Indian Health Service Funding

Floor Speech

By:  Lisa Murkowski
Date: Oct. 16, 2013
Location: Washington, DC

s. MURKOWSKI. Mr. President, I rise today to speak about a bill I introduced last week to provide forward funding appropriations for the Indian Health Service. The IHS is charged with delivering health services to American Indians and Alaska Natives as part of our Federal trust responsibility, and I believe that forward funding the IHS is the right thing to do, just like Congress forward funds our VA as part of our obligation to our veterans.

The budget uncertainty we have put our tribal health providers in is shameful. We may not be able to ensure our Nation's indigenous children will receive their immunizations. We might not be able to ensure our elders will be able to receive the care they need. We cannot guarantee basic medical services will be provided, including prenatal and dental for our first Americans, who rely on funding from the Indian Health Service. The situation is disgraceful, and the health statistics of our first Americans reflect that.

Without Federal funding for fiscal year 14, HHS has determined that those receiving care from the Indian Health Service will continue to receive clinical care, but for tribes that operate their own health programs, payments will not be transferred. Yet, just like the Indian Health Service, our tribal health providers must keep providing care. The budget uncertainty we have imposed on those delivering health services is unconscionable.

As I mentioned previously, my bill to forward fund the Indian Health Service makes sense because the IHS is charged with delivering health services to American Indians and Alaska Natives, as promised by the United States for the removal of Indians from their lands. The United States calls this obligation the Federal trust responsibility. This is not a relationship based on race--but a legal and political relationship defined by treaties, Executive orders, the U.S. Constitution, statutes, and Supreme Court decisions.

Health care services are either delivered by the Indian Health Service or by tribal health providers themselves operating under Indian Self-Determination Act agreements. Delayed funding means health care providers cannot budget with certainty, recruit health professionals, retain health professionals, adequately deliver services, nor manage facility maintenance and construction efforts. Late funding for tribal health programs has significantly hampered the delivery of health services for American Indians and Alaska Natives.

Let me take this opportunity to remind you of the health status of our Nation's first peoples. For too long in our Nation's history, American Indians and Alaska Natives have experienced severe health disparities compared to other Americans as a result of the poor economic and social conditions. According to the Indian Health Service, American Indians and Alaska Natives die at higher rates compared to other Americans from many causes: alcoholism is 522 percent higher, diabetes is 182 percent higher, unintentional injuries is 138 percent higher, homicide is 83 percent higher, and suicide is 74 percent higher.

We must recognize the historical traumas that played a role in these percentages, including the removal of lands, forced relocation and assimilation of Native communities, new diseases introduced, deaths experienced, and the loss of indigenous cultures. These are wounds that have been internalized and manifest themselves in high rates of alcoholism and substance abuse, driving the statistics of domestic violence, sexual assault, and suicide. And this sadness is passed down from one generation to the next.

Our tribes are working to break this cycle. Under the Federal policy of Indian self-determination we have empowered tribes to address the needs of their tribal members. Yet whether it be the denial of full operational support costs for Indian programs or the ceasing of payment under a government shutdown, we are failing on that promise.

Just as this Nation has made a promise to its veterans for the delivery of health care, we cannot forget the promise made to American Indians and Alaska Natives. In 2010, Congress forward funded the VA. Veterans groups, alarmed by the impact of delayed funding and concerned about the VA's ability to plan and manage its resources, demanded forward funding. Let me tell you our tribal health providers have those same concerns. Our tribal health providers have demanded that Congress forward fund IHS appropriations so they may better manage the health funds for American Indians and Alaska Natives, and I think we should do so.

The present government shutdown demonstrates why this is so important: we have compromised the delivery of health services for our first Americans, especially those who receive care from tribally administered hospitals. Forward funding would allow Indian health programs to more be more effectively managed and improve health outcomes for our first Americans. Tribal administrators would know how many physicians and nurses they could hire without wondering if funding for positions would be available. They would also be able to manage clinics without the uncertainty of shutting them down.

I am proud to introduce this bill to forward fund HIS, and I hope my colleagues support this effort.

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