[Senate Report 108-165]
[From the U.S. Government Publishing Office]



                                                       Calendar No. 308
108th Congress                                                   Report
                                 SENATE
 1st Session                                                    108-165

======================================================================

 
  IMPLEMENTING THE RECOMMENDATIONS OF THE GARRISON UNIT JOINT TRIBAL 
ADVISORY COMMITTEE BY PROVIDING AUTHORIZATION FOR THE CONSTRUCTIONS OF 
 A RURAL HEALTH CARE FACILITY ON THE FORT BERTHOLD INDIAN RESERVATION, 
                              NORTH DAKOTA

                                _______
                                

                October 15, 2003.--Ordered to be printed

                                _______
                                

   Mr. Campbell, from the Committee on Indian Affairs, submitted the 
                               following

                              R E P O R T

                         [To accompany S. 1146]

    The Committee on Indian Affairs, to which was referred the 
bill (S. 1146) to implement the recommendations of the Garrison 
Unit Joint Tribal Advisory Committee by providing authorization 
for the construction of a rural Health Care facility on the 
Fort Berthold Indian Reservation, North Dakota having 
considered the same, reports favorably thereon with an 
amendment and recommends that the bill (as amended) do pass.

                                Purpose

    The purpose of S. 1146 is to implement certain 
recommendations of the JTAC relating to the replacement by the 
Federal government of a health care facility on the Fort 
Berthold Indian Reservation, North Dakota, which was destroyed 
as a consequence of the construction of the Garrison Dam and 
Reservoir (the Garrison Dam). The bill authorizes $20 million 
for the construction of a health care facility and such sums as 
are necessary for related facility expenses.

                               Background

    The Committee Report for Title XXXV of Pub. L. 102-575, the 
Three Affiliated Tribes and Standing Rock Sioux Tribe Equitable 
Compensation Act (the Equitable Compensation Act), S. Rep. No. 
102-250, contains an extensive history of the development and 
impacts of the Garrison Dam, the relevant portions of which are 
summarized herein.
    The Flood Control Act of 1944 (the Flood Control Act), also 
known as the Pick-Sloan Project, was a water development 
program comprised of multi-purpose dams and reservoirs designed 
by the U.S. Army Corps of Engineers and the U.S. Bureau of 
Reclamation.
    The Flood Control Act resulted in substantial flood 
control, navigation, recreation and power benefits throughout 
the Missouri River Basin but also generated significant impacts 
to the states and Indian tribes in the upper Missouri River 
Basin.
    The Garrison Dam, constructed under the Flood Control Act, 
resulted in the loss of over 150,000 acres on the Fort Berthold 
Indian Reservation. Although existing treaty rights provided 
that this land could not be ``taken'' without the consent of 
the Three Affiliated Tribes of the Fort Berthold Indian 
Reservation (the tribe), the tribe was not consulted prior to 
enactment of the Flood Control Act. The Bureau of Indian 
Affairs had prior notice of the probable harm the tribe would 
suffer, yet registered no objection to the plan while it was 
being debated in Congress in 1944.
    In 1949, 325 families of the tribe, representing 80 percent 
of the tribal membership, were forced to relocate due to the 
construction of the Garrison Dam. One quarter of the tribe's 
reservation land base was flooded and vital infrastructure, 
including the Elbowoods facility, a U.S. Public Health Service 
hospital, was destroyed.
    Thirty years after completion of the Garrison Dam, the 
Secretary of the Interior (the Secretary) appointed the 
Garrison Diversion Unit Commission (the ``GDUC'') to review the 
initial stages of the Garrison Diversion Unit.
    In its Final Report of December 20, 1984, the GDUC 
recommended that the Secretary establish a committee ``to find 
ways to resolve inequities'' borne by the tribe in the 
implementation of the Flood Control Act. S. Rep. No. 102-250, 
at 3. Compensation provided the tribe for the lands flooded by 
the Garrison Dam was determined by the GDUC to be inequitable 
relative to the losses experienced by the tribe.
    On May 10, 1985, the Secretary established the JTAC to more 
closely examine the effects of the construction of the Garrison 
Dam on the tribe and make recommendations regarding 
compensation. In its Final Report of May 23, 1986, the JTAC 
concluded that the tribe was entitled to the replacement of 
lost infrastructure, including the health facility which the 
JTAC found to be an ``urgent and critical need''. S. Rep. No. 
102-250, at 6.
    C. Emerson Murry, former Chairman of the JTAC, testified 
before the Committee in 1991 that ``many assurances were given 
expressly or by implication by various federal officials that 
the problems anticipated by the Indians would be remedied,'' 
yet many of the promises were never fulfilled.
    Since that time, Congress has acted on several, but not 
all, of the recommendations contained in the JTAC report. The 
Equitable Compensation Act authorized a recovery fund to return 
to the tribe the Four Bears area of the reservation, among 
other things. However, no funding or authorization was provided 
to replace lost infrastructure. Accordingly, recommendations 
relating to the replacement or reconstruction of 
infrastructure, particularly the health facility, remain 
unfulfilled.

                         A. THE HEALTH FACILITY

    S. 1146 would implement the JTAC's recommendations that the 
tribe is entitled to replacement of the Elbowoods facility. S. 
Rep. No. 102-250, at 6. The bill would amend the Equitable 
Compensation Act to authorize $20 million for the construction 
of a health facility. The bill also authorizes ``such sums as 
are necessary'' for expenses related to the facility. These 
expenses include the costs associated with staffing, equipping, 
operating and maintaining the facility.
    The Committee wishes to make clear that the facility 
authorized under this bill is not intended to be a full service 
hospital. The Committee agrees that a full service inpatient 
hospital is not feasible and recognizes that such a facility 
would duplicate services already provided by existing 
facilities near the tribe's reservation.
    The health care facility authorized under this bill is 
intended to provide extended hours of care to meet the 
emergency medical needs on the tribe' reservation in the 
evenings and on weekends on an outpatient basis. The facility 
will also provide such services as cancer screening and care, 
testing for cardiovascular diseases, expanded dialysis 
services, and tele-health capabilities not currently available 
at the existing Indian Health Service clinic.
    The Committee has urged previous administrations to provide 
the resources to replace the health facility destroyed by the 
Garrison Dam. The Committee believes that with this 
authorization, every effort should be made by the 
administration and Congress to provide the federal funding for 
this health facility as expeditiously as possible.
    The Committee also recognizes that funding for construction 
of Indian Health Service facilities is currently limited to 
only those facilities already on the construction priority 
list. The facility authorized by this legislation is not on 
this priority list.
    The Committee does not wish to bypass the priority list, 
given that some of the projects on that list have been waiting 
a decade or more to be funded. However, the Committee does 
recognize the unique federal responsibility of replacing the 
facility on the Fort Berthold Indian Reservation and urges the 
Administration to give this project full and fair 
consideration.

                          Legislative History

    S. 1146 was introduced on May 23, 2003, by Senator Conrad 
for himself, and for Senator Dorgan. The bill was referred to 
the Committee on Indian Affairs. Senator Campbell was added as 
a cosponsor on June 11, 2003.
    The Committee held a hearing on S. 1146 on June 11, 2003. 
The Committee received testimony from the Three Affiliated 
Tribes and the Mandan, Hidatsa and Arikara Elders Organization. 
During the hearing, tribal representatives expressed their 
support for the bill and the need for the federal government to 
fulfill the longstanding commitment made during the 
implementation of Flood Control Act.

                      Section-by-Section Analysis


Sec. 1. Short title

    This Act may be cited as the ``Three Affiliated Tribes 
Health Facility Compensation Act''.

Sec. 2. Findings

    This section sets forth the findings of Congress regarding 
the effects of the Garrison Dam and Reservoir upon the Fort 
Berthold Indian Reservation. Congress found that the Garrison 
Dam and Reservoir flooded over 150,000 acres of the reservation 
and destroyed tribal infrastructure including a hospital. 
Congress further found that after examination by the Garrison 
Unit Joint Tribal Advisory Committee, established by the 
Secretary of the Interior, the Three Affiliated Tribes of the 
Fort Berthhold Indian Reservation were entitled to reparations, 
much of which have yet to be fulfilled.

Sec. 3. Rural health care facility, Fort Berthold Indian Reservation, 
        North Dakota

    This section amends Title XXXV of Pub. L. 102-575, the 
Three Affiliated Tribes and Standing Rock Sioux Tribe Equitable 
Compensation Act, to authorize $20,000,000 for the construction 
of a health care facility on the Fort Berthold Indian 
Reservation and such additional sums which are necessary for 
other expenses related to the health care facility.

            Committee Recommendation and Tabulation of Vote

    On July 16, 2003, the Committee, in an open business 
session, considered S. 1146 and an amendment recommended by 
Senator Conrad. The Committee voted unanimously to favorably 
report S. 1146, as amended, to the full Senate with a 
recommendation that the bill, as amended, do pass.

                   Cost and Budgetary Considerations

    The cost estimate for S. 1146 as calculated by the 
Congressional Budget Office, is set forth below:

                                     U.S. Congress,
                               Congressional Budget Office,
                                Washington, DC, September 22, 2003.
Hon. Ben Nighthorse Campbell,
Chairman, Committee on Indian Affairs,
U.S. Senate, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for S. 1146, the Three 
Affiliated Tribes Health Facility Compensation Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Eric Rollins.
            Sincerely,
                                       Douglas Holtz-Eakin,
                                                          Director.
    Enclosure.

S. 1146--Three Affiliated Tribes Health Facility Compensation Act

    Summary: S. 1146 would authorize the appropriation of $20 
million for the construction of a new hospital on the Fort 
Berthold Indian Reservation in North Dakota. The bill also 
would authorize the appropriation of such sums as necessary for 
other expenses--such as operating costs--associated with the 
new facility.
    CBO estimates that implementing S. 1146 would cost $2 
million in 2004 and $57 million over the 2004-2008 period, 
assuming appropriation of the necessary funds. These costs 
would be borne by the Indian Health Service (IHS), which would 
construct and operate the new hospital. The bill would have no 
effect on direct spending or revenues.
    S. 1146 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA) 
and would not affect the budgets of state, local, or tribal 
governments.
    Estimated cost to the Federal Government: The estimated 
budgetary impact of S. 1146 is shown in the following table. 
The costs of this legislation fall within budget function 550 
(health).

------------------------------------------------------------------------
                                By fiscal year, in millions of dollars--
                               -----------------------------------------
                                 2003   2004   2005   2006   2007   2008
------------------------------------------------------------------------
                    SPENDING SUBJECT TO APPROPRIATION

Construction of new hospital:
    Estimated authorization         0      1      1     12      6      0
     level....................
    Estimated outlays.........      0      1      1     12      6      0
Construction of staff
 quarters:
  Estimated authorization           0      1      1     12      5      0
   level......................
    Estimated outlays.........      0      1      1     12      5      0
Equipment and furnishings:
    Estimated authorization         0      0      0      0      3      0
     level....................
    Estimated outlays.........      0      0      0      0      3      0
Operating costs:
    Estimated authorization         0      0      0      0      5     10
     level....................
    Estimated outlays.........      0      0      0      0      5     10
Total spending under S. 1146:
    Estimated authorization         0      2      2     24     19     10
     level....................
    Estimated outlays.........      0      2      2     24     19     10
------------------------------------------------------------------------

    Basis of estimate: CBO estimates that implementing S. 1146 
would cost a total of $57 million over the 2004-2008 period, 
assuming appropriation of the necessary funds. Construction of 
the new hospital would cost $20 million over that period, while 
related costs would total $37 million.

Construction of new hospital

    S. 1146 would authorize the appropriation of $20 million 
for a new hospital on the Fort Berthold Indian Reservation in 
North Dakota. Based on the Indian Health Service's experience 
in building other hospitals, CBO assumes that planning and 
design for the new hospital would take place during 2004 and 
2005, and that construction would begin in 2006 and be 
completed in 2007. CBO estimates that costs for these 
activities would be $1 million in both 2004 and 2005, $12 
million in 2006, and $6 million in 2007.

Construction of staff quarters

    In addition to the hospital itself, IHS would also have to 
build living quarters for hospital staff. Based on information 
from IHS, CBO estimates that the cost of these quarters would 
total about $19 million. CBO assumes that these quarters would 
be built at the same time as the hospital, with costs of $1 
million in both 2004 and 2005, $12 million in 2006, and $5 
million in 2007.

Equipment and furnishings

    Based on information from IHS, CBO estimates that the 
purchase of medical equipment and furnishing for the new 
hospital would cost $3 million in 2007.

Operating costs

    Based on information from IHS, CBO estimates that staffing 
and maintenance costs for the new hospital would total $5 
million in 2007 and $10 million in 2008. Costs in 2007 would be 
lower because CBO assumes that the new hospital would be open 
for only part of the year.
    Intergovernmental and private-sector impact: S. 1146 
contains no intergovernmental or private-sector mandates as 
defined in UMRA and would not affect the budgets of state, 
local, or tribal governments.
    Estimate prepared by: Federal Costs: Eric Rollins. Impact 
on State, Local, and Tribal Governments: Leo Lex. Impact on the 
Private Sector: Cecil McPherson.
    Estimate approved by: Peter H. Fontaine, Deputy Assistant 
Director for Budget Analysis.

               Regulatory and Paperwork Impact Statement

     Paragraph 11(b) of rule XXVI of the Standing Rules of the 
Senate requires that each report accompanying a bill to 
evaluate the regulatory and paperwork impact that would be 
incurred in carrying out the bill. The Committee has concluded 
that S. 1146 will not require the promulgation of regulations 
so the regulatory and paperwork impact should be minimal.

                        Executive Communications

    There have been no executive communications received on 
this legislation.

                         Changes in Existing Law

    In compliance with subsection 12 of rule XXVI of the 
Standing Rules of the Senate, changes in existing law made by 
the bill S. 1146, as ordered reported, are shown as follows 
(existing law proposed to be omitted is enclosed in black 
brackets, new matter is printed in italic, existing law in 
which no change is proposed is shown in roman):

     RECLAMATION PROJECTS AUTHORIZATION AND ADJUSTMENT ACT OF 1992


                           Public Law 102-575


 AN ACT To authorize additional appropriations for the construction of 
   the Buffalo Bill Dam and Reservoir, Shoshone Project, Pick-Sloan 
                    Missouri Basin Program, Wyoming

    Be it enacted by the Senate and House of Representatives of 
the United States of America in Congress assembled,

           *       *       *       *       *       *       *


   TITLE XXXV. THREE AFFILIATED TRIBES AND STANDING ROCK SIOUX TRIBE 
EQUITABLE COMPENSATION PROGRAM, NORTH DAKOTA

           *       *       *       *       *       *       *


SEC. 3504. FUNDS.

           *       *       *       *       *       *       *


    Authorization of Appropriations.--There are authorized to 
be appropriated such sums as are necessary to carry out this 
section.

[SEC. 3511. AUTHORIZATION.

    [There are authorized to be appropriated such sums as may 
be necessary to carry out the provisions of section 3504 of 
this title.]

SEC. 3511. RURAL HEALTH CARE FACILITY, FORT BERTHOLD INDIAN 
                    RESERVATION, NORTH DAKOTA.

    There are authorized to be appropriated to the Secretary of 
Health and Human Services $20,000,000 for the construction of, 
and such sums as are necessary for other expenses relating to, 
a rural health care facility on the Fort Berthold Indian 
Reservation of the Three Affiliated Tribes, North Dakota.

                                
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