[Congressional Record (Bound Edition), Volume 154 (2008), Part 2]
[Senate]
[Pages 2366-2380]
[From the U.S. Government Publishing Office, www.gpo.gov]




         INDIAN HEALTH CARE IMPROVEMENT ACT AMENDMENTS OF 2007

  The ACTING PRESIDENT pro tempore. Under the previous order, the 
Senate will resume consideration of S. 1200, which the clerk will state 
by title.

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

  Pending:

       Vitter amendment No. 3896 (to amendment No. 3899), to 
     modify a section relating to limitation on use of funds 
     appropriated to the Service.
       Dorgan amendment No. 3899, in the nature of a substitute.
       Smith amendment No. 3897 (to amendment No. 3899), to modify 
     a provision relating to development of innovative approaches.
       Murkowski (for DeMint) amendment No. 4015 (to amendment No. 
     3899), to authorize the Secretary of Health and Human 
     Services to establish an Indian health savings account 
     demonstration project.
       Murkowski (for DeMint) amendment No. 4066 (to amendment No. 
     3899), of a perfecting nature.
       Murkowski (for DeMint) amendment No. 4070 (to amendment No. 
     3899), of a perfecting nature.
       Murkowski (for DeMint) amendment No. 4073 (to amendment No. 
     3899), of a perfecting nature.
       DeMint amendment No. 4080 (to amendment No. 4070), to 
     rescind funds appropriated by the Consolidated Appropriations 
     Act, 2008, for the city of Berkeley, CA, and any entities 
     located in such city, and to provide that such funds shall be 
     transferred to the Operation and Maintenance, Marine Corps 
     account of the Department of Defense for the purposes of 
     recruiting.

  The ACTING PRESIDENT pro tempore. The Senator from North Dakota is 
recognized.
  Mr. DORGAN. Mr. President, my understanding is that we have a cloture 
vote that will begin at 5:30 this evening. I know Senator DeMint has 
two amendments he intends to offer this evening. We expect to have 
votes on those amendments. I have an opening statement I wish to give 
for a short period, and I will defer on that. Senator Kyl wishes 10 
minutes to speak, with 5 minutes on the bill and 5 minutes, I believe, 
in morning business. I don't want to disadvantage either of my 
colleagues. I want to comment about the legislation.
  We are finally, at long last, going to pass an Indian Health Care 
Improvement Act. It has been 8 long years. It is long past due. By 
tomorrow midday, we will have disposed of all of the amendments, and 
having succeeded in invoking cloture, we will have finally done 
something that will give cause for millions of Americans to celebrate 
in this country for the first time in a long time--an improvement in 
Indian health and Indian health care.
  Mr. President, Senator Kyl has asked that he be allowed to speak for 
5 minutes at this point. I ask unanimous consent that Senator Kyl be 
recognized, following which I would like to speak--and I will make it 
short--and then Senator DeMint will be recognized. I notice that the 
ranking member, Senator Murkowski, is on the floor as well.
  I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Arizona is 
recognized.
  Mr. KYL. Mr. President, first of all, I will address an amendment to 
the underlying Indian health bill. It is amendment No. 3897, offered by 
my friend from Oregon. It is an amendment which I hope my colleagues 
will reject.
  This is an amendment that deals with the way in which moneys are 
disbursed for health facility construction on Indian reservations. For 
those of us who represent the majority of our Native American 
population in the United States, this is a very important proposition 
because most of the construction, as you could imagine, is on the 
Indian reservations in the Southwest--in particular, Arizona, New 
Mexico, and, to a lesser extent, some of the other States. It is wrong, 
therefore, to try to change the formula by which funding is allocated 
for construction of these facilities to a broader based around-the-
country formula rather than based upon the population we are trying to 
serve. As a result, I think my colleagues should oppose the amendment.
  It is helpful that the amendment is not mandatory but, rather, 
provides that the Secretary can use what is called an ``innovative 
approach'' and distribute funding equally among the Indian health care 
regions rather than target funding to areas where the health care 
services are needed the most. But it still doesn't make sense to try to 
use this Indian construction funding as kind of a honey pot of money 
for everybody to share in equally when certain key areas have the bulk 
of the need based upon their population. I think this priority based 
upon need is a much more sensible way to serve our Indian population.
  I disagree that the area distribution fund is the answer. It will 
turn the current process upside down. It would disrupt pending 
projects. While it may be well intentioned, the amendment doesn't 
ensure that Federal dollars will be appropriately allocated based upon 
the greatest health care needs of the individual members of the tribes. 
Therefore, I urge my colleagues to oppose that amendment.


                          the fisa legislation

  Mr. President, I wish to take 2 minutes to address the matter dealt 
with by my counterpart on the majority side a little while ago, 
legislation we will presumably have to deal with again--certainly the 
House of Representatives will--and that is the FISA

[[Page 2367]]

Act legislation. I wish to put a couple of things in the Record. I will 
explain what they are, and then I will ask consent to do that.
  As you know, the Senate has passed this important FISA legislation. 
The legislation will enable us to continue to collect foreign 
intelligence on our terrorist enemies. We are waiting for the House of 
Representatives to act on that legislation so that it can be sent to 
the President for signature.
  There has been some confusion about what the effect of the failure of 
the House to act really is, because the House allowed the current law 
to lapse. The person who ought to know what the effect is is Admiral 
McConnell, the Director of National Intelligence, who joined with 
Attorney General Mukasey in writing a letter to the chairman of the 
House Permanent Select Committee on Intelligence, dated February 22, in 
which he addressed the significant concerns we have, given the fact 
that there is no current law that enables us to appropriately collect 
this intelligence.
  I ask unanimous consent that this letter be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:
                                                February 22, 2008.
     Hon. Silvestre Reyes,
     Chairman, House Permanent Select Committee on Intelligence, 
         House of Representatives, Washington, DC.
       Dear Chairman Reyes: The President asked us to respond to 
     your letter of February 14, 2008, concerning the urgent need 
     to modernize the Foreign Intelligence Surveillance Act of 
     1978 (FISA). Your assertion that there is no harm, in 
     allowing the temporary authorities provided by the Protect 
     America Act to expire without enacting the Senate's FISA 
     reform bill is inaccurate and based on a number of 
     misunderstandings concerning our intelligence capabilities. 
     We address those misunderstandings below. We hope that you 
     find this letter helpful and that you will reconsider your 
     opposition to the bill passed last week by a strong 
     bipartisan majority in the Senate and, when Congress returns 
     from its recess, support immediately bringing the Senate bill 
     to the floor, where it enjoys the support of a majority of 
     your fellow members. It is critical to our national security 
     that Congress acts as soon as possible to pass the Senate 
     bill.


                        Intelligence Collection

       Our experience since Congress allowed the Protect America 
     Act to expire without passing the bipartisan Senate bill 
     demonstrates why the Nation is now more vulnerable to 
     terrorist attack and other foreign threats. In our letter to 
     Senator Reid on February 5, 2008, we explained that: ``the 
     expiration of the authorities in the Protect America Act 
     would plunge critical intelligence programs into a state of 
     uncertainty which could cause us to delay the gathering of, 
     or simply miss, critical foreign intelligence information.'' 
     That is exactly what has happened since the Protect America 
     Act expired six days ago without enactment of the bipartisan 
     Senate bill. We have lost intelligence information this past 
     week as a direct result of the uncertainty created by 
     Congress' failure to act. Because of this uncertainty, some 
     partners have reduced cooperation. In particular, they have 
     delayed or refused compliance with our requests to initiate 
     new surveillances of terrorist and other foreign intelligence 
     targets under existing directives issued pursuant to the 
     Protect America Act. Although most partners intend to 
     cooperate for the time being, they have expressed deep 
     misgivings about doing so in light of the uncertainty and 
     have indicated that they may well cease to cooperate if the 
     uncertainty persists. We are working to mitigate these 
     problems and are hopeful that our efforts will be successful. 
     Nevertheless, the broader uncertainty caused by the Act's 
     expiration will persist unless and until the bipartisan 
     Senate bill is passed. This uncertainty may well continue to 
     cause us to miss information that we otherwise would be 
     collecting.
       Thus, although it is correct that we can continue to 
     conduct certain activities authorized by the Protect America 
     Act for a period of one year from the time they were first 
     authorized, the Act's expiration has and may well continue to 
     adversely affect such activities. Any adverse effects will 
     result in a weakening of critical tools necessary to protect 
     the Nation. As we explained in our letter to Senator Reid, 
     expiration would create uncertainty concerning: The ability 
     to modify certifications and procedures issued under the 
     Protect America Act to reflect operational needs and the 
     implementation of procedures to ensure that agencies are 
     fully integrated protecting the Nation; The continuing 
     validity of liability of protection for those who assist us 
     according to the procedures under the Protect America Act; 
     The continuing validity of the judicial mechanism for 
     compelling the assistance of private parties needed to 
     protect our national security; The ability to cover 
     intelligence gaps created by new communication paths or 
     technologies.
       Our experience in the past few days since the expiration of 
     the Act demonstrates that these concerns are neither 
     speculative nor theoretical: allowing the Act to expire 
     without passing the bipartisan Senate bill has had real and 
     negative consequences for our national security. Indeed, this 
     has led directly to a degraded intelligence capability.
       It is imperative that our intelligence agencies retain the 
     tools they need to collect vital intelligence information. As 
     we have explained before, the core authorities provided by 
     the Protect America Act have helped us to obtain exactly the 
     type of information we need to keep America safe, and it is 
     essential that Congress reauthorize the Act's core 
     authorities while also extending liability protection to 
     those companies who assisted our Nation following the attacks 
     of September 11, 2001. Using the authorities provided in the 
     Protect America Act, we have obtained information about 
     efforts of an individual to become a suicide operative, 
     efforts by terrorists to obtain guns and ammunition, and 
     terrorists transferring money. Other information obtained 
     using the authorities provided by the Protect America Act has 
     led to the disruption of planned terrorist attacks. The 
     bipartisan Senate bill would preserve these core authorities 
     and improve on the Protect America Act in certain critical 
     ways, including by providing liability protection to 
     companies that assisted in defending the country after 
     September 11.
       In your letter, you assert that the Intelligence 
     Community's ability to protect the Nation has not been 
     weakened, because the Intelligence Community continues to 
     have the ability to conduct surveillance abroad in accordance 
     with Executive Order 12333. We respectfully disagree. 
     Surveillance conducted under Executive Order 12333 in a 
     manner that does not implicate FISA or the Protect America 
     Act is not always as effective, efficient, or safe for our 
     intelligence professionals as acquisitions conducted under 
     the Protect America Act. And, in any event, surveillance 
     under the Protect America Act served as an essential adjunct 
     to our other intelligence tools. This is particularly true in 
     light of the changes since 1978 in the manner in foreign 
     targets with speed and agility. If we revert to a legal 
     framework in which the Intelligence Community needs to make 
     probable cause showings for foreign terrorists and other 
     national security threats located overseas, we are certain to 
     experience more intelligence gaps and miss collecting 
     information.
       You imply that the emergency authorization process under 
     FISA is an adequate substitute for the legislative 
     authorities that have lapsed. This assertion reflects a basic 
     misunderstanding about FISA's emergency authorization 
     provisions. Specifically, you assert that the National 
     Security Agency (NSA) or the Federal Bureau of Investigation 
     (FBI) ``may begin surveillance immediately'' in an emergency 
     situation. FISA requires far more, and it would be illegal to 
     proceed as you suggest. Before surveillance begins the 
     Attorney General must determine that there is probable cause 
     that the target of the surveillance is a foreign power or an 
     agent of a foreign power and that FISA's other requirements 
     are met. As explained above, the process of compiling the 
     facts necessary for such a determination and preparing 
     applications for emergency authorizations takes time and 
     results in delays. Again, it makes no sense to impose this 
     requirement in the context of foreign intelligence 
     surveillance of targets located overseas. Because of the 
     hurdles under FISA's emergency authorization provisions and 
     the requirement to go to the FISA Court within 72 hours, our 
     resource constraints limit our use of emergency 
     authorizations to certain high-priority circumstances and 
     cannot simply be employed for every foreign intelligence 
     target.
       It is also inaccurate to state that because Congress has 
     amended FISA several times, there is no need to modernize 
     FISA. This statement runs counter to the very basis for 
     Congress's passage last August of the Protect America Act. It 
     was not until the passage of this Act that Congress amended 
     those provisions of FISA that had become outdated due to the 
     communications revolution we have experienced since 1978. As 
     we explained, those outdated provisions resulted in dangerous 
     intelligence gaps by causing constitutional protections to be 
     extended to foreign terrorists overseas. It is critical that 
     Congress enact long-term FISA modernization to ensure that 
     the Intelligence Community can collect effectively the 
     foreign intelligence information it needs to protect the 
     Nation. The bill passed by the Senate would achieve this 
     goal, while safeguarding the privacy interests of Americans.


                          liability protection

       Your assertion that the failure to provide liability 
     protection for those private-sector firms that helped defend 
     the Nation after the September 11 attacks does not affect our 
     intelligence collection capability is inaccurate and contrary 
     to the experience of intelligence professionals and to the 
     conclusions the Senate Select Committee on Intelligence 
     reached after careful study of the matter. It also ignores 
     that providing liability protection to those companies sued 
     for answering their country's call for assistance in the

[[Page 2368]]

     aftermath of September 11 is simply the right thing to do. 
     Through briefings and documents, we have provided the members 
     of your committee with access to the information that shows 
     that immunity is the fair and just result.
       Private party assistance is necessary and critical to 
     ensuring that the Intelligence Community can collect the 
     information needed to protect our country from attack. In its 
     report on S. 2248, the Intelligence Committee stated that 
     ``the intelligence community cannot obtain the intelligence 
     it needs without assistance'' from electronic communication 
     service providers. The Committee also concluded that 
     ``without retroactive immunity, the private sector might be 
     unwilling to cooperate with lawful Government requests in the 
     future without unnecessary court involvement and protracted 
     litigation. The possible reduction in intelligence that might 
     result from this delay is simply unacceptable for the safety 
     of our Nation.'' Senior intelligence officials also have 
     testified regarding the importance of providing liability 
     protection to such companies for this very reason.
       Even prior to the expiration of the Protect America Act, we 
     experienced significant difficulties in working with the 
     private sector because of the continued failure to provide 
     liability protection for such companies. These difficulties 
     have only grown since expiration of the Act without passage 
     of the bipartisan Senate bill, which would provide fair and 
     just liability protection. Exposing the private sector to the 
     continued risk of billion-dollar class action suits for 
     assisting in efforts to defend the country understandably 
     makes the private sector much more reluctant to cooperate. 
     Without their cooperation, our efforts to protect the country 
     cannot succeed.


                          pending legislation

       Finally, as you note, the House passed a bill in November 
     to amend FISA, but we immediately made clear that the bill is 
     unworkable and unacceptable. Over three months ago, the 
     Administration issued a Statement of Administration Policy 
     (SAP) that stated that the House bill ``falls far short of 
     providing the Intelligence Community with the tools it needs 
     to collect effectively the foreign intelligence information 
     vital for the security of the Nation'' and that ``the 
     Director of National Intelligence and the President's other 
     senior advisers would recommend that the President veto the 
     bill.'' We adhere to that view today.
       The House bill has several grave deficiencies. First, 
     although numerous senior intelligence officials have 
     testified regarding the importance of affording liability 
     protection for companies that assisted the Government in the 
     aftermath of September 11, the House bill does not address 
     the critical issue of liability protection. Second, the House 
     bill contains certain provisions and serious technical flaws 
     that would fatally undermine our ability to collect 
     effectively the intelligence needed to protect the Nation. In 
     contrast, the Senate bill deals with the issue of liability 
     protection in a way that is fair and that protects the 
     national security. In addition, the Senate bill is carefully 
     drafted and has been amended to avoid technical flaws similar 
     to the ones in the House bill. We note that the privacy 
     protections for Americans in the Senate bill exceed the 
     protections contained in both the Protect America Act and the 
     House bill.
       The Department of Justice and the Intelligence Community 
     are taking the steps we can to try to keep the country safe 
     during this current period of uncertainty. These measures are 
     remedial at best, however, and do not provide the tools our 
     intelligence professionals need to protect the Nation or the 
     certainty needed by our intelligence professionals and our 
     private partners. The Senate passed a strong and balanced 
     bill by an overwhelming and bipartisan margin. That bill 
     would modernize FISA, ensure the future cooperation of the 
     private sector, and guard the civil liberties we value. We 
     hope that you will support giving your fellow members the 
     chance to vote on this bill.
           Sincerely,
     Michael B. Mukasey,
       Attorney General.
     J.M. McConnell,
       Director of National Intelligence.

  Mr. KYL. Mr. President, in addition to that, the Department of 
Justice has issued a news release dated February 23 that is titled 
``Statement by the Department of Justice and the Office of the Director 
of National Intelligence Regarding Cooperation with Private Partners,'' 
which press release makes it very clear that we are having a very 
difficult time in dealing with the telecommunications companies that 
are assisting the U.S. Government in the absence of a law which 
properly provides for liability protection for them and sets out the 
ground rules for their intelligence collection.
  I ask unanimous consent to have printed in the Record the statement 
to which I just referred.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

 Statement by the Department of Justice and the Office of the Director 
  of National Intelligence Regarding Cooperation With Private Partners

       As stated in the joint letter from the Attorney General and 
     the Director of National Intelligence dated February 22, the 
     Department of Justice and the Intelligence Community have 
     been working assiduously to mitigate the effects of the 
     uncertainty caused by the failure to enact long-term 
     modernization of the Foreign Intelligence Surveillance Act of 
     1978. We learned last night after sending this letter that, 
     as a result of these efforts, new surveillances under 
     existing directives issued pursuant to the Protect America 
     Act will resume, at least for now. We appreciate the 
     willingness of our private partners to cooperate despite the 
     uncertainty. Unfortunately, the delay resulting from this 
     discussion impaired our ability to cover foreign intelligence 
     targets, which resulted in missed intelligence information. 
     In addition, although our private partners are cooperating 
     for the time being, they have expressed understandable 
     misgivings about doing so in light of the on-going 
     uncertainty and have indicated that they may well discontinue 
     cooperation if the uncertainty persists. Even with the 
     cooperation of these private partners under existing 
     directives, our ability to gather information concerning the 
     intentions and planning of terrorists and other foreign 
     intelligence targets will continue to degrade because we have 
     lost tools provided by the Protect America Act that enable us 
     to adjust to changing circumstances. Other intelligence tools 
     simply cannot replace these Protect America Act authorities. 
     The bipartisan Senate bill contains these authorities, as 
     well as liability protection for those companies who answered 
     their country's call in the aftermath of September 11. We 
     hope that the House will pass this bill soon and end the 
     continuing problems the Intelligence Community faces in 
     carrying out its mission to protect the country.

  Mr. KYL. Finally, Mr. President, the Director of National 
Intelligence, Admiral McConnell, was on a television program in which 
he made some points related to this issue. Among other things, he said:

       We cannot do this mission, we cannot do this activity 
     without the help of the private sector.

  Upon expiration of the Protect America Act ``the private sector 
partner said, `Well, wait a minute, are we now protected?' So we went 
through a discussion for the entire week. Now, this is the problem. We 
may have the authority to conduct surveillance, and we do, for example, 
on al-Qaida, but you can't make that actionable if you don't have 
something specific to load in our systems to target. So when we wanted 
to load new information, the private partners said, `We're not prepared 
to do that.' So we negotiated all week to be able to come to closure.''
  The point he is making is, we are in a situation right now of grave 
vulnerability. Intelligence is not being collected, so there is no law 
under which it can be collected. The private parties with whom we must 
work to collect that intelligence are in a position of great 
vulnerability because of lack of liability protection, as a result of 
which there can undoubtedly arise a question as to whether they will 
continue to be able to perform this service for us. That is why we ask 
the House of Representatives to take up the Senate-passed legislation 
and to pass it as soon as possible and send it to the President so this 
vulnerability of which the Director has spoken can come to an end and 
we can resume collection of intelligence on our terrorist enemies.
  The PRESIDING OFFICER (Mr. Menendez). The Senator from North Dakota.
  Mr. DORGAN. Mr. President, I will make a few comments, and then 
Senator DeMint, by unanimous consent, will be recognized. He will have 
the time that he desires to speak about his two amendments that we will 
vote on this evening.
  I begin quickly by saying that we have had a lot of help to get this 
bill this far: Senator Reid, first of all, for allowing us and being 
persistent in getting this bill to the floor and to keep it here. 
Senator Kyl has worked closely with us. Senator Murkowski, the ranking 
member, has worked very hard to help me get this bill from our 
committee to the floor. Senator Kennedy and Senator Enzi and so many 
others have worked with us to try to make a difference on this 
legislation.
  Let me describe why there is an urgency. We have a trust 
responsibility

[[Page 2369]]

for Indian health care. That is different from other responsibilities. 
A trust responsibility means we took the land from the indigenous 
Americans, from the first Americans. We took their land but signed 
treaties and said: Tell you what, we will give you a deal. Here is our 
responsibility: We will provide health care for you. That was 
interpreted much later as a trust responsibility.
  Let me show what we do on Indian health care compared to other 
responsibilities we have. This describes how much we spend per person 
on Medicare, veterans, Medicaid, and so on. We actually spend twice as 
much money to provide health care for Federal prisoners, those 
incarcerated in Federal prisons, as we do to meet our responsibility 
for health care for American Indians. We have a responsibility for 
both, but we spend twice as much for Federal prisoners' health care as 
we do for American Indians.
  It is not as if there is not a need. American Indians have a 600 
percent higher rate of tuberculosis, a 510 percent rate of alcoholism, 
and diabetes is off the charts. There are about one-third of doctors 
for Indians versus other populations, and one-fourth of nurses for 
Indians as other populations. There is a much higher rate of sudden 
infant death syndrome. Cervical cancer is four times higher. The 
suicide rate among Indian teens is 10 times higher in the northern 
Great Plains, and it is triple in the rest of the country. The 
statistics are endless. We have a full-scale health care crisis.
  This bill in itself will not fix all that is wrong, but it is the 
first time in 8 years we are finally getting this bill reauthorized. It 
should have been done 8 years ago. It is now being done, and it is 
important.
  I have described this bill through the eyes of two girls--one age 5, 
the other age 14, both dead. Let me describe them. Their relatives and 
parents have allowed me to use their names so that we understand what 
this is about and what this urgency is.
  First, I will explain Ta'Shon Rain Littlelight, a beautiful 5-year-
old Indian girl from the Crow Reservation in Montana. Ta'Shon Rain 
Littlelight died, and the last 3 months of her life was in unmedicated 
pain. This little girl went to an Indian health clinic again and again 
to be diagnosed as having a condition of depression, and she was 
treated for depression. It turns out she had terminal cancer. She was 
finally rushed to Billings, MT, then rushed to Denver, CO, and 
diagnosed as having terminal cancer when it was undiagnosed many months 
before, and it may well have been able to be treated.
  When they finally diagnosed this 5-year-old girl, who loved to dance 
the Indian dances, as having terminal cancer, she asked her mom if she 
could go to Disney World and see Cinderella's castle and the Make-a-
Wish Foundation allowed her to go to Orlando, FL, to see Cinderella's 
castle.
  They got there and checked into a motel, and that evening, in her 
mother's arms, Ta'Shon Rain Littlelight said: Mommy, I'm sorry I'm 
sick. I will try to be better. She died that night in her mother's 
arms. She never got to see Cinderella's castle.
  This little girl deserved health treatment, deserved a health system 
that we would expect for our children, a good diagnosis, first-class 
health treatment. She did not get it, and she is dead.
  So is Avis Littlewind. Avis was 14. Avis Littlewind committed 
suicide. She lay in her bed for 90 days in a fetal position, missing 
school, missing everything. Her sister had committed suicide. Her dad 
took his own life. This young girl age 14 was lying in a fetal position 
for 3 months and somehow nobody missed her. No mental health treatment 
was available. Nobody seemed to identify this little girl was in 
trouble. And then she hung herself. She felt hopeless and helpless and 
took her life.
  A 14-year-old girl is gone. A 5-year-old girl is gone. But it is 
thousands, thousands of people suffering with a health care system that 
is not working. It is not working the way we would expect it to work 
for us and for our families, and it does not work for Native Americans, 
the first Americans, for whom we have a trust responsibility and to 
whom we made a promise. That is why we must get this bill done. We will 
have a cloture vote at 5:30 p.m.
  We will have two amendments this evening by Senator DeMint, a couple 
of amendments tomorrow morning, and final passage, and there will be a 
celebration by people who have waited a long time for this legislation 
to move through the Senate.
  Mr. President, I know my colleague, Senator DeMint, has been waiting 
patiently. I yield the floor, and my guess is that Senator Murkowski, 
the ranking member, will wish to be recognized following Senator 
DeMint.
  The PRESIDING OFFICER. The Senator from South Carolina.
  Mr. DeMINT. Mr. President, I appreciate the words of the chairman on 
the need to improve Indian health care. It is clear from the Government 
Accounting Office study that there is no doubt Indian health is 
suffering and there are many reforms that are desperately needed. I 
wish to talk about several amendments we proposed that we think will 
help the bill. One is related to what Senator Dorgan was just talking 
about and the fact that there is just not enough money currently to 
provide the health care that is needed for many Indians across the 
country today.
  Unlike a lot of other Federal support for health care, Indian health 
care provides 100 percent coverage to all members of tribes across the 
country, regardless of income level. The problem that creates at a time 
when we are offering new programs and reforms is we are not offering 
enough money to actually support all the programs that are in this new 
bill.
  My amendment No. 4073, which we call the Indian gaming amendment, 
would allocate the scarce resources to the poorer tribes by excluding 
some of the richer tribes that benefit from class III or casino-style 
gambling.
  Many of us have looked at the statistics. Revenues from Indian casino 
gambling have surpassed $12 billion, and many members of these tribes 
will receive income from these casinos from $30,000 to over $300,000. 
There are clear discrepancies in the income in the tribes across the 
country, and in designing Indian health care reform, it is important 
that we recognize that fact.
  In 2001, there were 290 Indian casinos across 28 States that brought 
in more than $12.5 billion with more than $5 billion in profit. To put 
this in context, the average family in South Carolina makes around 
$50,000 a year. These families, sometimes on their own, sometimes 
through their employers, have to pay and help pay for their health care 
and many times deductibles and copays. The average income in the tribes 
that have casino gambling is generally much higher than that amount. 
Yet we are providing free health care for these tribes.
  This amendment would exclude from the new programs in the underlying 
bill those tribes with casino gambling, class III gambling, which would 
take the money that is provided in the bill and allocate it to the 
poorer tribes, which uses just basic common sense. If we have a limited 
amount of money to go around, let's target those tribes with the 
greatest poverty and the greatest need and allow those tribes with the 
highest incomes to participate in purchasing their own health care. 
That is amendment No. 4073. We will vote on that amendment today.
  Let me address another amendment that will be voted on today; that 
is, amendment No. 4070 which recognizes that some of the programs in 
the bill that are designed for injury prevention or safety have 
actually been used in the past by Government agencies to promote 
antifirearm programs, gun buyback programs, or programs that generally 
stigmatize the ownership of guns for collecting, hunting, or self-
defense.
  This amendment provides that none of the funds in the bill may be 
used to fund antifirearm programs, gun buyback programs, or programs 
aimed at discouraging or stigmatizing the private ownership of firearms 
for collecting, hunting, or self-defense. That is basically the 
language in the bill.
  We know from programs we have looked at before--we have legislation,

[[Page 2370]]

for instance, that we passed that would prohibit the Centers for 
Disease Control from doing exactly the same thing; that is, using money 
that is supposed to be used for safety programs or other injury 
prevention and actually use it to promote a political agenda which is 
an anti-second-amendment agenda. This is another amendment we will vote 
on today.
  So two amendments we will be voting on today after the cloture motion 
vote is the Indian gaming amendment that would exclude those tribes 
that have the revenue from casinos, as well as the other amendment 
which would prohibit funds from being used to stigmatize the ownership 
of guns.
  Mr. President, I wish to address another amendment which is pending 
to this bill, which is what we call the health savings account choice. 
This amendment would simply make another choice available to Indians in 
the purchase of their health care. Right now, they have most of the 
options that we have at the Federal level in our Federal employees 
plan, but they do not yet have a health savings account option which we 
have added to our Federal programs. This simply would allow Indians the 
same choice that we have. They could purchase a PPO or other plans--
managed care, HMO, or with this amendment, they could also have a 
health savings account with a high-deductible plan.
  I encourage my colleagues to support this amendment. I am actually 
working with the chairman on the possibility that this amendment could 
be accepted and avoid a vote on the amendment tomorrow; otherwise, we 
will be voting on it tomorrow before final passage.
  I wish to make a few comments on a second-degree amendment that I 
added to one of these amendments the week before we left last week 
which we call the Semper Fi amendment. This is an amendment that is not 
germane and will fall after cloture but still deserves some comment. 
The Semper Fi amendment is named in honor of the marine motto, which 
means ``always faithful,'' and it is a bill which I introduced after 
the Berkeley, CA, city council voted to refer to our marines as 
unwelcome intruders and had proposed that they leave town--that their 
recruiting office actually leave town. When I heard of this, it 
immediately angered me and we developed this bill which would simply 
take away about $2 million of wasteful Federal earmarks, which were not 
voted on in the Senate or the House, but were added as what we call 
report language. We are not trying to take away all their Federal 
funding but simply to say, if they are not going to respect our marines 
or their mission, which part of it is recruiting, then certainly they 
should not be the beneficiary of taxpayer-funded earmarks, and 
certainly those that aren't necessary.
  When I first introduced this bill, it was more to make a point and 
maybe rattle the cages of the city council, because I know all the 
people in Berkeley don't feel this way. If anyone looked at the video--
and it was one of the most watched videos on YouTube--you could see 
person after person stepping up and maligning our marines and the job 
they are doing, not only in Iraq but throughout history, and referring 
to them as murderers and thugs, unthinkable things being said about the 
same marines who provided them their freedom of speech.
  Some have said by my introducing this bill I am against freedom of 
speech, and that is not it at all. In fact, the anti-American group 
Code Pink had been demonstrating for months in front of the marine 
recruitment office there in Berkeley, and I have no problem with that. 
They have every right. But they wanted more than freedom of speech, 
they wanted the power of the local government behind them, to give them 
an advantage over those who supported the marines, supported their 
mission, and supported our country. So the city council voted to give 
Code Pink a free parking place in front of the marine recruitment 
office, and also voted to give them a permit to use a bullhorn, a 
megaphone, to shout down any who would want to come into that 
recruitment office. That is not free speech. That is a government-
sponsored political agenda that took the side of a few liberal 
demonstrators against traditional Americans and the marines who have 
fought for our freedom of speech.
  My amendment got a fair amount of attention and a lot of supporters 
here in the Senate, which I appreciate. The same bill was also 
introduced in the House by a number of Republicans. I have been 
surprised at the response we have gotten--literally thousands of phone 
calls and e-mails and letters. What this has exposed to me is it is not 
only a single event, but it has exposed a raw wound not only of our 
marines but everyone serving in uniform, and their families.
  I have heard it when I have been in Iraq, more than once, when I ask 
our soldiers, marines, and airmen what they need, and the response has 
often been: Don't forget us. The letters and e-mails I have gotten have 
indicated the same thing, that finally some are standing up for those 
who are fighting for our freedoms.
  I was surprised by the response. I have gotten letters at home from 
mothers who have sent me pictures of their marines, thanking those of 
us who have stood up for their marines. I have agonized over the fact 
that they need someone to stand up for them.
  But when I go back and see what was said in this Chamber and the 
House Chamber, and what governments such as the city of Berkeley have 
done, it should come as no surprise to us that there are doubts in the 
minds of those who put on the uniform that we support them, that we 
believe in what they do, and that we support their constitutional 
mission to recruit and to talk about what we offer in our services. 
People--Americans--are concerned about this.
  We have tried to get the Semper Fi act on the floor for an up-or-down 
vote, and we have not been able to do so. We tried to pass it by 
unanimous consent, which got 100 percent Republican support but was 
blocked on the Democratic side. I added it to an amendment to this 
bill, to try to get a vote, but it will fall after we vote for cloture.
  I promise the marines and all those in uniform that I am going to 
continue to persist until we get a vote on this, because it is not just 
about this amendment, it is not just about those who support it, it is 
about letting those who put on the uniform and who are willing to fight 
for our freedoms know we stand behind them. When any government, at any 
level, takes a position against them, it is our responsibility here in 
the Congress to stand up for those marines and those fighting men and 
women and not to allow them to be taken advantage of and intimidated 
and bullied by some local government such as we saw in Berkeley.
  I have been happy to see some local governments across the country 
actually pass resolutions in support of the marine recruiters, and I 
appreciate any across this country who stand and make a statement on 
behalf of those who are fighting for our freedom. Again, I emphasize 
that anyone who wants to speak out in protest against marine 
recruiters, against the Iraq war, or anything, it is their free right. 
But when government, whether it is a local government or a State 
government, takes a position against our Federal constitutional 
amendment to defend this country, which requires the recruitment of 
marines, soldiers, airmen, and Coast Guard, that is part of our job. It 
is not freedom of speech when a local government takes a position 
against what we are charged to do here at the Federal level.
  I encourage all those parents, all those in uniform, that the 
majority of those here in the Senate, in the House, and across this 
country respect and appreciate what you are doing every day. I got back 
from Iraq last week, with 2 days on the ground, and I know I speak for 
all my colleagues when I say I was never prouder of my country and what 
I do here than when I stood with those in uniform who are sacrificing, 
in many instances, more than a year away from their family, and some on 
second and third tours. They are fighting for us and we need to stand 
up for them. I am going to continue to persist until my colleagues give 
me a chance to stand with our marines and to support the Semper Fi 
bill.

[[Page 2371]]

  Mr. President, I yield the floor, and I reserve the remainder of my 
time.
  The PRESIDING OFFICER (Mr. Whitehouse). The Senator from Alaska.
  Ms. MURKOWSKI. Mr. President, at this time I yield 7 minutes to the 
Senator from Wyoming.
  The PRESIDING OFFICER. Without objection, it is so ordered. The 
Senator from Wyoming is recognized.
  Mr. ENZI. Mr. President, I thank the Senator from Alaska.
  I rise in support of renewing and reinvigorating the Indian health 
care programs. For too long we have neglected our duty to review this 
program and ensure that it continues to efficiently deliver high-
quality health care. As part of that effort in the last Congress, 
Senator McCain and I and Senator Dorgan and Senator Murkowski 
introduced comprehensive legislation that would do that, and I am 
pleased that a great portion of the bill we are discussing today 
includes provisions of that bill, which was S. 4122.
  In crafting that legislation last Congress, we kept in mind the 80/20 
rule in working between the Health, Education, Labor and Pensions 
Committee and the Indian Affairs Committee. We used this 80/20 rule--or 
the 80-percent rule--which is that 80 percent of the time we are going 
to agree on a topic and it is only 20 percent of the time that we 
disagree. So to gain broad support we focused on that 80 percent to 
ensure it was a strong bipartisan piece of legislation. It is a piece 
that is long overdue. This should have been reauthorized years ago. It 
leaves out some important things that are necessary for the tribes in 
administering Indian health.
  A few weeks ago, I did mention a few remaining concerns I had with 
the underlying Indian health care bill, and thankfully, due to the work 
of many in this Chamber, and particularly Senator Dorgan and Senator 
Murkowski, I no longer have concerns with the underlying legislation. 
The improvements to the bill required minimal language changes, but 
they do have huge policy implications. I am glad we are better able to 
clarify the scope of Federal liability coverage. By doing so, we no 
longer imply that the Federal Government could be telling Americans how 
to practice their own religious beliefs. For this and the issue of 
urban Indians, we were able to find a third way, a middle ground, on 
the appropriate role for providing services to urban Indians.
  I am also pleased to hear that at least two outstanding issues within 
the Finance Committee's title of this bill have also been resolved. I 
thank Senator Kyl for all his efforts in the area to create better 
Medicaid copays and better citizenship documentation. I realize others 
may not see these compromises as the perfect solution. However, they 
are moving us in the right direction on these key topics. As I remind 
people around here a lot, there is no such thing as a perfect piece of 
legislation.
  The 80 percent this bill contains will solve immense problems for 
tribes throughout the United States. It will move health care forward 
for all who are involved, and it will make a huge difference. It is 
past due. We still can work on other issues that are outstanding that 
we hear mentioned around the Chamber in the debate, but this piece of 
legislation needs to pass. It needs to pass now. It should have passed 
a year and a half ago.
  We almost passed it at the end of that session, until we got the 
scoring, and the scoring used the wrong bill. They did not use the bill 
Senator McCain and I and Senators Murkowski and Dorgan put together. 
They used a different bill, and the cost came in extremely high. And it 
would, under that bill. It wasn't this bill. It wasn't what we worked 
on.
  It has taken us another year and a half to get to the point where we 
can pass a bill that will solve the problems for the tribes and keep 
this program moving forward in a very positive way. I am glad we will 
be able to pass this legislation out of the Senate, and I look forward 
to working with others to get this bill signed into law.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Alaska.
  Ms. MURKOWSKI. Mr. President, I appreciate the comments of my 
colleague from Wyoming, speaking to essentially the urgency of where we 
are, and the recognition that we have been working on this legislation, 
the Indian Health Care Improvement Act and its reauthorization--and as 
he mentioned, it should have passed a year and a half ago--but that we 
have been working on it for a good 10 years. It has been a 
collaborative effort of many leaders in the Senate. Senator McCain has 
been mentioned, as the former chairman of the Indian Affairs Committee. 
Prior to his chairing that committee, it was Senator Ben Nighthorse 
Campbell who was leading the effort to move forward with this very 
important reauthorization.
  I had the opportunity to go home to Alaska over this past recess, and 
it was a busy recess for me, as it was for, I know, many of my 
colleagues. I had an opportunity to visit Galena, which is the 
Athabascan Indian village on the Yukon River. I was in Fairbanks, 
Seward, Anchorage, and my hometown of Girdwood. I had a chance to visit 
with seven or eight Alaskan natives who are training under the dental 
health aide therapist program in Anchorage. This is a very unique 
partnership with the University of Washington School of Medicine. What 
we are doing in Alaska now is training Alaska natives as mid-level 
professional dental health aide therapists to go out and provide for 
the dental health needs of so many in our rural communities, in our 
villages around the State where they simply do not have any level of 
dental health care. I am not talking about a dentist who comes every 
other week. I am saying we don't have a dentist every other year 
practically in some of these villages. So we are providing a training 
opportunity that is unique to Alaska and is very important.
  So even though it is tough to leave home and come back here to work, 
it is good to be back here knowing that we are working on the Indian 
Health Care Improvement Act, working to finish this very important 
legislation.
  We have had many of our colleagues speak about the challenges of 
delivering quality health care to America's Native people and the 
funding environment that all have admitted is inadequate to support 
those needs.
  Those challenges are not limited to the lack of funding, they also 
include the lack of trained personnel who are willing to live in some 
of the most remote places in which Indian health care is delivered. So 
that is one side of the coin. But there is also some very real 
innovation that is going on within the Indian health care delivery 
system.
  As I listened to the debate that went on on the Senate floor in the 
past several weeks, it dawned on me that we saw a lot of focus, a lot 
of attention on some of the inadequacies but that we did not spend any 
time during that debate to recognize the people, the tribal leaders, 
the health care professionals who are unwilling to let the lack of 
funding stand in the way of excellence in health care delivery.
  So as we move to conclude our debate on this very important piece of 
legislation for the health of our Native people, I wish to take a few 
moments this evening to focus on some of the ways, in my home State, 
our Native leaders and our Indian health care professionals have 
partnered to overcome what seemed to be insurmountable obstacles in 
their quest for excellence.
  My focus now on these examples from Alaska is not intended to imply 
we are not seeing innovation in Indian health care delivery in other 
places of Indian Country, but I have chosen to speak about these 
programs because I know them, I believe in them.
  In the State of Alaska, we have Native people who have lived in more 
than 200 traditional villages along the rivers and coasts for thousands 
of years, and Natives continue to occupy those villages today. But 
those are places, many of them are places where doctors and nurses and 
physicians assistants or the PAs, where they did not live, and they 
will not live.
  But that does not mean Alaska's Native people lack access to basic 
medical care. If one gets sick or injured in a Native village which may 
be hundreds of miles from the nearest hospital, you

[[Page 2372]]

need to know you are not alone. In our State, we faced up to the 
challenge of providing access to medical care in remote places by 
training Native people to serve as community health aide practitioners. 
This is a program that originated during the tuberculosis epidemics 
back in the 1950s. They had volunteer chemotherapy aides who gave out 
oral medicine in the village under the remote supervision of a 
physician.
  In the 1960s, a structured training program was created to train 
Native people residing in the villages to function as the eyes and 
ears, the hands of medical personnel who may be hundreds of miles away.
  At one point in time, this link between the village health aide and 
the doctor in the regional hospitals was carried out by a single-
sideband radio similar to what the ham operators use. Then later it was 
carried out by telephone, subsequently e-mail. Now we have a state-of-
the-art telemedicine backbone that connects the health aides and the 
supervising physicians.
  Alaska's Community Health Aide/Practitioner Program was first 
recognized and funded by the Congress in 1968 and is 40 years old this 
year. It has earned the respect of the medical profession and has 
tremendously improved the health condition of Alaska's Native people. I 
mentioned earlier I had a chance to view those young people who are 
currently in the Dental Health Aide Therapist Program. This is an 
extension of this concept to improve the oral health condition of 
Native people who live in places where the dentists may visit once a 
year if they visit at all.
  These are a few examples from my State of the kind of innovation we 
have seen going on in Indian health care delivery for some time. I wish 
to give you a more recent example. This is the Southcentral 
Foundation's patient-centered primary care initiative.
  The initiative has transformed the quality of health care delivered 
to Native people residing in a service area of 150,000 square miles 
within southcentral Alaska. The Southcentral Foundation is a tribal 
health provider which delivers health care under a self-governance 
compact with the IHS.
  Our CEO of the Southcentral Foundation is Katherine Gottlieb, an 
Aleut. She was the first Alaskan ever to win the MacArthur Foundation 
Genius Award. She won that award for the patient-centered primary care 
initiative I will describe for you.
  The initiative itself has been discussed in professional journals 
ranging from the Journal of the American Medical Association, the 
Family Practice Magazine published by the American Association of 
Family Physicians. It is the subject of a case study published by the 
Institute for Health Care Improvement in Boston, which is one of our 
Nation's foremost think tanks on health care quality.
  In 1977, when Southcentral Foundation began to take over primary care 
delivery from the IHS, the average delay to schedule a routine 
appointment ranged from 4 weeks to several months. The no-show rate was 
about 25 percent for appointments, and patients did not have any idea 
who their primary care provider was. In 1999, Southcentral Foundation 
embarked on a massive effort to redesign their system.
  Today, patients are guaranteed same-day access to their own primary 
care provider if they call by a certain point in the afternoon; they 
get to choose their own primary care provider. They get to change their 
provider if they do not like the one they have chosen. Use of the 
emergency room and urgent care for primary care is down 50 percent. Use 
of specialists is down 50 percent. Wait times have decreased across the 
system.
  Customer satisfaction, 91 percent of customers rate their overall 
care favorably. That is pretty impressive. Staff satisfaction has 
improved immeasurably. This is a system where you have members of the 
medical team, the doctors, the nurses, the physicians assistants, their 
technicians, and they all come together, they all rely on one another. 
Everyone is expected to work at the highest level allowed by their 
professional license.
  What we saw with this transformation of Southcentral Foundation was 
it was not just achieved by throwing more money at the problem, it was 
achieved by changing the values of the system, from a staff-centered 
system to a patient-centered system that basically went from kind of a 
big and impersonable crank-them-through-the-process place--and these 
are the words of the medical director, Doug Eby--to a customer-owned-
and-directed system which operates in accordance with Native values, 
not necessarily bureaucratic principles.
  That transformation began with the decision of Native leaders to 
exercise their rights of self-governance under the provisions of the 
Indian Self-Determination and Education Assistance Act.
  These self-governance provisions allowed tribes to take over the 
responsibilities for the delivery of health care from the Federal 
Government. The bill that is before us today, the Indian Health Care 
Improvement Act, will provide self-governance providers, such as 
Southcentral Foundation, with the tools and the flexibilities they need 
to further expand these innovations.
  We know the bill, S. 1200, was not written in an ivory tower; it was 
written primarily by Indian health care providers, tribal leaders who 
know the challenges we face in improving the health conditions of our 
Native people.
  The leaders of our Alaska Native delivery system were key players in 
the process of formulating this legislation. For me, it is truly an 
honor and a privilege to be able to give voice to their ideas in the 
Senate. It is my sincere hope our colleagues today will vote to bring 
the debate on this important legislation to a close.
  The process, as has been mentioned, of drafting this legislation 
began back in 1999. It has moved through the Indian Affairs Committee 
in so many different years--I mentioned, under the leadership of 
Senator Nighthorse Campbell, Senator McCain, Senator Thomas before his 
death, Senator Dorgan, so many who have put so much time and effort 
into this very important legislation.
  It is long time that Congress modernize the legislation which governs 
the Indian health care delivery system in a way that promotes exactly 
this type of innovation I have spoken to that we have seen in Alaska. 
It is long time that we give our Indian health care providers the tools 
they need in their quest for excellence.
  I anticipate we will move this legislation to final passage. It is 
something that as I speak to my constituents back home and as we talk 
about those issues that are most important to them, so much seems to 
come back to health care and how we are providing health care within 
the State of Alaska or around the Nation.
  So passage of the Indian Health Care Improvement Act is long overdue. 
I look forward to seeing the day the President will be able to enact 
these changes into law.
  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. 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. I ask unanimous consent that the vote sequence beginning 
at 5:30 today be as follows:
  Cloture on the Dorgan-Murkowski substitute amendment; DeMint 
amendment No. 4070; and DeMint amendment No. 4073.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DORGAN. Mr. President, I ask unanimous consent that the votes 
following the first vote be 10-minute votes, with 2 minutes equally 
divided for debate.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DORGAN. Let me explain that the legislation, the Indian Health 
Care Improvement Act, does a number of things. We have talked about the 
urgency for it, but it expands cancer

[[Page 2373]]

screenings, for example; it expands monitoring and prevention programs 
for communicable and infectious diseases; it expands recruitment and 
scholarship programs for those nurses and doctors who serve American 
Indians; it seeks to address the epidemic of teenage suicides on some 
Indian reservations; it enhances and expands the current diabetes 
screening efforts; it tries to address the shortage of health care 
professionals; provides for home- and community-based services and 
hospice care; also authorizes convenient care services; and authorizes 
programs to address domestic violence and sexual abuse.
  In short, it is a piece of legislation that attempts to modernize the 
Indian health care system that has been waiting to be reauthorized now 
for 8 years. So this is a piece of legislation that I think is going to 
make a difference in the lives of Americans who have expected and have 
been promised good health care and have, for a long time, not received 
it.
  While we are waiting for colleagues who may wish to speak prior to 
5:30, I ask unanimous consent to speak for 3 minutes in morning 
business.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                      Strategic Petroleum Reserve

  Mr. DORGAN. Tomorrow, we have a hearing in the Senate Energy 
Committee that deals with the issue of the Strategic Petroleum Reserve, 
called SPR, and the Administration's oil fill policies. In the 1970s, 
we have created a Strategic Petroleum Reserve to put oil underground to 
save it in case of a national security concern. It would be for an 
emergency so we would have some that is saved and would be available to 
take out of the underground caverns and use it in these circumstances. 
This is the basis of our strategic petroleum reserve. It is now almost 
97 percent filled. Over its 30-year lifetime, the barrels that have 
been put into the Strategic Petroleum Reserve have averaged about a $27 
a barrel. Yet, right now, when oil is trading at $100 a barrel and 
gasoline prices are going through the roof, we are putting 50,000 to 
60,000 barrels a day underground into the Strategic Petroleum Reserve 
that is already almost 97 percent full.
  How are we doing that? Our Government carries that out through 
royalty-in-kind transfers. This oil is primarily coming from the Gulf 
of Mexico through the drilling and the production that occurs there. We 
are receiving this oil in kind in lieu of royalties paid to the 
government for its production. So rather than put that oil into the 
supply system, get the money for it, and reduce the Federal deficit, we 
are effectively sticking that money underground in a hole. At a time 
when oil is $100 a barrel and gas is $3 to $3.50 a gallon, we are 
taking 50,000 to 60,000 barrels a day and sticking it underground. Is 
somebody missing a few tubes here? I don't understand it. The wiring 
must be wrong for people who think that is the right thing to do. This 
is exactly the wrong time to be sticking oil underground when oil is 
$100 a barrel. Yet I have tried very hard to get this changed, and I 
have been unable to do so.
  We have a hearing tomorrow where we have representatives coming from 
the Department of Energy as well as other witnesses. I will have an 
opportunity, if I am not here on the floor--and I hope I am not--to 
question them. I have recently introduced legislation--S. 2598, the 
Strategic Petroleum Reserve Fill Suspension and Consumer Protection Act 
of 2008. I will try very hard to move this bill on anything that moves, 
especially a supplemental appropriations bill, to make sure we stop 
this as soon as possible.
  I chair the Senate Energy and Water Appropriations Subcommittee that 
funds the Department of Energy. When I write my bill this spring, I 
will be able to put a provision that stops filling the SPR in my bill. 
But that bill likely won't be effective until towards the end of the 
year. By that time, they will have continued to put all of this oil 
underground to its full capacity and also boost the gas prices for the 
American driver. I don't understand what they could be thinking.
  As a part of this fill policy, they are putting underground a 
disproportionate amount of sweet light crude. That is a subset of the 
oil produced in the U.S. We had testimony before a joint Energy and 
Government Affairs/Homeland Committee hearing last year by an expert, 
Dr. Phillip Verleger, who said that even the small amount of sweet 
light crude they are putting underground is having a disproportionate 
impact on the markets and may be increasing the price of gasoline by 10 
percent.
  If there are some wires crossed someplace, I urge the Department of 
Energy to track those wires down and get them squared away. Let's start 
thinking straight. Do not be sticking oil underground when oil is $100 
a barrel. That takes oil out of our supply. It means supply is 
diminished, even if it is a seemingly small amount as DOE contends. It 
means the price goes up.
  This is a classic supply-demand question. All of us have studied 
economics. I taught economics in college ever so briefly. I was able to 
overcome that experience, nonetheless. But we all understand the 
supply-demand relationship. If you take oil out of what otherwise would 
be 50,000 or 60,000 additional barrels in the supply, you put upward 
pressure on gasoline prices. That is especially true if you take the 
subset of sweet light crude coming from the Gulf of Mexico and stick it 
underground at exactly the time it ought be to be in the supply 
pipeline.
  Tomorrow, we will have the opportunity to have a public discussion 
with the Department of Energy and representatives with other opinions. 
If they don't do what is, in my judgment, obvious, I intend to move my 
legislation forward. I have introduced this bill with about six 
cosponsors. I certainly hope many others will join me to put the brakes 
on what the Department of Energy is now doing.
  It is completely counterintuitive to anything one would expect that 
should be done at a time when oil is bouncing around at $100 a barrel 
and you have to get a loan to gas up your car these days. My hope is we 
can get the Department of Energy to think straight about this issue of 
putting oil underground in the SPR.
  It felt good to say that because I have been thinking about it all 
weekend. There is so much we need to do that just represents a deep 
reservoir of common sense. This is one of those steps. My hope is we 
will make some progress on it.
  Mr. COCHRAN. Mr. President, I am pleased to be a cosponsor of the 
Indian Health Care Improvement Act.
  Under the terms of many treaties and agreements, the U.S. Government 
has the responsibility to provide health care and other benefits to 
Native Americans.
  The Indian Health Care Service estimates that it provides only about 
60 percent of the health care that is needed in Indian Country: an 
amount that is less than half of what we spend on the health care needs 
of Federal prisoners. Tribes with the resources, attempt to make up the 
difference. In most cases, the result is inadequate to meet the needs 
of our Native American population.
  In my State, the Mississippi Band of Choctaw Indians has made 
progress in improving its health care, and the overall health of its 
population, over the last 30 years. But, the sad fact is that health 
care on the reservation is not adequate.
  There are 9,600 members of the tribe and there are only 4 doctors. 
Their small hospital has only 14 beds.
  Over the last 5 years, there has been a 30.4-percent increase in the 
number of patients from the Mississippi Band of Choctaw Indians who 
accessed the health care system. During that same time period there was 
a 41.4-percent increase in the number of ambulatory visits.
  According to the Centers for Disease Control, 7 percent of Americans 
have diabetes. By comparison, 20.5 percent of Choctaws have diabetes, 
one of the highest percentages of any tribe in the country. Over the 
last 5 years, there was a 62.3-percent increase in the number of 
patients diagnosed with diabetes.
  Statistics for other tribes are similar. Some include alarming 
incidences of suicide, high infant mortality rates

[[Page 2374]]

and practically nonexistent mental health care.
  Some in the Senate have suggested that those tribes that have made 
progress with economic development initiatives, specifically through 
gaming, ought not be eligible for Indian Health Care Services. I don't 
agree. The tribe in my State should not be penalized for its modest 
economic success.
  The tribe is responsible for the safety of not only its members but 
those who visit. It maintains roads, schools, courts, law enforcement, 
fire fighting, housing, and other services we expect from local and 
State governments.
  It has a poverty rate of approximately 30 percent. Forty years ago 
there was a near 100 percent unemployment rate of tribal members.
  There is no health care system near the tribe that has the capacity 
to serve tribal members. Even now, treatment facilities for dialysis, 
heart patients, and serious medical conditions are 80 miles away.
  I urge the Senate to support the Indian Health Care Improvement Act.
  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. 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.


                             Cloture Motion

  The PRESIDING OFFICER. Under the previous order, pursuant to rule 
XXII, the Chair lays before the Senate the pending cloture motion, 
which the clerk will state.
  The legislative clerk read as follows:

                             Cloture Motion

       We, the undersigned Senators, in accordance with the 
     provisions of rule XXII of the Standing Rules of the Senate, 
     hereby move to bring to a close debate on the Dorgan 
     substitute amendment No. 3899 to S. 1200, the Indian Health 
     Care Improvement Act Amendments.
         Harry Reid, Russell D. Feingold, Kent Conrad, Richard 
           Durbin, Amy Klobuchar, Patty Murray, Maria Cantwell, 
           Jon Tester, Jeff Bingaman, Carl Levin, Max Baucus, 
           Byron L. Dorgan, Barbara Boxer, Dianne Feinstein, 
           Debbie Stabenow, Ken Salazar, Daniel K. Akaka.

  The PRESIDING OFFICER. By unanimous consent, the mandatory quorum 
call is waived.
  The question is, Is it the sense of the Senate that debate on 
amendment No. 3899, offered by the Senator from North Dakota, Mr. 
Dorgan, to S. 1200, shall be brought to a close?
  The yeas and nays are mandatory under the rule.
  The clerk will call the roll.
  The bill clerk called the roll.
  Mr. DURBIN. I announce that the Senator from Maryland (Mr. Cardin), 
the Senator from New York (Mrs. Clinton), the Senator from Hawaii (Mr. 
Inouye), the Senator from Massachusetts (Mr. Kerry), the Senator from 
Louisiana (Ms. Landrieu), the Senator from Illinois (Mr. Obama), and 
the Senator from Michigan (Ms. Stabenow) are necessarily absent.
  I further announce that, if present and voting, the Senator from 
Maryland (Mr. Cardin) would vote ``yea.''
  Mr. KYL. The following Senators are necessarily absent: the Senator 
from Tennessee (Mr. Alexander), the Senator from North Carolina (Mr. 
Burr), the Senator from Texas (Mr. Cornyn), the Senator from Arizona 
(Mr. McCain), the Senator from Virginia (Mr. Warner), and the Senator 
from Mississippi (Mr. Wicker).
  Further, if present and voting, the Senator from Tennessee (Mr. 
Alexander) and the Senator from Texas (Mr. Cornyn) would have voted 
``yea.''
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The yeas and nays resulted--yeas 85, nays 2, as follows:

                      [Rollcall Vote No. 28 Leg.]

                                YEAS--85

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

                                NAYS--2

     DeMint
     Vitter
       

                             NOT VOTING--13

     Alexander
     Burr
     Cardin
     Clinton
     Cornyn
     Inouye
     Kerry
     Landrieu
     McCain
     Obama
     Stabenow
     Warner
     Wicker
  The PRESIDING OFFICER. On this vote, the yeas are 85, the nays are 2. 
Three-fifths of the Senators duly chosen and sworn having voted in the 
affirmative, the motion is agreed to.
  Mr. DORGAN. Mr. President, I move to reconsider the vote, and I move 
to lay that motion on the table.
  The motion to lay on the table was agreed to.


                           Amendment No. 4080

  Mr. DORGAN. Mr. President, I make a point of order that the DeMint 
amendment No. 4080 is not germane postcloture.
  The PRESIDING OFFICER. The point of order is sustained. The amendment 
falls.


                Amendment No. 4070 to Amendment No. 3899

  The PRESIDING OFFICER. Under the previous order, there will now be 2 
minutes of debate equally divided prior to a vote on amendment No. 4070 
offered by the Senator from South Carolina, Mr. DeMint.
  Who yields time?
  Mr. DeMINT. Mr. President, the underlying Indian health care bill 
allows Federal funds to be used for certain health promotion activities 
which include injury prevention, personal safety, and violence 
prevention. My amendment would simply say that none of these funds in 
the bill may be used to fund any firearm programs, gun buyback 
programs, or programs aimed at discouraging or stigmatizing the private 
ownership of firearms for collecting, hunting, or self-defense 
purposes, which are important to the Indian community. So that is my 
amendment.
  The PRESIDING OFFICER. The Senator from North Dakota is recognized.
  Mr. DORGAN. Mr. President, I have no objection to the amendment. I 
know of no cases in which Indian health funds have been used for 
firearms programs. So I have no objection to the amendment and intend 
to vote for it.
  The PRESIDING OFFICER. The question is on agreeing to the amendment.
  Mr. DeMINT. Mr. President, I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second? There appears to 
be a sufficient second.
  The clerk will call the roll.
  The legislative clerk called the roll.
  Mr. DURBIN. I announce that the Senator from Maryland (Mr. Cardin), 
the Senator from New York (Mrs. Clinton), the Senator from Hawaii (Mr. 
Inouye), the Senator from Louisiana (Ms. Landrieu), the Senator from 
Illinois (Mr. Obama), and the Senator from Michigan (Ms. Stabenow) are 
necessarily absent.
  Mr. KYL. The following Senators are necessarily absent: the Senator 
from Tennessee (Mr. Alexander), the Senator from Texas (Mr. Cornyn), 
the Senator from Arizona (Mr. McCain), the Senator from Virginia (Mr. 
Warner), and the Senator from Mississippi (Mr. Wicker).
  Further, if present and voting, the Senator from Tennessee (Mr. 
Alexander) and the Senator from Texas (Mr. Cornyn) would have voted 
``yea.''
  The PRESIDING OFFICER (Mr. Sanders). Are there any other Senators in 
the Chamber desiring to vote?
  The result was announced--yeas 78, nays 11, as follows:

[[Page 2375]]



                      [Rollcall Vote No. 29 Leg.]

                                YEAS--78

     Akaka
     Allard
     Barrasso
     Baucus
     Bayh
     Bennett
     Bingaman
     Bond
     Brown
     Brownback
     Bunning
     Burr
     Byrd
     Cantwell
     Carper
     Casey
     Chambliss
     Coburn
     Cochran
     Coleman
     Collins
     Conrad
     Corker
     Craig
     Crapo
     DeMint
     Dodd
     Dole
     Domenici
     Dorgan
     Ensign
     Enzi
     Feingold
     Graham
     Grassley
     Gregg
     Hagel
     Harkin
     Hatch
     Hutchison
     Inhofe
     Isakson
     Johnson
     Kerry
     Klobuchar
     Kohl
     Kyl
     Leahy
     Levin
     Lieberman
     Lincoln
     Lugar
     Martinez
     McCaskill
     McConnell
     Murkowski
     Murray
     Nelson (FL)
     Nelson (NE)
     Pryor
     Reid
     Roberts
     Rockefeller
     Salazar
     Sanders
     Sessions
     Shelby
     Smith
     Snowe
     Specter
     Stevens
     Sununu
     Tester
     Thune
     Vitter
     Voinovich
     Webb
     Wyden

                                NAYS--11

     Biden
     Boxer
     Durbin
     Feinstein
     Kennedy
     Lautenberg
     Menendez
     Mikulski
     Reed
     Schumer
     Whitehouse

                             NOT VOTING--11

     Alexander
     Cardin
     Clinton
     Cornyn
     Inouye
     Landrieu
     McCain
     Obama
     Stabenow
     Warner
     Wicker
  The amendment (No. 4070) was agreed to.
  Mr. DORGAN. Mr. President, I move to reconsider the vote, and I move 
to lay that motion on the table.
  The motion to lay on the table was agreed to.


                      Amendment No. 4073 Withdrawn

  The PRESIDING OFFICER. Under the previous order, there will be 2 
minutes of debate equally divided prior to a vote in relation to 
amendment No. 4073 offered by the Senator from South Carolina, Mr. 
DeMint.
  Mr. DORGAN. Mr. President, on behalf of the sponsor, I ask unanimous 
consent that amendment No. 4073 be withdrawn.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Mr. DORGAN. Mr. 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. 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, with the withdrawal of the last amendment, 
there will be no further votes tonight. My understanding is the next 
vote starts at 10 tomorrow morning. The withdrawal of the second 
amendment on which we were going to have a recorded vote means there 
will be no further recorded votes necessary this evening.
  Mr. REID. Mr. President, the only question is, I have not had a 
chance to confer with my distinguished Republican colleague, Senator 
McConnell. We will make a decision as to what time we should start in 
the morning. There is a lot of committee business going on, and I want 
to visit with Senator McConnell first.
  Mr. DORGAN. Mr. 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. SMITH. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                           Amendment No. 3897

  Mr. SMITH. Mr. President, I rise today to speak in favor of my 
amendment No. 3897. The amendment is cosponsored by Senators Cantwell, 
Murray, Crapo, and Wyden. It clarifies section 301(F) of the Indian 
health bill regarding innovative approaches to funding Indian Health 
Services facilities construction.
  The amendment would allow those innovative approaches to include an 
area distribution fund. Such a fund would allow the IHS to take a 
portion of facility construction dollars and cede that money to all 12 
IHS areas throughout the country.
  To be clear, my amendment neither creates an area distribution fund 
nor does it require the IHS to do so; rather, we are simply giving IHS 
the authority to do what is needed to bring equity to the system.
  Currently, the vast majority of Federal funding for construction and 
modernization of tribal health care facilities goes to tribes in less 
than 10 States. In fact, my home State of Oregon, among many other 
States, has never received funds to build an Indian Health Services 
hospital. This is a function of the current flawed construction formula 
and of the regrettably low levels of funding for IHS, particularly its 
facilities construction budget.
  These two wrongs, however, do not make a right. To correct this, it 
will take a two-part process: one part to increase funding for IHS and 
its construction budget, but this is an appropriations issue. Another 
is to amend the language in the Indian health bill to create some level 
of parity in the way IHS funds construction projects, and that is an 
authorizing issue.
  As we debate today about the authorization of health care funding, I 
stand here to represent all the tribes that do not have access to 
funding to improve or build health care facilities because of an 
archaic formula. If tribes do not have access, no amount of 
appropriations will make a difference. We have to create the access, 
and my amendment would do just that. Again, it would authorize, not 
require, the IHS to use an area distribution fund.
  The amendment would not rob one IHS area to pay for another. It 
simply allows other tribes across the Nation to also be eligible for 
funding. This area distribution fund is not the idea of a single 
Senator or a single region of the country. It is the product of years 
of work and compromise by the Indian Health Services and tribes after 
Congress recognized the need to create a more equitable facilities 
construction system.
  This approach is supported by tribes and area health boards that 
cover IHS areas representing over 400 of the 562 federally recognized 
tribes that are based in 39 States. For Members and staff currently 
listening to my floor statement, allow me to read a list of the States 
where IHS areas want the type of flexibility provided by my amendment. 
To my colleagues in the Senate, if they have the privilege of 
representing Native Americans, I hope they will listen to find out if 
their State is mentioned because, right now, if they are mentioned, 
they are not getting any construction dollars. It is that simple.
  The Nashville area, which serves 28 States, includes these States: 
Maine, Pennsylvania, Virginia, West Virginia, New Hampshire, Vermont, 
Maryland, Ohio, Massachusetts, Rhode Island, Connecticut, North 
Carolina, South Carolina, New York, New Jersey, Delaware, Kentucky, 
Indiana, Tennessee, Georgia, Florida, Alabama, Illinois, Missouri, 
Arkansas, Louisiana, Texas, and Mississippi. Then the Bemidji area 
which serves three States: Minnesota, Wisconsin, and Michigan; the 
Alaska-California areas which serve those States; the Oklahoma area 
which serves Oklahoma and Kansas; the Portland area which serves 
Oregon, Washington, and Idaho. Additionally, many tribes in Nevada also 
support this amendment.
  The State of the Presiding Officer was mentioned, and so was mine. 
Mr. President, you are getting no construction dollars because of the 
way this is managed.
  Last May, during an Indian Affairs Committee meeting, we were doing a 
markup on the Indian Health Care Improvement Act. I filed a much more 
prescriptive amendment which would have mandated funds for the area 
distribution fund. I withdrew that amendment in good faith because I 
wanted to work with the chairman and the vice chair and my other 
colleagues to find a win-win compromise on this issue. Since then 
tribes have put in hundreds of hours of work to find a compromise that 
could benefit all of Indian country. I have since scaled back my 
original amendment to reflect and recognize this compromise between the 
majority of the IHS areas.

[[Page 2376]]

  Unfortunately, my efforts to reach a compromise before floor action 
were not successful. Yet I believe this issue is better left to the 
Indian Health Services than Members of Congress. That is why my 
amendment would simply give them the flexibility to work this out on 
their own in consultation with the tribes. Opposition to my amendment 
is based on the notion that IHS funds will remain at the slow drip they 
are now for the foreseeable future. I wish to change that. I want IHS 
facility funds to grow and to flow to every area that needs them. But 
then again, that is an appropriations issue and not an authorization 
issue, the business before us.
  I have already written to the administration in support of increased 
IHS funding, and I intend to follow up on that request with the 
Appropriations Committee. I am hopeful that request will be met and 
that some of those funds would make their way to the 43 tribes in the 
Pacific Northwest or to the 25 tribes in the Nashville IHS area or the 
40 tribes in the Oklahoma IHS area or the 109 tribes in the California 
IHS area, among others across the Nation. My amendment preserves that 
possibility for every State and every Native American in Indian 
Country.
  On numerous occasions, Chairman Dorgan has invoked the words of Chief 
Joseph, who said: ``Good words do not last long unless they amount to 
something.'' Chief Joseph said those words after being chased by the 
U.S. Cavalry out of the Wallowa Valley of Oregon, through the States of 
Washington, Idaho, Wyoming, and Montana toward Canada. Chief Joseph 
also rightfully said: ``I am tired of talk that comes to nothing.''
  I feel the same way. Eight years ago, Congress asked IHS and the 
tribes to revise the failed system for allocating facilities funding. 
The compromise they reached may amount to nothing without my amendment. 
That is why I feel so strongly about this issue. It is not just about 
one region or a group of regions, this amendment is about holding true 
to the government-to-government relationship the United States holds 
with all tribes.
  I ask my fellow colleagues to support this amendment to ensure that 
all Native American Indians receive the health care they need--the 
health care they deserve.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from North Dakota.
  Mr. DORGAN. Mr. President, let me very briefly say that I understand 
the point Senator Smith is making. There is not enough money for the 
facilities in these programs. There is a $3 billion backlog for 
facilities. I am not able to support his amendment, however, and the 
difficulty is to create an area-wide distribution fund right this 
moment, at a time when we have a priority list and some tribes have 
been waiting on that priority list for a long period of time for the 
construction that was to begin in their area. I think that would be the 
wrong approach.
  But I do think we ought to, in a more comprehensive way, on the 
Indian Affairs Committee, with the help of Senator Smith and Senator 
Murkowski and my colleagues, we ought to try to work through this to 
figure out how we do a better job of getting the funding for the 
construction that is necessary. I have been to so many facilities that 
are terrible facilities in terrible disrepair, and they are desperately 
in need of reform and change and new construction, and we have to get 
about the business of doing it. But I regret I can't support this 
amendment. He is raising the right question, just providing the wrong 
solution, in my judgment.
  The PRESIDING OFFICER. The Senator from Alaska.
  Ms. MURKOWSKI. Mr. President, while we are waiting, I wish to make a 
few brief comments in reference to the amendment Senator Smith has 
introduced regarding the area distribution fund.
  Coming from the State of Alaska, I do support Senator Smith's 
amendment, as we believe it will enable more Indian tribes to build the 
facilities and to address the inequities currently in the system. We 
recognize it has been under review, having been looked at for revision 
for years, but I think it is time to do something to create 
improvements to the system to get more facilities for the tribes.
  Now, we recognize that funding is at the crux of this, but Senator 
Smith's amendment does not mandate that the Secretary create this 
system. It says if funding is available, that opportunity exists. 
Furthermore--and I think this goes to the concern many have--that 
within the current priority system, if there is a change, somehow or 
other those who have made their way up to the top will somehow be 
displaced. We understand it doesn't impact the current health care 
facilities priority system. What we are attempting to do with this 
amendment is to enhance that system.
  I appreciate Senator Smith working with the committee, with the 
tribes, and with our colleagues on this issue. It is a very important 
issue, as Senator Dorgan has noted. So I do stand in support of Senator 
Smith.
  With that, I yield the floor.
  The PRESIDING OFFICER. The Senator from North Dakota.
  Mr. DORGAN. Mr. President, we were expecting to clear two unanimous 
consent requests, but I am told that, at the moment, the minority side 
has yet to clear them. If we are not able to clear them at the moment, 
perhaps we will be able to clear them first thing in the morning before 
we go to the votes that will be scheduled tomorrow.
  I think we are at a point where we have about two or three votes 
remaining and then final passage tomorrow. And that should occur 
probably close to midday, which will be a pretty happy occasion for a 
lot of folks who have waited a long time for this legislation to pass 
the Senate.
  I know a couple of my colleagues are waiting to do a colloquy, so if 
we are not yet cleared, I think we will try to clear both these 
unanimous consent requests tomorrow morning. Our colleagues, I believe, 
are not on this subject, so at this point I will defer and we will come 
back to this tomorrow morning.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Rhode Island.
  Mr. REED. Mr. President, I ask unanimous consent to speak as in 
morning business and also to engage in a colloquy with my colleague 
from Oregon.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                            Childhood Cancer

  Mr. REED. Mr. President, I initially wish to make a few comments, and 
then I will yield to my colleague from Oregon. Today, I rise to honor 
two young heroes and their families. Ben Haight of Rhode Island and 
Boey Byers of Oregon were two remarkable young people whose lives were 
cut short by cancer, but whose hopes were not.
  Of course, when a child has cancer, it deeply affects the parents, 
siblings, friends, and extended family. In fact, a pediatric illness 
affects the entire family. Even those who don't bear the damage of the 
illness bear the pressures, the strains, and the frustrations over 
dealing with the serious illness of a child. These two young children 
were extraordinary. We mourn their loss and at the same time we 
celebrate their lives.
  Ben Haight was only 4 years old when he was diagnosed with 
neuroblastoma. He fought valiantly, enduring chemotherapy, two bone 
marrow transplants, and total body radiation. Ben did not let cancer 
stop him from living life. I am told he would dictate his treatment 
schedules to his doctors: ``No treatments during science class; have to 
be out by 3 to go to Cub Scouts, baseball or soccer.''
  Even at a young age, Ben knew a lot about what was important in life. 
He cared about others and wanted to help. He held a bandaid drive at 
school to donate colorful bandaids to the hospital, which used plain 
bandaids to save money. Ben knew that patients enjoyed picking out a 
``cool'' bandaid and that this simple pleasure offered them a brief 
respite from the rigors of their disease.
  Ben's cancer went into remission, but after 2 years it came back. The 
doctors gave him 3 months to live, but he was tough. He fought for 2 
more years. Ben was 9 years old when he died.

[[Page 2377]]

  I never had a chance to meet Ben, but I have had the honor of meeting 
his wonderful family. His family has turned the tragedy of losing their 
son into a message of hope for other families.
  Just before Ben died, he and his family enjoyed a special activity 
together--swimming with dolphins. Now, the Haight family's mission is 
to do all they can to fight cancer and to provide one child a year with 
the opportunity to swim with dolphins.
  I think there is a sort of symbolic link here between his family and 
these dolphins. His father was a career enlisted man in the U.S. Navy, 
a chief in our submarine service. Of course, submarines use the 
dolphins as the symbol of their service branch. This is a family who 
has served the Nation in uniform and who continues to serve the Nation 
by fighting hard for other families who are afflicted by childhood 
cancer.
  Now, Boey Byers was, in her words, a warrior against cancer, and I 
was very saddened to learn she has recently passed way. A few months 
ago, I had the privilege of speaking with Boey over the phone. She was 
full of life and spirit and struck me as very polite, poised, and wise 
beyond her years. I wanted to thank Boey for all she was doing to try 
to help other kids with cancer. Her passion in life was to find a cure 
for her warrior friends, as she called them, so they didn't have to 
suffer anymore and so they could live out their dreams and contribute 
to this great country.
  We must remember there are thousands of children like Ben and Boey 
across the country. Each year, there are about 9,500 new cases of 
pediatric cancer, the leading cause of death by disease among children 
in the United States. While the incidence of cancer in children is 
increasing, the causes are largely unknown.
  The National Cancer Institute--the NCI--currently spends about $170 
million a year on pediatric cancer research, but most of the money goes 
toward laboratory research and preclinical testing. While it is 
important to test treatments in a test tube, Petri dish, or on animals, 
it is equally important to test treatments on humans in clinical 
trials.
  For example, a recent clinical trial found that for children with 
neuroblastoma, less intensive chemotherapy is as effective as more 
intensive and toxic chemotherapy.
  In 2002, an NCI peer review group of scientists recommended about $50 
million in funding for pediatric cancer clinical trials. That level was 
never funded, and since then it has been cut, despite biomedical 
inflation and the increasing incidence of childhood cancer. 
Unfortunately, declining funding has stopped promising clinical trials. 
Pediatric cancer researchers expect only flat funding for clinical 
trials this year.
  We can do better. The Conquer Childhood Cancer Act invests $30 
million a year to expand pediatric cancer research and develop 
pediatric cancer clinical investigators. The bill also creates a 
national childhood cancer registry to track pediatric cancer. 
Researchers would be able to contact patients within weeks, enroll them 
in research studies, and follow up with them over time. Similar 
registries are already in place in Europe. If Europe can do it, we can 
do it, and we should do it.
  This bill awaits action by the full Senate. It recently reached a 
significant milestone, garnering its 51st cosponsor. So even before any 
vote, we know for sure a majority of the Senate supports the bill. It 
has broad bipartisan support, with 14 Republican cosponsors and the 
support of both the majority and minority leaders.
  Regrettably, a small minority is blocking this bill, and I call on 
the Senate to carry out the will of the majority and pass the bill. It 
is my hope that in doing so we will intensify our fight against 
childhood cancer, so that one day the hopes of Ben and Boey, and 
thousands of children like them, will be realized.
  Mr. President, I yield now for the purpose of a colloquy with my 
colleague from Oregon.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. WYDEN. Mr. President, first, I wish to commend my friend from 
Rhode Island for persistently and energetically prosecuting this cause, 
because having gotten to know Boey at home and visiting her in the 
hospital, I think all of us will understand it is hard to conceive of 
anything more tragic than seeing a young person's life claimed by 
cancer.
  Senator Reed has been educating the Senate on this issue of 
importance, of research of this disease. I got to know Boey, and that 
is why I am glad he referred to her as a warrior. I would just tell my 
colleagues that if Boey had been an elected official, she would have 
been the chair of the Warrior Caucus because this very young child 
really did not know how to rest in the effort to try to get this 
legislation passed and to help our youngsters.
  When she was taken from us, she had battled cancer not once but 
twice. The first time, she had beaten her cancer into remission. She 
lost her second battle, but she simply never rested. The day that I saw 
her last in the hospital, what we spent our time on was Boey and I 
walking down the halls with Boey trying to cheer up the other 
youngsters who were at the hospital. She put aside her own pain and 
fear that cancer would claim her life because she wanted to be, as 
Senator Reed has noted so eloquently, a warrior for all of the other 
children who have been suffering.
  I am pleased to be out here with Senator Reed. I think this is 
another example of the entire country coming together to try to stand 
up for these kids. As Senator Reed has noted, when cancer strikes, it 
strikes a whole family. That was the certainly the case with Boey. Her 
loving parents, Rob and Rachel, her older brothers, Chris and Joe--all 
of us have continued to think about Boey and all she did to brighten 
our lives and particularly stand up for our children.
  So for purposes of this evening, I simply wanted to ask my friend one 
question. This Senate can certainly have spirited debates about a lot 
of issues. Senators can have differences of opinion on a variety of 
questions, and we come from different parts of the land. The Senator 
from Rhode Island represents a State 3,000 miles from mine where Boey 
lives. But I am still troubled why the Senate cannot come together and 
pass this legislation. I think Senator Reed has made the case and made 
it well. He has clearly reached out to colleagues on both sides of the 
aisle. Surely, there should be nothing partisan about legislation such 
as this that will be so meaningful to children and their families.
  For purposes of this evening, I wanted to get a sense from my 
colleague of what else he felt we ought to be trying to do to pass this 
important legislation and get it on its way to the President.
  Mr. REED. I thank the Senator. One of the things we are doing this 
evening is once again highlighting the critical importance of this 
legislation, the impact it would make in the lives of children and 
families across the country. And your voice is a strong voice for not 
only this legislation but for issues affecting health care and children 
in this country.
  I think we are picking up speed, but we need the cooperation of 
virtually all of our colleagues, not to pass the bill--we have 51 
votes--but to get it on the floor. That is not something unusual here 
in the Senate. But I think this is the type of legislation that should 
not be caught up in the kind of procedural rules that we all use.
  I am going to try to reach out and explain personally what is at 
stake, how we have tried to make changes, how we have pursued a 
bipartisan approach. I hope we can be persuasive enough to get this 
legislation on the floor for a vote. I do not think the opposition, 
frankly, is the concept and the mechanisms we are talking about. 
Certainly it is not opposition to helping families and children who 
have cancer. I think it is caught up in other issues. We would like to 
disentangle those issues and focus on what we can for children who have 
cancer.
  I think that is one of Boey's works.
  Mr. WYDEN. One of her many, and you can see her enthusiasm literally 
popping out of the drawing. She was an incredibly passionate woman. You 
have stated it well. I know of no Members of

[[Page 2378]]

the Senate who get up in the morning and say they want to be hostile to 
children who are suffering this way. I think a piece of legislation 
such as this gets lost in the clutter of the Senate calendar and the 
business of the Senate.
  All of us have staffers who handle health legislation and staffers 
who are serving as legislative directors. I think for purposes of 
tonight, particularly given your eloquent remarks, I hope the phone 
will ring off the hook in your office tomorrow with Senators and 
staffers calling and making clear they want to know more about this 
legislation and hopefully be cosponsors so we can get it passed.
  Mr. REED. I am encouraged also. It is incumbent upon supporters like 
myself and yourself to begin to reach out, which I think we are both 
committed to doing, and doing it personally to try to get through. I 
think my sense is a lot like yours. It is not an issue that people are 
objecting to; it is caught up in bigger issues. And sometimes we just 
have to step back and understand that the big issues will still be 
there and the points can still be made, but we can get this bill done.
  I noticed the warriors in Boey's drawing at the White House. My hope 
is one day the President in the White House is going to sign this bill. 
She will be there, and Ben will be there in spirit because they are the 
warriors, and the young men and women who are helping us in our 
mission.
  So that is my hope. I think we can do that. We are going to try. If 
it is because we have not been as explicit or as communicative as we 
should have been with all of our colleagues, that is something we will 
correct very quickly.
  Mr. WYDEN. I will do everything I can to help. I think the Senator 
has said it well. In a sense, his work acknowledges something we all 
see every time we are home, and that is that health care has always 
been the biggest issue here at home.
  The Senator from Rhode Island is someone I admire in so many areas, 
relating to international affairs, with great expertise, and obviously 
there are many pressing concerns around the world. But the reality is, 
here at home, if our loved ones and our families do not have their 
health, it is hard to do anything else. I know in the case of Boey and 
the wonderful family, Rob and Rachel and her brothers, they were 
consumed by this. They all threw everything they had into trying to be 
there to comfort Boey, to get her the treatment she needed. So we ought 
to do this for the kids, and we ought to do this for the families. 
There are a lot of other issues we will be tackling both in health care 
and around the Senate schedule. This is something we ought to do now.
  Mr. REED. I agree. I think it is something we can do. The effort is 
to bring people together and move from 51 to 61 to 71 to 100. I think 
we can.
  Mr. WYDEN. Well said.
  Mr. REED. We have begun in earnest months ago, and we are picking up 
the pace. I thank the Senator for his wise and kind words.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Kansas.
  Mr. BROWNBACK. Mr. President, I ask consent to speak for 10 minutes 
in support of the Vitter amendment. I believe there is a time agreement 
for 30 minutes on each side of the Vitter amendment.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BROWNBACK. Mr. President, if my colleagues need to interrupt, I 
would be happy to yield to them.
  I yield to the Senator from North Dakota.
  Mr. DORGAN. I ask unanimous consent that the vote sequence with 
respect to S. 1200 tomorrow be as follows: Vitter amendment No. 3896, 
Smith amendment No. 3897, DeMint amendment No. 4015, DeMint amendment 
4066, and final passage of S. 1200; further, that the cloture motion 
with respect to S. 1200 be withdrawn, with no debate time in order 
except for 2 minutes prior to each vote; that after the first vote, 
vote time be limited to 10 minutes each; all other provisions of the 
previous order remaining in effect.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DORGAN. Mr. President, I further ask unanimous consent that on 
Tuesday, February 26, upon disposition of S. 1200, there be a period of 
morning business until 12:30 p.m., with Senators permitted to speak 
therein, with the time equally divided and controlled between the two 
leaders or their designees, with Senator Feingold controlling 20 
minutes of the majority time, if available; that at 2:30 p.m., there be 
20 minutes of debate prior to a vote on the motion to invoke cloture on 
the motion to proceed to S. 2633, with the time divided and controlled 
between the leaders, with the majority leader controlling the final 10 
minutes prior to the vote; that upon the use of that time, the Senate 
then vote on the motion to invoke cloture on the motion to proceed to 
S. 2633, with other provisions of the previous order remaining in 
effect.
  My understanding is that this has been cleared on both sides.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DORGAN. Mr. President, let me do one small piece of business with 
the bill before the Senator from Kansas proceeds.


   Amendments Nos. 4019, as Modified, and 4021 to Amendment No. 3899

  Senator Murkowski and I wish to have considered two unanimous consent 
requests that were originally to have been included in the previous 
unanimous consent by which we conducted business today. One is 
amendment No. 4021, and one is amendment No. 4019, as modified.
  I send both amendments to the desk and ask that they be considered en 
bloc and agreed to.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendments (No. 4019, as modified, and 4021) were agreed to, as 
follows:


                    Amendment No. 4019, as modified

       On page 298, after line 25, insert the following:

     ``SEC. 71_. TESTIMONY BY SERVICE EMPLOYEES IN CASES OF RAPE 
                   AND SEXUAL ASSAULT.

       ``(a) Approval by Director.--
       ``(1) In general.--The Director shall approve or 
     disapprove, in writing, any request or subpoena for a sexual 
     assault nurse examiner employed by the Service to provide 
     testimony in a deposition, trial, or other similar proceeding 
     regarding information obtained in carrying out the official 
     duties of the nurse examiner.
       ``(2) Requirement.--The Director shall approve a request or 
     subpoena under paragraph (1) if the request or subpoena does 
     not violate the policy of the Department to maintain strict 
     impartiality with respect to private causes of action.
       ``(3) Treatment.--If the Director fails to approve or 
     disapprove a request or subpoena by the date that is 30 days 
     after the date of receipt of the request or subpoena, the 
     request or subpoena shall be considered to be approved for 
     purposes of this subsection.
       ``(b) Policies and Protocol.--The Director, in coordination 
     with the Director of the Office on Violence Against Women of 
     the Department of Justice, in consultation with Indian Tribes 
     and Tribal Organizations, and in conference with Urban Indian 
     Organizations, shall develop standardized sexual assault 
     policies and protocol for the facilities of the Service.''.


                           Amendment No. 4021

        (Purpose: To require a study of tribal justice systems)

       On page 347, after line 24, add the following:

     SEC. 104. GAO STUDY OF TRIBAL JUSTICE SYSTEMS.

       (a) In General.--Not later than 1 year after the date of 
     enactment of this Act, the Comptroller General of the United 
     States shall conduct, and submit to Congress a report 
     describing the results of, a study of the tribal justice 
     systems of Indian tribes located in the States of North 
     Dakota and South Dakota.
       (b) Inclusions.--The study under subsection (a) shall 
     include, with respect to the tribal system of each Indian 
     tribe described in subsection (a) and the tribal justice 
     system as a whole--
       (1)(A) a description of how the tribal justice systems 
     function, or are supposed to function; and
       (B) a description of the components of the tribal justice 
     systems, such as tribal trial courts, courts of appeal, 
     applicable tribal law, judges, qualifications of judges, the 
     selection and removal of judges, turnover of judges, the 
     creation of precedent, the recording of precedent, the 
     jurisdictional authority of the tribal court system, and the 
     separation of powers between the tribal court system, the 
     tribal council, and the head of the tribal government;

[[Page 2379]]

       (2) a review of the origins of the tribal justice systems, 
     such as the development of the systems pursuant to the Act of 
     June 18, 1934 (25 U.S.C. 461 et seq.) (commonly known as the 
     ``Indian Reorganization Act''), which promoted tribal 
     constitutions and addressed the tribal court system;
       (3) an analysis of the weaknesses of the tribal justice 
     systems, including the adequacy of law enforcement personnel 
     and detention facilities, in particular in relation to crime 
     rates; and
       (4) an analysis of the measures that tribal officials 
     suggest could be carried out to improve the tribal justice 
     systems, including an analysis of how Federal law could 
     improve and stabilize the tribal court system.

  The PRESIDING OFFICER. The Senator from Kansas.


                           Amendment No. 3896

  Mr. BROWNBACK. I rise to discuss the Vitter amendment to the Indian 
Health Care Improvement Act No. 3896. It is an important amendment. I 
am a cosponsor.
  I want to give a bit of outline on this provision. This codified 
within the Indian Health Care Improvement Act a provision that is 
referred to as the Hyde amendment that has been public law for some 25 
years. Congressman Henry Hyde, whom both the Presiding Officer and 
myself served with in the House of Representatives, who passed away 
last year, was a giant on the issue, bringing the issue of life to the 
Congress, to the country.
  The so-called Hyde amendment prohibits taxpayer funding for abortions 
other than in case of rape, incest, and the life of the mother. This is 
a provision which has really not been contested for some period of the 
time because while we have a contentious debate about abortion in the 
United States, the level of the contention of the debate is much lower 
regarding taxpayer funding of abortion when it involves anything other 
than rape, incest, life of the mother. That has generally been agreed 
to in this body, that we should not use taxpayer money in those 
particular situations.
  What the Vitter amendment does is take that particular provision and 
puts it in the Indian health care bill and says that we should not fund 
abortions through the Indian health care provisions or Indian health 
care facilities other than in cases of rape, incest, or the health of 
the mother. Federal taxpayer dollars should not be used. Most people 
agree. They may be pro-choice, they may be pro-life, but they are 
saying still--most people in this country do not want their Federal 
taxpayer dollars used for this purpose. And what we are doing in this 
particular provision is codifying within the Indian Health Care 
Improvement Act this provision. The Hyde amendment is normally put in 
the Labor-HHS appropriations bill. It has typically not been put within 
the Interior appropriations bill where Indian health care is normally 
funded.
  Indian health care legislation being an authorizing piece of 
legislation, I think it is important that we codify this particular 
provision. This will be a key vote. It will be a key vote on people's 
views toward taxpayer funding of these types of abortions other than in 
cases of rape, incest and the life of the mother. I would hope that 
most of our colleagues would say, even if they are pro-choice: Well, I 
do not think that is something we should be doing with Federal taxpayer 
dollars. I would hope a number of people would look and say: This is 
such a contentious debate and so many people in the country do not 
agree with abortion and particularly do not want their dollars, their 
taxpayer dollars used to fund selective abortions, that people say: 
Okay, you are right, an individual may be pro-choice, but I do not 
think we ought to do that in this particular situation, and would then 
vote for the Vitter amendment.
  It is very carefully drafted. It is narrowly cast. It is a policy 
issue where there has been agreement between the House, the Senate, and 
the President. There has been agreement on the Hyde amendment provision 
for over 20 years, particularly cast on this contentious issue.
  That is why I hope colleagues will look at this carefully and say: I 
have supported Hyde amendment-type language in the past. This makes 
sense. It is a commonsense provision.
  I hope my colleagues will support the Vitter amendment because of 
this particular provision and will agree that it makes sense to them as 
well.
  Overall, it is a contentious issue, but this particular provision 
should not be. I urge my colleagues to look at it carefully and see if 
they could not support the Vitter amendment. I strongly urge its 
passage.
  I ask unanimous consent that any time I did not use be kept on the 
Vitter amendment.
  I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. THUNE. 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. THUNE. Mr. President, I am pleased we are making headway and are 
approaching finality and conclusion in regard to the Indian Health Care 
Improvement Act. I give great credit to Senator Dorgan from North 
Dakota and Senator Murkowski from Alaska for their persistence in 
working with the leaders on both sides to get this legislation moved 
and ultimately adopted.
  It has been a long time since we have had the Indian Health Care 
Improvement Act reauthorized. I think it goes back to about 2001. So 
this is a long overdue step toward attempting to improve health care 
throughout Indian Country, and I applaud the work that has been done. I 
hope tomorrow we can dispose of the final amendments that remain and 
get to a final vote on this legislation so we can begin to address what 
are some very serious needs regarding Indian Country and health care.
  I wish to specifically acknowledge a couple of amendments--one that 
is still pending and one that has been adopted.


                           Amendment No. 3896

  First, Mr. President, I wish to speak to the Vitter amendment, which 
is going to be voted on tomorrow. If adopted, this amendment would 
codify longstanding policy against the funding of abortions with 
Federal Indian Health Service funds.
  Senator Vitter's amendment would permanently apply to the IHS the 
policy set forth by the Hyde amendment, which prohibits the Federal 
funding of abortions and has been national policy since 1976. For over 
30 years, Democratic and Republican administrations, the U.S. Supreme 
Court, and bipartisan Congresses have all upheld and affirmed this 
essential policy. In addition to maintaining this legislative 
precedent, amendment No. 3896 includes important exceptions to save the 
life of the mother or in cases of rape or incest.
  Now, some of my colleagues may ask why statutory codification of this 
policy is necessary. Let me assure them it is necessary to ensure this 
decades-long legislative precedent does not fall needlessly through 
procedural and political cracks.
  Without this amendment, there is no true assurance that Federal IHS 
funds will not be used to pay for abortions on demand in the future. As 
everyone in this Chamber knows, the language of future HHS 
appropriations bills depends upon a host of political and legislative 
contingencies which can shift suddenly and unpredictably.
  This amendment would extend and codify good policy--policy that 
protects the vulnerable rather than restricting rights. The Federal 
Register contains scores of national policies that are in place to 
protect women, young children, and citizens of minority status from 
harm.
  Abortion is a practice that can harm women physically, emotionally, 
and spiritually. Statistics clearly demonstrate that abortion in this 
country falls disproportionately on minority populations, including 
Native Americans.
  By supporting this amendment, we affirm life. As a nation we have 
come a long way in protecting the unborn since the Supreme Court's 
decision in Roe v. Wade. However, we still have a long way to go in the 
fight to protect life in this country. I believe there is an essential 
human dignity attached to

[[Page 2380]]

all persons, including the unborn, and I will continue working with my 
colleagues in the Congress to promote a culture of life in this Nation.
  As a cosponsor of this amendment, I offer my strong support of 
amendment No. 3896, and I urge my colleagues to support it.
  I hope when the vote comes up tomorrow, we will have a good, strong 
bipartisan vote in support of this amendment.
  Mr. President, I see the majority leader has come on the floor. I 
yield to him at this time. I assume he has some business to dispose of.
  The PRESIDING OFFICER. The majority leader is recognized.
  Mr. REID. Mr. President, I very much thank my distinguished friend 
from the State of South Dakota who has, certainly, intimate knowledge 
of Native Americans. His State, I think, has one of the largest 
reservations in the country and one of the poorest all at the same 
time.

                          ____________________