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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Ms. MURKOWSKI. Mr. President, I thank the chairman of the Indian Affairs Committee for his leadership on this very importation reauthorization bill. As he has indicated, this work is a long time in coming, and it is a collaborative effort not only of those on the committee, those of us who represent so many in Indian country across the Nation, but truly for so many who have put so much work into this reauthorization, this very important health care reform.

We do have amendments we have received and are looking forward to having discussion on them. As Chairman Dorgan has noted, Senator Coburn will have an opportunity to offer some of those this morning. But in the spirit of focusing on what we have in front of us today, I think it is important that we keep in mind we have an obligation to advance a health care system that has been left behind the times in terms of any updates, whether it is in the area of behavioral health or telemedicine or substance abuse or what we are doing with diabetes treatment or how we are moving forward with construction of facilities. We recognize that we have a ways to go in updating the system. This is important and is necessary.

Recognizing the limitations on Senator Coburn's time at this point, I yield to the Senator so he can offer his amendments. We will continue our conversation later in the morning.

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Ms. MURKOWSKI. Mr. President, I understand that the Senator from Oregon, Mr. Smith, is on his way to the floor, so when he arrives, I will yield such time to him as he needs. I know he wants to speak to an amendment.

I wish to take just a couple of minutes this morning to respond to some of the comments made by the Senator from Oklahoma. Clearly, he is very passionate about Indian health care and making sure that we do right by our treaty obligations and that we do right by all American Indians and Alaska Natives when it comes to their health care needs. He cited some of the obvious. Unfortunately, the statistics are real. In fact, the statistics may be even more devastating than he has indicated because we know that a lot of times our statistics aren't as reliable as we may want, and, in fact, they are worse than what we have seen.

When he spoke to prenatal care, when he spoke to the incidence of diabetes and substance abuse and suicides, we know they are horrific statistics. We recognize we must do more. I, too, applaud him for bold action, for reform in a system that has been unwieldy and bureaucratic and stovepiped in so many areas.

Senator Barrasso yesterday brought forward an amendment that asks for a GAO study to look to the efficiency. There are some other amendments that have been introduced that also task us with evaluating to make sure we are doing right by the programs that are put in place, how the funding is directed to them, and are we doing what we need to be doing. I think it is fair to say that we recognize it is not sufficient, it is not enough. We do need to be doing more, and certainly, as the chairman of the Indian Affairs Committee has mentioned, we have to put our money where our mouth is. We have to put our money toward those programs. We have to make sure we put the resources there to make the difference.

The Senator from Oklahoma spoke about the rationed care. It is not rationed care because we just don't want to give it; it is rationed care because of the lack of resources, and that is very real and something that must be dealt with, and it must be dealt with in a very strong way.

The Senator from Oklahoma really spoke as well to the issue of prevention, and it was his opinion in his comments that this Indian Health Care Improvement Act doesn't go far enough, that we need to be doing more in the area of prevention. He speaks to a part of me that I feel very strongly about. When we talk about health care in this country, whether it is in Indian Country or in the United States as a whole, it has been referred to as not a system of health care, it is a system of sick care. We take care of you after you are sick. It is no different within the Indian health system. That does have to change. We must focus on the prevention. We know this. We are seeing this. We are working here in the Congress to change those policies to help put greater focus on prevention because we know for a fact that we can reduce costs if we focus on prevention.

Now, the Senator from Oklahoma has indicated that there isn't enough here in the Indian Health Care Improvement Act in the area of prevention. I want to mention some of the initiatives that are included in the legislation that will make a difference, that will reduce health care costs, and that will provide for greater access. It is in the area of prevention.

Diabetes--we have all listened to the stats. They are absolutely unacceptable. We have to be doing more when it comes to diabetes prevention. We must be doing more to keep the elderly woman whom he was discussing off of the dialysis machine. We have to have the focus there. So included within the legislation is a focus on diabetes prevention.

We also look to the issue of domestic violence and sexual assault. Again, in these areas, our statistics with our American Indians and our Alaska Natives are absolutely unacceptable.

Are we doing enough in the area? No, we need to do more.

It has been mentioned we have not reauthorized the Indian Health Care Improvement Act in some 10 years. Think about what has happened in this country in terms of health care and how we provide health care, how we focus on prevention in the last 10 years, the technologies that are made available to us, and also the areas of focus. Behavioral health is something about which in my State of Alaska we have been forced to be innovative. We do not have the psychologists and the psychiatrists who are available in all of our little communities. We have been forced to utilize a telehealth system, and we are absolutely making some remarkable progress. But through this Indian Health Care Improvement Act and what we are allowing for, we can allow for expanded opportunities to help, such as in the area of behavioral health.

I have a whole list of other programs that are also included--programs to control blood pressure, immunizations, youth suicide prevention, injury prevention, sudden infant death syndrome training, tobacco cessation programs. These are all programs that go right to the heart of prevention. These are initiatives that will help us reduce our costs, that will help us keep people from becoming ill in the first place, keep people from losing a limb due to diabetes, keep young people from having to live a life afflicted with FAS or FASD.

There are initiatives contained within this legislation that need to be authorized, need to be updated and included to allow American Indians and Alaska Natives the same opportunity for preventive care that we find wherever we go in the country in a community hospital or in the clinic down the street. We have to make sure these programs are included.

Mr. President, I see Senator Smith has arrived. In recognition of his time limitations today, I yield to him so he can speak to an amendment he is proposing.

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Ms. MURKOWSKI. Madam President, if I may take a few moments to speak to some of the issues the Senator from Oklahoma has raised about the prioritization, giving priority to the provision of those basic medical services, medical needs.

I think we all agree that is the first requirement, to make sure those services are provided for. In the State of Alaska, we hear from those most vulnerable in our Alaska Native population, our elderly--the elders in the village who have lived through some pretty incredible times. At the end of their lives, they are certainly seeking basic medical services. Yet we recognize that with the facilities we have available to them, the services we have available to them, the medical professionals we have available to them, it is very difficult to meet all of those needs. So for them, the opportunity for hospice care, assisted living service, long-term care service, or the home or community-based service--that is singled out in the amendment. They are looking at this not as a luxury, or an add-on, certainly, but something that is basic, something that would be fundamental to a quality of life in their final years.

This is a matter for many seniors, not just in the State of Alaska, and for many who are looking to, again, provide for those services at a level and in a manner that is culturally relevant and appropriate--the community-based services, home-based services. I think it is important that we recognize we are not without limitation when we are talking about the services that are provided to American Indians and Alaska Natives. You have heard time and time again on the Senate floor that we are not meeting their needs; that we are funding at 60 percent; that there is a curtailment or a shortage in services based on the resources. So when we are able to enhance the quality of life, whether it is through assistance, such as long-term care services or assisted living or the community-based services, or whether it is enhancing the end-of-life care, as we do throughout this Indian Health Care Improvement Act, these are the things we ought to be encouraging, that we ought to be moving forward with in a positive manner.

So I stand in opposition to the amendment of the Senator from Oklahoma which says we cannot attend to any of these quality-of-life issues--if it is in your final days--unless and until the Secretary has given priority to the provision of these basic medical services to all Indians.

It is, again, a situation where we want to attempt to do as much as we possibly can. But I think if you were to tell the elder in the community of Buckland that somehow or other services to help her in her final years, to die gracefully and with dignity in her home, is something she doesn't qualify for, is not eligible for, I think we would all find that cuts to the quick.

Madam President, I understand that there are several Members who are here and wish to speak briefly on FISA for a few minutes before we move to our vote. I am prepared to yield to the Senator from Missouri.

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