[Congressional Record (Bound Edition), Volume 154 (2008), Part 2]
[Senate]
[Pages 2046-2051]
[From the U.S. Government Publishing Office, www.gpo.gov]




     INDIAN HEALTH CARE IMPROVEMENT ACT AMENDMENTS OF 2007--Resumed

  Mr. REID. Madam President, I believe the regular order now is Indian 
Health. I would ask the Chair to report if that is in fact the case.
  The PRESIDING OFFICER. That is correct.
  The clerk will report.
  The assistant legislative clerk read as follows:

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

  Pending:

       Bingaman-Thune amendment No. 3894 (to amendment No. 3899), 
     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.
       Vitter amendment No. 3896 (to amendment No. 3899), to 
     modify a section relating to limitation on use of funds 
     appropriated to the Service.
       Brownback amendment No. 3893 (to amendment No. 3899), 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.
       Dorgan amendment No. 3899, in the nature of a substitute.
       Sanders amendment No. 3900 (to amendment No. 3899), to 
     provide for payments under subsections (a) through (e) of 
     section 2604 of the Low-Income Home Energy Assistance Act of 
     1981.

  Mr. REID. Madam President, Senator Tester has indicated to me that he 
has an amendment to work on. There are a number of people who want to 
offer amendments, and I think it would be to our advantage--it is not 
as if it is the middle of the night; it is still in the 4s--if there 
could be some amendments offered. We are going to work on this all day 
tomorrow and hopefully we can finish it Friday. If not, we are going to 
stay here until we finish it.
  Indian health deserves this. There is no group of people in America 
who deserves our attention more than Indians. It is that way with the 
22 different organizations in Nevada and all over the country. So I 
would hope we can work together.
  I think we have had some success during these first few weeks of this 
year of Congress. We were at the White House with the President signing 
the stimulus bill. It is time to celebrate that. Was it everything we 
wanted? No. But it is good work, and we should all be proud of that.
  We passed this conference report on intelligence, and the President 
will have to make a decision on that in the future, as to what he wants 
to do, but it is out of this body.
  I hope we could move forward on Indian health. We have been waiting 
years to direct the attention to them. The attention is now directed, 
and with the result of what has happened here, we can spend some 
quality time on this matter. I hope those who wanted to offer 
amendments will do so. We can work into the night. I hope we can have 
some votes tonight. Senator Dorgan and Senator Murkowski are anxious to 
move forward.
  Madam President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. SANDERS. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                           Amendment No. 3900

  Mr. SANDERS. Madam President, I wish to call up amendment No. 3900, 
and I ask for its immediate consideration.
  The PRESIDING OFFICER. That is a pending amendment.
  Mr. SANDERS. Madam President, this tripartisan amendment is being 
cosponsored by Senators Clinton, Obama, Snowe, Collins, Leahy, Sununu, 
Kennedy, Gordon Smith, Coleman, Kerry, Stabenow, Schumer, Lautenberg, 
Lincoln, Klobuchar, Murray, Cantwell, Menendez, and Durbin.
  This amendment is simple and straightforward. At a time when home 
heating prices are going through the roof--and I think every Member who 
goes back to his or her State understands that the cost of home heating 
oil is soaring--people understand that in areas around this country, 
including the State of Vermont, the weather has been well below zero. 
What this amendment would do is provide real relief to millions of 
senior citizens on fixed incomes, low-income families with children, 
and people with disabilities.
  Specifically, this amendment would provide $800 million in emergency 
funding for the Low-Income Home Energy Assistance Program--otherwise 
known as LIHEAP--a program that has won bipartisan support year after 
year here in Congress because people know it works.
  Its goal is simply stated: To keep Americans from going cold in the 
wintertime. It has done this for years, and we have to appropriate more 
money to make sure we do that again this year. Specifically, $400 
million of the $800 million would be distributed under the regular 
LIHEAP formula, while the other $400 million would be used under the 
emergency LIHEAP program.
  This amendment has strong support not only from many Members of the 
Senate and Members of the House, but it has strong support from the 
National Governors Association, the National Conference of State 
Legislators, the AARP, the National Energy Assistance Directors 
Association, and many other groups.
  Let me very briefly quote from a letter I received from the National 
Governors Association in support of this amendment.

       Additional funding distributed equitably under this 
     amendment will support critically needed heating and cooling 
     assistance to millions of our most vulnerable, including the 
     elderly, disabled and families who often have to choose 
     between paying their heating or cooling bills and food, 
     medicine and other essential needs.

  According to the National Governors Association, this amendment will 
provide much needed energy assistance to at least 1 million American 
families--1 million. Others already receiving LIHEAP will receive more 
help due to the skyrocketing costs of home heating fuel.
  Let me very briefly quote from a letter I recently received from the 
AARP. This is what the AARP says:

       People should not have to choose between heating and 
     eating. Older Americans who are more susceptible to 
     hypothermia and heat stroke know the importance of heating 
     and cooling their homes. They pay their utility bills and 
     skimp on other necessities to get by. However, no one in 
     America should be forced to skip their medications or cut 
     back on essential nutritional needs in order to keep their 
     heat on.


[[Page 2047]]


  That is from the AARP.
  I ask unanimous consent to have these letters printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                                         AARP,

                                 Washington, DC, January 24, 2008.
     Hon. Bernard Sanders
     U.S. Senate,
     Washington, DC.
       Dear Senator Sanders: AARP applauds you for your continued 
     efforts to increase funding for the Low Income Energy 
     Assistance (LIHEAP) program. We thank you for offering an 
     amendment to increase LIHEAP funding for FY 2008 by $800 
     million on S. 1200, the Indian Health Care Improvement Act 
     Amendments of 2007. We are pleased to support your amendment.
       People should not have to choose between heating and 
     eating. Older Americans, who are more susceptible to 
     hypothermia and heat stroke, know the importance of heating 
     and cooling their homes; they pay their utility bills and 
     skimp on other necessities to get by. However, no one in 
     America should be forced to skip their medications or cut 
     back on essential nutritional needs in order to keep their 
     heat on.
       LIHEAP helps the poorest of the poor. Nearly three out of 
     four families receiving LIHEAP assistance have incomes of 
     less than 100 percent of the federal poverty level ($16,600 
     for a family of three) and almost one in two have incomes 
     less than 75 percent of the federal poverty level ($12,225 
     for a family of three).
       LIHEAP is serving more households than ever before, but 
     still cannot meet the need. Since 2002, an additional 1.5 
     million households are receiving LIHEAP assistance. At the 
     same time, requests for LIHEAP assistance in 2006 soared to 
     the highest level in 12 years.
       Additional funding is needed now. High energy prices have 
     not gone away and the weather has proven very unpredictable--
     additional funding is needed now and in the future to protect 
     some of the most vulnerable populations in America. Should 
     you have any questions regarding this request, please contact 
     me or Timothy Gearan of our Federal Affairs staff.
           Sincerely,

                                             David P. Sloane, 

                                         Senior Managing Director,
     Government Relations and Advocacy.
                                  ____



                               National Governors Association,

                                 Washington, DC, January 24, 2008.
     Hon. Bernie Sanders,
     U.S. Senate,
     Washington, DC.
       Dear Senator Sanders: On behalf of the nation's governors, 
     we write to express our support for the Sanders-Snowe 
     amendment to add $800 million in emergency funding to the 
     Low-Income Home Energy Assistance Program (LIHEAP) for FY 
     2008. We commend you and your colleagues for working in 
     partnership to build bipartisan support for this proposal, 
     and we believe the compromise of splitting this funding 
     equitably between the LIHEAP base formula grant under the 
     ``Tier II'' formula and the contingency fund is a step in the 
     right direction.
       Additional funding distributed equitably under this 
     amendment will support critically needed heating and cooling 
     assistance to millions of our most vulnerable, including the 
     elderly, disabled, and families that often have to choose 
     between paying their heating or cooling bills and food, 
     medicine and other essential needs. With greater financial 
     support, states will be better able to increase benefit 
     levels in correspondence with rising energy costs, and to 
     reach at least a million other federally-eligible households 
     who currently do not receive assistance due to funding 
     limitations.
       The National Governors Association applauds the bipartisan 
     efforts of you and your colleagues in reaching this 
     compromise, and fully supports adding $800 million to FY 2008 
     to help LIHEAP respond to the current emergency energy 
     situation.
           Sincerely,
     James H. Douglas,
       Chair, Health and Human Services Committee.
     Jon S. Corzine,
       Vice Chair, Health and Human Services Committee.
                                  ____

                                            National Conference of


                                           State Legislatures,

                                 Washington, DC, January 23, 2008.
       Dear Senator, I am writing on behalf of the National 
     Conference of State Legislatures (NCSL) to strongly urge you 
     to support the amendment offered by Senator Sanders and 
     Senator Snowe that would add an additional $800 million to 
     the Low Income Home Energy Assistance Program (LIHEAP) 
     funding for FY 2008. The amendment would divide the 
     additional funding equally between the formula and emergency 
     contingency portions of the program.
       LIHEAP is a highly efficient federal block grant program 
     that helps our most vulnerable low-income households pay 
     their heating bills in the winter and cooling bills in the 
     summer. LIHEAP prioritizes at-risk households that shelter 
     America's elderly, disabled, and very young and protects 
     public health and safety by helping low-income families cover 
     energy costs. By leveraging private dollars to supplement 
     federal dollars, LIHEAP has nurtured positive, effective 
     partnerships between the private sector and both federal and 
     our state governments.
       Millions of low-income families are burdened with the 
     hardship of paying arrearage from both last winter's heating 
     bills and summer's cooling bills, in addition to grappling 
     with impending and actual shut-off situations. At a time of 
     heightened need and with energy prices expected to continue 
     to climb, state legislatures do not want our citizens 
     choosing between paying an energy bill and putting food on 
     the table, or purchasing necessary medications. For 
     individuals and households facing these difficult choices, 
     funding from LIHEAP makes an intrinsic difference in their 
     ability to address such formidable challenges.
       Since LIHEAP's inception, the number of eligible households 
     has increased by 78 per cent, yet in FY 2006, states were 
     only able to serve less than a quarter of the 24.4 million 
     eligible households. An increase in funding for LIHEAP will 
     help ensure that households in all regions are prepared to 
     handle both the cold and warm, and in the past few years 
     unpredictable, weather. NCSL believes that increased LIHEAP 
     funding should be a top priority to help low-income families, 
     senior citizens, and disabled individuals maintain economic 
     stability while addressing ever-increasing energy prices.
       We urge you to support the Sanders-Snowe LIHEAP amendment, 
     and to continue the fight for full funding of LIHEAP.
           Sincerely,
                                                 Pete Hershberger,
           Arizona Representative, Chair, NCSL Committee on Human 
     Services & Welfare.
                                  ____



                              Southern Governors' Association,

                                Washington, DC, December 18, 2007.

   Statement on Additional FY 2008 Low Income Home Energy Assistance 
                        Program (LIHEAP) Funding

       Due to high and rising energy costs, efforts are underway 
     in Congress to allocate an additional $800 million to the 
     LIHEAP program for FY 2008. Senator Dole has worked with her 
     colleagues from cold weather states on a compromise agreement 
     that would equitably distribute these additional funds by 
     splitting them equally between the LIHEAP base formula grant 
     and the contingency fund. The additional $400 million in the 
     base formula grant would be distributed by the LIHEAP ``tier 
     II'' formula, which bases funding to states on the actual 
     energy needs of low-income households, and therefore provides 
     for equitable distribution to Southern slates.
       Recognizing the increasing need for LIHEAP funds and the 
     interest of the Congress in providing these funds, the 
     Southern Governors' Association supports this compromise. SGA 
     supported a similar compromise in FY 2006 when Congress made 
     an additional $1 billion available for LIHEAP, split equally 
     between the base formula grant and the contingency fund.
       This compromise is an important step towards the long-term 
     goal of a more equitable distribution of LIHEAP funding among 
     all states. SGA urges Congress to move immediately to address 
     equity as a priority as part of LIHEAP reauthorization.

  Mr. SANDERS. I commend subcommittee chairman Senator Harkin, 
subcommittee ranking member Senator Specter, Appropriations chairman 
Senator Byrd, and ranking member Senator Cochran for providing a total 
of about $2.6 billion in funding for LIHEAP in the Omnibus 
appropriations bill. Their job was a difficult one. There was not 
enough money available to do all that needed to be done, but they did 
their best for LIHEAP and for our critical needs.
  Unfortunately, this $2.6 billion in funding for LIHEAP, while an 18-
percent increase from last year, is still 23 percent below what was 
provided for LIHEAP just 2 years ago. That 23 percent reduction is not 
even adjusting for inflation. We are talking here about nominal 
dollars.
  Two years ago, the price of heating oil was less than $2.50 a gallon; 
today, it is over $3.30 a gallon. In central Vermont, we have seen 
prices as high as $3.73 a gallon this winter for heating oil.
  According to the National Energy Assistance Directors Association, 
due to insufficient funding, the average LIHEAP grant only pays for 18 
percent of the total cost of heating a home with heating oil this 
winter, 21 percent of residential propane costs, 41 percent of natural 
gas costs, and 43 percent of electricity costs. What this means, in

[[Page 2048]]

plain English, is that low-income families with children, senior 
citizens on fixed incomes, and people with disabilities will have to 
make up the remaining cost out of their own pockets. The problem is 
that millions of those people simply do not have the money to make up 
the difference.
  In addition, only 16 percent of eligible LIHEAP recipients currently 
receive assistance with their home heating bills, and 84 percent of 
eligible low-income families with children, seniors on fixed incomes, 
and people with disabilities do not receive any LIHEAP assistance 
whatsoever due to a lack of funding.
  In my State of Vermont, it has been reported that outrageously high 
home heating costs are pushing families into homelessness. In fact, it 
is not uncommon for families with two working parents to receive help 
from homeless shelters in the State of Vermont because they cannot find 
anyplace else to live in winter.
  But this is a national energy emergency certainly well beyond Vermont 
and well beyond the Northeast. On January 17, 1 day after the President 
released $450 million in emergency LIHEAP funding, the National Energy 
Assistance Directors Association testified in front of the Health, 
Education, Labor, and Pensions Committee field hearing chaired by 
Senator Kennedy. Here is what the national energy directors reported on 
just a few of the States:
  In Arkansas, the number of families receiving LIHEAP assistance is 
expected to be reduced by up to 20 percent from last year unless we get 
more funding.
  The State of Arizona estimates they will have to cut the number of 
families receiving LIHEAP assistance by 10,000 as compared to last 
year.
  In Delaware, the number of families receiving LIHEAP assistance will 
be reduced by up to 20 percent.
  In Iowa, regular LIHEAP grants have been cut by 7 percent from last 
year.
  In Maine, the average LIHEAP grant will only pay for about 2 to 3 
weeks of home heating costs in most homes in that State.
  The State of Kentucky could run out of LIHEAP funds in the near 
future.
  In Massachusetts, the spike in energy costs means that the purchasing 
cost for LIHEAP has declined by 39 percent since 2006.
  The State of Minnesota could run out of LIHEAP funding as well.
  On and on it goes. In New York State, in Ohio, in Rhode Island, in 
Texas, in Washington, in State after State the simple arithmetic works 
out that if the cost of heating fuel is soaring, in order to provide 
the same benefits to the same number of people, we need to 
significantly increase our funding for LIHEAP, and we are not doing 
that. That is what this amendment is about.
  There is a lot of discussion on this floor about emergencies. This is 
an emergency. There is a lot of discussion on this floor about moral 
values. This is a moral issue. In the United States of America, the 
wealthiest Nation in the history of the world, millions of senior 
citizens and low-income parents with kids should not be forced to worry 
about whether their homes will be warm this winter. People should not 
have to make the choice between keeping warm or paying for other basic 
necessities of life. This is an emergency situation. This is a moral 
situation.
  I wish to thank all of the cosponsors who have come on board this 
legislation. I ask my colleagues to strongly support this amendment.
  I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There does not appear to be a sufficient second.
  Mr. SANDERS. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Pryor) The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. TESTER. I ask unanimous consent that the order for the quorum 
call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. TESTER. Mr. President, I ask unanimous consent that the pending 
amendment be set aside.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                Amendment No. 4020 to Amendment No. 3899

  Mr. TESTER. I send amendment No. 4020 to the desk and ask for its 
immediate consideration.
  The PRESIDING OFFICER. The clerk will report.
  The bill clerk read as follows:

       The Senator from Montana [Mr. Tester] proposes an amendment 
     numbered 4020 to amendment No. 3899.

  Mr. TESTER. 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 express the sense of Congress regarding law enforcement 
             and methamphetamine issues in Indian country)

         On page 336, between lines 2 and 3, insert the following:

     ``SEC. 815. SENSE OF CONGRESS REGARDING LAW ENFORCEMENT AND 
                   METHAMPHETAMINE ISSUES IN INDIAN COUNTRY.

         ``It is the sense of Congress that Congress encourages 
     State, local, and Indian tribal law enforcement agencies to 
     enter into memoranda of agreement between and among those 
     agencies for purposes of streamlining law enforcement 
     activities and maximizing the use of limited resources--
     ``(1) to improve law enforcement services provided to Indian 
     tribal communities; and
     ``(2) to increase the effectiveness of measures to address 
     problems relating to methamphetamine use in Indian Country 
     (as defined in section 1151 of title 18, United States Code).

  Mr. TESTER. Mr. President, this amendment is designed to encourage 
law enforcement in Indian country--at the local, State, and Federal 
level--to work together to combat methamphetamine issues. It encourages 
local, State, and Federal police to enter into memorandums of 
understanding with tribal law enforcement to pool resources to fight 
meth addiction. It does not require it; it just encourages it. All four 
law enforcement entities should collaborate to ensure that all can be 
done to beat back the meth problems that plague Indian country.
  Methamphetamine abuse is an American problem. It infiltrates and 
devastates communities across the country. Unfortunately, it is a 
problem that disproportionately impacts tribal communities. American 
Indians now experience the highest meth usage rates of any ethnic 
group.
  I will give one example. American Indians use methamphetamines 17 
times higher than African Americans. The list goes on and on. They are 
the highest meth usage ethnic group. Beyond the high rate of meth use 
among American Indians, Alaska natives, and native Hawaiians 
nationwide, individual Indian tries have been struggling with the 
impact of meth use on their communities. For example, on the Northern 
Cheyenne reservation in Montana in 2005, 16 out of 64 babies, or 25 
percent, were born to meth-addicted mothers. This number has increased 
in 2006. We must do everything possible to address this epidemic and 
protect our children from this scourge of modern society.
  In hearings before the Indian Affairs Committee, we heard testimony 
about Mexican drug cartels targeting rural reservations. They are 
targeting these vulnerable areas both for the sale of meth and for 
distribution hubs. Drug smugglers target Indian communities for several 
reasons: the complex nature of their criminal jurisdiction on Indian 
reservations and because tribal police forces have been historically 
underfunded and understaffed. This is a big problem. It is a huge 
problem in Indian country. We need to encourage Indian tribes, Federal 
police, local police to sign memorandums of understanding by each of 
these four different entities--Indian government, State government, 
local government, and Federal law enforcement agencies. These 
memorandums will identify specific law enforcement activity and 
establish exactly what each agency is responsible for.
  The feedback we hear is that the memorandums that are in place are 
working and that the agencies participating in these agreements report 
a significant increase in communication and a decrease in traffic. This 
amendment simply asks law enforcement and agencies at every level to 
work together to beat the meth problem and

[[Page 2049]]

improve quality of life in Indian country.
  By signing memorandums of understanding, our communities will be 
better prepared to tackle this meth problem. At the same time we foster 
Indian self-determination and strengthen government-to-government 
relationships. The amendment will improve Indian country and, in 
effect, every community in this country. I encourage my colleagues to 
join me in voting for this amendment.
  The PRESIDING OFFICER. The Senator from North Dakota.
  Mr. DORGAN. Mr. President, for the information of colleagues, with 
the agreement of the minority, I ask unanimous consent that we have the 
vote scheduled at 5:25 and that we have consent that there not be other 
amendments in order prior to the vote on this amendment.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DORGAN. Mr. President, the issue of methamphetamine on Indian 
reservations is a dilemma. It is devastating scourge to Indian 
reservations. The Senator from Montana asks for cooperation of law 
enforcement jurisdictions to form opportunities to work together. It 
makes a lot of sense. It is not a mandate. He is not requiring it. But 
he is shining a spotlight on one of the significant health problems on 
Indian reservations. If I spent the time to talk to you about the 
testimony we received in committee hearings about what methamphetamine 
addiction has done, it is almost unbelievable. I won't describe that in 
detail here.
  I support the sense-of-the-Senate resolution. It makes a great deal 
of sense.
  My colleague from Alaska will no doubt want to give her thoughts. I 
believe the Senator from Montana will ask for the yeas and nays.
  The PRESIDING OFFICER. The Senator from Alaska.
  Ms. MURKOWSKI. Mr. President, I rise in support of the amendment and 
of the Senator from Montana in this effort. We are using a pretty 
devastating word here--scourge--but that is what we are talking about 
when we talk about methamphetamine use as it has come into this country 
and, more particularly, how it has devastated the American Indian and 
the Alaska native populations. What more can we be doing? What else can 
we do to shine the spotlight, to activate those who need to be 
activated in how do we make a difference? Some would suggest a sense of 
the Senate that encourages this action entering into a memorandum of 
understanding between agencies, they should be doing that anyway. They 
should be. They should be doing it. They should be working to 
streamline. They should be working to better coordinate. They should be 
making that difference. Let's encourage them even further by a 
statement such as the Senator from Montana has suggested. We need to do 
far more when it comes to meth use and abuse. We need to do far more 
when it comes to drug abuse in general. I appreciate the focus and 
attention to this particularly deadly scourge, that of methamphetamine. 
I will stand with the Senator from Montana and support the amendment.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. TESTER. I thank the chairman of the committee as well as the 
ranking member for their support. Anything we can do to help limit the 
impact of methamphetamine in Indian country and throughout society is a 
step in the right direction.
  I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There is a sufficient second.
  The question is on agreeing to amendment No. 4020. The clerk will 
call the roll.
  The legislative clerk called the roll.
  Mr. DURBIN. I announce that the Senator from New York (Mrs. Clinton), 
the Senator from Missouri (Mrs. McCaskill), and the Senator from 
Illinois (Mr. Obama) are necessarily absent.
  Mr. KYL. The following Senators are necessarily absent: the Senator 
from South Carolina (Mr. Graham) and the Senator from Texas (Mrs. 
Hutchison).
  The PRESIDING OFFICER (Ms. Cantwell). Are there any other Senators in 
the Chamber desiring to vote?
  The result was announced --- yeas 95, nays 0, as follows:

                      [Rollcall Vote No. 23 Leg.]

                                YEAS--95

     Akaka
     Alexander
     Allard
     Barrasso
     Baucus
     Bayh
     Bennett
     Biden
     Bingaman
     Bond
     Boxer
     Brown
     Brownback
     Bunning
     Burr
     Byrd
     Cantwell
     Cardin
     Carper
     Casey
     Chambliss
     Coburn
     Cochran
     Coleman
     Collins
     Conrad
     Corker
     Cornyn
     Craig
     Crapo
     DeMint
     Dodd
     Dole
     Domenici
     Dorgan
     Durbin
     Ensign
     Enzi
     Feingold
     Feinstein
     Grassley
     Gregg
     Hagel
     Harkin
     Hatch
     Inhofe
     Inouye
     Isakson
     Johnson
     Kennedy
     Kerry
     Klobuchar
     Kohl
     Kyl
     Landrieu
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lincoln
     Lugar
     Martinez
     McCain
     McConnell
     Menendez
     Mikulski
     Murkowski
     Murray
     Nelson (FL)
     Nelson (NE)
     Pryor
     Reed
     Reid
     Roberts
     Rockefeller
     Salazar
     Sanders
     Schumer
     Sessions
     Shelby
     Smith
     Snowe
     Specter
     Stabenow
     Stevens
     Sununu
     Tester
     Thune
     Vitter
     Voinovich
     Warner
     Webb
     Whitehouse
     Wicker
     Wyden

                             NOT VOTING--5

     Clinton
     Graham
     Hutchison
     McCaskill
     Obama
  The amendment (No. 4020) was agreed to.
  Mr. TESTER. Madam President, I move to reconsider the vote.
  Mrs. MURRAY. Madam President, I move to lay that motion on the table.
  The motion to lay on the table was agreed to.
  The PRESIDING OFFICER. The Senator from New Hampshire is recognized.


                Amendment No. 4022 To Amendment No. 3900

  Mr. GREGG. Madam President, I send an amendment to the desk.
  Madam President, is the Sanders amendment pending?
  The PRESIDING OFFICER. The Senator's amendment is pending. The clerk 
will report.
  The legislative clerk read as follows:

       The Senator from New Hampshire [Mr. Gregg] proposes an 
     amendment numbered 4022 to amendment No. 3900.

  Mr. GREGG. 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 provide funding for the Low-Income Home Energy Assistance 
               Program in a fiscally responsible manner)

       Strike all after line 1 and insert the following:

                        TITLE III--MISCELLANEOUS

     SEC. 301. LOW-INCOME HOME ENERGY ASSISTANCE PROGRAM.

       (a) In General.--There are authorized to be appropriated, 
     and there are appropriated, out of any money in the Treasury 
     not otherwise appropriated--
       (1) $400,000,000 (to remain available until expended) for 
     making payments under subsections (a) through (d) of section 
     2604 of the Low-Income Home Energy Assistance Act of 1981 (42 
     U.S.C. 8623); and
       (2) $400,000,000 (to remain available until expended) for 
     making payments under section 2604(e) of the Low-Income Home 
     Energy Assistance Act of 1981 (42 U.S.C. 8623(e)), 
     notwithstanding the designation requirement of section 
     2602(e) of that Act (42 U.S.C. 8621(e)).
       (b) Rescission.--
       (1) In general.--Notwithstanding any other provision of 
     law, each discretionary amount provided by the Consolidated 
     Appropriations Act, 2008 (Public Law 110-161; 121 Stat. 
     1844), excluding the amounts made available for the purposes 
     described in paragraph (2), is reduced by the pro rata 
     percentage required to reduce the total amount provided by 
     that Act by $800,000,000.
       (2) Excepted purposes.--The reduction under paragraph (1) 
     shall not apply to any discretionary amount made available in 
     the Consolidated Appropriations Act, 2008 (Public Law 110-
     161; 121 Stat. 1844), for purposes of--
       (A) the Department of Defense; or
       (B) the low-income home energy assistance program 
     established under the Low-Income Home Energy Assistance Act 
     of 1981 (42 U.S.C. 8621 et seq.).

  Mr. GREGG. Madam President, this amendment is simply an attempt to 
recognize the need for expanding the LIHEAP program in the face of the 
dramatic increase in oil prices, but also recognizing that in extending 
the LIHEAP program for today, we shouldn't send the heating bill for 
that to our children to pay tomorrow, which is exactly how the Sanders 
amendment

[[Page 2050]]

works. It is essentially borrowing money today. That is obviously not 
good policy.
  Clearly, if we have extra heating bills in this country today which 
should be paid for--and we do--the LIHEAP program does need to be 
increased because the cost of heating oil has gone up so significantly. 
We should pay for those costs today. So this amendment takes the 
Sanders language and pays for it. The Sanders language represents about 
an $800,000 increase in the LIHEAP program. This would be about a two-
tenths-of-1-percent cut across the board in nondefense appropriations 
in order to pay for that amendment.
  It is very simple. It is obviously an attempt to bring some fiscal 
discipline but, more importantly, to reflect the fact that if these 
heating bills are going to be paid for--and they should be paid for--we 
shouldn't borrow the money to do it. We shouldn't ask our children 10 
years, 15 years from now to pay those heating bills, with interest, 
when the bills are incurred today.
  So that is all it does. I appreciate the courtesy of the Senate in 
allowing me to proceed to offer this amendment. I especially appreciate 
the courtesy of the Senator from Wyoming.
  I ask for the yeas and nays on my amendment.
  The PRESIDING OFFICER. Is there a sufficient second?
  Mr. GREGG. Madam President, I withdraw my request.
  The PRESIDING OFFICER. The Senator from Wyoming is recognized.


                Amendment No. 3898 to Amendment No. 3899

  Mr. BARRASSO. Madam President, I ask unanimous consent that the 
pending amendment be temporarily set aside, and I call up amendment No. 
3898.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  The clerk will report.
  The legislative clerk read as follows:

       The Senator from Wyoming [Mr. Barrasso] proposes an 
     amendment numbered 3898 to amendment No. 3899.

  Mr. BARRASSO. 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 require the Comptroller General to report on the 
   effectiveness of coordination of health care services provided to 
         Indians using Federal, State, local, and tribal funds)

       The Indian Health Care Improvement Act (as amended by 
     section 101(a)) is amended--
       (1) by redesignating sections 816 and 817 as sections 817 
     and 818, respectively; and
       (2) by inserting after section 815 the following:

     ``SEC. 816. GAO REPORT ON COORDINATION OF SERVICES.

       ``(a) Study and Evaluation.--The Comptroller General of the 
     United States shall conduct a study, and evaluate the 
     effectiveness, of coordination of health care services 
     provided to Indians--
       ``(1) through Medicare, Medicaid, or SCHIP;
       ``(2) by the Service; or
       ``(3) using funds provided by--
       ``(A) State or local governments; or
       ``(B) Indian Tribes.
       ``(b) Report.--Not later than 18 months after the date of 
     enactment of the Indian Health Care Improvement Act 
     Amendments of 2007, the Comptroller General shall submit to 
     Congress a report--
       ``(1) describing the results of the evaluation under 
     subsection (a); and
       ``(2) containing recommendations of the Comptroller General 
     regarding measures to support and increase coordination of 
     the provision of health care services to Indians as described 
     in subsection (a).''.

  Mr. BARRASSO. Madam President, as a physician I have worked for over 
two decades to help people stay healthy and to help keep down the costs 
of their medical care. But health issues go way beyond that of a 
twisted knee or a painful shoulder.
  In my practice I have seen firsthand the obstacles that families face 
to obtain medical care. Rural hospitals and rural providers must 
overcome significant challenges to deliver high-quality care in an 
environment with limited resources.
  Our unique circumstances require us to work together to share 
resources and to develop networks. I think everyone can agree that 
these same principles are critical to support and modernize the Indian 
health care delivery system.
  The Wind River Reservation, located near Riverton, WY, is the home of 
10,415 members of the Eastern Shoshone and Northern Arapaho Tribes. It 
is the third largest reservation in the United States, covering more 
than 2.2 million acres.
  I recently visited with my friends on the Wind River Reservation. The 
tribal leaders told me of the hopes they have for their families, their 
communities, for Wyoming, and for our great Nation. We spent much of 
the time discussing health care.
  Individuals living on the Wind River Reservation have worse than 
average rates for infant mortality, for suicide, for substance abuse, 
for unintentional injuries, for lung cancer, for heart disease, and for 
diabetes. They shared with me how difficult it can be for them to 
recruit and retain health professionals, to respond effectively to 
cultural barriers, and to help individuals make better lifestyle 
changes and choices.
  We talked about reauthorization of the Indian Health Care Improvement 
Act, and that is the bill that is now in front of the Senate. This 
legislation is important. It is important to give Native Americans the 
quality care they deserve, but it is also important to support critical 
health facilities that can help drive economic development and job 
creation.
  When Congress debates improving the Indian health care system, the 
first instinct is to allocate more financial resources or to create new 
initiatives. Now, this stems from a strong desire from all of us to 
help. Yet this same helping hand can produce overlapping government 
programs, and these will be overlapping programs that are all trying to 
achieve the same goals.
  For example, today, neither the government nor Indian advocacy groups 
can explain exactly how funds are used to coordinate medical services. 
The Indian Health Service is not like other Federal health care 
programs. Congress has only limited access to the research data that is 
needed to improve Indian health care. If we do not know where the 
resources are being spent, if we do not know the number of programs 
dedicated to provide various health care services, and if we do not 
know how health care services are coordinated, then how can we be 
certain that we are maximizing our ability to help Native Americans and 
Alaska Natives?
  That is why I have offered amendment No. 3898 today. This amendment 
requires the Government Accountability Office--the GAO--to submit a 
report to Congress. The report would lay out how these various 
government and local programs coordinate health care services in Indian 
country.
  The GAO study would focus on programs such as Medicare, Medicaid, 
children's health insurance programs, and the Indian Health Service. It 
also would require the GAO to research how these Federal programs 
interact with efforts by State, local, and tribal groups to deliver the 
essential health care services that are so vital to these citizens. By 
identifying any overlaps in spending, as well as pinpointing the 
service gaps, then we can develop reasonable, commonsense solutions 
that streamline and improve Indian health care. This way, we can target 
Federal funds to programs that are making the greatest impact. Then we 
can focus on additional areas where Native Americans and Alaska Natives 
need our support and need more support.
  The GAO is well known as the investigative arm of Congress, and it is 
also known as the congressional watchdog. GAO helps Congress improve 
the Federal Government's performance and ensures programs meet strict 
accountability standards.
  Now, all of that they do for the benefit of the American people. We 
rely on their expert recommendations, which are unbiased and are set up 
to make sound policy decisions. This oversight shows us ways to make 
government more efficient, more effective, ethical, and equitable. It 
uncovers what is working and what is not working, and it offers 
valuable advice on how to fix it. But, most importantly, this oversight 
helps us plan for the future.

[[Page 2051]]

  Over the years, the GAO has submitted a few reports dealing with 
specific Indian health issues. Do any of my colleagues recall the last 
time the GAO completed a comprehensive Indian health care report?
  I am certainly unaware of any recent efforts in this area. How many 
GAO reports have been released regarding Medicare, Medicaid, and the 
different health professional programs? I think we all know the answer.
  We owe it to Native Americans, to Alaska Natives, and to the American 
taxpayers to adopt this amendment.
  Madam President, I wish to make sure that people of the Wind River 
Reservation in Wyoming, and all Native American people across America, 
have equal access to quality, affordable medical care.
  The Indian Affairs Committee, of which I am a member, will continue 
focusing on this issue long after this Indian Health Care Improvement 
Act is reauthorized.
  It is essential that our committee have the information it needs to 
evaluate the current delivery system--exposing barriers that prevent 
collaboration, that prevent networking, that prevent innovation, and 
that prevent the sharing of resources.
  It is my hope that this GAO report will help all policymakers begin 
to understand where the delivery system is working, where it is not, 
and offer the recommendations that are so important and so needed to 
streamline and to modernize it.
  I encourage my colleagues to support the amendment.
  With that, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mrs. MURRAY. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

                          ____________________