Indian Health Care Improvement Act Amendments of 2007
Floor Speech
INDIAN HEALTH CARE IMPROVEMENT ACT AMENDMENTS OF 2007 -- (Senate - February 25, 2008)
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Ms. MURKOWSKI. Mr. President, I appreciate the comments of my colleague from Wyoming, speaking to essentially the urgency of where we are, and the recognition that we have been working on this legislation, the Indian Health Care Improvement Act and its reauthorization--and as he mentioned, it should have passed a year and a half ago--but that we have been working on it for a good 10 years. It has been a collaborative effort of many leaders in the Senate. Senator McCain has been mentioned, as the former chairman of the Indian Affairs Committee. Prior to his chairing that committee, it was Senator Ben Nighthorse Campbell who was leading the effort to move forward with this very important reauthorization.
I had the opportunity to go home to Alaska over this past recess, and it was a busy recess for me, as it was for, I know, many of my colleagues. I had an opportunity to visit Galena, which is the Athabascan Indian village on the Yukon River. I was in Fairbanks, Seward, Anchorage, and my hometown of Girdwood. I had a chance to visit with seven or eight Alaskan natives who are training under the dental health aide therapist program in Anchorage. This is a very unique partnership with the University of Washington School of Medicine. What we are doing in Alaska now is training Alaska natives as mid-level professional dental health aide therapists to go out and provide for the dental health needs of so many in our rural communities, in our villages around the State where they simply do not have any level of dental health care. I am not talking about a dentist who comes every other week. I am saying we don't have a dentist every other year practically in some of these villages. So we are providing a training opportunity that is unique to Alaska and is very important.
So even though it is tough to leave home and come back here to work, it is good to be back here knowing that we are working on the Indian Health Care Improvement Act, working to finish this very important legislation.
We have had many of our colleagues speak about the challenges of delivering quality health care to America's Native people and the funding environment that all have admitted is inadequate to support those needs.
Those challenges are not limited to the lack of funding, they also include the lack of trained personnel who are willing to live in some of the most remote places in which Indian health care is delivered. So that is one side of the coin. But there is also some very real innovation that is going on within the Indian health care delivery system.
As I listened to the debate that went on on the Senate floor in the past several weeks, it dawned on me that we saw a lot of focus, a lot of attention on some of the inadequacies but that we did not spend any time during that debate to recognize the people, the tribal leaders, the health care professionals who are unwilling to let the lack of funding stand in the way of excellence in health care delivery.
So as we move to conclude our debate on this very important piece of legislation for the health of our Native people, I wish to take a few moments this evening to focus on some of the ways, in my home State, our Native leaders and our Indian health care professionals have partnered to overcome what seemed to be insurmountable obstacles in their quest for excellence.
My focus now on these examples from Alaska is not intended to imply we are not seeing innovation in Indian health care delivery in other places of Indian Country, but I have chosen to speak about these programs because I know them, I believe in them.
In the State of Alaska, we have Native people who have lived in more than 200 traditional villages along the rivers and coasts for thousands of years, and Natives continue to occupy those villages today. But those are places, many of them are places where doctors and nurses and physicians assistants or the PAs, where they did not live, and they will not live.
But that does not mean Alaska's Native people lack access to basic medical care. If one gets sick or injured in a Native village which may be hundreds of miles from the nearest hospital, you need to know you are not alone. In our State, we faced up to the challenge of providing access to medical care in remote places by training Native people to serve as community health aide practitioners. This is a program that originated during the tuberculosis epidemics back in the 1950s. They had volunteer chemotherapy aides who gave out oral medicine in the village under the remote supervision of a physician.
In the 1960s, a structured training program was created to train Native people residing in the villages to function as the eyes and ears, the hands of medical personnel who may be hundreds of miles away.
At one point in time, this link between the village health aide and the doctor in the regional hospitals was carried out by a single-sideband radio similar to what the ham operators use. Then later it was carried out by telephone, subsequently e-mail. Now we have a state-of-the-art telemedicine backbone that connects the health aides and the supervising physicians.
Alaska's Community Health Aide/Practitioner Program was first recognized and funded by the Congress in 1968 and is 40 years old this year. It has earned the respect of the medical profession and has tremendously improved the health condition of Alaska's Native people. I mentioned earlier I had a chance to view those young people who are currently in the Dental Health Aide Therapist Program. This is an extension of this concept to improve the oral health condition of Native people who live in places where the dentists may visit once a year if they visit at all.
These are a few examples from my State of the kind of innovation we have seen going on in Indian health care delivery for some time. I wish to give you a more recent example. This is the Southcentral Foundation's patient-centered primary care initiative.
The initiative has transformed the quality of health care delivered to Native people residing in a service area of 150,000 square miles within southcentral Alaska. The Southcentral Foundation is a tribal health provider which delivers health care under a self-governance compact with the IHS.
Our CEO of the Southcentral Foundation is Katherine Gottlieb, an Aleut. She was the first Alaskan ever to win the MacArthur Foundation Genius Award. She won that award for the patient-centered primary care initiative I will describe for you.
The initiative itself has been discussed in professional journals ranging from the Journal of the American Medical Association, the Family Practice Magazine published by the American Association of Family Physicians. It is the subject of a case study published by the Institute for Health Care Improvement in Boston, which is one of our Nation's foremost think tanks on health care quality.
In 1977, when Southcentral Foundation began to take over primary care delivery from the IHS, the average delay to schedule a routine appointment ranged from 4 weeks to several months. The no-show rate was about 25 percent for appointments, and patients did not have any idea who their primary care provider was. In 1999, Southcentral Foundation embarked on a massive effort to redesign their system.
Today, patients are guaranteed same-day access to their own primary care provider if they call by a certain point in the afternoon; they get to choose their own primary care provider. They get to change their provider if they do not like the one they have chosen. Use of the emergency room and urgent care for primary care is down 50 percent. Use of specialists is down 50 percent. Wait times have decreased across the system.
Customer satisfaction, 91 percent of customers rate their overall care favorably. That is pretty impressive. Staff satisfaction has improved immeasurably. This is a system where you have members of the medical team, the doctors, the nurses, the physicians assistants, their technicians, and they all come together, they all rely on one another. Everyone is expected to work at the highest level allowed by their professional license.
What we saw with this transformation of Southcentral Foundation was it was not just achieved by throwing more money at the problem, it was achieved by changing the values of the system, from a staff-centered system to a patient-centered system that basically went from kind of a big and impersonable crank-them-through-the-process place--and these are the words of the medical director, Doug Eby--to a customer-owned-and-directed system which operates in accordance with Native values, not necessarily bureaucratic principles.
That transformation began with the decision of Native leaders to exercise their rights of self-governance under the provisions of the Indian Self-Determination and Education Assistance Act.
These self-governance provisions allowed tribes to take over the responsibilities for the delivery of health care from the Federal Government. The bill that is before us today, the Indian Health Care Improvement Act, will provide self-governance providers, such as Southcentral Foundation, with the tools and the flexibilities they need to further expand these innovations.
We know the bill, S. 1200, was not written in an ivory tower; it was written primarily by Indian health care providers, tribal leaders who know the challenges we face in improving the health conditions of our Native people.
The leaders of our Alaska Native delivery system were key players in the process of formulating this legislation. For me, it is truly an honor and a privilege to be able to give voice to their ideas in the Senate. It is my sincere hope our colleagues today will vote to bring the debate on this important legislation to a close.
The process, as has been mentioned, of drafting this legislation began back in 1999. It has moved through the Indian Affairs Committee in so many different years--I mentioned, under the leadership of Senator Nighthorse Campbell, Senator McCain, Senator Thomas before his death, Senator Dorgan, so many who have put so much time and effort into this very important legislation.
It is long time that Congress modernize the legislation which governs the Indian health care delivery system in a way that promotes exactly this type of innovation I have spoken to that we have seen in Alaska. It is long time that we give our Indian health care providers the tools they need in their quest for excellence.
I anticipate we will move this legislation to final passage. It is something that as I speak to my constituents back home and as we talk about those issues that are most important to them, so much seems to come back to health care and how we are providing health care within the State of Alaska or around the Nation.
So passage of the Indian Health Care Improvement Act is long overdue. I look forward to seeing the day the President will be able to enact these changes into law.
I yield the floor, and I suggest the absence of a quorum.
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Ms. MURKOWSKI. Mr. President, while we are waiting, I wish to make a few brief comments in reference to the amendment Senator Smith has introduced regarding the area distribution fund.
Coming from the State of Alaska, I do support Senator Smith's amendment, as we believe it will enable more Indian tribes to build the facilities and to address the inequities currently in the system. We recognize it has been under review, having been looked at for revision for years, but I think it is time to do something to create improvements to the system to get more facilities for the tribes.
Now, we recognize that funding is at the crux of this, but Senator Smith's amendment does not mandate that the Secretary create this system. It says if funding is available, that opportunity exists. Furthermore--and I think this goes to the concern many have--that within the current priority system, if there is a change, somehow or other those who have made their way up to the top will somehow be displaced. We understand it doesn't impact the current health care facilities priority system. What we are attempting to do with this amendment is to enhance that system.
I appreciate Senator Smith working with the committee, with the tribes, and with our colleagues on this issue. It is a very important issue, as Senator Dorgan has noted. So I do stand in support of Senator Smith.
With that, I yield the floor.
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