
those of non-Indians. That is largely explained because American 
Indians on tribal lands have accidents that are far from trauma 
centers, and therefore they do not have rapid access to lifesaving 
care.
  These disparities in mortality rates contribute to a shortened life 
expectancy for Indians compared to other Americans. National statistics 
show that Indians live, on average, 6 years less than do other 
Americans. That discrepancy is as high as 11 years for some South 
Dakota tribes.
  The Indian Health Service is one of the primary sources of health 
care for Native Americans. For years, the Indian Health Service has 
struggled to meet the needs of the Indian population, but in doing so 
they have faced enormous challenges. There are aging facilities, staff 
shortages, funding shortfalls, and all of these present challenges to 
the Indian Health Service. When facilities and staff are not sufficient 
to meet the needs, contract health services need to be purchased at the 
prevailing rates. Funds supporting contract health services generally 
run

[[Page 483]]

out by about midyear, and that leaves the Indian Health Service with no 
alternative but to ration care. Life-and-limb saving measures are 
selected by necessity over such things as health promotion and disease 
prevention.
  So what resources would be adequate to meet these challenges? To 
answer that question, I call my colleagues' attention to information 
that has been provided by the Congressional Research Service.
  Let me put up a chart that makes the comparison that I think is 
useful. This is a graphic illustration of 10 years of health care 
expenditures per person in various of the programs we support. The top 
line, the red line, is Medicare, primarily individuals 65 or older in 
this country. Medicaid is the level of funding per capita we provide 
under Medicaid. The Indian Health Service number is this blue line 
which is the lowest line on the chart. The sum of all public and 
private sources of health care dollars divided by the number of users 
nationally, or the average health care expenditure per American, is 
depicted in the green line. So we can see that the average American 
gets substantially more per recipient spent on them for health care 
services than does the average Indian American.
  In 2004, the U.S. Commission on Civil Rights produced a report 
entitled ``Broken Promises: Evaluating the Native American Health Care 
System.'' This report contained four important findings.
  No. 1, they found annual per capita health expenditures for Native 
Americans are far less than the amount spent on other Americans under 
mainstream health plans. That is exactly what this chart says.
  No. 2, they find annual per capita expenditures fall below the level 
provided for every other Federal medical program. And, again, that is 
demonstrated very well on this chart.
  No. 3, they found annual increases in Indian Health Service funding 
have failed to account for medical inflation rates or for increases in 
Indian population.
  And, No. 4, they found that annual increases in Indian health care 
funding are less than those for other health and human services 
components.
  This 2004 report concluded:

       Congress failed to provide the resources necessary to 
     create and maintain an effective health care system for 
     Native Americans. The Indian Health Care Improvement Act has 
     not been reauthorized since.

  That report was done in 2004. Reauthorization of this legislation is 
long overdue. As many of my colleagues have already said, we need to 
act now to ensure its swift passage because of the very serious funding 
shortages within the Indian Health Service.
  Senator Thune and I are offering an amendment to provide for an 
expansion of section 506 of the Medicare Modernization Act, which 
protects Indian Health Service contract health services funding. This 
contract health services funding is utilized by the Indian Health 
Service and tribes to purchase health care services that are not 
available through the IHS and tribal facilities. These are health 
services such as critical medical care and speciality inpatient and 
outpatient services.
  Nationally, the Indian Health Service and tribes contract with more 
than 2,000 private providers in order to get these services. 
Unfortunately, because of the very low funding levels available for 
contract health services, funding often runs out in midyear, as I 
indicated before.
  Making this problem even worse, prior to section 506 of the Medicare 
Modernization Act, there was no limitation on the price that could be 
charged for contract health services. In many instances, providers were 
charged commercial rates or even higher rates for those services, far 
in excess of the rates that were being paid by Medicare, by Medicaid, 
by the Veterans' Administration, and by other Federal health care 
programs.
  Section 506 of the Medicare Modernization Act provided that Medicare 
participating hospitals had to agree to accept contract health services 
patients and had to agree that Medicare payment rates would serve as a 
ceiling for contract health services payment rates to those hospitals.


                           Amendment No. 3894

  Mr. President, I send a Bingaman-Thune amendment to the desk and ask 
for its consideration.
  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       The Senator from New Mexico [Mr. Bingaman], for himself and 
     Mr. Thune, proposes an amendment numbered 3894.

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

 (Purpose: To amend title XVIII of the Social Security Act to provide 
 for a limitation on the charges for contract health services provided 
                   to Indians by Medicare providers)

       At the end of title II, add the following:

     SEC. ____. LIMITATION ON CHARGES FOR CONTRACT HEALTH SERVICES 
                   PROVIDED TO INDIANS BY MEDICARE PROVIDERS.

       (a) All Providers of Services.--
       (1) In general.--Section 1866(a)(1)(U) of the Social 
     Security Act (42 U.S.C. 1395cc(a)(1)(U)) is amended by 
     striking ``in the case of hospitals which furnish inpatient 
     hospital services for which payment may be made under this 
     title,'' in the matter preceding clause (i).
       (2) Effective date.--The amendment made by paragraph (1) 
     shall apply to Medicare participation agreements in effect 
     (or entered into) on or after the date that is 1 year after 
     the date of enactment of this Act.
       (b) All Suppliers.--
       (1) In general.--Section 1834 of the Social Security Act 
     (42 U.S.C. 1395m) is amended by adding at the end the 
     following new subsection:
       ``(n) Limitation on Charges for Contract Health Services 
     Provided to Indians by Suppliers.--No payment may be made 
     under this title for an item or service furnished by a 
     supplier (as defined in section 1861(d)) unless the supplier 
     agrees (pursuant to a process established by the Secretary) 
     to be a participating provider of medical care both--
       ``(1) under the contract health services program funded by 
     the Indian Health Service and operated by the Indian Health 
     Service, an Indian Tribe, or Tribal Organization (as those 
     terms are defined in section 4 of the Indian Health Care 
     Improvement Act), with respect to items and services that are 
     covered under such program and furnished to an individual 
     eligible for such items and services under such program; and
       ``(2) under any program funded by the Indian Health Service 
     and operated by an urban Indian Organization with respect to 
     the purchase of items and services for an eligible Urban 
     Indian (as those terms are defined in such section 4),
     in accordance with regulations promulgated by the Secretary 
     regarding payment methodology and rates of payment (including 
     the acceptance of no more than such payment rate as payment 
     in full for such items and services.''.
       (2) Effective date.--The amendment made by paragraph (1) 
     shall apply to items and services furnished on or after the 
     date that is 1 year after the date of enactment of this Act.

  Mr. BINGAMAN. Mr. President, the Bingaman-Thune amendment would build 
on section 506 to ensure that these requirements, the requirements that 
506 apply to hospitals that were contracted with by the IHS, apply not 
just to hospitals but to all participating Medicare providers and 
suppliers. In other words, the amendment would ensure that scarce 
contract health services dollars are used more efficiently, providers 
would be ensured a greater likelihood of receiving contract health 
services payments and would be provided continuity in the payment 
levels with other Federal programs.
  The Bingaman-Thune amendment is supported by a wide range of Indian 
health advocates, including the National Indian Health Board, the 
Navajo Nation, and First Nations Community Health Source in New Mexico.
  I urge my fellow Senators to join Senator Thune and myself in 
supporting this important amendment.
  In conclusion, I underscore that passage of this overall legislation, 
the Indian Health Care Improvement Act, is critically needed and long 
overdue. I congratulate the Senator from North Dakota for his 
persistence in getting this legislation brought to the floor, and I 
congratulate and thank our majority leader, Senator Reid, for 
scheduling this as the first item of business in this second session of 
this Congress. It speaks volumes about the importance Senator Reid 
attaches to this legislation.

[[Page 484]]

  I hope my fellow Senators will join me in strongly supporting passage 
of the legislation once the Bingaman-Thune amendment has been adopted.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER (Mr. Carper). The Senator from North Dakota.
  Mr. DORGAN. Mr. President, I thank the Senator from New Mexico for 
offering the amendment. I know he offers it on behalf of himself and 
Senator Thune from South Dakota. I fully support the amendment. This 
amendment will provide maximum opportunity to stretch the Indian health 
care dollars. The amendment is a thoughtful amendment that will, in my 
judgment, strengthen the underlying bill.
  I am very interested in supporting it. We are working to see if we 
can get a vote on this amendment today. I believe the majority leader 
wishes to begin voting today, and I hope perhaps we can arrange consent 
to have a vote on this amendment later this afternoon.
  I also thank the majority leader for bringing this bill to the floor 
of the Senate. When I was vice chairman of the Indian Affairs Committee 
and Senator John McCain was chairman, we worked on this bill. We tried 
very hard to get it to the floor, but we were not successful. This is 
the culmination of lot of work and important work, in my judgment, to 
get it to the floor. I appreciate the cooperation of the majority 
leader for giving us the opportunity to get it to the floor.
  My hope is we will have the cooperation of other Members of the 
Senate. If there are amendments to be offered, we wish they would come 
and offer those amendments. We would like to get amendments and time 
agreements and try to find a way to complete this legislation.
  I also failed to mention earlier that the Senate Finance Committee 
had a referral on this bill. They did some very important work. Senator 
Baucus, Senator Grassley, and other members of the Senate Finance 
Committee were very helpful, as has been Senator Kennedy and Senator 
Enzi on the HELP Committee, and Senator Kyl and others.
  This bill is bipartisan. We are trying very hard to get this 
legislation completed. As I indicated earlier, this is long past the 
time when this should have been done. People are literally dying for 
lack of decent health care that most of us take for granted, most of us 
expect and receive. That is not the case with respect to Native 
Americans. We desperately need to change this situation.
  My hope is, if there are those who are intending to offer amendments 
today, that they come to the floor and offer the amendments. We know of 
a number of amendments. I appreciate the cooperation of Senator 
Bingaman in offering his amendment now. If there are others, I hope we 
can proceed.
  Mr. President, I wish to briefly speak about another issue we have 
been dealing with. My colleague from New Hampshire spoke briefly, and I 
think in the absence of others being in the Chamber, I wish to speak as 
in morning business for 5 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                              The Economy

  Mr. DORGAN. Mr. President, some of my colleagues have spoken today 
about the difficulty in the economy. I am concerned about it, as are 
virtually all Americans at this point. The stock market seems to be 
bouncing around like a yo-yo. The economy is slowing and consumer 
spending is down. Recently, there was a substantial increase in 
unemployment in a single month--and a whole series of items that 
suggest there are real economic problems.
  My colleague from New Hampshire said: I am concerned about a stimulus 
package. So am I, but in my judgment, we need to err on the side of 
taking action rather than err on the side of doing nothing. The Federal 
Reserve Board this morning cut interest rates by 75 basis points. That 
is a blunt instrument of monetary policy to try to address what is seen 
as a serious weakness in this economy.
  I want to say this: No matter what we do--and we almost certainly 
will produce some sort of stimulus package--I believe a stimulus 
package should provide some tax rebates to middle and lower income 
people. It also ought to provide an extension of unemployment benefits. 
We have done that during previous economic downturns. I think a 
stimulus package should provide investment tax credits for businesses 
with an end date and other temporary tax incentives to persuade 
businesses to make capital investments now when the economy would 
benefit most from it. So we should do two things: We should put money 
in the hands of consumers, middle to lower income consumers, and we 
also should stimulate businesses to make needed capital investments 
earlier rather than later in order to prime the pump with respect to 
the economy.
  I also think it is important to consider, even as we talk about 
stimulus, making investments in this country's infrastructure. There is 
nothing that puts people back to work more quickly than money that goes 
to building roads and bridges and making other improvements in this 
country's infrastructure that are so desperately needed. Many of us are 
working on and talking about that issue. But that ought to be a part of 
a second phase of a stimulus package. To ignore that, in my judgment, 
is to ignore significant job-creating opportunities at a time when we 
desperately need those opportunities.
  Having said all of that, I believe we need to act to provide 
confidence to the American people about the future--after all, that is 
what the business cycle is about. If people are confident about the 
future, they manifest that confidence. They take the trip they wanted 
to take. They buy the car they wanted to buy. They do the things that 
manifest confidence in the future. That represents expansion.
  If they feel as if the future has some troublesome aspects, they say: 
I am going to defer taking the trip, I am going to defer buying that 
car or piece of equipment, I am going to defer purchasing that piece of 
furniture, and then the economy contracts.
  There are some in Washington with an overinflated sense of self who 
think this is a ship of state with an engine room. And you get out of 
the engine room and you dial the knobs and the switches and the 
levers--M-1 B, taxes and all of these things--and somehow the ship of 
state just sails right on forward.
  That is not the case at all. This ship of state moves or fails to 
move based on the people's expectation about the future. If they are 
optimistic, they do things that express that optimism, and the economy 
expands.
  I wish to talk for a moment about some of the fundamentals. We can 
genuflect here and even do some dancing in the Senate Chamber about the 
issue of stimulus packages, but if we don't address the fundamentals, 
we are not going to get out of this problem.
  Every single day, 7 days a week, all year long, we import $2 billion 
more in goods than we export. So we run up a bill of $700 billion plus 
a year in trade deficits. Our trade situation is an abysmal failure. Do 
you think the rest of the country doesn't know that? Do you think that 
has no impact on the falling dollar? Of course it does. It is one of 
the reasons the dollar is falling.
  In addition to that, we have a fiscal policy that has been reckless. 
Last year, we had a $196 billion request from the President in front of 
us, none of it paid for--add it to the debt, he says--for Iraq and 
Afghanistan and restoring military accounts. Well, that is $16 billion 
a month, $4 billion a week, and none of it paid for. That is on top of 
the yearly deficit, which is understated. It uses all the Social 
Security money as if it were other revenue in order to show a lower 
deficit.
  The American people know better and so do the financial markets. They 
see the combination of a reckless fiscal policy and a trade policy that 
is deeply in debt. They see a country whose fundamentals are out of 
line. These electronic herds, called the currency buyers or currency 
traders, when they see these things and they run against the currency, 
a country is in trouble. We have to get our fundamentals in order. We 
need to fix our trade policy, stop these hemorrhaging deficits, and we 
need to fix our fiscal policy.

[[Page 485]]

  We can't say yes to a President who says let's fight a war and do tax 
cuts for wealthy Americans at the same time. Let's fight a war, spend a 
lot of money doing it--two-thirds of a trillion at this point but 
heading north--and none of it paid for; all of it borrowed. This from a 
conservative President. This Congress has to stop saying yes to that. 
This reckless fiscal policy has helped set the stage and table for part 
of what we have seen the last couple of weeks, the jitters and concerns 
about where this country is headed and the economic difficulty we are 
now in.
  Let me talk about something my colleague from New Hampshire talked 
about, and that is the underlying issue of the so-called subprime loan 
scandal. That is a fascinating thing. Someday somebody will do a book 
about that and just about that issue. Here is what happened, and we 
know better. Everybody knows better.
  You wake up in the morning and go to brush your teeth and perhaps you 
have a television set on. You are sort of getting ready for work and 
you see a television ad. We see them every morning, and the ads say: Do 
you have bad credit? Do you have trouble getting a loan? Have you been 
missing payments on your home loan? Have you filed for bankruptcy? It 
doesn't matter. Come to us; we will give you a loan.
  We have all seen these ads, and you think to yourself: Well, how can 
they do that? How can they advertise that if you have bad credit you 
can borrow money from them? The fact is, you can't do that. But that is 
what we were doing all across this country. Here is what was happening. 
Mortgage brokers were making a fortune in big fees by selling subprime 
mortgages. The companies that were writing these mortgages, the largest 
of which was Countrywide Financial, were saying to people: You know 
what, take our low-interest mortgage, with a teaser rate at 2 percent. 
It won't reset for 3 years. By the way, if you have an existing home 
loan, so you can get rid of that and we will lend you money you can pay 
back at a 2-percent interest rate, and it will not reset for 3 years, 
during which time the market is going to go up and you can flip it and 
sell it. In any event, what we will do is decide that on your home loan 
you don't have to make any principal payments at this point, just 
interest. We will add the principal later on.
  Or they will say, borrow this money from us, and we will make the 
first 12 months' payments. For the first year, you make no payments at 
all.
  OK, that practice was totally, completely and thoroughly 
irresponsible by a bunch of greedy folks. They are talking to people, 
cold-calling them and saying, we would like to put you in a better 
mortgage but not telling them, of course, there is a prepayment 
penalty. They are telling you monthly mortgage payments that didn't 
include real estate taxes, insurance costs, and so forth. So they were 
quoting borrowers 2 percent teaser rates with prepayment penalties that 
didn't include the escrow. So they put these people in these loans.
  Now, were the victims partly at fault? Sure. By victims, I am talking 
about those who took these loans out. But these were high-powered 
salespeople working for big companies that were putting bad products in 
the hands of a lot of unsuspecting people.
  Then what do they do? They have these subprime loans packaged up with 
other loans. It is sort of like the old days when they used to put 
sawdust in sausage in the meat plants and mix it all up as filler. Then 
they would cut it up and you would never know where the filler was and 
where the sausage was. Well, similar to that, they would take the good 
loans and the subprime loans and they would mix them all together and 
put them in securities--securitize them. Then they would sell the 
securities to these hedge funds, among others. So hedge funds were 
buying securities. They didn't have the foggiest idea what they were 
buying because the rating agency said it looked okay. These agencies 
were dead from the neck up.
  Everybody was greedy, and now the whole tent comes collapsing down. 
Now, you say, how could that be? Well, it was because people were 
loaning money to people who were never going to be able to repay it. 
The CEO of Countrywide, the largest company doing this, made hundreds 
of millions of dollars selling the stock back. It looks like 
Countrywide is going to go belly up, so Bank of America comes in and 
buys Countrywide. No idea why, but the big guys, they all waltz off 
smiling ear to ear, sparkling teeth and big smiles. Why? Because they 
made a lot of money--hundreds of millions of dollars. Meanwhile, all 
these folks can't repay their mortgages and are left to try to pick up 
the pieces and then we wonder what on Earth happened here.
  In the midst of all this, this morning I was listening to a TV show 
with a man named Jim Cramer, who talks about stock prices. He has a TV 
show. Half the time he is yelling. I don't have the foggiest idea why 
he thinks that is the approach to use to thoughtfully talk about stock 
prices, but apparently it is successful. So he says this morning that 
one of the ways we should deal with the problem in the economy is to 
start trying to provide some recompense or some money to the insurers 
of bonds and other things that are going to get hit--derivatives, he 
said. And I thought, I understand that language. He is talking about 
credit default swaps.
  That sounds like a flatout foreign language, but it can't be because 
I don't speak a foreign language. Credit default swaps. So what Jim 
Cramer was talking about on the television this morning is that in 
order to bail out this country, his approach is we ought to provide 
about 50 percent of taxpayer money to the losses for those who have 
credit default swaps. Let me talk a moment about what this means 
because, as I said, it sounds completely foreign.
  Hedge funds in this country are largely unregulated. I, Senator 
Feinstein, and many others have tried for a long time to say that is 
dangerous for this country. Hedge funds are somewhere around $1 to $1.5 
trillion. Now, that is not so much, considering mutual funds are about 
$9 trillion. The total of the stocks and bonds in the stock market and 
bond funds are about $40 billion. So hedge funds are about $1 to $1.5 
trillion. But hedge funds represent one-half of all the trades on the 
stock market. Think of that--$1 trillion plus unregulated--and they 
comprise half the trades on the stock market.
  Now, because of the very heavy use of the leverage, it is a fact that 
hedge funds can lose much more than they are worth. If somebody goes 
into a casino in Las Vegas with a pocketful of money and grinning, 
thinking they are going to win a lot of money but end up losing it all, 
in most cases the only thing they lose is the money they have. That is 
not the case with heavily leveraged hedge funds.
  That is why the episode with Long-Term Capital Management, a hedge 
fund that had the smartest people working for them, was so important 
that over a decade ago the Federal Reserve Board had to try to save 
Long-Term Capital Management. That hedge fund was unbelievably 
leveraged, over $1 trillion. Its collapse would have affected the 
entire American economy.
  So here is what we have. We have this language now called credit 
default swaps. The credit default swap is a derivative, and it is an 
insurance policy on a bond or some other instrument. The person who 
sells the swap is actually writing a policy that collects a premium, 
and it says if nothing goes wrong with the underlying instrument, the 
person who sold the swap gets the premium and looks like a genius. If, 
however, the bond or the underlying instrument collapses, then the swap 
seller has to make good. The notional amount--understand this--the 
notional amount, the aggregate of bonds, loans, and other debt called 
by credit default swaps in the United States, is now $26 trillion.
  I have spoken before on the floor of the Senate about creating a 
house of cards, every child has done it, and then pulled out a card on 
the bottom. Everyone understands what happens to the house of cards. We 
now have roughly $1-$1.5 trillion in hedge funds, as I understand it, 
doing one-half of the stock

[[Page 486]]

trades on the stock exchanges. In most cases, hedge funds have a 
notional value of $26 trillion in credit default swaps, and the 
question is: Where is all this exposure? How much exposure? We don't 
know. Most hedge funds are unregulated, and a whole lot of folks in 
this Chamber have wanted to keep it that way, despite the efforts of 
some of us who believe it is dangerous to our economy to pretend this 
kind of risk does not exist.
  It is interesting to me that we are in this situation and troubling 
to me we are in a situation that all of us knew was going to be 
difficult. You can't run a $2-billion-a-day trade deficit without 
consequence. Warren Buffett always pointed out with the housing bubble 
that every bubble bursts. It is one of the immutable laws. The question 
isn't whether, it is when. He makes the same point about the trade 
deficit. The trade deficit is unsustainable. The question isn't whether 
we will see consequences, the question is when will those consequences 
exist.
  The consequences are beginning to exist now, with the declining value 
of the dollar and the combination of all the other issues--the highest 
deficits in human history, the trade deficit, a fiscal policy that is 
completely and thoroughly reckless, combined with the scandal that 
exists with respect to subprime loans and the massive amount of 
unregulated hedge fund credit swap defaults. I mean it is staggering to 
see what we have done. Again, the credit default swap is a notional 
derivative whose value is dramatic and the consequences of which could 
be dramatic for the entire economy.
  Most regulators were looking the other way and doing so deliberately. 
If ever one wonders whether thoughtful and effective regulation is 
necessary, look at all this. If anyone has ever wondered whether you 
can get by with a trade deficit of $2 billion a day, look at where we 
find ourselves now. If anyone ever wonders if you can spend money you 
don't have on things you don't need, look at this country's fiscal 
policy and its consequences for the country.
  Having said that, all of us want the same thing for this country's 
future. We want a country that grows and provides economic opportunity. 
We want a country where the fundamentals are fair and put in order. 
That means a trade deficit that is eliminated, or at least close to 
eliminated, and a trade policy that works for this country's interest. 
It means a fiscal policy that pays our bills, and it means effective 
regulation in areas where you have substantial potential risk for the 
entire economy, and that means regulation of certain hedge funds' 
transactions and derivatives now well outside the view of public 
regulators.
  So I think this is going to be a very difficult time for this 
country. It is one thing for us to take a shower in the morning, put on 
a suit and drive to work and talk about it, it is another thing for the 
people who go home tonight and say: Sweetheart, I have lost my job, not 
because I didn't do a good job, but they are laying people off where I 
work. That is a consequence for that family in which unemployment is 
100 percent.
  We face some pretty daunting challenges. My hope with this President 
and with Republicans and Democrats working together, as the Speaker of 
the House and the majority leader of the Senate said last week, with 
all of us working together, combined with the Federal Reserve's 
monetary policy, that we can develop some thoughtful approaches in 
fiscal policy that might lead us in a constructive direction to say to 
the American people we believe you can honestly look at the future and 
have a positive view. But they won't believe that if they feel we are 
not serious about the fundamentals. The American people aren't going to 
be fooled. If we don't fix our trade policies and get rid of these 
unbelievable deficits, if we don't put our fiscal house in order and 
stop doing what the administration suggests we do, we are in big 
trouble.
  We had a Treasury Secretary named Paul O'Neill--the first Treasury 
Secretary under this President. If ever there was a straight shooter in 
Government, it was Paul O'Neill. He came here as an executive from an 
aluminum company. He was blunt-spoken, an interesting guy, and I 
happened to like him a lot. Paul O'Neill got fired. In fact, Dick 
Cheney is the one who fired him, at the request of the President. When 
fired, he was told that deficits don't matter. Deficits don't matter.
  Well, we now understand they do matter and we have to do something 
about it. This fiscal policy is out of control. Our trade policy is 
broken and we have had regulators who looked the other way while we had 
grand theft in this area of the subprime scandal, and it is time we 
tell the American people we are serious about addressing these issues 
and we are going to do it now.
  I yield the floor and I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Ms. STABENOW. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Ms. STABENOW. Mr. President, I rise today in strong support of the 
Indian Health Care Improvement Act. I, first, wish to thank our 
chairman, Senator Dorgan, for his passion and commitment. I have had 
the opportunity to listen to some of the floor debate and opening 
comments and very much appreciate the way you have laid out the 
incredible need for this legislation and the fact it is long overdue.
  It is a promise that has not been kept, and hopefully today we are 
going to move forward in keeping that. Also, thank you to my friend and 
ranking member, Senator Murkowski, for her eloquence as well in laying 
out the legislation. It is wonderful to see the partnership that has 
happened on this legislation.
  I also wish to remember our colleague, former Senator Craig Thomas, 
who I know was a wonderful friend to Indian Country and cared very 
deeply about these issues. We certainly take a moment again to remember 
him and send our best wishes to his family in remembrance of his 
leadership on this issue as well.
  Just over 31 years ago, this bill, the original bill, was signed into 
law by the late President Gerald R. Ford, who I am proud to say resided 
and represented the great State of Michigan. It had the purpose of 
bringing the health status of Native Americans up to the level of other 
Americans.
  This program, the Indian Health Services Program, funds health 
services to about 1.8 million Native Americans from our Nation's more 
than 500 federally recognized American Indian and Alaskan Native 
tribes. I am proud to have many of them in Michigan.
  The Federal Government provides those health care services based on 
our trust responsibility to Indian tribes derived from Federal 
treaties, statutes, court rulings, Executive actions, and from our own 
Constitution, which assigns authority over Indian relations to the 
Congress.
  Reauthorization of the various Indian health care programs has 
languished for 15 years in this body, so our work today is vital. It is 
a vital component, it is long overdue, as our chairman has reminded us 
over and over again in bringing this issue forward for years.
  It is a vital component in improving and updating health care 
services in Indian Country. The Indian Health Care Improvement Act will 
modernize and improve Indian health care services and delivery. We know 
this is an incredibly important step. We know more needs to be done, 
but we know this is an incredibly important step.
  The bill will also allow for in-home care for Indian elders and will 
provide much-needed programs to address mental health and other issues 
related to the well-being of Indian communities.
  More importantly, the Indian Health Care Improvement Act will address 
many health care disparities in Indian Country. For example, infant 
mortality rates are 150 percent greater for Indians than for Caucasian 
infants.
  Those in the Indian communities are 2.6 times more likely to be 
diagnosed with diabetes. Tuberculosis rates for

[[Page 487]]

Native Americans are four times the national average. The life 
expectancy for Native Americans is nearly 6 years less than the rest of 
the U.S. population.
  What this bill, unfortunately, cannot do is mandate the necessary 
funding from our budget every year to uphold our country's trust 
responsibility to provide adequate health care to our tribal members. 
But we intend to make sure that happens.
  As it stands, the Indian Health Services annual funding does not 
allow it to provide all the needed care for eligible Native Americans. 
That is what we are speaking to today, that sense of urgency we have in 
making that happen.
  As of today, funding levels are only at 60 percent of the demand for 
services each year, which requires IHS tribal health facilities, 
organizations, and urban clinics to ration care so the most critical 
care and the needs are funded first and foremost, which, in turn, 
results in the tragic denial of needed services for too many men, 
women, and children, old and young in Indian country.
  As unbelievable as it may sound, health care expenditures to Native 
Americans are less than half of what America spends on Federal 
prisoners.
  Preventative health care is so important for Indian Country due to 
the high incidence of chronic diseases such as diabetes and obesity 
within these communities. IHS funding shortfalls for medical personnel 
have only further contributed to the severe gaps in health care 
delivery in Indian Country. In 2005, there were job vacancy rates of 24 
percent for dentists, 14 percent for nurses, 11 percent for physicians 
and pharmacists, according to IHS data.
  I am very pleased and proud to be a cosponsor of this important 
legislation, as it establishes objectives to address these health 
disparities between Native Americans and other members of the American 
community. It will enhance IHS ability to attract and retain qualified 
health care professionals for Indian Country.
  As a government, I am also hopeful we will commit the additional 
resources to Indian health care for this year and every year in the 
future. The time has long passed for this reauthorization. I am very 
proud our leader, Senator Reid, has determined this to be a priority 
for the Senate. I am proud of the work that has been done. It is truly 
time to get this done now.
  I yield the floor and I suggest the absence of a quorum
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. VITTER. 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. VITTER. Mr. President, I ask unanimous consent to call up my 
amendment at the desk, Vitter amendment No. 3896.
  The PRESIDING OFFICER. Is there objection to setting aside the 
pending amendment?
  Mr. DORGAN. Mr. President, I have not had a chance to visit with the 
Senator from Louisiana. I object.
  The PRESIDING OFFICER. Objection is heard.
  Mr. VITTER. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. VITTER. I ask unanimous consent that the order for the quorum 
call be rescinded.
  The PRESIDING OFFICER (Mrs. McCaskill). Without objection, it is so 
ordered.


                           Amendment No. 3896

  Mr. VITTER. Madam President, I ask unanimous consent to call up 
amendment No. 3896 at the desk.
  The PRESIDING OFFICER. Is there objection to setting aside the 
committee amendment?
  Without objection, it is so ordered.
  The clerk will report.
  The bill clerk read as follows:

       The Senator from Louisiana [Mr. Vitter] proposes an 
     amendment numbered 3896.

  Mr. VITTER. 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 modify a section relating to limitation on use of funds 
                      appropriated to the Service)

       Strike section 805 of the Indian Health Care Improvement 
     Act (as amended by section 101(a)) and insert the following:

     ``SEC. 805. LIMITATION RELATING TO ABORTION.

       ``(a) Definition of Health Benefits Coverage.--In this 
     section, the term `health benefits coverage' means a health-
     related service or group of services provided pursuant to a 
     contract, compact, grant, or other agreement.
       ``(b) Limitation.--
       ``(1) In general.--Except as provided in paragraph (2), no 
     funds or facilities of the Service may be used--
       ``(A) to provide any abortion; or
       ``(B) to provide, or pay any administrative cost of, any 
     health benefits coverage that includes coverage of an 
     abortion.
       ``(2) Exceptions.--The limitation described in paragraph 
     (1) shall not apply in any case in which--
       ``(A) a pregnancy is the result of an act of rape, or an 
     act of incest against a minor; or
       ``(B) the woman suffers from a physical disorder, physical 
     injury, or physical illness that, as certified by a 
     physician, would place the woman in danger of death unless an 
     abortion is performed, including a life-endangering physical 
     condition caused by or arising from the pregnancy itself.''.

  Mr. VITTER. Madam President, I offer an important amendment with 
regard to abortion and the pro-life cause. It is a very appropriate day 
that we talk about this because as we speak tens of thousands upon tens 
of thousands of people, particularly young people, from all around the 
country are marching in Washington, on the Mall, at the Supreme Court, 
in a positive, vibrant march for life. In offering this amendment, I 
also want to thank all of my original amendment cosponsors: Senators 
Allard, Brownback, Thune, and Inhofe.
  This amendment is very simple. This amendment codifies, solidifies 
the Hyde amendment policy in this important Indian Health Care 
Improvement Act. It establishes, reasserts, the policy of the Hyde 
amendment with regard to the Indian Health Care Improvement Act and 
puts that Hyde amendment language in the authorization language for 
this important part of Federal law.
  Let me explain why it is necessary. For many years the Hyde amendment 
has been honored, including in this Federal program, but in a very 
roundabout and precarious way. For many years this program and this 
authorization have included language that says: This program will be 
governed by whatever abortion language is contained in the current 
Health and Human Services appropriations bill. And for those years, 
Congress has included Hyde amendment language in that appropriations 
bill to which this program points. That has worked, sort of, in 
accomplishing having the Hyde amendment in Federal law with regard to 
Indian health care, but it puts it in a tenuous and precarious posture. 
It puts it up for debate and possible change of policy every year, 
every time we debate a new Health and Human Services appropriations 
bill. Therefore, it doesn't make the policy very solid, very secure, or 
very clear.
  My amendment is very simple. It would simply place that Hyde 
amendment language directly in the Indian health care language and say: 
No Federal funds in this program will be used to perform abortions 
except in the rare exceptions delineated in the original Hyde 
amendment.
  This is very appropriate. Why should we go to this in such a 
roundabout and tenuous and precarious way? I think we should place that 
clear policy, which has been accepted over many years, since the 
original Hyde amendment debate, directly in the Indian Health Care 
Improvement Act and not have it sort of get there maybe every year 
through such a torturous and tenuous and precarious route.
  It is very simple. On this day, where tens of thousands upon tens of 
thousands of Americans, particularly young people--and that is so 
heartening--are marching on Washington in a positive march for life, 
will we clearly reaffirm that Hyde amendment language in the

[[Page 488]]

Indian Health Care Improvement Act? I suggest all of us should do that. 
I suggest that would be a positive statement for life, for positive 
values for the future. Voting for the amendment will accomplish just 
that.
  I have talked to the chairman of the committee, and he has indicated 
that a vote will be forthcoming further on in the debate of this bill. 
I welcome that. I welcome everyone on both sides of the aisle joining 
together around this consensus amendment to make a positive statement 
for life, to reaffirm what has been Federal policy for several years, 
the Hyde amendment, and to move forward, hopefully together, in a 
positive spirit, making that positive statement for life.
  In closing, this is a very important issue and a very important 
amendment, a very important vote to millions of people around the 
country who care deeply about life. Because of that, this will be a 
vote focused on and graded by several key national groups; 
specifically, the National Right to Life Committee, Concerned Women of 
America, and the Family Research Council.
  I have letters from all three of these groups making clear their 
strong support of the Vitter amendment and also making clear that this 
vote on this amendment will be graded in their activity monitoring the 
Congress. I ask unanimous consent that three letters be printed in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                                    National Right


                                      to Life Committee, Inc.,

                                 Washington, DC, October 23, 2007.
     Re Vitter Amendment to S. 1200 (abortion funding).

       Dear Senator: The Senate is expected to soon consider S. 
     1200, the Indian Health Care Improvement Act Amendments of 
     2007. The National Right to Life Committee (NRLC) urges you 
     to vote for an amendment that Senator Vitter will offer, 
     which would codify a longstanding policy against funding of 
     abortions with federal Indian Health Service (IHS) funds 
     (except to save the life of the mother, or in cases of rape 
     or incest).
       For Medicaid, federal funding of abortion was restricted 
     beginning in 1976 by enactment of the Hyde Amendment to the 
     annual HHS appropriations bill. However, because the IHS is 
     funded through the separate Interior appropriations bill, 
     which has never contained a ``Hyde Amendment,'' the IHS 
     continued to pay for abortion on demand long after the Hyde 
     Amendment was enacted. The Reagan Administration curbed the 
     practice administratively in 1982, as a temporary fix. 
     Subsequently, in an IHS reauthorization bill in 1988, 
     Congress enacted 25 U.S.C. Sec. 1676, which said that any 
     abortion funding limitations found in the HHS appropriations 
     measure in effect at any given time will also apply to the 
     IHS. That requirement, which would be continued by Section 
     805 of S. 1200 as reported, provides no real assurance that 
     federal IHS funds will not be used to pay for abortion on 
     demand in the future, because the language of future HHS 
     appropriations bills depends upon a host of legislative and 
     political contingencies. Rather than merely extending such a 
     convoluted arrangement, NRLC urges adoption of Senator 
     Vitter's amendment, which would simply codify the 
     longstanding policy: No federal funds for abortion, except to 
     save the life of the mother, or in cases of rape or incest. 
     The substance of Senator Vitter's amendment is based directly 
     on the version of the Hyde Amendment that has been in effect 
     since 1997, which appears as Section 508 in the current 
     Labor/HHS appropriations bill (H.R. 3043).
       In short, if you are opposed to direct federal funding of 
     abortion on demand, you should support the Vitter Amendment. 
     Rejection of the Vitter Amendment would have the effect of 
     leaving the door open to future federal funding of abortion 
     on demand by the IHS.
       We anticipate that the roll call on the Vitter Amendment 
     will be included in NRLC's scorecard of key pro-life votes of 
     the 110th Congress. Thank you for your consideration of 
     NRLC's position on this important issue.
           Sincerely,
                                                  Douglas Johnson,
     Legislative Director.
                                  ____

                                                 October 29, 2007.
     Hon. David Vitter,
     U.S. Senate,
     Washington, DC.
       Dear Senator Vitter: The 500,000 members of Concerned Women 
     for America are grateful for your continued commitment to the 
     sanctity of life. We appreciate your work to eliminate 
     federal funding of abortions through the Indian Health Care 
     Improvement Act (S. 1200). This amendment will benefit many 
     women and save innocent lives as Indian Health Services (IHS) 
     funds will be prohibited for use for abortions.
       Thank you for your work to codify a longstanding policy and 
     ensure that despite the change in partisan politics, this 
     nation will stand for life. A permanent adoption of this 
     policy to the IHS program will be a positive step in the 
     direction of upholding our nation's claim to the sanctity of 
     life.
       The Hyde amendment of 1976 restricted the federal funding 
     of abortion through Medicaid, but this policy did not apply 
     to the IHS due to its receiving funding through a separate 
     Interior Appropriations bill. The IHS continued to pay for 
     abortion on demand until 1982. This was six years too long. 
     Though the Reagan administration administratively curbed the 
     practice, future administrations have not been and will not 
     be barred from paying for abortion on demand using IHS funds.
       Senator Vitter, that is why we are grateful for your pro-
     life amendment to S. 1200. Legislative policies are needed to 
     ensure that the sanctity of life is not subject to partisan 
     politics. We appreciate your commitment to prohibit the 
     federal government from funding abortion on demand.
           Sincerely,

                                                 Wendy Wright,

                                                        President,
     Concerned Women for America.
                                  ____



                                      Family Research Council,

                                 Washington, DC, January 14, 2008.
     U.S. Senate,
     Washington, DC.
       Dear Senator: On behalf of Family Research Council and the 
     families we represent, I want to urge you to vote for the 
     amendment offered by Senator David Vitter (R-LA) to the 
     Indian Health Care Improvement Act of 2007 (S. 1200) which 
     would prevent Indian Health Service funds from being used for 
     abortion. Exceptions would include cases where the life of 
     the mother is at risk, or in the case of rape or incest with 
     a minor. We strongly support this amendment.
       Current federal law since the 1988 Indian Health Care 
     reauthorization limits Indian Health Service funds from being 
     used to perform abortion. It does so by referencing the Hyde 
     provision in the annual LHHS appropriations bill, which 
     prohibits such funding for abortion. S. 1200 in Section 805 
     reiterates this reference to the Hyde provision. However, if 
     the Hyde provision were removed from the LHHS appropriations 
     bill, funding of abortion under Indian Health Services would 
     ensue.
       Senator Vitter's amendment language is similar to the Hyde 
     provision and would simply codify this long-standing policy 
     in the Indian Health Care Improvement Act. As such, federal 
     Indian Health Service funds would not be used for abortions, 
     no matter what happens with the Hyde provision in future 
     appropriations cycles.
       Your support for the Vitter amendment will uphold the long-
     standing policy that United States taxpayers should not 
     subsidize abortion. FRC reserves the right to score votes 
     surrounding this amendment in our scorecard for the Second 
     Session of the 110th Congress to be published this fall.
           Sincerely,
                                                  Thomas McClusky,
                            Vice President for Government Affairs.

  Mr. VITTER. Again, in closing, I welcome all of our colleagues to 
support this commonsense, pro-life, positive amendment. I look forward 
to any further debate on it, to answer any questions that might arise, 
and to an important vote before we conclude consideration on this bill.
  I yield the floor.
  Mr. DORGAN. I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. SPECTER. I ask unanimous consent that the order for the quorum 
call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (The remarks of Mr. Specter pertaining to the introduction of S. 2539 
and S. 2540 are located in today's Record under ``Statements on 
Introduced Bills and Joint Resolutions.'')
  The PRESIDING OFFICER. The Senator from Minnesota is recognized.
  Ms. KLOBUCHAR. Madam President, I come to the floor today to talk 
about my support for the reauthorization of the Indian Health Care 
Improvement Act. I am a cosponsor of this bill because there is a vital 
need for our Native American communities to have access to modernized 
health care.
  Today, the health disparities between our tribal communities and the 
rest of the country are shocking. According to the Indian Health 
Service, the average life expectancy for Native Americans is almost 
2\1/2\ years below any other group in the country. The incidence of 
sudden death syndrome among tribal communities is more than three times 
the

[[Page 489]]

rate of nontribal infants. If you are a Native American, you are 200 
percent more likely to die of diabetes, you are 500 percent more likely 
to die from tuberculosis, you are 550 percent more likely to die from 
alcoholism, and you are 60 percent more likely to commit suicide.
  These may seem like nothing but statistics, but behind them are real 
people who are in real need of modernized health care services.
  The suicide rate among Native American youth is the highest of any 
racial group in the Nation. In fact, suicide is the third leading cause 
of death among Native American youth. One of the country's most recent 
victims is a 12-year-old Red Lake boy who hanged himself last October. 
This young boy's suicide only added to the heartache of the Red Lake 
Indian Reservation, which is located in my State of Minnesota. This 
Indian reservation, the people there had already suffered a lot. Back 
in March of 2005, at the Red Lake High School, a troubled teenager 
named Jeff Weise went on a shooting rampage, killing nine people before 
turning the gun on himself. Most of the news reports highlighted the 
troubled teen's past, including a history of depression and suicide 
attempts and the daunting socioeconomic conditions in his reservation 
community. This calamity serves as a tragic reminder of the importance 
of increasing efforts to effectively address mental health issues in 
Indian Country and elsewhere. I know my colleague, Senator Dorgan, has 
been leading this effort, this bipartisan effort, to make sure we 
reauthorize this important act.
  We know the negative impact mental health issues have on our 
communities, but we also know access to modern mental health care 
resources can make a difference. That is why it is so critical to 
reauthorize the Indian Health Care and Improvement Act.
  Reauthorizing this bill will provide tribal communities with the 
tools needed to build comprehensive behavioral health prevention and 
treatment programs--programs that emphasize collaboration among alcohol 
and substance abuse, social services, and mental health programs, and 
programs that will help communities such as Red Lake prevent further 
tragedies.
  Reauthorizing this bill will also help tribal communities attract and 
retain qualified Indian health care professionals and address the 
backlog in needed health care facilities on Indian reservations. I have 
visited the facilities. I visited the reservations throughout my State, 
and I know they are in need of this help. The lack of availability of 
nearby health care facilities and specialized treatment is a major 
concern for tribal communities, especially those with large 
reservations.
  On the Minnesota White Earth Indian Reservation, which is the largest 
reservation in our State, spanning 200 miles and home to almost 10,000 
people, elective surgeries are not even an option--in an area that 
spans 200 miles--due to a lack of modernized health care resources and 
facilities. Currently, these White Earth tribal members are unable to 
undergo elective surgery on the reservation. These are people who need 
a hip replacement or a knee replacement or a simple cataract surgery, 
but they are unable to get the health care they deserve because there 
is a lack of doctors, adequate medical facilities, and basic insurance 
coverage.
  The Federal Government has a trust responsibility to provide health 
care for our tribal communities. I cosponsored the Indian Health Care 
Improvement Act because we made a commitment to our tribal communities. 
We must ensure our tribal communities have access to convenient, 
preventive, and modern health care. I urge my colleagues to join me and 
support reauthorizing this important bill.
  I yield the floor, and I note the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. DORGAN. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DORGAN. Madam President, I believe Senator Nelson of Florida is 
on his way. Before that, the legislation we brought to the floor from 
the Committee on Indian Affairs has been worked on for a long while. It 
is long past due to be considered by the Congress. It deals with the 
urgent need for Indian health care.
  I want to especially say we worked with the National Indian Health 
Board on this legislation and Sally Smith, chair of the board; with the 
Tribal Leaders Steering Committee on Indian Health, Buford Rollin, 
cochair, and Rachel Joseph, cochair. We worked closely with the 
National Congress of American Indians, Joe Garcia, president, and 
Jackie Johnson, executive director. We held listening sessions at many 
Indian reservations to talk about the challenges and what we need to do 
to resolve these issues.
  I wish to mention as well today we have from the White House a 
statement of administration policy in which the White House is talking 
about a potential veto of this legislation. That is not particularly 
unusual. The White House has been talking about vetoing almost anything 
and everything for the last several months. So I am not particularly 
surprised. My hope is we can work with the White House. This is a 
bipartisan piece of legislation. We expect to pass it through the 
Congress, and my hope is the President will sign it.
  I wish to address one of the issues the White House is concerned 
about--the Indian urban health care program. The President has 
requested we not have any funding for it, that we discontinue the urban 
Indian health care program. My colleague, Senator Murkowski, and I and 
many others have disagreed with that. We believe there is a need for 
the urban Indian health care program.
  I wish to describe that need by describing one person, a Native 
American, the late Lyle Frechette. This is a photograph taken after he 
finished high school. He was a member of the Menominee Tribe of Indians 
in Wisconsin. He was a proud veteran, who went into the Marine Corps 
right after high school, when this picture was taken. After serving his 
country as a U.S. marine, he came home to the Indian reservation to 
find life had significantly changed. That was at a time in this country 
when we were going through what is called ``termination and 
relocation.'' The policy in this country was to say to American Indians 
that we want to get you off the reservation and to a city someplace.
  In fact, the official policy of the Federal Government was to 
terminate government-to-government relationships with 109 Indian tribes 
during that period, the early 1950s. It was suggested, well, let's 
terminate relationships with tribes and say to these Indians: Go to the 
city and leave your reservation. So many did, and Lyle Frechette did. 
The movement from a tribal reservation, where there was some Indian 
health care, although inadequate, to the major cities meant that Lyle 
Frechette was leaving an area that had vast forests and timber 
resources that represented financial stability for the Menominee Tribe. 
Yet the Federal Government thought this was a great candidate for 
termination. So they took steps to terminate the tribal status.
  That termination had catastrophic effects on the lives of many of the 
tribal governments and the people who were members of the tribes. It 
required many of the young tribal members, such as Lyle Frechette, to 
either stay on the reservation and live in abject poverty, with no 
further health or any benefits that had long been promised to them, or 
participate in the Federal urban relocation program. Often, they were 
given a one-way bus ticket and told good luck; they ended up in cities 
with substantial limitations on what they could do.
  Lyle Frechette had a young wife and a child and they relocated to 
Milwaukee, WI, 3\1/2\ hours from the reservation. He no longer had 
access to health care on the Indian reservation. There were very few 
urban clinics and the relocated Indians only qualified for private 
sector insurance for 6 months, and that was over. Health care is 
essential. Many of these folks, including this

[[Page 490]]

young man, left the reservation because of the termination and 
relocation program and discovered they were not able to access health 
care programs.
  Then, over a period of years, urban health care programs were 
established to try to be helpful to those whom we had literally forced 
off the reservations. The fact is it has been a lifesaving experience 
for many urban Indians to be able to access that which was guaranteed 
them as part of the trust responsibility of the Federal Government to 
American Indians, even being able to access that in some of our urban 
areas. The President has wanted to shut down that program. We have said 
we don't support that, on a bipartisan basis. Congress has said the 
urban health care programs for American Indians has worked very well.
  I wished to describe that issue because the President indicated that 
is one of the issues in his letter and the statement of administrative 
policy today in which he suggests he may well veto this legislation. I 
hope he will not and that we will work on a bipartisan basis to 
convince the President doing this is the right thing to do.
  I know my colleague from Florida is here ready to speak. At this 
point, I yield the floor, and my colleague wishes to be recognized.
  The PRESIDING OFFICER. The Senator from Florida is recognized.
  Mr. NELSON of Florida. Madam President, I wish to say to the very 
distinguished Senator from North Dakota he has always been one of the 
foremost advocates for improving Indian health on the tribal lands, and 
I intend to support him. I thank him for his advocacy.
  In my State of Florida, we have a number of very prominent Indian 
tribes, the Seminoles, the Mikasukis, and others. The good fortune is 
they do not have the health problems other tribes have throughout other 
parts of the country. Yet there are some problems in Florida as well. 
This is a matter we cannot continue to close our eyes to. We need to 
help them. I intend to support the Senator from North Dakota on this 
bill. I look forward to its passage and, hopefully, working out the 
problems with the White House so they will not veto this legislation.
  Madam President, I wish to talk about this. We are now obviously in a 
recession: The gyration of the stock market, the weakness of the 
dollar, the roiling markets around the world, the emergency meeting of 
the Federal Reserve, the cutting of the rate three-quarters of a 
percent, from 4\1/4\ to 3\1/2\, the likelihood they will meet again 
next week and cut the interest rate further. We are in a full-scale 
recession.
  I have returned from my State of Florida and this recess having done 
town hall meetings all over the State, in which the town halls were 
packed, with standing room only. They were out into the hallways. They 
were hungry to be heard, and that is the way I conduct those town hall 
meetings. I go in and say: This is your meeting, and I want to hear 
what is on your mind, what your concerns are, and I want to know how 
you are hurting, so we can try to help you. We pick up huge numbers of 
cases for our caseworkers as a result of these outreach town hall 
meetings all over my State.
  Let me remind you my State is the fourth largest in the Union and by 
2012 it will surpass New York and will be the third largest in the 
Union. In that midst of 18 million people who are as diverse as 
America, indeed becoming as diverse as the Western Hemisphere, people 
are hurting. In addition to the global and national economies, our 
people are triply hurting by getting the double whammy of increased 
real estate taxes, as well as huge increases in homeowners insurance. 
We talked about this crisis many times on the floor--about an 
appropriate Federal role to assist the States with regard to insurance 
markets that have gone out of control, jacking the rates to the Moon, 
in the anticipation of another catastrophe following Katrina in New 
Orleans and the previous year, 2004, four hurricanes that hit Florida 
within a 6-week period.
  All those things have come together, so that I can tell you in these 
15 town hall meetings I did, from literally one end of Florida, Key 
West, to the other, Pensacola, people are hurting. You take a very 
upscale, increasingly hot economy, such as Fort Myers, Lee County, they 
are in the economic doldrums. They are hurting. Go to your rural areas. 
We always talk about rural health care. It is certainly true there. But 
the rural areas are depressed. The jobs have diminished. Unemployment 
has gone up. The people are concerned about their investments. The main 
investment the average Florida family has is their home. If they need 
cash and need to sell their home, now they cannot sell their home 
because there is a complete flat market; and if they need cash, trying 
to get an additional loan because of equity, the banks are not loaning. 
So you get the picture of what is happening in Florida. Indeed, Florida 
is the microcosm of America. This is happening all over America.
  Now, what we have already voted on in the Senate is a first step. But 
it is a small step. We have voted on, and I have supported, mortgage 
forgiveness debt relief so if a bank were to forgive part of the loan, 
we want to change the Tax Code so the homeowner doesn't have to pay 
income tax on that reduction in the amount of the loan the bank grants 
them, to try to keep them solvent so they can continue to pay off the 
loan.
  We are also supporting property tax relief, which is that 32 million 
homeowners, or 70 percent of taxpayers, do not itemize their real 
estate property taxes, and of that 70 percent, 32 million of those are 
homeowners. What we are suggesting is that we give them a standard 
deduction, so if you own real estate property and you don't itemize 
your deductions, there will be a standard deduction that will be 
available.
  And then in December the Senate passed, and this Senator voted for, 
the Federal Housing Administration Modernization Act. It was intended 
to help homeowners in the risky subprime mortgages to be able to 
refinance them through the FHA into more reliable mortgages. These are 
all attempts at getting at the problem. But that was December and this 
is now late January and the economy has slipped further and deeper into 
recession. So we need to come out in a bipartisan way with a fix that 
will help stimulate the economy and try to get us back on track: 
increasing unemployment compensation perhaps from the 26 weeks to as 
many as 46 weeks; the ability to go in and put money quickly in 
somebody's pocket, such as a reduction of the payroll taxes, that in 
those every 2-week paychecks, they will see an increase in that take-
home pay; perhaps for those who are hurting the most at the lower end 
of the economic scale, additional food stamps; infrastructure support 
that would get money into the economy, stimulating and turning over 
those dollars into the economy if it is invested in items that can be 
spent immediately in the much needed repair of roads and bridges.
  Whatever the ideas are, there is going to be an ideological divide. 
Let's hope it does not come down to this question of taxing the poor 
and giving the tax breaks to the more well off. That is not going to 
give the economic stimulus this country needs. And then approaching 
this question of all these defaulted loans or the ones that are about 
to be defaulted, over and above what we have already attempted to do in 
December, is something that we must address. What is the appropriate 
action, not to reward those who were gaming the system, but for those 
who are genuinely hurting because they either did not know or they were 
deceived into signing a mortgage that lulled them along with cheap 
interest rates and then all of a sudden has an escalation of that 
interest rate that they cannot pay.
  A combination of all these actions is what we ought to think about 
and come up with a stimulus package very soon in a bipartisan way. 
Let's in the Senate rise above the petty partisan politics that has so 
dominated this Chamber now for the last several years. Let's rise and 
come together and help our people with a quick passage of a stimulus 
package that will get America back on the economic track.

[[Page 491]]




                            Florida Primary

  I end by saying a word or two about a completely different subject. 
It has been painful for this Senator to see the Democratic candidates 
for President stay out of my State of Florida because they had to sign 
a pledge that was insisted upon by the four first privileged States--
Iowa, New Hampshire, Nevada, and South Carolina--even though it was a 
Republican State legislature, signed into law by a Republican Governor 
of Florida, moving the primary 1 week before super Tuesday, February 5, 
to the Florida primary date of January 29, those four privileged States 
insisted that the candidates sign a pledge or else suffer the 
consequences in those early four States.
  The pledge was that they would not campaign in Florida, they would 
not hire staff in Florida, they would not open an office, they would 
not make telephone calls, they would not make advertisements, they 
would not, can you believe, have press conferences.
  This Senator thinks that the first amendment protections have been 
shredded. Nevertheless, that is what the Democratic candidates did, and 
they have stayed out of Florida.
  The Republican National Committee, not taking away all the delegates 
as the Democratic National Committee did from Florida, took away half 
the Republican delegates from Florida but did not extract such a 
pledge. Thus, since the South Carolina primary was already held for the 
Republicans, and it is still to be held this Saturday for the 
Democrats, we see the Republicans en masse in Florida campaigning, much 
to the chagrin of Florida Democrats who do not see their candidates.
  What is going to happen is that next Tuesday, Florida is going to 
vote; Florida, 18 million people, the first big State to vote, the 
first State that is representative of the country as a whole in almost 
any demographic that we line up with the country, it is going to vote, 
and it is going to cast its ballots for President of both parties, and 
it is going to be reported how Florida votes. It is definitely going to 
have an effect 7 days going into super Tuesday when 22 States vote.
  Senator Levin of Michigan and I have filed a bill that will bring 
some order out of this chaos. There should not be a person in America 
who thinks this is the way to nominate a President of the United States 
for their party. If we continue to allow this kind of chaos going on, 
the States will continue to leapfrog each other, and the first primary 
will be at Halloween.
  This is not a good way of selecting nominees. Senator Levin and I 
have suggested a more orderly system that I will describe in detail at 
a later time but that would have six primaries: the first in March, two 
in April, two in May, and the last one in June, through which the 
States, large and small, geographically distributed, would each, 
according to the sequence of which they would draw out of a hat one to 
six, proceed on that order. Four years later, they would rotate. The 
ones second would go first, and the ones first would go to the last 
primary in June, 4 years down the road in the next Presidential cycle.
  We have to bring order out of this chaos. In the meantime, I am here 
as Florida's senior Senator to say and to let all those Presidential 
candidates know that Florida takes its vote very seriously. Florida 
will express herself in both parties. Florida will have the influence 
of the first big State, and by the time we get to the conventions in 
August and September, the entire Florida delegation will be seated and 
voted.
  So I ask the Presidential candidates to consider the frustration and 
the consternation on the Democratic side as we approach our Florida 
Presidential primary on January 29.
  Madam President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Kansas.


                           Amendment No. 3893

  Mr. BROWNBACK. Madam President, I ask unanimous consent that the 
pending business be set aside and that my amendment, No. 3893, be 
called up.
  The PRESIDING OFFICER. Without objection, it is so ordered. The clerk 
will report the amendment.
  The legislative clerk read as follows:

       The Senator from Kansas [Mr. Brownback] proposes an 
     amendment numbered 3893.

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

 (Purpose: To acknowledge a long history of official depredations and 
   ill-conceived policies by the Federal Government regarding Indian 
  tribes and offer an apology to all Native Peoples on behalf of the 
                             United States)

       At the end, add the following:

                        TITLE III--MISCELLANEOUS

     SEC. 301. RESOLUTION OF APOLOGY TO NATIVE PEOPLES OF UNITED 
                   STATES.

       (a) Findings.--Congress finds that--
       (1) the ancestors of today's Native Peoples inhabited the 
     land of the present-day United States since time immemorial 
     and for thousands of years before the arrival of people of 
     European descent;
       (2) for millennia, Native Peoples have honored, protected, 
     and stewarded this land we cherish;
       (3) Native Peoples are spiritual people with a deep and 
     abiding belief in the Creator, and for millennia Native 
     Peoples have maintained a powerful spiritual connection to 
     this land, as evidenced by their customs and legends;
       (4) the arrival of Europeans in North America opened a new 
     chapter in the history of Native Peoples;
       (5) while establishment of permanent European settlements 
     in North America did stir conflict with nearby Indian tribes, 
     peaceful and mutually beneficial interactions also took 
     place;
       (6) the foundational English settlements in Jamestown, 
     Virginia, and Plymouth, Massachusetts, owed their survival in 
     large measure to the compassion and aid of Native Peoples in 
     the vicinities of the settlements;
       (7) in the infancy of the United States, the founders of 
     the Republic expressed their desire for a just relationship 
     with the Indian tribes, as evidenced by the Northwest 
     Ordinance enacted by Congress in 1787, which begins with the 
     phrase, ``The utmost good faith shall always be observed 
     toward the Indians'';
       (8) Indian tribes provided great assistance to the 
     fledgling Republic as it strengthened and grew, including 
     invaluable help to Meriwether Lewis and William Clark on 
     their epic journey from St. Louis, Missouri, to the Pacific 
     Coast;
       (9) Native Peoples and non-Native settlers engaged in 
     numerous armed conflicts;
       (10) the Federal Government violated many of the treaties 
     ratified by Congress and other diplomatic agreements with 
     Indian tribes;
       (11) the United States should address the broken treaties 
     and many of the more ill-conceived Federal policies that 
     followed, such as extermination, termination, forced removal 
     and relocation, the outlawing of traditional religions, and 
     the destruction of sacred places;
       (12) the United States forced Indian tribes and their 
     citizens to move away from their traditional homelands and 
     onto federally established and controlled reservations, in 
     accordance with such Acts as the Act of May 28, 1830 (4 Stat. 
     411, chapter 148) (commonly known as the ``Indian Removal 
     Act'');
       (13) many Native Peoples suffered and perished--
       (A) during the execution of the official Federal Government 
     policy of forced removal, including the infamous Trail of 
     Tears and Long Walk;
       (B) during bloody armed confrontations and massacres, such 
     as the Sand Creek Massacre in 1864 and the Wounded Knee 
     Massacre in 1890; and
       (C) on numerous Indian reservations;
       (14) the Federal Government condemned the traditions, 
     beliefs, and customs of Native Peoples and endeavored to 
     assimilate them by such policies as the redistribution of 
     land under the Act of February 8, 1887 (25 U.S.C. 331; 24 
     Stat. 388, chapter 119) (commonly known as the ``General 
     Allotment Act''), and the forcible removal of Native children 
     from their families to faraway boarding schools where their 
     Native practices and languages were degraded and forbidden;
       (15) officials of the Federal Government and private United 
     States citizens harmed Native Peoples by the unlawful 
     acquisition of recognized tribal land and the theft of tribal 
     resources and assets from recognized tribal land;
       (16) the policies of the Federal Government toward Indian 
     tribes and the breaking of covenants with Indian tribes have 
     contributed to the severe social ills and economic troubles 
     in many Native communities today;
       (17) despite the wrongs committed against Native Peoples by 
     the United States, Native Peoples have remained committed to 
     the protection of this great land, as evidenced by the fact 
     that, on a per capita basis, more Native Peoples have served 
     in the United States Armed Forces and placed themselves in 
     harm's way in defense of the United States in every major 
     military conflict than any other ethnic group;

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       (18) Indian tribes have actively influenced the public life 
     of the United States by continued cooperation with Congress 
     and the Department of the Interior, through the involvement 
     of Native individuals in official Federal Government 
     positions, and by leadership of their own sovereign Indian 
     tribes;
       (19) Indian tribes are resilient and determined to 
     preserve, develop, and transmit to future generations their 
     unique cultural identities;
       (20) the National Museum of the American Indian was 
     established within the Smithsonian Institution as a living 
     memorial to Native Peoples and their traditions; and
       (21) Native Peoples are endowed by their Creator with 
     certain unalienable rights, and among those are life, 
     liberty, and the pursuit of happiness.
       (b) Acknowledgment and Apology.--The United States, acting 
     through Congress--
       (1) recognizes the special legal and political relationship 
     Indian tribes have with the United States and the solemn 
     covenant with the land we share;
       (2) commends and honors Native Peoples for the thousands of 
     years that they have stewarded and protected this land;
       (3) recognizes that there have been years of official 
     depredations, ill-conceived policies, and the breaking of 
     covenants by the Federal Government regarding Indian tribes;
       (4) apologizes on behalf of the people of the United States 
     to all Native Peoples for the many instances of violence, 
     maltreatment, and neglect inflicted on Native Peoples by 
     citizens of the United States;
       (5) expresses its regret for the ramifications of former 
     wrongs and its commitment to build on the positive 
     relationships of the past and present to move toward a 
     brighter future where all the people of this land live 
     reconciled as brothers and sisters, and harmoniously steward 
     and protect this land together;
       (6) urges the President to acknowledge the wrongs of the 
     United States against Indian tribes in the history of the 
     United States in order to bring healing to this land by 
     providing a proper foundation for reconciliation between the 
     United States and Indian tribes; and
       (7) commends the State governments that have begun 
     reconciliation efforts with recognized Indian tribes located 
     in their boundaries and encourages all State governments 
     similarly to work toward reconciling relationships with 
     Indian tribes within their boundaries.
       (c) Disclaimer.--Nothing in this section--
       (1) authorizes or supports any claim against the United 
     States; or
       (2) serves as a settlement of any claim against the United 
     States.

  Mr. BROWNBACK. Madam President, I thank my colleague from North 
Dakota, the chairman of the Indian Affairs Committee, who has been a 
sponsor of this bill that I put in amendment form and am calling up now 
as an amendment, as an official apology to Native Americans in the 
United States for past issues. It is an amendment with a lot of history 
to it.
  The bill has been brought up this Congress, the last Congress, and it 
has passed the Indian Affairs Committee both Congresses. It is an 
amendment with an issue of a lot of history to it. The chairman and 
myself are from Plains States where there is a lot of Native American 
history, as there is throughout the United States. It is a history that 
is both beautiful, difficult, and sad at the same time.
  I have four tribal lands in my State, four areas where there are 
tribal lands, some that are tribal but don't have a resident tribe in 
the State. This has been an issue that has been around for some time--
the relationship between the Federal Government and the tribes.
  What we have crafted in this amendment, a previous bill that is now 
in amendment form, is an official apology. It does not deal with 
property issues whatsoever, but it recognizes some of the past 
difficulty in the relationship.
  It says that for those times the Federal Government was wrong, we 
acknowledge that and apologize for it. Apologies are difficult and 
tough to do, but I think this one is meritorious and, as I present my 
case, I hope my colleagues will agree and support this amendment.
  I rise today to speak about this issue that I believe is important to 
the well-being of all who reside in the United States. It is an issue 
that has lain unresolved for far too long, an issue of the United 
States Government's relationship with the Native peoples of this land.
  Native Americans have a vast and proud legacy on this continent. Long 
before 1776 and the establishment of the United States of America, 
Native peoples inhabited this land and maintained a powerful physical 
and spiritual connection to it. In service to the Creator, Native 
peoples sowed the land, journeyed it, and protected it. The people from 
my State of Kansas have a similar strong attachment to the land.
  Like many in my State, I was raised on the land. I grew up farming 
and caring for the land. I and many in my State established a 
connection to this land as well. We care for our Nation and the land of 
our forefathers so greatly that we too are willing to serve and protect 
it, as faithful stewards of the creation with which God has blessed us. 
I believe without a doubt citizens across this great Nation share this 
sentiment and know its unifying power. Americans have stood side by 
side for centuries to defend this land we love.
  Both the Founding Fathers of the United States and the indigenous 
tribes that lived here were attached to this land. Both sought to 
steward and protect it. There were several instances of collegiality 
and cooperation between our forbears--for example, in Jamestown, VA, 
Plymouth, MA, and in aid to explorers Lewis and Clark. Yet, sadly, 
since the formation of the American Republic, numerous conflicts have 
ensued between our Government, the Federal Government, and many of 
these tribes, conflicts in which warriors on all sides fought 
courageously and which all sides suffered. Even from the earliest days 
of our Republic there existed a sentiment that honorable dealings and a 
peaceful coexistence were clearly preferable to bloodshed. Indeed, our 
predecessors in Congress in 1787 stated in the Northwest Ordinance:

       The utmost good faith shall always be observed toward the 
     Indians.

  Many treaties were made between the U.S. Government and Native 
peoples, but treaties are far more than just words on a page. Treaties 
represent our word, and they represent our bond. Treaties with other 
governments are not to be regarded lightly. Unfortunately, again, too 
often the United States did not uphold its responsibilities as stated 
in its covenants with Native tribes.
  I have read all of the treaties in my State between the tribes and 
the Federal Government that apply to Kansas. They generally came in 
tranches of three. First, there would be a big land grant to the tribe. 
Then there would be a much smaller one associated with some equipment 
and livestock, and then a much smaller one after that.
  Too often, our Government broke its solemn oath to Native Americans. 
For too long, relations between the United States and Native people of 
this land have been in disrepair. For too much of our history, Federal 
tribal relations have been marked by broken treaties, mistreatment, and 
dishonorable dealings. I believe it is time to work to restore these 
relationships to good health. While the record of the past cannot be 
erased, I am confident the United States can acknowledge its past 
failures, express sincere regrets, and work toward establishing a 
brighter future for all Americans. It is in this spirit of hope for our 
land that I am offering Senate Joint Resolution 4, the Native American 
Apology Resolution, as an amendment to the bill currently before us. 
This resolution will extend a formal apology from the United States to 
tribal governments and Native peoples nationwide--something we have 
never done; something we should have done years and years ago.
  I want my fellow Senators to note this resolution does not--does 
not--dismiss the valiance of our American soldiers who fought bravely 
for their families in wars between the United States and a number of 
the Indian tribes, nor does this resolution cast all the blame for the 
various battles on one side or another.
  Further, this resolution will not resolve the many challenges still 
facing Native Americans, nor will it authorize, support or settle any 
claims against the United States. It doesn't have anything to do with 
any property claims against the United States. That is specifically set 
aside and not in this bill. What this resolution does do is recognize 
and honor the importance of Native Americans to this land and to the 
United States in the past and today

[[Page 493]]

and offers an official apology for the poor and painful choices the 
U.S. Government sometimes made to disregard its solemn word to Native 
peoples. It recognizes the negative impact of numerous destructive 
Federal acts and policies on Native Americans and their culture, and it 
begins--begins--the effort of reconciliation.
  President Ronald Reagan spoke of the importance of reconciliation 
many times throughout his Presidency. In a 1984 speech to mark the 40th 
anniversary of the day when the Allied armies joined in battle to free 
the European Continent from the grip of the Axis powers, Reagan 
implored the United States and Europe to ``prepare to reach out in the 
spirit of reconciliation.''
  Martin Luther King, whom we recognized and celebrated yesterday, who 
was a true reconciler, once said:

       The end is reconciliation, the end is redemption, the end 
     is the creation of the beloved community.

  This resolution is not the end, but perhaps it signals the beginning 
of the end of division and a faint first light and first fruits of the 
creation of beloved community. This is a resolution of apology and a 
resolution of reconciliation. It is a step toward healing the wounds 
that have divided our country for so long--a potential foundation for a 
new era of positive relations between tribal governments and the 
Federal Government.
  It is time--as I have stated, it is way past time--for us to heal our 
land of division, all divisions, and bring us together. There is 
perhaps no better place than in the midst of the Senate's consideration 
of the Indian Health Care Improvement Act reauthorization to do this. 
With this in mind, I hope my Senate colleagues will support this 
amendment. I would ask their consideration on it. I would ask for their 
positive vote for it.
  I hope a number of my colleagues in the Senate will join me as a 
cosponsor of the amendment itself so we can show a united front and 
that it is time for us to heal. I ask they give us that consideration. 
I simply ask my colleagues to look for this, and I hope they can vote 
for it as well.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from North Dakota.
  Mr. DORGAN. Madam President, I thank the Senator from Kansas. I am a 
cosponsor in support of the amendment he has offered.
  If one studies the history in this country with respect to Indian 
tribes, it is a tragedy. It is very hard for someone to study it, 
understand it, and not wish our country to apologize for it. We entered 
into treaties with the tribes; agreements, signed treaties, with the 
tribes. We took tribal homelands and pushed them onto reservations and 
made agreements, including trust agreements, to provide for their 
health care and many other things.
  Then we decided we wanted to push them off reservations and move them 
into urban areas. Then we decided we would discontinue a government-to-
government relationship with 109 tribes. We terminated the tribal 
status of 109 tribes, and we told these folks to leave the reservations 
and here is a one-way ticket. We want you to go to the cities to be 
assimilated into the cities. So we sent them off to the cities, far 
away from families and health care facilities. Then we sent them off to 
boarding schools and terminated their governmental status. We took 
lands off protected trust status and then turned, once again, and began 
to revitalize tribal language and culture and governments.
  When you understand what this country has done, in terms of 
abrogating agreements and treaties it has made, one can understand the 
words of Chief Joseph. Here is what Chief Joseph said:

       Good words do not last long unless they amount to 
     something. Good words do not pay for my dead people. Good 
     words cannot give me back my children. Good words will not 
     give my people good health and stop them from dying. I am 
     tired of talk that comes to nothing. It makes my heart sick 
     when I remember all of the good words and then all of the 
     broken promises.

  Chief Joseph was an honorable Indian leader. He negotiated face-to-
face with the leaders of our country. And while he lived, he saw 
promise after promise after promise broken. U.S. Supreme Court Justice 
Hugo Black wrote:

  Great nations, like great men, should keep their word.

  That is all Chief Joseph and so many other Indian leaders asked, and 
it was never granted. We are trying now, in some small and some 
significant ways, to remedy and address these issues. The Indian Health 
Care Improvement Act is one step in the right direction to say this 
country will start to keep its promise, its promise, as a trust 
responsibility, to provide health care for American Indians.
  I say to my colleague from Kansas, I used a chart earlier today to 
say the American people, the American Government, is responsible, 
because of treaty obligations and a trust obligation, a trust 
obligation we have for American Indians, to provide health care to two 
groups of people. One group is incarcerated Federal prisoners. That is 
our charge. We put them in prison for crimes, we are required to 
provide for their health care in Federal prisons. We also have a 
responsibility for health care for American Indians because of the 
trust responsibility and treaties by which we made that promise.
  Compare the two. We spend twice as much money providing health care 
for incarcerated prisoners in Federal prisons as we do providing health 
care to American Indians. And that is why today it is likely somewhere 
on an Indian reservation someone is dying who shouldn't have to die. 
Some young child is suffering who shouldn't have to suffer because the 
health care we expect for our families is not available to them.
  If I might, for another minute, say once again that I showed a 
picture this morning of a young girl named Ta'Shon Rain Littlelight. 
She died at the age of 5. Ta'Shon Rain Littlelight didn't get the 
health care most of us would expect for our children. She was a 
beautiful young child on the Crow reservation, and she spent the last 3 
months of her life in unmedicated pain. Finally, she was diagnosed with 
a terminal illness. And when she was, and I talked about this earlier, 
she asked to go to see Cinderella's castle, and so the Make-A-Wish 
Foundation sent her and her mother to Orlando. In the hotel, on the 
night before she was to see Cinderella's castle, she died in her 
mother's arms. As she lay in her mother's arms, she said: Mommy, I will 
try not to be sick. Mommy, I will try to get better.
  This young girl, time after time after time, had been taken to the 
clinic and was diagnosed and treated for depression at the age of 5 
when, in fact, she had terminal cancer and she is now dead. A beautiful 
young girl--Ta'Shon Rain Littlelight. This is happening across our 
country, and we have to stop it. It is our responsibility to stop it.
  My colleague from Kansas offers a resolution that talks about past 
abuses, and they are unbelievable. But some of them continue, and that 
is the purpose of this bill and the reason I appreciate his support for 
the underlying bill. But I did wish to say I am a cosponsor of the 
amendment offered by Senator Brownback. It is the right thing for our 
country to do. I am proud to cosponsor what he is suggesting to the 
Senate today. He is offering it now as an amendment. I have previously 
cosponsored it as a bill when he has introduced it in the Senate.
  So my thanks to the Senator from Kansas. And after he speaks, Madam 
President, I know the Senator from Ohio wishes to be recognized. But I 
suspect the Senator from Kansas wishes to say a word, at which point I 
am happy the Senator from Ohio is here and wishes to speak on this 
bill.
  The PRESIDING OFFICER. The Senator from Kansas.
  Mr. BROWNBACK. Madam President, I wished to thank my colleague from 
North Dakota, and I would ask the amendment be referred to as the 
Brownback-Dorgan amendment, if that would be acceptable to my 
colleague. We will put it forward that way because he has been lead 
sponsor of this for the past several Congresses, and I appreciate his 
hard work.
  I appreciate his heart and his practicality on the current situation. 
We do have to get better health care on the reservations and for the 
Native tribes.

[[Page 494]]

I appreciate the effort to get that done, and I think that is an 
important effort for us and a very practical and necessary thing, so 
the examples he talks about, and unfortunately so many others, don't 
continue to happen across this country.
  The amendment put forward by my colleague from Louisiana, Senator 
Vitter, is also important, his view about codifying a situation 
regarding abortions with Native Americans. I would hope that would be 
something we could see passed as something that is a hopeful sign in 
pushing to the future, rather than a sign of despair and the killing of 
children, which I think is completely wrong for us to see taking place 
and for us to be funding it as well.
  I am delighted this bill is coming up. I think this is an important 
issue for us to debate, and I am glad to support it.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Ohio.
  Mr. BROWN. Madam President, Wall Street and international markets are 
clearly concerned or worse over a possible U.S. recession. Congress is 
formulating, as we know--the President, both parties' leadership, the 
Members of the House and Senate--an economic stimulus package, which is 
the right thing to do, but there are several pieces to this puzzle. The 
economy is faltering, to be sure, and we have those concerns about our 
economy as a whole. Equally important, I would argue more importantly, 
more Americans are losing access to basic necessities because of it.
  A stimulus package should do two things. First of all, a stimulus 
package needs to stimulate the economy so we can pull ourselves more 
quickly and more vigorously, if you will, out of this recession. A 
stimulus package also, equally or more importantly, needs to help those 
people who have been most victimized by the recession.
  I rise to urge this body to take responsibility for helping those who 
are without food, without adequate heat, and without adequate housing; 
those for whom the economic crisis is not just a source of anxiety, in 
some sense it is a thief in the night who has robbed Americans of basic 
human needs.
  In December, I spoke about the crisis food banks across our Nation 
face. It was the lead-up to Christmas, a time when the spirit of giving 
is at its peak. The holidays are now over and we are deep into January. 
Not surprisingly, food bank donations have fallen off precipitously. 
Yet the need for food grows as the economic crisis deepens.
  Across this country more Americans are in need of food assistance and 
less food is available. The result is hunger. In the wealthiest Nation 
in the world, people are waiting in line for a subsistence level of 
food, food that runs out too often before the lines run out. People who 
live in the communities we serve are facing increasing food insecurity. 
In too many cases, people don't know from where their next meal will 
come.
  Increasingly, these are families with children. Food banks in Ohio 
and Virginia and Arizona and California and in the Presiding Officer's 
home State of Missouri, in Colorado and every State in the Union are 
underfunded, overextended. The unemployed, the sick, the aged, the 
homeless, the mentally ill--these are the individuals who typically 
seek food banks and food pantries for assistance. And now more working 
families are also being forced to seek food assistance as factories 
close and as gas prices and transportation prices--the cost of 
transportation goes up for people driving to work, wages stagnate, food 
prices go up, and daily necessities become more expensive.
  Five years ago, the Food Bank of Southeast Virginia reported serving 
95,000 people--95,000 people in 2002. In 2007, that food bank served 
203,000. Forty-two percent of their recipients are categorized as 
working poor, a population that is on the rise.
  In Warren County, OH, a generally affluent county northeast of 
Cincinnati--the county seat is Lebanon, which I visited last week--in 
that county, 90 percent of people who go to food pantries have jobs, 90 
percent of them are working. They are working often in part-time jobs, 
often in full-time jobs without benefits, always in jobs that cannot 
pay their bills.
  For many years, one of my constituents, Tim, and his wife donated 
time and money to Cleveland-area food banks and soup kitchens. But over 
time, cash for Tim and his wife became tight. They stopped giving money 
to the food bank; they continued to donate their time to the food bank. 
This year, after months of rationing food in their own household, Tim 
and his wife were forced to use the food bank themselves. It took great 
humility, Tim recalls. Tim says he used to be middle class, but he does 
not see himself as middle class anymore. He says his wages have not 
kept pace with subsistence expenses. What he gets from the food bank is 
not enough either. The groceries he receives last his household about 1 
week. Food distributions are limited to once a month.
  In Ohio, 70 percent of food pantries do not have enough food to serve 
everyone in need. This problem is not unique to Ohio. It is affecting 
cities across the country, with Denver and Orlando and Phoenix 
particularly hard-hit. American's Second Harvest, the nationwide food 
bank network, projected a food shortage of 15 million pounds--11.7 
million meals--by the end of 2007.
  Congress must act swiftly to alleviate the current food shortage. 
That is why I introduced last month legislation that would allocate $40 
million in emergency assistance--$40 million is all. Just to put it in 
perspective, we are spending $3 billion a week on the war in Iraq. We 
are asking for $40 million in short-term emergency funding for the 
Emergency Food Assistance Program, so-called TEFAP.
  With legislators still negotiating the details of the farm bill, 
critical TEFAP funding, which provides food at no cost to low-income 
Americans in need of short-term hunger relief, has dried up at the 
worst possible time. This bill will provide the funding necessary to 
keep food banks funding intact until the farm bill is signed into law.
  On a cold December morning about a month ago in southeast Ohio, in 
the town of Logan, at 3:30 in the morning--3:30 in the morning--people 
began to line up at a food bank at the Smith Chapel United Methodist 
Church pantry. By 8 o'clock, about 4\1/2\ hours later, when volunteers 
began distributing food, the line of cars stretched for more than a 
mile and a half. By early afternoon of this cold December day, more 
than 2,000 residents had received food. That is 7 percent of the local 
population in a county where people drove 20 or 30 minutes to get 
there. Seven percent of the local population in 1 day, in one church, 
came to this food pantry for food. Just 8 years ago, that pantry served 
17 families a month--17 families a month. One December day, 2,000 
families, that is a crisis.
  In the Los Angeles Times yesterday, a grateful recipient of scant 
food donations said: I eat anything they give me.
  In the Virginia Pilot in southeast Virginia yesterday, a recipient 
admitted: What I get here lasts all month. I kind of stretch it.
  Of the shortages at the food banks, Tim from Cleveland asked: How 
hard is it to give a can of tuna?
  In a nation as wealthy as ours, no one who works hard for a 
lifetime--as most of these people who have gone to food banks do and 
have worked a lifetime to provide for their families, to get along, try 
to join the middle class--no one who works hard for a lifetime should 
ever have to make statements like those statements.
  This is a national crisis. In a faltering economy, more people 
descend into crisis. It is inevitable. The need for economic stimulus 
goes hand in hand with the need for a caring community. Again, the 
economic stimulus package needs to stimulate the economy. It also 
needs, equally, maybe more importantly, to help those who have been 
victimized by this recession.
  Our Nation has always been a caring community. More children are 
hungry today. More elderly Americans cannot pay their heating bills. 
More middle-class families now consider themselves among the working 
poor. Americans do not turn their backs on fellow Americans in need. As 
individuals, Americans do not; as a government, we should not.

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  The economic stimulus package should revive the economy and reaffirm 
our bonds with each other. This economic stimulus package is an 
opportunity to demonstrate our economic and moral strength. Let us take 
that opportunity. Let us act immediately to prevent more Americans from 
going to bed hungry.
  The stimulus package needs to include food banks, food pantries, 
extension of unemployment compensation, and help for those elderly 
Americans who simply cannot pay their heating bills.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Massachusetts.
  Mr. KENNEDY. Madam President, I wish to commend my friend and 
colleague from Ohio for addressing this issue on the challenges we are 
facing in terms of our economic situation here in the United States. 
The world is aware of this, as is anyone who watches the early morning 
programs. But most of all, we have been seeing this develop over a 
period of time, as the Senator has pointed out, and it is really 
shocking to me that it has really taken this long for the 
administration to come up and develop its own program.
  I join with him in urging early action. We cannot delay. We cannot 
wait. The time is now on this issue. And I just thank him for telling 
us how it was out in the State of Ohio because the conditions he has 
described out in his State are very similar to the conditions in my 
State of Massachusetts. We will hear from many of our colleagues that 
they are feeling this as well. So we look forward to working with him 
and others here in the Senate and helping to fashion this program that 
is absolutely essential for the well-being of working families in this 
country.
  I am always reminded, as the Senator is, that the American people who 
are so adversely affected did not do anything wrong. They have been 
working hard, playing by the rules, and trying to provide for their 
families. The responsibility to do something about it is right here 
with the administration and with the Congress. So many Americans' lives 
have been turned upside down, in many respects shattered. It adds a 
very special responsibility for all of us. So I thank him for his very 
useful and important contribution.
  In recent weeks, the headlines have been filled with bad economic 
news. Two weeks ago, it was an alarming increase in the unemployment 
rate. Last week, it was rising prices for basic essentials such as food 
and gasoline. Week after week, there is more bad housing news. 
Foreclosures are skyrocketing. Bankruptcies are rising. Yesterday, the 
Washington Post discussed challenges facing the more than 1.3 million 
Americans who have been actively looking for a job for more than 6 
months--for more than 6 months without success. It is a tragic tale. 
College-educated professionals and people who have worked for decades 
are now forced to drain their retirement accounts and rely on charity 
to make ends meet. It seems that every day there is new information 
showing that the economy is headed in the wrong direction, that no one 
will be spared.
  These are not statistical trends or indicators. Every bad number 
reflects a real hardship in real people's lives. When food prices 
increase by 5 percent, that means average families will pay over $400 
more next year to put meals on the table. When the unemployment rate 
rises 1.5 percent, it pushes a typical family's wages down $2,400. Each 
higher cost or lower paycheck adds up to big problems for working 
Americans. Parents are giving up time with their families to work 
longer hours or take a second job. Employees are struggling with credit 
card debt and skyrocketing interest rates. Young couples are losing 
their first homes because they cannot pay the mortgage, and parents are 
pulling their children out of college because they cannot pay the 
bills. For these families, a recession is not just part of the business 
cycle; it is a life-changing event from which they may never fully 
recover.
  I have heard from many in Massachusetts who are struggling in these 
tough times. There is Teresa in Everett. She is a single mom with three 
children aged 10, 6, and 3. She is proud that she has worked her way 
out of welfare, but her life as a working mother is increasingly hard. 
Her bills are out of control, and each day she is faced with impossible 
decisions: Do I feed myself or feed my children? Can I turn on the heat 
or just put on an extra layer of clothing and try to get by? In 
Teresa's household, a $4 gallon of milk has become a luxury she cannot 
afford.
  Teresa's family is not alone. A looming crisis is now facing tens of 
millions of American families. Economists across the spectrum, from 
former Treasury Secretary Larry Summers to Federal Reserve Chairman Ben 
Bernanke, and even President Bush himself, all agree that we are facing 
tough times to come and the Government must act.
  But even more importantly than advice from these noted scholars is 
the clear message of the American people. They are struggling. They 
need our help now. They elected us to make their lives and their 
children's lives better, and now is the time.
  We need a simple, effective plan to stimulate the economy and also 
put back in workers' pockets resources and money to give them the 
support they need to weather the storm. This plan should be built on 
one fundamental principle: People do not work for the economy; the 
economy should work for the people. If we want an economic recovery 
that works, if we want real opportunities and sustainable growth, that 
effort must start and end with working families.
  Putting people first means targeting our stimulus efforts to meet 
three essential goals.
  First, we must act quickly to provide immediate help for those in 
crisis. The declining economy may be a current issue in the newspapers, 
but working families have been suffering for some time; 7.7 million 
Americans are already unemployed. There have been almost 2 million 
foreclosure filings in the last year alone, including 225,000 last 
month. The number of families facing bankruptcy has risen by 40 percent 
in the past year. For these Americans, the recession is already here, 
and they need help now to get back on their feet.
  Second, we must do the most for those who need help the most. 
Targeting families at the very bottom of the economic ladder is 
essential because it also provides the biggest economic boost. Every 
dollar a low-income household receives is spent on basic needs, putting 
money back into the local economy right away. In regions with many 
struggling families, such spending is critical to help keep entire 
communities afloat.
  Finally, we must find solutions that will make a real difference in 
people's lives. It is not enough just to tinker at the margins. Our 
economic problems are getting worse every day, and we need a strong 
medicine to make things right.
  There are a number of short-term steps we can take to achieve these 
goals and restore hope and opportunity to families across the country. 
They are simple. They build on existing programs. They are effective. 
We should pass them, and we should pass them now.
  For workers who are struggling to find a job, we must support them in 
the difficult process of finding work. It becomes harder and harder to 
find a good job in today's economy. The Nation is enduring profound 
changes as we adapt to the global economy. Entire industries are 
disappearing, leaving workers and communities devastated in their wake. 
Madam President, 1.3 million workers have been getting up early every 
morning, day in and day out, looking for a job for more than 6 months. 
That number will only rise as the recession deepens. Just last week, 
Goldman Sachs economists predicted that the unemployment rate would 
reach 6.5 percent by the beginning of 2009 compared to 5 percent today.
  This is a dual challenge. We now have projections about what we are 
going to have in terms of unemployment. No matter what we do in terms 
of stimulating the economy--we have to stimulate the economy--we also 
have to be mindful that we are going to have significant unemployment 
even in the outyear of 2009 as Goldman Sachs has

[[Page 496]]

predicted. We have both challenges, the economy and the fact that 
people are going to be unemployed.
  To help these unemployed men and women weather the storm we need to 
extend unemployment benefits and expand access to benefits. As workers, 
they have paid into the system and they deserve help when they need it. 
We should also provide transitional health care assistance. People who 
receive unemployment compensation have paid into the fund. The problem 
now is many of them, even though they paid into the fund, are unable to 
benefit from it. That is wrong. We should address that. We have 
legislation to do so. It passed the House of Representatives, and we 
should pass it as part of a stimulus program at the present time.
  Most importantly, we should do more to help unemployed workers find 
good jobs they are seeking. We have open jobs, 93,000 in Massachusetts 
alone. We certainly have jobs that are available, and we have more than 
178,000 unemployed workers. So we have the jobs that are available, and 
we have the unemployed workers. What is missing? Training programs. How 
many applicants do we have for every training program? We have 21 
applicants for every training program. We have good jobs with good 
benefits, and we have the people who want them. The only ingredient 
missing is training, and these workers want the training. They will 
sacrifice for training. But they haven't got it because we have cut 
back on training programs in recent years. We ought to be able to 
address those issues, and we ought to do it now.
  It is not just those who have lost their jobs and are facing a 
crisis. Millions more families are living on the brink of disaster 
because they are struggling to pay bills. Since President Bush took 
office, the cost of health insurance has risen 38 percent. Housing 
prices are up 39 percent. A tank of gas is up 78 percent; tuition, 43 
percent; and wages are stagnant, up 6 percent. This is the pressure 
families are feeling today, a sense of insecurity.
  Security is an issue that is of major importance and consequence to 
families. They are concerned about security overseas. They are 
concerned about homeland security. But they are also concerned about 
job security and health security and education security. They are also 
concerned about energy security. They are concerned about their long-
term security, what is going to happen to pensions, as they see the 
safety net for pensions increasingly fragmented. They are concerned 
about unemployment insurance security as they have seen that safety net 
fragment. They are deeply concerned. They are all worried deeply about 
it.
  It is interesting. I don't know how many times during the course of 
the debate on the stimulus that we will take a moment and think of what 
is the cost of the anxiety that these families have, when they are 
worried primarily about their children or grandparents. That doesn't 
appear on the bottom line of any sheet we will have on the floor of the 
Senate, but it is out there and being felt now, and it is very real. We 
ought to understand that--real anxiety, real frustration, real 
suffering, real worry every day, every night, primarily by parents as 
they are concerned about their children. They worry about their loved 
ones and their families, immediate family, and less about themselves. 
They worry about others. We have the ability to deal with that, and we 
must.
  We need a boost in basic support programs to help working families 
cope with the relentless pressure of everyday life during this time. 
This means expanding home heating assistance. A typical household may 
have to spend as much as $3,000 on heating oil this winter, probably 
closer to $4,000 in Massachusetts. Fuel assistance will cover less than 
a third of these costs. Of the 35 million households eligible for fuel 
assistance nationwide, only 5 million receive such benefits. Six of 
seven families in need receive no help at all because the States run 
out of funds.
  Last week, the White House released $450 million in emergency 
assistance to States across the Nation, including $27 million for 
Massachusetts. The reality is, when oil prices are surging past $3.30 
per gallon, and households will need at least 800 gallons of heating 
oil this winter, it is just not enough.
  Bob Coard of Action for Boston Community Development, one of the 
largest community action agencies in the Northeast, says the emergency 
funds will barely cover enough to make a 100-gallon delivery to ABCD 
clients, and the 100-gallon delivery will cost about $300 and will 
provide a family with heat for about 2 to 3 weeks. Talk about something 
that will have a direct impact. A week ago Massachusetts was notified 
that it was going to receive approximately $30 million, and they were, 
within a 2-week period, able to get the oil tankers up to find those 
who are eligible for that program to deliver 100 gallons of fuel oil to 
needy families. That will only last 2 weeks. It is out there. We know 
what the need is. We know what these individuals suffer. So we can do 
things that can have an immediate impact. Certainly this is something 
to which we should be attentive.
  The people who are receiving this fuel assistance are in danger of 
this perfect storm that we refer to in New England where they have 
extraordinary increases in prices generally. One part of the storm is 
an increase in the cost of fuel oil to heat their homes. A second part 
is their ability to afford to pay their mortgage. If they cannot pay 
the mortgage, this is what happens. They make a judgment about whether 
they are going to pay the fuel or pay the mortgage. With children in 
the picture, they pay their fuel and they end up losing their home. So 
the fact that they don't get maybe 100 gallons, 200 gallons, 300 
gallons of oil means they lose their home.
  The cost in Massachusetts of providing services to a homeless family 
can be thousands of dollars a year. You can provide the oil for a 
fraction of that and keep people in their homes.
  These are the kinds of things that make a difference. We should give 
focus and attention to them.
  In our hearing this last week, I heard from Margaret Gilliam who 
takes care of her grandchildren in Dorchester and has already spent 
more on heating oil this heating season than she did all of last year. 
We still have many weeks of cold weather ahead, and she wonders what is 
going to happen to her grandchildren and to her home. Diane Colby, a 
single mother of two in Lynn, MA, keeps the thermostat at only 62 
degrees to stretch out the heating oil as long as possible. She has to 
sit down and decide which bills get paid and which don't. Otherwise she 
can't afford to keep the heat on. We must ensure that these families 
have the help they need through the winter. This is part of the 
challenge we are facing.
  In the proposals we have had from the President, we find that he 
proposes a tax break and a stimulus program that would completely leave 
out the poorest Americans. That is bad policy. Not only are low-income 
families the ones who suffer most in a recession, helping them is the 
best way to be certain that any stimulus goes directly into the economy 
and benefits our country the most. We can't keep repeating the mistakes 
of the past. Any tax rebate we pass now should be for everyone so that 
everyone can get back on their feet. The President's tax cuts for 
business are ill-advised. Past experience shows that such corporate tax 
breaks do not provide an effective stimulus. The problem with our 
economy today is a lack of demand, not of capacity. Businesses will not 
produce more until they know that customers are ready to buy. That is 
extremely important.
  We heard at our Joint Economic Committee hearing economists talk 
about the lack of demand, not a lack of capacity. Since there is a lack 
of demand, it doesn't make a lot of sense to increase capacity if there 
is not demand for it. Yet that is what the administration is attempting 
to do.
  Personal tax cuts targeting middle- and low-income families and 
funding boosts for programs such as unemployment insurance and food 
stamps are a better stimulus than business tax cuts because they 
encourage consumers to start spending. The economy is at a crossroads, 
and we must act carefully

[[Page 497]]

to choose the right path for the future. I am confident we can do that. 
I am certain we must do it to get America back on track.
  Finally, I want to review a few of the charts I have that spell out 
exactly where we are globally on this issue. Americans are deeply 
anxious about the economy. In a survey from just two weeks ago, Madam 
President, 61 percent of Americans say the condition of the economy is 
bad; one in five think things are very bad. This is an indication of 
the attitude of the American people. Here is one of the reasons.
  We see a significant increase in the unemployment rate in December, 
going to 5 percent. Among unemployed workers, 17.5 percent are long-
term unemployed. If you look at 2001 as we approached the last 
recession, it was only 11 percent. Now it is 17.5 percent, up 55 
percent. These are individuals who are out there, workers who want a 
job and have been spending month after month after month looking for 
one, unable to get a job. That has a devastating impact, particularly 
when you terminate the unemployment compensation for them which these 
individuals should be eligible to receive and which they have paid 
into.
  This shows the prediction from economists that unemployment will 
skyrocket next year. We heard this in testimony in the Joint Economic 
Committee hearing last week. Assuming we have a stimulus program, they 
say the economy can improve, but even with the economy improving, we 
are going to have a continued increase in the numbers of unemployed. 
That is something we have to be aware of.
  We still have job openings that are here, but nearly 8 million 
unemployed workers competing for 4 million jobs. It is a real problem. 
Not being able to get these jobs is a result of administration cuts to 
training programs all of these years. This is a pretty good indicator 
of what happens with the limitations.
  Americans cannot access job training programs. Opportunities are 
limited for workers to improve their skills. In Massachusetts alone, as 
I mentioned, for every available slot in a job training program, there 
are 21 workers on a waiting list. I have in the Chamber a picture of 
workers waiting on a waiting list. These people want to work. They want 
to provide for their families. They have the skills, the training 
programs to be able to get the job done, but they cannot afford that. 
We have had training programs, the kind the administration has cut 
back. Last year, it was close to half a billion dollars.
  This chart shows what has been happening with the unemployment rate. 
It has been going steadily up. High unemployment drives down wages. A 
1.5-percent increase in the unemployment rate would decrease the 
average family's income by $2,400 because of the downward pressure it 
puts on wages. So for every family--we know from Goldman Sachs; this is 
not our estimate, we have it from financial institutions--economic 
indicators indicate we are still going to have high unemployment. What 
that means is a real reduction for average working families in their 
purchasing power by $2,400. That is what is going on.
  We have seen what is happening as to the kinds of products that 
families are used to purchasing. The price of food is rising far faster 
than the rate of inflation. We have milk going up 16 percent, eggs 
going up 78 percent, and beef going up some 13 percent.
  In our part of the country, still, about 75 percent of all the homes 
are heated with home heating oil. Look what has happened. There has 
been a 40-percent increase in the cost of home heating oil since last 
year. And a great many of our people in my part of the country who own 
their homes are living on fixed incomes. They are getting this kind of 
increase. Social Security, for the average person, went up only 2.3 
percent from last year. But here we have a 40-percent increase in the 
cost of home heating oil, and it has been a cold winter.
  So these charts indicate, in different ways, how the average family 
is facing more and more difficulties. Too many middle-class families 
could not pay the essential expenses in the event of a job loss or 
other financial hardship. Seventy-seven percent of middle-class 
families do not have enough assets to pay the essential expenses for 3 
months.
  What is happening is many people are relying on their credit cards to 
do it, and then they are unable to meet their ends with their credit 
cards. That directly affects their credit standing for the rest of 
their lives--under the last bankruptcy bill we passed here, which was 
such an unfortunate action that we took in the Senate.
  We find out parents are listing credit cards in the names of their 
children--young children--in order to be able to heat their homes. It 
is affecting so many hard-working Americans who are facing that 
whammy--the fact they are in danger of losing their homes because of 
the mortgage challenge. They cannot afford heating oil, and then they 
find out, when they resort to using credit cards, they lose all of 
their potential for credit for years to come.
  This chart is a reflection of what is happening with people losing 
their homes. Foreclosures have gone up 181 percent from 2005. Millions 
of American families face losing their homes. Make no mistake about it, 
many who lose their homes have in the past paid their mortgages each 
month, and yet now they lose their home. We have to ask: What are we 
going to do about it?
  Just a final two points I will make. There has been a 40-percent 
increase in bankruptcies. This is a result of the kind of economic 
squeeze these families have been under. There has been a 40-percent 
increase in bankruptcies. With the way that last bankruptcy act was 
enacted, they will find out, once the hooks get into these families, 
they will never get free from them. Families are going to be indebted 
for a very considerable period of time. That is now happening to 
working Americans.
  The final chart I will put up is that in looking at the stimulus 
program we ought to look at what gets the biggest bang for the buck. 
Targeted stimulus programs deliver far more bang for the buck. As to 
unemployment benefits, for every $1 we invest, there is $1.73 in 
economic growth; for aid to the States, $1.24; for income taxes, it is 
only 59 cents. These are the areas the administration is talking about: 
business write-offs, 24 cents; capital gains tax cuts, 9 cents.
  If we are going to pass a stimulus package--which we should do--let's 
look at the areas that will have the greatest impact, the greatest 
stimulus that will help the working families of this country in the 
most meaningful way. That is what we should do. That is what should be 
the first order of business in the Senate. I hope we will get about the 
business of helping working families in America.
  I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Cardin). The clerk will call the roll of 
the Senate.
  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.
  Mr. DORGAN. Mr. President, I ask unanimous consent that the pending 
amendment be set aside.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                           Amendment No. 3899

              (Purpose: To provide a complete substitute.)

  Mr. DORGAN. Mr. President, I have a substitute at the desk and ask 
for its consideration.
  The PRESIDING OFFICER. The clerk will report the amendment.
  The assistant legislative clerk read as follows:

       The Senator from North Dakota [Mr. Dorgan] for himself, Ms. 
     Murkowski, Mr. Baucus, Mr. Kennedy, Mr. Smith, Mr. Nelson of 
     Nebraska, and Mr. Salazar, proposes an amendment numbered 
     3899.

  (The amendment is printed in today's Record under ``Text of 
Amendments.'')
  Mr. DORGAN. Mr. President, I ask unanimous consent that the 
amendments previously considered be conformed to the substitute I have 
just offered.
  The PRESIDING OFFICER. Without objection, it is so ordered.

[[Page 498]]


  Mr. DORGAN. Mr. President, I suggest the absence of a quorum.
  I withhold that suggestion.
  The PRESIDING OFFICER. The assistant majority leader is recognized.
  Mr. DURBIN. Mr. President, I ask unanimous consent to speak as in 
morning business for 5 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (The remarks of Mr. Durbin are printed in today's Record under 
``Morning Business.'')
  Mr. DURBIN. 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. 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.
  Mr. DORGAN. Mr. President, we have had a lot of discussion and debate 
today about the Indian Health Care Improvement Act. We, on behalf of 
myself and Senator Murkowski, sent the substitute to the desk. The 
substitute is something we worked on that amends and changes somewhat 
what we had originally moved out of the committee. We have refined it, 
improved it, and changed it a bit. The substitute was agreed to by 
Senator Murkowski and myself and other Senators with whom we have 
worked. So we have made some progress by laying down the substitute 
which perfects this bill. We have a number of amendments pending.
  What I would ask--and so would Senator Murkowski--is if there are 
others who have amendments to this bill, they come to the floor and 
offer them. We want to finish this piece of legislation. It is not as 
if we haven't had a lot of discussion and debate. We have pretty much 
filled the time today. But we do want additional amendments to be 
offered. What we would like to see is if those Senators who have 
amendments would contact us, we could schedule them and hopefully we 
can get some time agreements, so when we finish this evening and come 
back on this bill, we could get a list of amendments, work through 
those amendments and finish the bill and send it along to the House. 
Because there is an urgency here.
  There are some things we do that are not particularly urgent. I 
understand that. If anyone thinks the issue of Indian health care is 
not urgent, I urge them to go to the nearest Indian reservation and 
have a visit about what is happening with respect to the Indian Health 
Service. I know there are a lot of good people working in the Indian 
Health Service, but I am telling you, go sit and listen for awhile, 
listen to a discussion about what happens when you ration health care, 
when health care is not a right and not only not a right but when 
health care is absolutely rationed. There are people dying. There are 
people living in pain. There are people who don't have access to any 
kind of health care facility. There are people who are having 
emergencies at 5 in the afternoon, when their local clinic closed their 
doors at 4, and they are 100 miles from the nearest hospital. That is 
what is happening on Indian reservations across this country.
  We have a responsibility, a trust responsibility to provide for that 
health care. The Congress, this country has not owned up to that 
responsibility, and we must. That is why we have brought this bill to 
the floor of the Senate, and I am hoping very much for the cooperation 
of my colleagues. Let's complete the amendments, raise them with us, 
let us work with you on getting them up and getting votes on them so we 
can at least indicate our support to do what we are required to do as 
American citizens: honor our treaties, meet our trust responsibilities, 
and keep the promises we have made to the first Americans.


                 Unanimous Consent Agreement--H.r. 4986

  Mr. DORGAN. Mr. President, I ask unanimous consent that at 5:30 p.m. 
today, the Senate proceed to the immediate consideration of H.R. 4986, 
the Department of Defense authorization, with no amendments in order to 
the bill; that the bill be read a third time, and without further 
action, the Senate proceed to vote on passage; that upon passage, the 
motion to reconsider be laid upon the table.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Mr. DORGAN. Mr. President, I yield the floor and I make a point of 
order that a quorum is not present.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. LEVIN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

                          ____________________