Indian Health Care Improvement Act Amendments of 2007

Floor Speech

Mrs. MURRAY. Mr. President, I come to the floor this afternoon to join with the Senator from Alaska and the Senator from North Dakota to urge our colleagues to support this legislation that is going to make a critical difference to thousands of American Indians in Washington State and across our country.

I join in the words of my colleague, the Senator from Alaska. She mentioned several of the tribes in Washington State. This has an important impact on them. I agree with her and thank her for the tremendous work on this issue, helping us bring it to the floor and hopefully to passage so we can make a difference.

I am proud to be an original cosponsor of this Indian Health Care Improvement Act. It does reauthorize and update the health care services our Government provides to American Indians and Alaska Natives. This bill will allow our Indian health clinics and our hospitals to modernize their services and enable them to provide better preventive care. These services are vitally important in Indian Country, where our tribal members suffer from high rates of diabetes and other chronic illnesses. Our Government has a legal responsibility to provide health care for American Indians, but we have a moral responsibility to ensure we provide the best care possible.

The Indian Health Care Improvement Act has not been reauthorized since 1992, and in the years since it expired in 2001, what Congress has done is simply appropriate money for health care programs without examining this act to see how we can improve it. This bill we are now considering takes important steps toward ensuring we are providing the best and the most cost-effective care. It is long time past to pass it.

The health disparity between American Indians and the general population is great. The numbers show why this bill deserves our attention now. The infant mortality rate among Indians is 150 percent greater than for Caucasians. Indians, in fact, are 2.6 times more likely to be diagnosed with diabetes. Indians suffer from greater rates of post-traumatic stress disorder, and the suicide rate among Indians is more than twice the national average. In fact, life expectancy for American Indians is nearly 6 years less than the rest of the U.S. population.

An example from my home State of Washington helps to illustrate the impact these numbers have on Indian communities.

Three years ago, in a 6-month period, the Skokomish Tribe, which has a reservation near Hood Canal, lost 9 of its 1,000 members. Among them were two children, two young adults, and five elders. One of those elders was Bruce Miller. He was a Vietnam veteran and a nationally known artist and spiritual leader. Bruce helped restore ceremonies that were once banned by the U.S. Government. His work to prevent drug abuse and rebuild tribal customs will be sorely missed. Bruce was only 60 years old when he passed away.

Many of the Skokomish Tribe members died of conditions that are all too common on our Indian reservations--drug overdose, heart disease, cancer, diabetes. These conditions we know are preventable, and many in Indian Country have been working very hard to reverse the numbers I mentioned. But their work has been hindered because Indian health services are badly in need of updating.

The most important thing the Indian Health Care Improvement Act does is help to modernize those services. In the last 16 years, as the Senator from Alaska said, we have revolutionized the way we approach chronic illnesses such as diabetes. Doctors' offices and health clinics around the country now emphasize the importance of eating right, staying healthy. We have changed where we provide services. Instead of treating elderly and chronically ill patients in the hospital, more and more people get care at home or in a community clinic. And now, of course, it is standard practice to coordinate mental health and substance abuse and domestic violence prevention services. But while we have done all that, health care for Indians has gone badly out of date. We are still providing services today as if it was 1992.

The bill we are considering today will help bring health care for Indians into the 21st century and enable their clinics to do more than treat symptoms and instead focus on prevention and mental health.

It is particularly important to ensure Indian health clinics can provide up-to-date care because for many of our tribal members, those clinics are the only source of health care available. For tribal members in rural Washington State and across the West, visiting a doctor off the reservation often means driving for hours to get to the nearest big city. In some of our remote areas, some tribal members never see a doctor off the reservation. They are born in Indian hospitals, they see that doctor for their entire life, and they die in the same hospital.

This bill also funds urban Indian health clinics. In recent years, President Bush and some of my colleagues have questioned the need to provide health services to Indians who live in and around major cities. In fact, disappointingly, the President's budget routinely eliminates funding for the 34 urban Indian health centers that exist in this country, and every year Congress restores the funding because those centers serve thousands of Indians, many of whom are uninsured and would not get care elsewhere. The doctors and the nurses who staff those urban clinics specialize in the conditions many Indians face. Even more importantly, they are sensitive to the cultural needs of their patients. That makes the difference all too often when a patient is deciding whether to seek care or to do preventive treatment and it increases the chance that an Indian will continue to get the treatment they need, as I said, for preventive or even mental health care.

I am disappointed Republican objections have limited how far the important improvements for urban Indians in this bill can go, but this bill, as now written, does ensure those important health centers stay open. My State has two of them. I have to tell you, I have heard firsthand from a number of our tribal members how important and critical they are.

Both our urban and our rural Indian health clinics also give tribes more decisionmaking power over health programs so they can determine how best to serve their people. In Washington State, we have the Nisqually Health Clinic that is located near Olympia. It offers a community health representative program that trains the tribal members about how to provide basic preventive care and education to help their elders and members who suffer from diabetes or substance abuse.

We need to give programs such as those a boost so they can grow and they can succeed so other tribes can try similar programs. Reauthorizing the Indian Health Care Improvement Act will help us to do that.

Finally, this bill also makes important improvements to the medical benefits provided to tribal veterans. Tribal veterans, as many of my colleagues know, have served throughout this Nation's history with great honor and valor. In fact, American Indians have served in higher numbers than any other ethnic minority in this Nation. But despite that extraordinary commitment to this Nation, veterans services for American Indians oftentimes falls short of what is available for non-Indians.

Fortunately, this bill we are considering changes current law to allow the Secretary to enter into or expand arrangements to share medical facilities and services with the Department of Veterans Affairs. That provision requires consultation with the affected Indian tribes before entering into those agreements, and it requires reimbursement to the IHS, tribes or tribal organizations.

I wish to repeat something I said earlier because it is important. Providing health care to Indians is part of our Government's trust responsibility. It dates back to the 18th and 19th centuries. Congress enacted the Indian Health Care Improvement Act in 1976 to better carry out that duty. In President Ford's signing statement, he said:

Indian people still lag behind the American people as a whole in achieving and maintaining good health. I am signing this bill because of my own conviction that our first Americans should not be last in opportunity.

Thirty-two years later, we still have a long way to go toward achieving that goal, but we can take some important steps by reauthorizing this bill now.

HOUSING AND EMERGENCY PREPAREDNESS

While I have the floor this afternoon, I wish to change gears and talk about two other issues I heard a lot about at home--housing and emergency preparedness--because I am hearing now disturbing rumors that the President's upcoming budget proposal is going to recommend cuts in those two areas.

First, I wish to emphasize how important it is we continue to provide Federal support for police, fire, and emergency responders in all our communities. This past month, I held several roundtables with our first responders in Washington State to hear what they need to protect their communities, and at every stop, they told me they have already been squeezed by budget cuts and that they have spent the last several years trying to do more with a lot less. They said they are very worried about what it will do if their budgets are cut again.

Emergency responders in our small and rural communities are especially concerned because they depend on Federal grants to keep their communities safe. Let me give one example of the impact these grants have had in my State that I think illustrates why Federal support is so important.

A month ago, storms causing major flooding and wind damage slammed into western Washington. Thousands of our homes on the coast and in the inland counties were flooded and damaged severely. Grays Harbor County, which sits along the Pacific coast, was one of the hardest hit. But Grays Harbor emergency officials told me they were ready because they had recently done exercises to practice emergency response training.

When those horrendous storms hit, first responders in Grays Harbor County relied on vital equipment, basic radio and other safety gear. Without that training, without that equipment, more people in Grays Harbor would have been hurt in that storm. Grays Harbor had both of those thanks to Federal homeland security grants.

From the flooding in Washington State to Hurricane Katrina, to California wildfires, we have had too many opportunities now to witness the need for effective predisaster planning and response support. Real security in our communities does not come cheap.

Now, I have already written to President Bush to warn him against cutting money for port security, transit security, and emergency management grants. I am prepared to fight for these grants. Supporting and protecting Americans here at home has to be a priority for all of us.

HOUSING

When I was home, I also heard from citizens and lenders, housing counselors, people involved in the housing issues in Washington State who are very concerned about the potential cuts to housing grants they are hearing about.

Washington State is fortunate that the economy is still relatively strong compared to the rest of the Nation. But we are seeing signs of trouble. In fact, I heard from a housing official who worked in Kitsap County, one of our more rural counties. She has seen a dramatic increase in the number of people who are now seeking housing counseling. She told me that last fiscal year, their two full-time housing counselors helped homeowners with 50 defaults. They saw that many people in this first quarter alone. In fact, in the 2 days she was with me and others talking about housing, she said she went back home and there were seven more calls on her answering machine about foreclosures.

The Federal Government has to do everything possible to address this wave of foreclosures. One way we can do that is investing in housing counseling. It is vital for troubled mortgage holders to get help early so they can avoid foreclosure and keep their homes.

At a time when we are trying to work to help repair the economy and ensure people can pay their bills, we cannot afford any cuts in our budget for that safety net for our homeowners.

We also have to ensure that low-income Americans who are not homeowners also get help. That means we have to continue to support programs such as Section 8, homeless assistance, and CDBG, which will help keep our communities strong through this and help make sure our low-income residents have a home and can avoid homelessness.

Next month, when we get the President's budget sent to us, you can count on me, I will be scrutinizing every word of it, and I will be back on this floor, if necessary, to fight funding cuts to those programs that are so important to keeping our communities strong.

I yield the floor.

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