[Congressional Record (Bound Edition), Volume 154 (2008), Part 2]
[Senate]
[Pages 2505-2513]
[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 resumes consideration of S. 1200, which the clerk will report by 
title.
  The assistant legislative clerk read as follows:

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

  Pending:

       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.

  The ACTING PRESIDENT pro tempore. The Senator from North Dakota.


                           Amendment No. 3896

  Mr. DORGAN. Mr. President, I believe by previous unanimous consent 
the Senate will now consider the Vitter amendment.
  The ACTING PRESIDENT pro tempore. The Senator is correct. There are 2 
minutes of debate equally divided.
  The Senator from Louisiana.
  Mr. VITTER. Mr. President, I strongly urge all of my colleagues to 
support this mainstream amendment. The Vitter amendment codifies the 
Hyde amendment and simply says in Indian health care no taxpayer funds 
will be used to support abortions, with the normal exceptions of the 
Hyde amendment.
  Up to now, this has been the practice and the law, but only because 
the Indian health care law points to whatever the current 
appropriations language is on the subject in Labor, Health, and 
Education. And so it is a very tenuous policy that is subject to change 
and a vote and a change in policy every year.
  This amendment will solidify that policy. It will put the Hyde 
amendment in permanent Federal authorization law with regard to the 
Indian health care act, just as was done decades ago in the Defense 
authorization bill. It is a solid mainstream amendment, and I urge 
support from both sides of the aisle.
  The ACTING PRESIDENT pro tempore. The Senator from North Dakota.
  Mr. DORGAN. Mr. President, this is not a debate about whether Federal 
dollars should be used for abortion services. Current law already 
prohibits that. I oppose Federal funding for abortions, and I have 
supported the Hyde provision. But the Vitter amendment is completely 
unnecessary.
  First of all, we have a provision in the underlying bill that relates 
to the Hyde provision that applies to all other appropriations bills. 
But I do want to say this: This is not a mainstream amendment that 
everybody is clear about. In fact, there is a provision in this 
amendment on page 2, section B. I don't know what it means, and I don't 
think Senator Vitter knows what it means. There have been no hearings, 
no discussion, yet onward through the fog on amendments like this.
  The fact is, we ought to have a hearing, but there has been no 
hearing. I don't understand what section B means, nor does the author, 
I believe.
  Having said all that, again, this is not a debate about whether 
Federal dollars should be used for abortion services. Current law 
already prohibits the use of Federal funds for abortion services, and 
the underlying bill contains a provision that relates to current law 
and continues the same policy.
  The ACTING PRESIDENT pro tempore. All time has expired. The Senator 
from Louisiana.
  Mr. VITTER. I ask unanimous consent for 30 additional seconds.
  Mr. DORGAN. I will agree, provided I am allowed 30 additional seconds 
following Senator Vitter.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Mr. VITTER. Mr. President, I do this to ask the distinguished Senator 
about the provision he is talking about. Maybe we can have a discussion 
about it rather than him vaguely alluding to it without pointing out 
the language and claiming nobody knows what it means.
  Mr. DORGAN. Well, Mr. President, the appropriate place for that kind 
of discussion would have been a congressional hearing. That is where 
you discuss what provisions mean and how they are written.
  The provision reads: As to provide or pay any administrative cost of 
any health benefits coverage that includes coverage of an abortion.
  I don't understand what that means with respect to facilities or 
other issues. There are a series of issues that relate to that. And 
that is not, incidentally, just codifying the Hyde amendment, as the 
Senator alleges. This provision doesn't exist with the Hyde amendment. 
This is something the Senator conceived of and added.
  My point is, it ought to be the subject of a hearing. We don't 
disagree on the issue of Federal funding for abortion. We agree on 
that. But the Senator has mischaracterized his amendment.
  Mr. VITTER. Reclaiming my remaining time, that was language I pointed 
out to the distinguished Senator 3 weeks ago when I introduced my 
amendment and we discussed it. So I think it is a little disingenuous 
to bring it up at this point.
  Mr. DORGAN. And, Mr. President, he indicated when he pointed it out 
to me that this is why it was different than the Hyde amendment, which 
doesn't point to what he claims today.
  The ACTING PRESIDENT pro tempore. The question is on agreeing to the 
amendment.
  Mr. VITTER. I ask for the yeas and nays.
  The ACTING PRESIDENT pro tempore. Is there a sufficient second? There 
appears to be a sufficient second.
  The clerk will call the roll.
  The assistant legislative clerk called the roll.
  Mr. DURBIN. I announce that the Senator from New York (Mrs. Clinton), 
the Senator from Connecticut (Mr. Dodd), and the Senator from Illinois 
(Mr. Obama) are necessarily absent.
  Mr. KYL. The following Senators are necessarily absent: the Senator 
from Texas (Mr. Cornyn), the Senator from Arizona (Mr. McCain), and the 
Senator from Virginia (Mr. Warner).
  Further, if present and voting, the Senator from Texas (Mr. Cornyn) 
would have voted ``yea.''
  The ACTING PRESIDENT pro tempore. Are there any other Senators in the 
Chamber desiring to vote?
  The result was announced--yeas 52, nays 42, as follows:

                      [Rollcall Vote No. 30 Leg.]

                                YEAS--52

     Alexander
     Allard
     Barrasso
     Bayh
     Bennett
     Bond
     Brownback
     Bunning
     Burr
     Byrd
     Casey
     Chambliss
     Coburn
     Cochran
     Coleman
     Corker
     Craig
     Crapo
     DeMint
     Dole
     Domenici
     Ensign
     Enzi
     Graham
     Grassley
     Gregg
     Hagel
     Hatch
     Hutchison
     Inhofe
     Isakson
     Johnson
     Kyl
     Landrieu
     Lugar
     Martinez
     McConnell
     Murkowski
     Nelson (NE)
     Pryor
     Reid
     Roberts
     Salazar
     Sessions
     Shelby
     Smith
     Stevens
     Sununu
     Thune
     Vitter
     Voinovich
     Wicker

[[Page 2506]]



                                NAYS--42

     Akaka
     Baucus
     Biden
     Bingaman
     Boxer
     Brown
     Cantwell
     Cardin
     Carper
     Collins
     Conrad
     Dorgan
     Durbin
     Feingold
     Feinstein
     Harkin
     Inouye
     Kennedy
     Kerry
     Klobuchar
     Kohl
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lincoln
     McCaskill
     Menendez
     Mikulski
     Murray
     Nelson (FL)
     Reed
     Rockefeller
     Sanders
     Schumer
     Snowe
     Specter
     Stabenow
     Tester
     Webb
     Whitehouse
     Wyden

                             NOT VOTING--6

     Clinton
     Cornyn
     Dodd
     McCain
     Obama
     Warner
  The amendment (No. 3896) was agreed to.
  Mr. DORGAN. I move to reconsider the vote and to lay that motion on 
the table.
  The motion to lay on the table was agreed to.


                           Amendment No. 3897

  The ACTING PRESIDENT pro tempore. There will now be 2 minutes of 
debate equally divided in relation to amendment No. 3897.
  The Senator from Oregon.
  Mr. SMITH. Mr. President, 8 years ago, Congress asked the Indian 
Health Service and the tribes to revise a failed system for allocating 
facilities funding. The compromise they reached may amount to nothing 
without this amendment. That is why I feel so strongly about it. It is 
not only about one region or group of regions; this amendment is about 
holding true the government-to-government relationship the United 
States holds with all tribes. I ask my colleagues to support the 
amendment to ensure that all Native Americans receive the health care 
they need and deserve.
  Members should know it is unlikely that Native Americans in their 
States are receiving construction funding for Indian Health Service 
facilities. All this does is say to the Indian Health Service: Come up 
with a formula that is fair. Otherwise, your State, the tribes you 
represent, will receive nothing.
  Mr. BINGAMAN. Mr. President, I rise in opposition to Senator Smith's 
amendment, No. 3897, to the Indian Health Care Improvement Act, S. 
1200, and urge my fellow Senators to vote against this amendment.
  This amendment would expressly authorize the Secretary of Health and 
Human Services, HHS, to utilize a new ``area distribution fund'' 
methodology to allocate Indian Health Service, IHS, health care 
facilities construction, HCFC, funding.
  This approach could result in critical projects that are on the 
current IHS HCFC priority list from receiving funding. These projects 
have been waiting for many years, and in some cases decades, to receive 
funding. Furthermore, section 301 of the underlying bill, which the 
Smith amendment would amend, represents the results of hours of 
bipartisan negotiations on this issue throughout the last 2 years. 
While I understand Senator Smith's desire to provide a possible avenue 
for his tribes to receive funding, this amendment would undo the very 
delicate compromise that was reached in the underlying bill.
  According to the IHS staff briefings, the entire concept of an area 
distribution fund does not guarantee that all IHS service areas receive 
HCFC funding; instead, it creates a new criterion that must be used to 
determine IHS HCFC funding priorities. The current criteria utilized by 
IHS are focused on directing funding to the IHS areas in most need, 
where IHS patients are most isolated and least likely to have access to 
care. This geographic criterion does not represent good policy but 
simply an attempt to spread the very paltry funding provided for IHS 
HCFC projects even more thinly based on location instead of need. 
Instead of playing games with the distribution formula, we in Congress 
should be working to ensure that there is adequate funding for IHS HCFC 
projects so that the current backlog is addressed and new projects from 
throughout the country may be added.
  I note that Navajo Nation also strongly opposes this amendment. The 
following discussion provides a summary of their concerns.


    I. CONGRESS SHOULD LEAVE THE CURRENT LANGUAGE OF SECTION 301 AS 
            CONTAINED WITHIN H.R. 1328 AND S. 1200 UNCHANGED

       The current language of section 301 ``grandfathers'' in 
     those health facility projects that have completed phase one 
     and two of the current health care facilities construction 
     priority system, and places them on the construction priority 
     list upon enactment of the Indian Health Care Improvement 
     Act.
       The following projects have completed phase one and two of 
     the current health facilities construction funding process: 
     Winslow Dilkon, AZ, Pueblo Pintado, NM, Bodaway-Coppermine, 
     AZ, Gallup Indian Medical Center, NM, Alamo, NM, Albuquerque, 
     NM, Ft. Yuma, AZ, Rapid City, SD, Sells, AZ, Crown Point, NM, 
     and Shiprock, NM. These projects should not be penalized for 
     following the rules by eliminating the old process and 
     instituting a new ill-defined funding system.


     II. A LACK OF CONGRESSIONAL FUNDING CREATED CONTROVERSY OVER 
         DISBURSEMENT OF HEALTH FACILITIES CONSTRUCTION DOLLARS

       According to the Conference Report for H.R. 2466, the 
     fiscal year 2000 Interior appropriations bill, the managers 
     recognized the need for a ``base funding amount'' for 
     facilities: ``Given the extreme need for new and replacement 
     hospitals and clinics, there should be a base funding amount, 
     which serves as a minimum annual amount in the budget 
     request.'' Unfortunately, the managers' intent was never 
     fulfilled, and funding levels have dropped consistently for 
     several years. Congressional funding for health care 
     facilities construction has decreased from a high of 
     $134,300,000 in fiscal year 1993 to $13 million in fiscal 
     year 2007.
       Given the limited amount of funding, tribes are now 
     competing over an ever-decreasing pool of money for tribal 
     health facilities.


III. THE CURRENT SYSTEM RIGHTLY HONORS FUNDING FACILITIES BASED UPON A 
                           VOLUME OF SERVICES

       Most of the health facility projects on the current 
     priority list have been in the planning process for 20 to 30 
     years. These projects have done all that is asked of them 
     including adapting to any new requirements imposed on them 
     midway through the planning process.
       The current health facilities construction priority system 
     prioritizes projects based on several relevant factors such 
     as volume of services provided; square footage needs; size; 
     age; condition of existing facilities; demographics; 
     population density; isolation; and distance to inpatient, 
     outpatient, and alternative facilities.
       The current priority system favors providing health 
     facility construction dollars to those facilities that will 
     provide a large volume of services over 10 years. For 
     example, if a facility will serve 90,000 patient visits a 
     year, calculated over 10 years, then this amount would total 
     900,000 patient visits in a 10 year period. The current 
     system favors providing a volume of services that provides 
     the most access to health care by the largest pool of people 
     and need.
       On the other hand, any system that distributes funding 
     based upon equal distribution among the Indian health care 
     regions could not provide a sufficient volume of services 
     because some regions have larger native populations with less 
     access to health care than others. In other words, fewer 
     people would be provided health care by more facilities.
       Keeping the current priority system would provide certainty 
     and reinforce the work put into developing existing health 
     facility projects.


                  IV. DO NOT AUTHORIZE A VAGUE CONCEPT

       There is currently no consensus as to the meaning or impact 
     of an area distribution fund. In fact, the Federal 
     Appropriation Advisory Board, the workgroup created by the 
     IHS to evaluate various facilities construction funding 
     schemes, did not define the area distribution fund. It is at 
     best only a concept without a set methodology, structure, or 
     any idea of what effects such a change may have on the 
     current funding system. Randall Gardner, Acting Director of 
     the IHS Office of Environmental Health and Engineering, OHE, 
     has referred to the area distribution fund as only a concept 
     in need of further evaluation. It would be the height of 
     irresponsibility for Congress to replace a known system with 
     the uncertainty of a concept without further investigation.


 V. THE ISSUE IS ABOUT ACCESS TO HEALTH CARE AND NOT WHETHER TO BUILD 
                            ANOTHER HOSPITAL

       Some groups have argued that their IHS service areas have 
     not received much needed health facility funding. However, 
     the statistics, when weighed against isolated areas like 
     Sells and the Navajo Nation, do not support the need for 
     another hospital in, for example, the Portland, California, 
     Bemidji, or Nashville service areas. According to the IHS, 
     the Portland area has 218 hospitals providing health services 
     to 157,000 tribal members.
        The California, Bemidji, and Nashville areas are similarly 
     situated with respect to health care. In fiscal year 2001, 
     California tribal health programs had 119,362 registered 
     users with 69,238 active users served by 438 hospitals. The 
     Bemidji area comprising Wisconsin, Minnesota, and Michigan, 
     is made up

[[Page 2507]]

     of 34 tribes with 90,000 individual patients served by 494 
     hospitals. Finally, the Nashville area, which is the largest 
     service area, has a native population of 45,000 Indian people 
     with access to over 1,000 hospitals.
        However, the Navajo Nation area, which is as large as West 
     Virginia, has 238,515 users living on, or near, the 
     reservation with access to only 6 hospitals. That is 1 
     hospital for every 39,753 users. The need for more health 
     care facilities within the Navajo Nation area is clear.
        Further, IHS statistics show that while the Portland, 
     California, Bemidji, or Nashville service areas have not 
     received any health facility construction dollars, the native 
     people in these areas have always had access to superior 
     health care. All Native Americans living within IHS areas 
     also do not receive health facility dollars receive contract 
     health care dollars that cover expenses incurred at non-IHS 
     facilities.
        The current priority system rewards basic health care 
     access over building redundant hospitals in areas with many 
     non-IHS facilities that can provide much needed health care 
     services. Building another hospital in the Portland, 
     California, Bemidji, or Nashville service areas when the 
     Navajo Nation and other IHS area have significant unmet needs 
     is redundant and inefficient use of federal funds.


                             VI. CONCLUSION

        The current HCFC system now provides funding to ensure 
     that large populations without access to nearby hospitals 
     receive health care facilities funding. The area distribution 
     fund concept has yet to be established with any certainty as 
     to its meaning or impact. A new ill-defined system should not 
     replace the existing priority system without some study. 
     Authorizing such a concept without investigating thoroughly 
     the overall effect of such a dramatic change to how IHS 
     health care facilities funded would be irresponsible.

  The ACTING PRESIDENT pro tempore. The Senator from North Dakota.
  Mr. DORGAN. Mr. President, I share the frustration of the Senator 
from Oregon, but I must oppose the amendment. We have a backlog of $3 
billion in facilities. If the Secretary chooses to establish what is an 
area distribution fund, moneys would be taken from the priority list. 
Many of the tribes on that list have waited a long time for funding for 
facilities. If the Secretary begins to take money from that priority 
list and does an area-wide distribution, it would be a serious problem. 
I want to work with the Senator from Oregon. We desperately need new 
and improved facilities. We need more money addressed to that. He is 
raising the right question. I happen to believe it is the wrong answer. 
I regretfully will vote against it.
  Mr. SMITH. I ask for the yeas and nays.
  The ACTING PRESIDENT pro tempore. Is there a sufficient second?
  There is a sufficient second.
  The question is on agreeing to amendment No. 3897. The clerk will 
call the roll.
  The bill clerk called the roll.
  Mr. DURBIN. I announce that the Senator from New York (Mrs. Clinton), 
the Senator from Connecticut (Mr. Dodd), and the Senator from Illinois 
(Mr. Obama) are necessarily absent.
  Mr. KYL. The following Senators are necessarily absent: the Senator 
from Texas (Mr. Cornyn), the Senator from Arizona (Mr. McCain), and the 
Senator from Virginia (Mr. Warner).
  Further, if present and voting, the Senator from Texas (Mr. Cornyn) 
would have voted ``yea.''
  The ACTING PRESIDENT pro tempore. Are there any other Senators in the 
Chamber desiring to vote?
  The result was announced--yeas 56, nays 38, as follows:

                      [Rollcall Vote No. 31 Leg.]

                                YEAS--56

     Akaka
     Alexander
     Bennett
     Biden
     Bond
     Boxer
     Brownback
     Byrd
     Cantwell
     Casey
     Chambliss
     Cochran
     Coleman
     Collins
     Corker
     Craig
     Crapo
     Dole
     Durbin
     Ensign
     Feingold
     Feinstein
     Gregg
     Hatch
     Hutchison
     Isakson
     Kennedy
     Kerry
     Klobuchar
     Kohl
     Landrieu
     Lautenberg
     Levin
     Lincoln
     Lugar
     McConnell
     Menendez
     Murkowski
     Murray
     Pryor
     Reed
     Reid
     Roberts
     Schumer
     Shelby
     Smith
     Snowe
     Specter
     Stabenow
     Stevens
     Sununu
     Vitter
     Voinovich
     Whitehouse
     Wicker
     Wyden

                                NAYS--38

     Allard
     Barrasso
     Baucus
     Bayh
     Bingaman
     Brown
     Bunning
     Burr
     Cardin
     Carper
     Coburn
     Conrad
     DeMint
     Domenici
     Dorgan
     Enzi
     Graham
     Grassley
     Hagel
     Harkin
     Inhofe
     Inouye
     Johnson
     Kyl
     Leahy
     Lieberman
     Martinez
     McCaskill
     Mikulski
     Nelson (FL)
     Nelson (NE)
     Rockefeller
     Salazar
     Sanders
     Sessions
     Tester
     Thune
     Webb

                             NOT VOTING--6

     Clinton
     Cornyn
     Dodd
     McCain
     Obama
     Warner
  The amendment (No. 3897) was agreed to.
  Mr. DORGAN. Mr. President, I move to reconsider the vote and move to 
lay that motion on the table.
  The motion to lay on the table was agreed to.


                      Amendment No. 4015 Withdrawn

  The ACTING PRESIDENT pro tempore. There will now be 2 minutes of 
debate in regard to amendment No. 4015.
  Mr. DORGAN. Mr. President, we have reached agreement, and I ask 
unanimous consent that amendment No. 4015 be withdrawn.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.


                           Amendment No. 4066

  Mr. DORGAN. Mr. President, we have also been in discussions with 
Senator DeMint, and we are prepared--and I believe it has been agreed 
to on both sides--to accept amendment No. 4066 without debate. I ask 
unanimous consent that the amendment be adopted.
  The ACTING PRESIDENT pro tempore. Is there objection?
  Without objection, it is so ordered.
  The amendment (No. 4066) was agreed to.
  Mr. CONRAD. Mr. President, I want to join my colleagues in strong 
support of the Indian Health Care Improvement Act. Today has been a 
long time in coming. I want to particularly recognize the work of my 
friend Senator Dorgan, the chairman of the Indian Affairs Committee. We 
would not be here today without his dedication and persistence.
  In 2004, the U.S. Commission on Civil Rights issued a report on the 
Native American health care system. One item in the report struck a 
very somber note with me. The report notes that as early as 1926 the 
adequacy of the delivery of health care to Native American was formally 
questioned by the government. In response, a report was issued 2 years 
later that sparked a host of statements by the Federal Government that 
the health status of Native Americans was ``intolerable.''
  Unfortunately, the Commission notes that much of the 1928 report 
remains true today. It is indeed sad that in the 21st century Native 
Americans still do not have the access to and quality of health care to 
which they are entitled.
  As my colleague from North Dakota has so poignantly illustrated time 
and time again, there is a health care crisis in Indian country. Native 
Americans are 200 percent more likely to die from diabetes, 500 percent 
more likely to die from tuberculosis, 550 percent more likely to die 
from alcoholism, and 150 percent more likely to die from accidents. 
Suicide is the second-leading cause of death for Native American 
adolescents, 2\1/2\ times the national average. Native Americans have a 
life expectancy nearly 6 years less than the rest of the U.S. 
population.
  That is unacceptable. And it is why it is so important that we pass 
the reauthorization of the Indian Health Care Improvement Act.
  More than 1.8 million Native Americans and Alaska Natives rely on the 
Indian Health Service for health care. Since the act was first 
authorized in 1976, the ways in which health care is delivered in this 
country have changed enormously. The bill before us helps meet the 
contemporary needs of Indian country.
  I believe that the inability of many Indian people to receive 
preventive and nonemergency care is one of the reasons why there are 
such significant health disparities that exist between Native Americans 
and the rest of the U.S. population. In North Dakota, when the IHS 
clinic closes at 5 p.m. on the weekdays and is closed on the weekends, 
many go without care. I am pleased the bill before us addresses this 
challenge by establishing grants for demonstration projects including a

[[Page 2508]]

convenient care services program to expand the availability of health 
care. It also has a renewed emphasis on disease prevention and health 
promotion.
  The bill also takes important steps to provide training and 
incentives to increase the number of health care professionals in 
Indian country, especially Native health care professionals who 
understand the unique conditions facing their own communities and can 
provide care with greater cultural awareness. At the University of 
North Dakota, three programs authorized by the Indian Health Care 
Improvement Act--the Quentin N. Burdick Indians Into Medicine, Indians 
Into Nursing, and Indians Into Psychology Programs--are recruiting 
increasing numbers of Native Americans into medical professional 
programs. Graduates of these programs are making a real difference 
throughout Indian country, and I am pleased these successful programs 
are continued in the bill.
  It also includes much needed provisions to address the youth suicide 
crisis that exists throughout Indian country by authorizing grants to 
deliver more counseling and suicide prevention services to tribal 
communities.
  Finally, I am pleased my amendment to increase the use of video 
service delivery to assist in the outreach and enrollment of individual 
Indians in Medicare and Medicaid was incorporated into the managers' 
amendment. Remote video access to government services has all the 
benefits of face-to-face communication, without the costs and 
difficulties associated with traveling long distances from rural and 
remote reservations. To date, video service delivery has allowed for 
more than 300 completed applications for benefits, more than double 
what would be expected through conventional delivery methods. My 
amendment will allow for the expansion of this successful effort to 
other reservations across the country.
  We have been working on reauthorization of the Indian Health Care 
Improvement Act for a number of years. I think Native Americans have 
waited long enough and it is time we deliver them this bill which 
begins to reverse the disparate health disparities that exist.
  I do not expect that we will be able to solve all of the health care 
challenges that exist in Indian country with this one bill, but I 
expect that we will be able to make substantial progress in addressing 
some of the most pressing needs and creating a stronger system for the 
future.
  Again, I want to recognize the extraordinary work of Senator Dorgan 
in delivering a truly bipartisan bill that meets the urgent health care 
needs of Native Americans in North Dakota and across the country. I 
urge my colleagues to support this bill.
  Mr. LEVIN. Mr. President, today the Senate will pass the Indian 
Health Care Improvement Act of 2008. This bill would reauthorize and 
modernize the Indian Health Care Improvement Act which funds and 
authorizes health care services and programs to Native American Indians 
and Alaska Natives and reaffirms our commitment to ensuring that we 
meet our treaty and legal obligation to provide these communities with 
access to quality health care.
  Reauthorizing the Indian Health Care Improvement Act has been long 
overdue. The last time the Congress reauthorized the Indian Health Care 
Improvement Act was in 1992, and this act has been up for 
reauthorization since 2001. The Indian Health Service has not been 
updated for far too long. As health care evolves and improves programs 
must be modernized to reflect new advances in the health care system. 
The Indian Health Care Improvement Act has not been modernized since 
1992, 16 years ago, and is falling behind. We have a trust 
responsibility to provide health care to Native American Indians and 
Alaska Natives. We have not met that responsibility.
  The disparities that exist between Indian communities and other 
Americans are overwhelming. The life expectancy for Indians is almost 6 
years less than the rest of this country's population and the suicide 
rate is 2.5 times higher than the national average. Death due to 
alcoholism or tuberculosis is more than 600 percent more likely; and, 
Indians are 318 percent more likely to die from diabetes. These 
statistics are unacceptable and we need to continue to ensure that we 
close the gap.
  The passage of this bill brings us one step closer to ensuring that 
the Indian Health Service is adequately funded and that programs to 
address the health care needs of these communities are available.
  Mr. FEINGOLD. Mr. President, I am pleased to support final passage of 
the Indian Health Care Improvement Act Amendments of 2007. This bill is 
long overdue, and I hope that House works expediently to move this bill 
forward so that we can get this bill to the President and signed into 
law.
  Throughout the Senate's work on this bill, I have been impressed with 
the bipartisan work that Senator Dorgan and the Senate Indian Affairs 
Committee have put into moving this bill forward. It was not any easy 
process, but I commend the committee for its ongoing dedication to 
significant consultation with Indian Country in drafting this bill and 
seeing it through to completion.
  There are significant unmet needs in Indian Country throughout this 
Nation, and addressing the unmet health care needs ranks as one of the 
most significant problems that we must address. The Federal Government 
has a longstanding and well-established trust responsibility with 
regard to American Indian affairs, and this trust responsibility 
extends to providing good health care to communities throughout Indian 
Country.
  For too long, the Federal Government has not lived up to its Federal 
trust responsibility commitments, but I hope that passage of this 
legislation will set the Federal Government on a course toward better 
supporting the needs of our American Indian communities, whether they 
be health care, education, or housing needs. While this bill is a vital 
step in the right direction, we need to follow through with fiscally 
responsible increased funding for the important programs authorized in 
this legislation.
  This bill has the support of tribal governments throughout the United 
States, including the 11 tribes in my State of Wisconsin. I have heard 
from a number of constituents in Wisconsin about the need to pass this 
bill this year. The improvements that the legislation will make to 
various Indian Health Service programs including clinical programs on 
the various reservations throughout the State and urban Indian programs 
in Milwaukee and Green Bay are significant, and it is my hope that this 
bill will help improve the quality of health care provided to American 
Indians living throughout Wisconsin.
  Health care is consistently the No. 1 issue that I hear about all 
over my home State of Wisconsin. When I hold my annual townhall 
meetings across the State, many people come to tell me about problems 
with our overall health care system, and data shows us that these 
problems are often most acutely felt in Indian Country. Lack of access 
to good health care is a problem that disproportionately affects 
American Indians throughout the United States. According to recent 
studies, American Indians and Alaska Natives are 200 percent more 
likely to die from diabetes, more than 500 percent more likely to die 
from alcoholism, and approximately 500 percent more likely to die from 
tuberculosis.
  Some may doubt whether this legislation is needed or whether it will 
really help improve the lives of Americans. The staggering statistics 
that highlight the health care disparities faced by American Indians 
show just how imperative it is that we pass this legislation, which is 
long overdue. These statistics also help illustrate the vast amount of 
work that remains to be done to improve the quality of health care in 
American Indian communities beyond passage of this legislation. 
Nevertheless, this bill takes an important first step toward addressing 
these health care disparities through the many reforms it makes to 
Indian health care programs. For example, modernizing Indian Health 
Services programs through this legislation will help to address the 
diabetes and suicide crises that exist on reservations--just

[[Page 2509]]

two examples of the many health care issues that impact the daily lives 
of American Indians across the country.
  Reauthorization of this bill will help encourage health care 
providers to practice at facilities in Indian Country and encourage 
American Indians to enter the health care profession and serve their 
communities. Recruiting talented and dedicated professionals to serve 
in IHS facilities, whether urban or rural, is a key challenge facing 
many tribal communities in Wisconsin and around the country. I hope 
these provisions will help bring additional dedicated doctors, nurses, 
and other health care professionals to our tribal populations.
  This bill also reauthorizes programs that assist urban Indian 
organizations with providing health care to American Indians living in 
urban centers around the country. The Urban Indian Health Program 
represents a tiny fraction of the Indian Health Services budget, but 
the small amount of resources given to the urban programs provides 
critical health services to those Indians living in urban areas. 
Contrary to what some people may think, the majority of American 
Indians now live in urban areas around the country, including two urban 
areas in my State--Milwaukee and Green Bay. Throughout our Nation's 
history, some American Indians came to urban centers voluntarily, but 
many were forcibly sent to urban areas as a result of wrongheaded 
Federal Indian policy in the 1950s and 1960s and have since stayed in 
urban areas and planted roots in these communities.
  As a result of this movement to urban centers, Congress created the 
urban Indian program in the late 1970s to address the growing urban 
Indian population around the country. The Federal Government's 
responsibility to American Indians does not end simply because some 
American Indians left their ancestral lands and moved to urban 
locations--particularly when some of them had little choice in the 
matter.
  While this legislation takes important steps toward improving urban 
Indian health care programs, we need to do much more to support these 
urban programs, including fighting for increased appropriations. I have 
been disappointed that the President has proposed zeroing out the urban 
Indian program in past budgets, and unfortunately, the President's 
budget request for fiscal year 2009 is no different. As in years past, 
I have joined with my colleagues to urge the Senate to restore funding 
for urban Indian programs to the Federal budget for fiscal year 2009, 
and I hope this year the Senate can also provide a much-needed boost in 
funding for the urban Indian programs.
  I voted for an amendment offered by Senators Smith and Cantwell that 
would permit, but not require, the Secretary of HHS to create an area 
distribution fund to allocate funding resources for IHS facilities 
construction to all 12 of the IHS service areas. I have heard a lot of 
concern from tribes in my State of Wisconsin about the way that 
construction facility funds are allocated and the fact that certain IHS 
service areas, including the Bemidji region covering Wisconsin, do not 
fare well under the current system. I recognize that there needs to be 
an overall boost in the appropriations for IHS facilities construction 
to help tribes currently on the construction priority list as well as 
those tribes that cannot even get on the current list, and I look 
forward to supporting fiscally responsible efforts to boost funding for 
various IHS programs, including this one. But in the meantime, we 
should explore opportunities to address innovative solutions to this 
problem, and this amendment takes a reasonable approach to addressing 
this problem. Any efforts to create an area distribution fund should 
involve significant consultation with tribes throughout Indian Country, 
and I am pleased this amendment makes clear that such consultation 
would be required.
  I also voted for amendment 4032, offered by the Senator from 
Oklahoma, because it is critically important that sexual assault 
victims be able to find out whether they have been exposed to HIV. 
However, I am concerned about the way that the amendment was drafted. 
If there is a conference on this bill, I would urge conferees to 
consider making this provision consistent with the existing provision 
governing the testing of defendants in Federal cases, 42 U.S.C. section 
14011, or at a minimum to clarify how it would relate to that law. I 
also would urge them to ensure that the new provision complies fully 
with the requirements of the fourth amendment.
  Mr. President, Indian Country has made many compromises in order to 
move this bill forward, and passage of this bill is long overdue. The 
Senate's actions today mark an enormous victory for Indian Country, and 
I hope that the House will quickly take this bill up so that we can get 
this bill signed into law by the President this year.
  This bill takes concrete and positive steps toward addressing some of 
the health care needs facing American Indian communities around the 
country, and I look forward to working with my colleagues to build on 
this legislation in the coming months and years. Challenges facing 
American Indians throughout the United States extend beyond health care 
issues into issues of improving economic development, educational 
opportunities, and affordable and safe housing opportunities, and I 
hope we can continue to work together in a bipartisan way to pass other 
important measures this year. Together, tribal nations throughout all 
our States can work closely with the Federal Government to address the 
vast array of these unmet needs. Passage of the Indian Health Care 
Improvement Act Amendments of 2007 today provides an important 
foundation going forward, and it is up to all of us to see that this 
foundation is strengthened in the coming months and years.
  Mr. DORGAN. Mr. President, I wish to take a few minutes to talk about 
the vote we had earlier today on an amendment offered by Senator Vitter 
to the Indian Health Care Improvement Act. Senator Vitter described his 
amendment, which was adopted by the Senate, as codifying a longstanding 
policy that prohibits Federal funds from being used to pay for 
abortions.
  I agree that Federal funding should not be used to pay for abortions. 
I have always supported the existing funding prohibition known as the 
Hyde amendment that has been added in the appropriations process every 
year since 1976.
  That being said, I opposed Senator Vitter's amendment because the 
amendment would only codify the Hyde amendment with respect to the 
Indian Health Service. I think we should apply the same standard to all 
Federal health programs and not set up a separate standard that only 
applies in Indian Country.
  Mr. DORGAN. Mr. President, the next vote will be a vote on final 
passage. I will take just 30 seconds.
  I do want to say that Senator Murkowski has helped get us to this 
point in a very significant way. As to Senators Baucus, Grassley, 
Kennedy, Enzi, Kyl--and especially Senator Reid, who allowed us to 
spend time on the floor on this bill--and the 31 cosponsors of the 
legislation, I thank all of them.
  I thank Allison Binney, the majority staff director, and David 
Mullon, the minority staff director, and the really talented group of 
staff members who worked very hard on this legislation. I say a hearty 
thank-you to them.
  Mr. President, I ask unanimous consent that a list of all their names 
be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:
      Indian Affairs (Democratic staff)
       Allison Binney (Staff Director), Ted Charlton, Cindy Darcy, 
     Heidi Frechette, John Harte, Tracy Hartzler-Toon, David 
     Holland, Jerci Powell (intern), Eamon Walsh, Rollie Wilson.
      Indian Affairs (Republican staff)
       David Mullon (Staff Director), Megan Alvanna-Stimpfle, Jim 
     Hall, Rhonda Harjo, Gerald Moses, Jonathan Murphy.
      Finance Committee (Senator Baucus' staff)
       Catherine Dratz, Michelle Easton, Deidre Henry-Spires, 
     Richard Litsey, David Schwartz, Russ Sullivan.
     Finance Committee (Senator Grassley's staff)
       Becky Schipp, Rodney Whitlock.

[[Page 2510]]


     Democratic Policy Committee (DPC)
       Kory Caro, Liz Engel, Ryan Mulvenon.
     HELP Committee (Senator Kennedy's staff)
       David Bowen, Caya Lewis, Lauren McFarran, Peter Romer-
     Friedman, Tanchia Terry, Portia Wu.
     HELP Committee Staff (Senator Enzi's staff)
        Greg Dean, Shana Christup, Katherine McGuire, Randy Reid 
     (Senator Enzi's Legislative Director), Amy Shank.
     Senator Reid's Leadership staff
       Carolyn Gluck, Kate Leone, Darrel Thompson, Marcela Zamora.
     Senator Kyl's staff
       Jennifer Romans.

  Mr. DORGAN. It has been 8 years now that we should have advanced this 
legislation to improve Indian health care, and after 8 long years we 
finally have it done--at least through the Senate after this final 
passage vote. I say thanks to all of my colleagues for their patience 
and also their help.
  I yield the floor to Senator Murkowski.
  The ACTING PRESIDENT pro tempore. The Senator from Alaska.
  Ms. MURKOWSKI. Mr. President, I, too, want to thank so many who have 
done so much to advance this legislation. Very rarely do we see an 
opportunity for Indian bills of any nature to receive floor time, so I 
want to thank all our colleagues to be able to debate this very 
important issue with them.
  I thank especially Chairman Dorgan for his leadership on this 
legislation. He has mentioned so many who have participated throughout 
the years, including the staffs, but we also need to recognize the 
leadership of the former chairman, Senator Ben Nighthorse Campbell, 
and, of course, Senator McCain, Senator Dorgan, Senator Inouye--so many 
who have done so much.
  I also want to acknowledge the National Tribal Steering Committee for 
their efforts--great tribal leaders coming together to advance this 
very important legislation.
  I have a long list of thank-yous, but truly it has been a great 
effort, and we appreciate the leadership on both sides in advancing 
this legislation.
  The ACTING PRESIDENT pro tempore. The majority leader is recognized.
  Mr. REID. Mr. President, the one thing both of these Senators did not 
mention is the wonderful work they have done. The chairman and ranking 
member of the Indian Affairs Committee were able to reach out to 
Members on both sides of the aisle. This is truly a bipartisan piece of 
legislation. Is it everything we wanted? Is it everything they wanted? 
No. But it is a good piece of legislation. For the Indians around 
America today, it is a really bright day. So I appreciate the good work 
of Senators Dorgan and Murkowski, who have done very good work.
  Mr. President, I am happy to yield to my friend.
  The ACTING PRESIDENT pro tempore. The Republican leader is 
recognized.
  Mr. McCONNELL. Mr. President, let me add my congratulations to 
Senator Dorgan and particularly Senator Murkowski for their excellent 
work in putting together this very important piece of legislation. I 
commend them both for outstanding work.
  The ACTING PRESIDENT pro tempore. The majority leader is recognized.


                           Order of Procedure

  Mr. REID. Mr. President, I ask unanimous consent that notwithstanding 
the previous order, the Senate recess from 12:30 to 2:25 p.m. for the 
weekly caucus lunches; that at 2:25 p.m. the Senate begin the 20 
minutes of debate prior to a vote on the motion to invoke cloture on 
the motion to proceed to S. 2633 as provided under the previous order, 
with all other provisions of the previous order remaining in effect; 
further, that if cloture is not invoked, the next rollcall vote on the 
motion to invoke cloture on the motion to proceed to S. 2634 occur at 4 
p.m, with the Senate in a period of morning business until 4 p.m., with 
the time equally divided and Senators permitted to speak up to 10 
minutes each.
  So, Mr. President, because of problems that sometimes come here with 
scheduling, we are going to bifurcate, but it will only be for about 50 
minutes. We will have about 50 minutes of morning business until the 
vote at 4 o'clock. I appreciate everyone's cooperation.
  The ACTING PRESIDENT pro tempore. Is there objection?
  Without objection, it is so ordered.
  Under the previous order, the Dorgan substitute amendment, as 
amended, is agreed to.
  The amendment (No. 3899), as amended, was agreed to.
  The ACTING PRESIDENT pro tempore. The question is on the engrossment 
and third reading of the bill.
  The bill was ordered to be engrossed for a third reading and was read 
the third time.
  The ACTING PRESIDENT pro tempore. The bill having been read the third 
time, the question is, Shall it pass?
  Mr. DORGAN. Mr. President, I ask for the yeas and nays.
  The ACTING PRESIDENT pro tempore. 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 New York (Mrs. Clinton), 
the Senator from Connecticut (Mr. Dodd), the Senator from Connecticut 
(Mr. Lieberman), and the Senator from Illinois (Mr. Obama) are 
necessarily absent.
  I further announce that, if present and voting, the Senator from 
Connecticut (Mr. Lieberman) would vote ``yea.''
  Mr. KYL. The following Senators are necessarily absent: the Senator 
from Texas (Mr. Cornyn), the Senator from Arizona (Mr. McCain), and the 
Senator from Virginia (Mr. Warner).
  Further, if present and voting, the Senator from Texas (Mr. Cornyn) 
would have voted ``yea.''
  The ACTING PRESIDENT pro tempore. Are there any other Senators in the 
Chamber desiring to vote?
  The result was announced--yeas 83, nays 10, as follows:

                      [Rollcall Vote No. 32 Leg.]

                                YEAS--83

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

                                NAYS--10

     Allard
     Coburn
     Corker
     DeMint
     Graham
     Gregg
     Inhofe
     Sessions
     Sununu
     Vitter

                             NOT VOTING--7

     Clinton
     Cornyn
     Dodd
     Lieberman
     McCain
     Obama
     Warner
  The bill (S. 1200), as amended, was passed.
  (The bill will be printed in a future edition of the Record.)
  Mr. DORGAN. 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.
  Mr. REID. Mr. President, the Senate has taken an important step today 
by passing S. 1200, the Indian Health Care Improvement Act Amendments 
of 2007.
  I am now pleased to join the other 30 cosponsors of this legislation 
in sending it to the House for their consideration.
  When signed into law, this legislation will:
  increase and improve recruitment and retention programs for Indian 
health professionals;
  improve communicable and infectious disease monitoring and provide 
for more research on issues unique to those living on reservations;
  improve and expand diabetes screening and treatment programs;

[[Page 2511]]

  expand programs to prevent domestic violence, sexual abuse, and 
substance abuse, in Native American communities;
  incorporate and encourage the use of technology in delivering health 
care services and providing treatment, which is so important to our 
rural Indian communities;
  and encourage States to increase outreach to Indians to help them to 
enroll in Medicaid and SCHIP programs.
  This legislation is supported by a broad, bipartisan coalition, those 
in Indian Country, and many organizations that advocate for eliminating 
disparities in health care.
  I would like to take this opportunity to acknowledge the support and 
leadership of particular Senators and their staffs.
  The bill managers have been strong and articulate advocates for the 
bill, and shown great flexibility.
  I commend Senator Dorgan and his staff, particularly Allison Binney, 
Cindy Darcy, Heidi Frechette and Ben Klein.
  I commend Senator Murkowski and her staff, including David Mullon and 
Nathan Bergerbest.
  I commend Senator Baucus, and his staff, particularly David Schwartz 
and Richard Litsey; and Senator Grassley and his staff, including 
Rodney Whitlock, who have insisted on improvements in the 
administration of Indian health programs.
  I commend Senator Kennedy and his staff, particularly Caya Lewis, and 
Senator Mike Enzi and his staff, including Randi Reid, Shana Christrup, 
Greg Dean and Amy Shank, who helped us negotiate many difficult issues.
  On my staff and part of the Democratic leadership team, I commend 
Kate Leone, Carolyn Gluck; Kory Vargas Caro, Elizabeth Engel, and Ryan 
Mulvenon.
  I want to say a special word of thanks to Tracy Hartzler-Toon, who 
has worked tirelessly for over a year to help make today possible.
  She has served me, the Indian Affairs Committee, and the Senate very 
well. And most importantly, she has served the residents of Indian 
Country exceedingly well.
  I also thank my colleagues, the Republican leader, Senator McConnell, 
and his health policy advisor, Megan Hauck, and Senator Jon Kyl, and 
particularly Jennifer Romans, for their agreement and commitment to see 
that this bill finally received its due consideration.
  Lastly, I want to acknowledge the support of the late Senator Craig 
Thomas of Wyoming. Before he passed away last year, his leadership on 
the Indian Affairs Committee was helpful in bringing the Senate to this 
moment.
  With the help of so many, both in the Capitol and around the country, 
we have taken an important step toward providing Indian Country some of 
the health care services that many in the rest of this Nation have 
enjoyed for years.
  I urge the House to take quick action on H.R. 1328, the companion 
bill to what we passed today, so we can get this important legislation 
to the President's desk and make these services a reality.
  The ACTING PRESIDENT pro tempore. The Senator from North Dakota.
  Mr. DORGAN. Mr. President, I wish to say a few words about this vote, 
and then I am going to ask unanimous consent that Senator Murkowski be 
recognized, then Senator Enzi, Senator Feingold, and Senator Boxer. I 
believe Senator Enzi is going to ask for 10 minutes, Senator Feingold 
20 minutes, and Senator Boxer 15 minutes. I ask by unanimous consent 
that be the order.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Mr. DORGAN. Mr. President, I will take a couple of additional minutes 
to say how pleased and proud I am that we have passed by a very wide 
margin the first improvement in Indian health care since 1992. These, 
after all, are the first Americans. They were here first. We signed 
treaties with them, we took their land, we put them on reservations, 
made promises, and we have a trust responsibility. We said ``we 
promise.'' The fact is, we have not kept those promises for a long 
time, especially with respect to Indian health care.
  Finally, at long last, this Congress--and thanks to Senator Reid and 
all the folks who allowed this to be on the floor of the Senate for the 
time that it was--we finally have made some progress, the first time 
since 1992 that we have reauthorized the Indian Health Care Improvement 
Act. This is a big deal. This will save lives. We have more steps to 
take. The House has a bill with which it has to deal. It will, and we 
will be in conference, and finally we will be able to have a bill 
before the President of the United States for his signature in this 
year.
  I have spoken at length. I know people are tired of hearing me. The 
Presiding Officer is from Montana. He and I held a hearing on the Crow 
Indian Reservation in Montana. We heard an earful about Indian health. 
I have held listening sessions around the country in different States 
with Indian tribes. I cannot tell you the number of stories I have 
heard that had me going away from these meetings shaking my head 
wondering: What on Earth can we do to fix this situation? How much will 
it take for us to fix this situation?
  I recall a grandmother on the Crow Reservation, MT, standing up with 
a beautiful picture of her 5-year-old granddaughter who had died. After 
essentially a rather lengthy story, she asked: How do you justify this, 
a young girl spending the last 3 months of her life in unmedicated pain 
because the health care system does not work for that young girl? The 
stories go on and on.
  I am convinced we must do better, and I am determined and it was my 
priority when I became chairman of this committee to finish this job. I 
know Ben Nighthorse Campbell worked hard on it, and Senator McCain, 
when he was chairman of the committee, worked hard on it. Finally, 
Senator Murkowski and I made it a priority for this committee to say: 
We have to fix this situation. This is not some option. The promise of 
health care means if we do not keep this promise, people will die. I 
have named some of those people, some of them children.
  We have to do better. And this vote today, a very significant vote in 
the Senate, an overwhelming vote, 90 percent of the Senate saying we 
agree, let's fix it, that is something I think is going to be 
unbelievably welcome news to American Indians all across this country 
today. It has been a long time coming, 16 years, but finally--finally--
we made progress, and I believe this progress will save lives.
  Mr. President, I thank Senator Murkowski who has been an enormous 
partner in trying to get this bill completed. As I close, I will 
mention our staff director, Allison Binney, also Ted Charlton, Cindy 
Darcy, Heidi Frechette, John Harte, Tracy Hartzler-Toon, David Holland, 
Jerci Powell, Eamon Walsh, and Rollie Wilson on our side; and David 
Mullon, staff director on the minority side, Megan Alvanna-Stimpfle, 
Jim Hall, Rhonda Harjo, Gerald Moses, Jonathan Murphy, and so many 
others.
  Those people I have named have worked a lot. They worked behind the 
scenes, long hours, late at night, and on weekends to help make this 
possible. I say a heartfelt thanks to them for their wonderful work.
  I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Alaska.
  Ms. MURKOWSKI. Mr. President, I rise to recognize the passage of the 
Indian Health Care Improvement Act. I again thank the majority leader 
and minority leader for committing floor time for this bill. Rarely 
have Indian bills received time on the Senate floor, but this is one 
that is very important to the well-being of our country's Native people 
that the attention it has been given by the Senate is more than 
justified.
  I thank my colleagues for their commitment in considering this 
legislation, addressing the issues, and supporting our efforts to 
improve health care services for American Indians and Alaska Natives.
  As with many bills, the provisions fall under more than one 
committee's jurisdiction. The Committee on Indian

[[Page 2512]]

Affairs, on which I serve as the vice chairman, has shared this bill 
with the Finance and HELP Committees, and both of these committees have 
worked in earnest to assist us in crafting a bill to carry the Indian 
health care system into the 21st century.
  I am fortunate to have a chairman on the Indian Affairs Committee--
Senator Dorgan--with whom I share a close working relationship. We both 
have significant populations of Native people in our States with 
similar issues and challenges in many areas such as health care, 
education, housing, economic development and transportation.
  We have had numerous opportunities to work together in our committee, 
particularly on youth suicide prevention and treatment and 
telemedicine. I truly appreciate his persistence and dedication in 
advancing this bill.
  Senators Grassley and Baucus have also worked with us closely to 
advance this measure through the Finance Committee last year which 
reported the bill out favorably in both the 109th and 110th Congresses. 
I also wish to recognize their staff Rodney Whitlock, Becky Shipp, and 
David Schwartz, who worked so closely with the Indian Affairs staff on 
this bill.
  Likewise, Senator Enzi, in his capacity as chairman and now as 
ranking member of the HELP committee--worked very diligently on this 
legislation to refine key pieces of the legislation during the 109th 
Congress and again this year. Greg Dean, Shana Christrup, Randi Reid 
and Amy Shank devoted countless hours of work with the Indian Affairs 
Committee to work out issues, which I appreciate. I especially 
appreciate the leadership and commitment of Senator Kyl. He has one of 
the largest Indian populations in his State. His commitment to Indian 
issues was reflected by his continued involvement and that of his 
staff, Jennifer Romans, in working out issues to advance this bill.
  We must not forget that this bill reflects the work of our dear 
colleague and my predecessor, the late Senator Craig Thomas, who held 
the reins as vice chairman last year. He eagerly pursued efforts to 
improve health care services for all American Indian communities, 
including those in his home State of Wyoming on the Wind River Indian 
Reservation, and it is most fitting that we will honor his work with 
the passage of this bill. I pointed out on the floor yesterday, in the 
109th Congress, Senator McCain made a great effort to reauthorize the 
act in his role as chairman of the Indian Affairs Committee. Before 
that, Senator Campbell, who also served as chairman of the Indian 
Affairs Committee, carried this legislation since the 106th Congress as 
the original sponsor, along with Senator Inouye, until Senator 
Campbell's retirement in 2004.
  Between Chairmen Campbell and McCain in the 108th and 109th 
Congresses, there were 8 hearings on the reauthorization, including 
joint hearings with the HELP Committee and with the House Resources 
Committee.
  Our efforts had also great help from my good friends Senators 
Stevens, Domenici, Smith, Cochran, Hatch, and Thune. These Senators 
have been long-time friends of our country's Native people, and I want 
to acknowledge their dedication in promoting American Indian and Alaska 
Native health.
  The Republican staff of the Senate Committee on Indian Affairs has 
waited a long time for this day to come. David Mullon, the Republican 
staff director and chief counsel, and Rhonda Harjo, the deputy chief 
counsel, came to the committee during Senator Ben Nighthorse Campbell's 
tenure.
  Rhonda Harjo has been the lead Republican staff member of the 
committee for Indian Health Care Improvement Act reauthorization since 
2003. Indian country takes pride in her devotion to the betterment of 
her Native people and I share that pride today.
  I also wish to acknowledge the efforts of Jim Hall and Jon Murphy and 
two Alaskans who recently joined the committee--Gerald Moses and Megan 
Alvanna-Stimpfle--in preparing this bill for floor consideration.
  I also acknowledge the tireless efforts over the past 8 years of the 
Indian tribal and health care leaders and advocates across the U.S. in 
helping develop the legislative proposal which served as the basis for 
this bill. In particular, the National Tribal Steering Committee, 
consisting of tribal leaders and Indian health representatives, brought 
together the diverse interests of over 560 tribes across the country to 
a consensus on this very important measure.
  That is no small task and it was handled dutifully by the cochairs of 
the National Tribal Steering Committee, Chairman Buford Rolin of the 
Poarch Band of Creek Indians in Atmore, Alabama, Rachel Joseph, former 
Chairwoman of the Lone Pine Paiute-Shoshone Tribe, in Lone Pine, 
California, and staff, Kitty Marx from the National Indian Health 
Board.
  Three key Alaska Native leaders played significant roles on the 
National Tribal Steering Committee: Sally Smith, the chairman of the 
National Indian Health Board and the Bristol Bay Area Health 
Corporation; Don Kashevaroff, the president of the Seldovia Village 
Tribe and chair of the Tribal Self-Governance Advisory Committee; and 
Valerie Davidson from the Alaska Native Tribal Health Consortium. I 
appreciate their leadership and thoughtful consideration in the 
development of this legislation.
  A lot of good work went into this bill and our efforts should not go 
in vain. I look forward to working with my House colleagues and getting 
this bill on to the President's desk for signature.
  Mr. President, we had a brief opportunity to express our thanks to 
those who have worked so hard on the reauthorization of the Indian 
Health Care Improvement Act. Again, my sincere thanks and gratitude to 
Chairman Dorgan for all that he has done.
  This is a good day for Indian country, for Alaska Natives who are 
just waking up back home right now. They are going to wake up to news 
that they have been waiting to hear for a good decade: that finally we 
have advanced the Indian Health Care Improvement Act. We have taken 
that step. We recognize this is not the end-all and be-all in terms of 
providing for the health care needs of American Indians and Alaska 
Natives. We know we need to do more, and we are challenged to do that.
  We talked about the funding issue and how we must make that next step 
to make sure it is not just what we put in the authorization, but we 
back that up with the dollars for the programs.
  We have a long way to go, but I think we have made a very significant 
step today. I am proud of the work of my colleagues today and those who 
came before us on this very important issue.


                       ``Exxon Valdez'' Oilspill

  Mr. President, I wish to take a few minutes this morning to talk 
about tomorrow because tomorrow the United States Supreme Court will 
hear the appeal of the ongoing litigation between ExxonMobil and 
commercial fishermen and other plaintiffs whose livelihoods were 
negatively impacted, devastated, in fact, by the 1989 Exxon Valdez 
oilspill. The Exxon Valdez ran aground on Bligh Reef at 12:04 a.m. on 
March 24, 1989. It spilled 11 million gallons of oil--this is about the 
same size as 125 Olympic-sized swimming pools--directly into Prince 
William Sound in Alaska. The oil from the spill migrated several 
hundred miles from Bligh Reef and polluted roughly 1,300 miles of 
Alaskan shoreline. There were 11,000 square miles of ocean that were 
ultimately affected by this spill, which is believed to be the worst 
oilspill worldwide with respect to environmental damage.
  Regrettably, the spill area is still affected some 19 years later. In 
2001, the National Oceanic and Atmospheric Administration studied the 
shoreline of Prince William Sound for any remaining effects of the 
spill. Scientists reviewed 91 sites within Prince William Sound and 
found that 58 percent of these locations were still polluted by oil. 
Again, this is 19 years after the fact. Some estimates note that 
beaches and streams in this area are still polluted with over 25,000 
gallons of oil.
  Of course, the fisheries in Prince William Sound were affected. The 
herring fishery in this area experienced a dramatic decrease in the 
years immediately after the 1989 spill. As of 2007, the herring fishery 
had not improved to the pre-1989 levels. Another example

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is what has happened with the value of the fisheries permits in this 
part of the State. In 1988, a fishing permit in Prince William Sound 
was worth $400,000. As of 2004, the value of each such permit was less 
than $70,000, a drop of more than 82 percent.
  There was a class action jury trial held in Federal court in 
Anchorage, AK, in 1994. The plaintiffs at that time included over 
30,000 commercial fishermen, among those whose livelihoods were gravely 
affected by the disaster. The jury awarded $5 billion in punitive 
damages to the plaintiffs. This punitive damage award has been on 
repeated appeal by ExxonMobil since that time. On December 22, 2006, 
the Ninth Circuit Court of Appeals reduced the punitive damage award to 
$2.5 billion. In early 2007, ExxonMobil petitioned the Ninth Circuit 
for a rehearing en banc. Within a few months, the Ninth Circuit denied 
this petition and ExxonMobil appealed to the Supreme Court. 
Unfortunately, in this intervening time period, with years and years of 
litigation bringing delay in resolution, we have had several thousand 
plaintiffs pass away since this litigation began.
  Due to the limitations in admiralty law with respect to the recovery 
of compensatory damages, many Exxon Valdez plaintiffs were not able to 
recover the financial losses they sustained in the aftermath of this 
spill. So the punitive damages that are under consideration by the 
Supreme Court will provide them that level of compensation.
  Once the Supreme Court decided to hear this case, I joined with 
Senator Stevens and Representative Young in submitting an Alaska 
congressional delegation amicus brief to the U.S. Supreme Court. In 
that brief, we argue that the award of punitive damages in this case of 
reckless and wanton conduct by Exxon not only is permissible under the 
Clean Water Act, but it is supported by Federal maritime law. Only 
punitive damages will provide those who were harmed--and who continue 
to be harmed--with the justice and the fair compensation they deserve.
  This litigation needs to end. Nineteen years is far too long for 
these plaintiffs to wait to be compensated for their loss of income. I 
am hopeful that the Supreme Court will rule in favor of the plaintiffs 
in this case, and I, along with so many Alaskans, look for a final 
resolution to this great tragedy that occurred to us as a State some 19 
years ago.
  Mr. President, I yield the floor.

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