Small Business Tax Relief Act of 2007 --Continued

Floor Speech

SMALL BUSINESS TAX RELIEF ACT OF 2007--Continued -- (Senate - July 31, 2007)

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Mr. DORGAN. Mr. President, first of all, let me thank my colleagues, Senator Baucus and Senator Grassley, the chairman and ranking member of the Finance Committee, for bringing to the floor the piece of legislation called the Children's Health Insurance Program. It is a very important bill. It will add several million more children to the health insurance rolls and provide important health insurance for kids who otherwise would not have it. I believe all of us in this Chamber would believe that children's health care should not be a function of how much money their parents may have in their pocketbook or their checkbook. A sick child needs health care. This legislation moves in that direction. I am pleased to support it. I thank my colleagues for the work they have done on it.

I do wish to offer an amendment at this point, and I wish to talk a bit about a very important issue that also relates to health care.

My amendment deals with the Indian Health Care Improvement Act. It is true that we will now improve the lives of 3 million children with the underlying bill. I fully support that and compliment my colleagues for doing that. It is also true that there are at least 2 million American Indians in this country living on Indian reservations who are seeing health rationing virtually every day of their lives. It is unbelievable that that condition continues to exist.

We have a trust responsibility for those people. The American Indians are a group of people in our midst with whom we made treaties, we made agreements, and we have the trust responsibility for Indian health care. We have not nearly met those responsibilities.

I would observe that we have a responsibility for the health care of those who are incarcerated in Federal prisons. Guess what. We spend twice as much per person on health care for Federal prisoners as we do in meeting our health care responsibility for American Indians on a per capita basis.

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Mr. DORGAN. Mr. President, let me describe now, if I might, the issue of health care for American Indians, which I believe is an urgent national need. We have a trust responsibility for their health care. We have a piece of legislation that exists in law called the Indian Health Care Improvement Act, but it needs to be reauthorized. It has not been reauthorized for 15 years. It expired 7 years ago. We need to do this. Year after year after year, this Congress postpones it. We have passed legislation out of the committee; it does not get to the floor; it does not get done.

Let me show my colleagues a picture of a young 14-year-old girl. This precious child--her name is Avis Littlewind. Her relatives gave me permission to use her picture. Avis is dead. Avis committed suicide. I want to tell you the story about Avis because I went to talk to the school officials, the tribal officials, the mental health officials, and those who were in the extended family.

This 14-year-old girl took her own life. It probably should not have been a surprise to anyone because for 90 days this little girl lay in bed in a fetal position, missed school. Something was very wrong. This little girl had a sister who, 2 years previous, had committed suicide. This little girl had a father who took his own life. This little girl

had another parent who was a very serious drug abuser. She laid in bed 90 days before she took her life.

Now, one might ask the question: Why does this 14-year-old girl just fall through the cracks? She thinks she is in a situation that is hopeless. She feels helpless and she takes her own life. But this little girl had a full life in front of her.

You know something? On that Indian reservation where Avis Littlewind lived, there were no mental health treatment facilities for someone to take this young lady, this young girl. One might ask and certainly should ask: Why is it in this country that mental health treatment is not available to a young child like this? Why is it that the person responsible for trying to give this young lady some help did not even have a car or any transportation? Even if you could find a mental health professional to treat this person, there is no transportation to get the person to treatment. Why is it that for 90 days this young lady lay in bed, and nobody from the school, nobody from the area, said: All right, there must be a big problem here; let's find out what is going on.

The fact is, this is one precious child who took her life. We have had clusters of teen suicides on Indian reservations. This is but one aspect of the Indian Health Care Improvement Act, but it is not just mental health. The bill covers virtually every aspect of Indian health.

We are told that about 60 percent of Indian health care needs are met. That means 40 percent of the health care needs are unmet. There is full-scale health care rationing on Indian reservations. If we were to debate that on
the floor of the Senate, people would be appalled. You can't ration health care. Yet, that is what is happening.

We have a trust responsibility, and yet health care is being rationed with respect to Native Americans. American Indians die at higher rates with respect to tuberculosis, 6 times the national average; alcoholism, 5 times the national average; diabetes, 180 percent higher than the national average. In Alaska, Native communities in Alaska have fewer than 90 doctors for every 100,000 Alaska Natives. That compares to 229 doctors for every 100,000 Americans. Heart disease, diabetes, blood pressure, stroke--you name it. The incidence of most diseases affecting our Native Americans are at much higher rates than for non-Indians. Cervical cancer for American Indians and Alaska Natives is nearly four times higher than cervical cancer for other women in this country.

I mentioned before that Federal prisoners, for whom we have a responsibility for health care, receive twice as much funding per person on their health care needs than do American Indians for whom we have a trust responsibility. Stated another way, we spend twice as much per person on Federal prisoners than we do with respect to American Indians, and we have a trust responsibility in law to deal with American Indian health issues.

I want to show a photograph to describe health care rationing. This is a photograph of Ardel Hill Baker. She has also allowed me to use her photograph. Ardel Hill Baker was having a heart attack. As she was having a heart attack, she was taken from the Indian reservation by ambulance to a hospital. When they offloaded her from the ambulance onto a gurney to take her in the hospital, this woman, at the emergency room entrance, having a heart attack, had a piece of paper taped to her thigh. The hospital dutifully looked at that piece of paper. The piece of paper that was taped to her thigh said that the Indian Health Service contract health care is not an entitlement program, meaning there are no funds to pay for this service because it is not a life-or-limb medical condition.

Let me say that again. Someone is having a heart attack. When they are brought to the hospital, they have a big piece of paper taped to their leg. It says to the hospital: By the way, if you admit this person, you are on your own because our contract health care money is gone. In fact, this is the piece of paper which was taped to the leg of an Indian patient coming into a hospital, having a heart attack. What would anybody in this Chamber think if this were taped to the leg of their spouse or their son or their daughter? They are having a heart attack, but the hospital is told: You know what, we do not have any money for this person; if you admit this person, you are on your own. Contract health care. It is called health care rationing.

Tribal chairmen tell me that the refrain on their reservation is: Don't get sick after June because if you get sick after June, there is no money in contract health care. By the way, you can get a little help still, but it has to be life or limb. You must be threatened with the loss of a limb or the loss of your life; if not, tough luck.

We would be outraged, outraged, every single one of us, if this were our relative. But it was not. It was Ardel Hill Baker. She survived, but there are plenty who do not.

This is Lida Bearstail. Lida Bearstail had a serious problem with her leg. The bones in her knee were rubbing against each other; cartilage was worn away. She was in great pain, in great discomfort.

The normal treatment for perhaps someone in this Chamber or perhaps for a relative of someone in this Chamber would be to get a knee replacement, but in Lida Bearstail's case, Lida Bearstail was not given the option of getting a knee replacement.

Despite the great pain, it was not determined to be priority one, life or limb. She wasn't going to lose her limb or her life. She could just live with the pain. So because it wasn't priority one, life or limb, this woman whose bones were rubbing together in the knee in unbelievable pain was told: There is no health care available for you.

We have hearings to talk about all these issues. A doctor comes to our hearing and says: I had a patient come to me with a very serious problem with a knee. It was a ligament problem, very serious, very painful. That patient went to the Indian Health Service and they said: Wrap that knee in cabbage leaves for 4 days and you will be OK.

It is pretty unbelievable. Yet we can't get a bill on the floor of the Senate to deal with Indian health care. That is unbelievable. We have a responsibility to pass this legislation. I passed it out of the Indian Affairs Committee. Now we need to move it through the Senate and then the House so we can say to these people who need health care--the first Americans, Native Americans that this country understands its obligation, understands its trust responsibility, and we are going to do what we need to do to pass the legislation.

It is almost unbelievable that with all the priorities we discuss, we can't somehow make this a priority. In my State, we have some wonderful Indian tribes. The Three Affiliated Tribes is a wonderful tribe. It includes the Mandan, the Hidatsa, and the Arikara Nations. If you get sick on that reservation in Twin Buttes, ND, your nearest health facility is a little old building with a couple of tiny examination rooms. If you are lucky enough to get sick on one of the right days when a nurse is there and one of the few days when a doctor might be there, you might do OK. But this is a 1-million acre reservation. It is a big place. We had testimony from law enforcement the other day on that reservation. The first you would expect to be able to get someone to come to deal with a law enforcement call, no matter how serious, would be about an hour and a quarter to an hour and a half. So call while a crime is being committed and, perhaps an hour and a quarter later, if you are lucky, someone from law enforcement will show up. You might understand then that if you need a prescription or if you have a health care emergency, the dilemma Indians face on reservations.

A mother who has a feverish child who needs an antibiotic, or a diabetic who needs insulin--who don't have ready access to health care facilities, in circumstances such as that, we must find ways to meet these health care needs.

There are some who say--and I agree--we need substantial change. My colleague from Oklahoma is here. He talked about the prospect of saying: All right, let's have dramatic change. I am perfectly willing to work on dramatic change, to say that if we have a trust responsibility for someone for health care, let's let them show up at a hospital someplace and let's pay the bill so they can go to the providers who have the capability. We have the responsibility to do that. The problem is, we can't get a bill such as that through this Senate. I have offered time and again on the floor to add funding. The last time I tried to add $1 billion. It went down on a partisan vote. You can't get money added in this Senate to meet the responsibility we ought to meet with respect to Indian health care.

We have worked in a bipartisan way on this legislation in the Indian Affairs Committee. The vice chairman of the committee, Senator Murkowski of Alaska, is a cosponsor as well. The Indian Health Care Improvement Act is legislation that begins to answer and advance the interests of providing health care to American Indians and meeting our trust responsibility to do so. We would authorize additional tools to deal with the issue of teen suicide on Indian reservations.

I began by talking about Avis Littlewind, but I could have talked about many others. I have had several hearings on this subject. The bill also includes new provisions to address lack of health care services. We have begun trying to find a different construct of convenient care for American Indians on reservations. It includes several Medicaid provisions that are in the jurisdiction of the Finance Committee. The Finance Committee is going to be holding a markup. We will talk with the chairman and ranking member about including this bill in that markup.

My point today is very simple. I understand the need to provide additional health care opportunities for 3 million American children is very important. It is no more important than providing the health care we promised we would provide to 2 million American Indians who live on reservations for whom we
have trust responsibilities. We have broken far too many promises to American Indians. We have done it for far too many decades. It is time for this Congress and the country to keep its word and meet its promise. We don't have a choice, and it is not going to break the bank to do that.

I encourage all my colleagues, go to the Indian reservations. See for yourself. See a dentist practicing in an old trailer house for 5,000 patients, operating out of an old trailer. Go see that. Then ask yourself: Is this the kind of health care we promised? Are we delivering what we promised? The answer is a resounding no.

I understand in this Chamber there are priorities. With respect to the priorities all of us have, we all have different things we are passionate about. We have now on the floor a health care bill. This legislation is important. The reason I offer this amendment is, when we talk about health care, I think we have a responsibility to address Indian health as well. If we can, we need to, either tonight or tomorrow, get a commitment on dates to mark up and bring to the floor of the Senate the

Indian Health Care Improvement Act, which is 7 years overdue and 15 years since it was last reauthorized. If we can get that commitment, I will know we are going to get this through the Senate. That is the goal.

I am going to visit with Senator Baucus. Let me also make the point, Senator Baucus has been a very strong supporter of Indian issues. I have been happy to work with him. The Indian Health Care Improvement Act was sent to the Indian Affairs Committee. We have moved this out of committee. I think we have written it in a way that substantially improves Indian health care. Now it waits, as it waited last year, the year before and the year before that and the year before that. Every single year it is the same thing. I am flat out tired of it. I will not let it happen this time. One way or another, this needs to get done by this Senate because this Senate has a responsibility to do it. We have not met this responsibility for too many years. This year I insist we do so. The fact is, kids are dying. Elders are dying because the health care doesn't exist that we had previously promised. We have a responsibility to do something about it.

I say to the chairman of the committee, I will visit with Senator Reid, and I know Senator Baucus is a strong supporter of Indian issues. I hope if I can get a commitment that we can get from the Finance Committee a markup--and I know the Senator wants to do that--if I can then get a commitment from Senator Reid to bring this to the floor, I don't intend to interrupt the children's health insurance bill, but if I can't get that commitment, I fully intend to interrupt this bill as long as I can interrupt it because it is that important.

To my colleague from Montana, let me say thank you for allowing me to at least at this moment offer this amendment, and let me ask my colleague if I can get some hope that the two of us, working with others, can move together to get this through the Senate in a reasonable time. I am going to ask the same of the majority leader, who I know also is very supportive of Indian issues and very much wants to get this done.

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Mr. DORGAN. Mr. President, let me say thank you. If we can get a markup in the Senate Finance Committee on September 12, that allows the bill to move to the floor of the Senate. I am going to talk to Senator Reid, who I know is a strong supporter of Indian issues and feels very strongly about this. If I can get a commitment, I know he wants to provide that commitment to get to the floor of the Senate, then I will seek to withdraw the amendment from this bill. But I do want to visit, and perhaps in the morning on the floor, with Senator Reid on that subject.

I wished to make two more points, and then I know my colleague from North Carolina seeks recognition.

This chart shows the expenditures per capita relative to other Federal health expenditure benchmarks. This deals with Indians versus all others--Indians get far less. Here is the expenditure per capita for Medicare, the Veterans' Administration, Medicaid, Federal prisoners, the Federal Employees Health benefits. Here is Indian Health Service. It is unbelievable to me how much less it is. In many ways, all of this is intertwined--social services, health care, law enforcement, housing, education, it is all intertwined. What got me interested and involved in Indian issues--and I am privileged to serve as chairman of the Indian Affairs Committee and feel a deep responsibility to force us to do the right thing--what got me involved one day was a young girl named Tamara.

Tamara was a young 3-year-old American Indian girl who was put in a foster home. But the person who was handling the social services cases was handling 150 cases, so they did not bother to check the home this little girl was going to be put into. It was not long before, at a drunken party, that little girl had her nose broken, her arm broken, and her hair pulled out at the roots. It will scar that little girl for life. I met her. I met her granddad. I talked to the social worker. I fixed that social worker problem by getting additional workers in, so that it does not happen again.

The fact is that should never happen. These incidences should not happen. We do not have the resources to do what is necessary, to do what needs to be done. Nowhere is that more true than in health care. Health care is not a luxury. When there is a sick kid someplace, or a sick elder, when somebody has a health problem, we have a responsibility to find a way to help.

For those who might listen to this and say that Indian health care is not our responsibility, oh, yes, it is. We signed treaties. We made promises, and we broke them every chance we got. Maybe in the year 2007 we can begin keeping a promise or two. These are promises we have a responsibility to keep. It is our trust responsibility.

There is a lot to do in health care, but there is nothing more important than meeting our obligation to provide health care for Native Americans because we made that agreement with them, and we need to keep that agreement.

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