[Congressional Record (Bound Edition), Volume 159 (2013), Part 11]
[Senate]
[Page 15997]
[From the U.S. Government Publishing Office, www.gpo.gov]




                     INDIAN HEALTH SERVICE FUNDING

  Ms. MURKOWSKI. Mr. President, I rise today to speak about a bill I 
introduced last week to provide forward funding appropriations for the 
Indian Health Service. The IHS is charged with delivering health 
services to American Indians and Alaska Natives as part of our Federal 
trust responsibility, and I believe that forward funding the IHS is the 
right thing to do, just like Congress forward funds our VA as part of 
our obligation to our veterans.
  The budget uncertainty we have put our tribal health providers in is 
shameful. We may not be able to ensure our Nation's indigenous children 
will receive their immunizations. We might not be able to ensure our 
elders will be able to receive the care they need. We cannot guarantee 
basic medical services will be provided, including prenatal and dental 
for our first Americans, who rely on funding from the Indian Health 
Service. The situation is disgraceful, and the health statistics of our 
first Americans reflect that.
  Without Federal funding for fiscal year 14, HHS has determined that 
those receiving care from the Indian Health Service will continue to 
receive clinical care, but for tribes that operate their own health 
programs, payments will not be transferred. Yet, just like the Indian 
Health Service, our tribal health providers must keep providing care. 
The budget uncertainty we have imposed on those delivering health 
services is unconscionable.
  As I mentioned previously, my bill to forward fund the Indian Health 
Service makes sense because the IHS is charged with delivering health 
services to American Indians and Alaska Natives, as promised by the 
United States for the removal of Indians from their lands. The United 
States calls this obligation the Federal trust responsibility. This is 
not a relationship based on race--but a legal and political 
relationship defined by treaties, Executive orders, the U.S. 
Constitution, statutes, and Supreme Court decisions.
  Health care services are either delivered by the Indian Health 
Service or by tribal health providers themselves operating under Indian 
Self-Determination Act agreements. Delayed funding means health care 
providers cannot budget with certainty, recruit health professionals, 
retain health professionals, adequately deliver services, nor manage 
facility maintenance and construction efforts. Late funding for tribal 
health programs has significantly hampered the delivery of health 
services for American Indians and Alaska Natives.
  Let me take this opportunity to remind you of the health status of 
our Nation's first peoples. For too long in our Nation's history, 
American Indians and Alaska Natives have experienced severe health 
disparities compared to other Americans as a result of the poor 
economic and social conditions. According to the Indian Health Service, 
American Indians and Alaska Natives die at higher rates compared to 
other Americans from many causes: alcoholism is 522 percent higher, 
diabetes is 182 percent higher, unintentional injuries is 138 percent 
higher, homicide is 83 percent higher, and suicide is 74 percent 
higher.
  We must recognize the historical traumas that played a role in these 
percentages, including the removal of lands, forced relocation and 
assimilation of Native communities, new diseases introduced, deaths 
experienced, and the loss of indigenous cultures. These are wounds that 
have been internalized and manifest themselves in high rates of 
alcoholism and substance abuse, driving the statistics of domestic 
violence, sexual assault, and suicide. And this sadness is passed down 
from one generation to the next.
  Our tribes are working to break this cycle. Under the Federal policy 
of Indian self-determination we have empowered tribes to address the 
needs of their tribal members. Yet whether it be the denial of full 
operational support costs for Indian programs or the ceasing of payment 
under a government shutdown, we are failing on that promise.
  Just as this Nation has made a promise to its veterans for the 
delivery of health care, we cannot forget the promise made to American 
Indians and Alaska Natives. In 2010, Congress forward funded the VA. 
Veterans groups, alarmed by the impact of delayed funding and concerned 
about the VA's ability to plan and manage its resources, demanded 
forward funding. Let me tell you our tribal health providers have those 
same concerns. Our tribal health providers have demanded that Congress 
forward fund IHS appropriations so they may better manage the health 
funds for American Indians and Alaska Natives, and I think we should do 
so.
  The present government shutdown demonstrates why this is so 
important: we have compromised the delivery of health services for our 
first Americans, especially those who receive care from tribally 
administered hospitals. Forward funding would allow Indian health 
programs to more be more effectively managed and improve health 
outcomes for our first Americans. Tribal administrators would know how 
many physicians and nurses they could hire without wondering if funding 
for positions would be available. They would also be able to manage 
clinics without the uncertainty of shutting them down.
  I am proud to introduce this bill to forward fund IHS, and I hope my 
colleagues support this effort.

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