Indian Health Care Improvement Act Amendments of 2007
Floor Speech
INDIAN HEALTH CARE IMPROVEMENT ACT AMENDMENTS OF 2007 -- (Senate - February 14, 2008)
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Mr. WYDEN. Mr. President, today the Senate is considering the Indian Health Care Improvement Act Amendments. American Indians and Alaska Natives--along with all other Americans--should receive modern, efficient, and quality health care. Unfortunately, too many of those in the Indian health system do not receive that care today. This important legislation will change that.
Reforming our Nation's broken health care system is one of my highest priorities and I strongly support efforts to shore up Indian health care services, such as those proposed in this important legislation. Like all Americans, American Indians and Alaska Natives cannot prosper without access to modern, efficient, and quality health care.
The most recent census information available indicates there are 2.3 million American Indian and Alaska Native people in the United States. In my State of Oregon alone there are nine federally recognized tribes, and a large urban Indian population. Less than 40 percent of their people reside on reservations. It is a continuing failure of this Nation that American Indian and Alaska Native people rank at or near the bottom of so many social and economic indicators.
Most striking of these indicators are the health statistics involving American Indian and Alaska Natives. Diabetes, tuberculosis, alcoholism, fetal alcohol syndrome, and increasingly, AIDS, plague America's Native communities at rates far and above those of other Americans. As of 2007, there is a $1 billion backlog in unmet needs for health facilities, contributing to the degenerating health of Native communities.
The plight of Native American health care in this country is the result of one simple and tragic fact: The Federal Government has failed to meet its promise to Native Americans.
Through treaties and statutes, the Federal Government has promised to provide health care to American Indians and Alaska Natives. A critical aspect of this promise is sufficient funding for the Indian Health Service, IHS, part of the Department of Health and Human Services. IHS arranges health care services for Native Americans and provides some services through direct care at hospitals, health centers, and health stations, which may be federally or tribally operated. When services are not offered or accessible onsite, IHS offers them, as funds permit, through contract care furnished by outside providers.
In addition, in the Indian Health Amendments of 1992, Congress specifically pledged to ``assure the highest possible health status for Indians and urban Indians and to provide all resources necessary to effect that policy.'' These combined commitments are absolutely essential to help the Federal Government meet its legal and moral responsibilities to Native Americans.
Sadly, we haven't even come close to honoring these commitments. Sufficient funding has not been provided. IHS is so underfunded and understaffed that patients routinely are being denied care that most of us would take for granted and, in many cases, would consider essential. The resulting rationing of care means that all too often Indians are forced to wait until their medical conditions become more serious--and more difficult to treat--before they can even access necessary health care. The chronic underfunding has only grown worse in recent years, as Federal appropriations failed to keep up with the steep rise in public and private health care costs and expenditures.
The results are startling and disturbing. While per capita health care spending for the general U.S. population is about $7,000, the Indian Health Service spends only about $2,100 per person on individual health care services. The Government also spends considerably less on health care for Indians than it spends for Medicare beneficiaries, Medicaid recipients, and veterans.
It is appalling that we can live in one of the most prosperous nations on Earth, where most--but by far not all--Americans have access to health care services, yet we provide woefully inadequate health care for our Native American population.
These resource shortcomings underscore the need to make the Indian Health Service a priority in the Federal budget. It is also why I am supporting an amendment offered by my colleague from the State of Oregon, Senator GORDON SMITH, along with my colleague from Washington State, Senator MARIA CANTWELL. It would provide for innovative approaches in funding health care facilities by providing a way to distribute funds more equally with the establishment of an area distribution fund.
Each year, I travel to every county in Oregon to learn firsthand the challenges confronting my constituents. I often find that my most enlightening visits occur when I travel to Indian Country, especially when I hear or read compelling stories about Indian health care afforded to my tribal constituents. But I am also pleased that the northwest region has its share of success stories and examples of medical care for Native Americans that have worked.
With the support of the Native American Rehabilitation Association's Diabetes Prevention Program, made possible by the IHS Special Diabetes Program for Indians, diabetes patients are losing weight and improving their lifestyle. I am also pleased to note that the One Sky Center, a National Native Resource Center for Substance Abuse and Mental Health Services located at Oregon Health and Science University in Portland, is the only National Resource Center of its kind in Indian Country. Indian Country is in a crisis in combating alcohol, substance abuse, and methamphetamine. There is a real need for such a center for not only tribal people, but also for those who work and interface with Indian Country to try to find solutions, leverage programs, and build partnerships to address these key health issues.
In addition, on the national level, the recently reauthorized Special Diabetes Program for Indians, SDPI, has had significant success and is viewed as a model for improving preventive care and disease management for this significant chronic illness. Tragically, Native Americans are 2.6 times more likely to be diagnosed with diabetes than the general U.S. population and diabetes mortality is believed to be 4.3 times higher in the Native American population than in the general U.S. population. The combination of this special program and the legislation before us today could help make significant strides against this ongoing public health threat that disproportionately hits Native Americans. Importantly, the SDPI has given Indian health programs and tribal communities invaluable resources and tools to help prevent and treat diabetes. And it has had real medically measurable results. In just 10 years, the mean blood sugar level has decreased by 13 percent. Scientific research demonstrates that such a decrease results in a 40-percent decrease in diabetes-related complications, such as blindness and amputations. Furthermore, on the prevention front, it has also increased school-based prevention programs for children, such as increased physical activity programs, better school lunches, and removal of junk food-filled vending machines, and diabetes awareness education. There are also more community-based wellness centers offering exercise and nutrition programs for individuals at risk for diabetes.
Yet, this program has been funded apart from the traditional sources of funding for Indian health care, the IHS. It is imperative that Congress pass the Indian Healthcare Improvement Act Amendments so that our country can begin to fill the many gaps in Indian health care and have more success stories like the ones I just described.
I want to just take a few moments to reiterate how important it is for all Americans that the Federal Government move to reform our nation's health care system. It is very clear, in my view, that our Nation faces a health care crisis. In fact, I think when we get on the floor debating any health program, the Senate will see and the country will see that this debate illustrates how broken our health care system is.
Native Americans are not the only Americans who believed they would have health care when they would need it, only to find that faced with a serious or life-threatening illness the care or coverage available doesn't match their need. Despite paying more per person for health care services than any nation on Earth, so many go without care or coverage. For some Americans, this happens when they have lost a job, and hence the coverage that went with it, or they had minimal insurance that doesn't come close to providing them the financial security needed to cover the costs of the health care services they need. For 47 million Americans, often through no fault of their own and despite having tried to be able to afford or purchase health coverage, they find themselves with no health coverage at all. These fellow citizens are at the mercy of hospital emergency rooms should health care tragedy strike them or their families. Plus, in an unconscionably large number of cases, they are unable to pay for needed care without risking personal bankruptcy, if at all.
Many people agree with the need for change, but have a healthy skepticism about whether real, meaningful structural reform is possible in our lifetimes. I understand these doubts, and I do not underestimate the challenge. Yet, I do believe we have the possibility of a real ideological truce now in health care. More and more Senators of both political parties have come to understand that to fix health care we must cover everybody. If we don't cover everybody, people who are uninsured shift their bills to those who have insurance. So colleagues on my side of the aisle who made the point about getting everybody coverage, in my view, have been correct, and clearly the country and citizens of all political persuasions have come around to that point of view.
There is also strong support for something the Republicans feel strongly about, and that is not having the government run everything in health care. There can be a role for a healthy private sector in universal health care, one where there is a fairer and more efficient market. And there ought to be more choices; in fact, there can be an abundance of choices in a system like Members of Congress enjoy today.
I am very pleased that I could join with Senator BENNETT of Utah, a member of the Republican leadership, in offering a bill based on just those principles. It is S. 334, the Healthy Americans Act, and it is the first bipartisan universal coverage bill in more than 13 years. The last bipartisan, universal coverage health bill was offered by the late Senator Chafee more than 13 years ago. Now we do have the opportunity for the Senate to come together on a bipartisan basis and deal with the premier challenge at home, and that is fixing American health care.
My fellow Senators, it is my hope that we pass the Indian Healthcare Improvement Act Amendments as soon as possible and live up to our legal and moral obligations to provide health care services to our Native American population. I have been proud to join efforts to increase funding for the Indian Health Service, and I will continue to fight for more IHS funding because it benefits all people, Native and non-Native people, in tribal and surrounding communities. I am pleased to support these needed improvements and funding, which will move forward the cause of improved Indian health care.
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