To require a study of tribal justice systems.

INDIAN HEALTH CARE IMPROVEMENT ACT AMENDMENTS OF 2007

The ACTING PRESIDENT pro tempore. Under the previous order, the
Senate will resume consideration of S. 1200, which the clerk will state
by title.

A bill (S. 1200) to amend the Indian Health Care
Improvement Act to revise and extend that act.

Pending:

Vitter amendment No. 3896 (to amendment No. 3899), to
modify a section relating to limitation on use of funds
appropriated to the Service.
Dorgan amendment No. 3899, in the nature of a substitute.
Smith amendment No. 3897 (to amendment No. 3899), to modify
a provision relating to development of innovative approaches.
Murkowski (for DeMint) amendment No. 4015 (to amendment No.
3899), to authorize the Secretary of Health and Human
Services to establish an Indian health savings account
demonstration project.
Murkowski (for DeMint) amendment No. 4066 (to amendment No.
3899), of a perfecting nature.
Murkowski (for DeMint) amendment No. 4070 (to amendment No.
3899), of a perfecting nature.
Murkowski (for DeMint) amendment No. 4073 (to amendment No.
3899), of a perfecting nature.
DeMint amendment No. 4080 (to amendment No. 4070), to
rescind funds appropriated by the Consolidated Appropriations
Act, 2008, for the city of Berkeley, CA, and any entities
located in such city, and to provide that such funds shall be
transferred to the Operations and Maintenance, Marine Corps
account of the Department of Defense for the purposes of
recruiting.

The ACTING PRESIDENT pro tempore. The Senator from North Dakota is
recognized.
Mr. DORGAN. Mr. President, my understanding is that we have a cloture
vote that will begin at 5:30 this evening. I know Senator DeMint has
two amendments he intends to offer this evening. We expect to have
votes on those amendments. I have an opening statement I wish to give
for a short period, and I will defer on that. Senator Kyl wishes 10
minutes to speak, with 5 minutes on the bill and 5 minutes, I believe,
in morning business. I don't want to disadvantage either of my
colleagues. I want to comment about the legislation.
We are finally, at long last, going to pass an Indian Health Care
Improvement Act. It has been 8 long years. It is long past due. By
tomorrow midday, we will have disposed of all of the amendments, and
having succeeded in invoking cloture, we will have finally done
something that will give cause for millions of Americans to celebrate
in this country for the first time in a long time--an improvement in
Indian health and Indian health care.
Mr. President, Senator Kyl has asked that he be allowed to speak for
5 minutes at this point. I ask unanimous consent that Senator Kyl be
recognized, following which I would like to speak--and I will make it
short--and then Senator DeMint will be recognized. I notice that the
ranking member, Senator Murkowski, is on the floor as well.
I yield the floor.
The ACTING PRESIDENT pro tempore. The Senator from Arizona is
recognized.
Mr. KYL. Mr. President, first of all, I will address an amendment to
the underlying Indian health bill. It is amendment No. 3897, offered by
my friend from Oregon. It is an amendment which I hope my colleagues
will reject.
This is an amendment that deals with the way in which moneys are
disbursed for health facility construction on Indian reservations. For
those of us who represent the majority of our Native American
population in the United States, this is a very important proposition
because most of the construction, as you could imagine, is on the
Indian reservations in the Southwest--in particular, Arizona, New
Mexico, and, to a lesser extent, some of the other States. It is wrong,
therefore, to try to change the formula by which funding is allocated
for construction of these facilities to a broader based around-the-
country formula rather than based upon the population we are trying to
serve. As a result, I think my colleagues should oppose the amendment.
It is helpful that the amendment is not mandatory but, rather,
provides that the Secretary can use what is called an ``innovative
approach'' and distribute funding equally among the Indian health care
regions rather than target funding to areas where the health care
services are needed the most. But it still doesn't make sense to try to
use this Indian construction funding as kind of a honey pot of money
for everybody to share in equally when certain key areas have the bulk
of the need based upon their population. I think this priority based
upon need is a much more sensible way to serve our Indian population.
I disagree that the area distribution fund is the answer. It will
turn the current process upside down. It would disrupt pending
projects. While it may be well intentioned, the amendment doesn't
ensure that Federal dollars will be appropriately allocated based upon
the greatest health care needs of the individual members of the tribes.
Therefore, I urge my colleagues to oppose that amendment.

the fisa legislation

Mr. President, I wish to take 2 minutes to address the matter dealt
with by my counterpart on the majority side a little while ago,
legislation we will presumably have to deal with again--certainly the
House of Representatives will--and that is the FISA Act legislation. I
wish to put a couple of things in the Record. I will explain what they
are, and then I will ask consent to do that.
As you know, the Senate has passed this important FISA legislation.
The legislation will enable us to continue to collect foreign
intelligence on our terrorist enemies. We are waiting for the House of
Representatives to act on that legislation so that it can be sent to
the President for signature.
There has been some confusion about what the effect of the failure of
the

[[Page S1102]]

House to act really is, because the House allowed the current law to
lapse. The person who ought to know what the effect is is Admiral
McConnell, the Director of National Intelligence, who joined with
Attorney General Mukasey in writing a letter to the chairman of the
House Permanent Select Committee on Intelligence, dated February 22, in
which he addressed the significant concerns we have, given the fact
that there is no current law that enables us to appropriately collect
this intelligence.
I ask unanimous consent that this letter be printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
February 22, 2008.
Hon. Silvestre Reyes,
Chairman, House Permanent Select Committee on Intelligence,
House of Representatives, Washington, DC.
Dear Chairman Reyes: The President asked us to respond to
your letter of February 14, 2008, concerning the urgent need
to modernize the Foreign Intelligence Surveillance Act of
1978 (FISA). Your assertion that there is no harm, in
allowing the temporary authorities provided by the Protect
America Act to expire without enacting the Senate's FISA
reform bill is inaccurate and based on a number of
misunderstandings concerning our intelligence capabilities.
We address those misunderstandings below. We hope that you
find this letter helpful and that you will reconsider your
opposition to the bill passed last week by a strong
bipartisan majority in the Senate and, when Congress returns
from its recess, support immediately bringing the Senate bill
to the floor, where it enjoys the support of a majority of
your fellow members. It is critical to our national security
that Congress acts as soon as possible to pass the Senate
bill.

Intelligence Collection

Our experience since Congress allowed the Protect America
Act to expire without passing the bipartisan Senate bill
demonstrates why the Nation is now more vulnerable to
terrorist attack and other foreign threats. In our letter to
Senator Reid on February 5, 2008, we explained that: ``the
expiration of the authorities in the Protect America Act
would plunge critical intelligence programs into a state of
uncertainty which could cause us to delay the gathering of,
or simply miss, critical foreign intelligence information.''
That is exactly what has happened since the Protect America
Act expired six days ago without enactment of the bipartisan
Senate bill. We have lost intelligence information this past
week as a direct result of the uncertainty created by
Congress' failure to act. Because of this uncertainty, some
partners have reduced cooperation. In particular, they have
delayed or refused compliance with our requests to initiate
new surveillances of terrorist and other foreign intelligence
targets under existing directives issued pursuant to the
Protect America Act. Although most partners intend to
cooperate for the time being, they have expressed deep
misgivings about doing so in light of the uncertainty and
have indicated that they may well cease to cooperate if the
uncertainty persists. We are working to mitigate these
problems and are hopeful that our efforts will be successful.
Nevertheless, the broader uncertainty caused by the Act's
expiration will persist unless and until the bipartisan
Senate bill is passed. This uncertainty may well continue to
cause us to miss information that we otherwise would be
collecting.
Thus, although it is correct that we can continue to
conduct certain activities authorized by the Protect America
Act for a period of one year from the time they were first
authorized, the Act's expiration has and may well continue to
adversely affect such activities. Any adverse effects will
result in a weakening of critical tools necessary to
protect the Nation. As we explained in our letter to
Senator Reid, expiration would create uncertainty
concerning: The ability to modify certifications and
procedures issued under the Protect America Act to reflect
operational needs and the implementation of procedures to
ensure that agencies are fully integrated protecting the
Nation; The continuing validity of liability of protection
for those who assist us according to the procedures under
the Protect America Act; The continuing validity of the
judicial mechanism for compelling the assistance of
private parties needed to protect our national security;
The ability to cover intelligence gaps created by new
communication paths or technologies.
Our experience in the past few days since the expiration of
the Act demonstrates that these concerns are neither
speculative nor theoretical: allowing the Act to expire
without passing the bipartisan Senate bill has had real and
negative consequences for our national security. Indeed, this
has led directly to a degraded intelligence capability.
It is imperative that our intelligence agencies retain the
tools they need to collect vital intelligence information. As
we have explained before, the core authorities provided by
the Protect America Act have helped us to obtain exactly the
type of information we need to keep America safe, and it is
essential that Congress reauthorize the Act's core
authorities while also extending liability protection to
those companies who assisted our Nation following the attacks
of September 11, 2001. Using the authorities provided in the
Protect America Act, we have obtained information about
efforts of an individual to become a suicide operative,
efforts by terrorists to obtain guns and ammunition, and
terrorists transferring money. Other information obtained
using the authorities provided by the Protect America Act has
led to the disruption of planned terrorist attacks. The
bipartisan Senate bill would preserve these core authorities
and improve on the Protect America Act in certain critical
ways, including by providing liability protection to
companies that assisted in defending the country after
September 11.
In your letter, you assert that the Intelligence
Community's ability to protect the Nation has not been
weakened, because the Intelligence Community continues to
have the ability to conduct surveillance abroad in accordance
with Executive Order 12333. We respectfully disagree.
Surveillance conducted under Executive Order 12333 in a
manner that does not implicate FISA or the Protect America
Act is not always as effective, efficient, or safe for our
intelligence professionals as acquisitions conducted under
the Protect America Act. And, in any event, surveillance
under the Protect America Act served as an essential adjunct
to our other intelligence tools. This is particularly true in
light of the changes since 1978 in the manner in foreign
targets with speed and agility. If we revert to a legal
framework in which the Intelligence Community needs to
make probable cause showings for foreign terrorists and
other national security threats located overseas, we are
certain to experience more intelligence gaps and miss
collecting information.
You imply that the emergency authorization process under
FISA is an adequate substitute for the legislative
authorities that have lapsed. This assertion reflects a basic
misunderstanding about FISA's emergency authorization
provisions. Specifically, you assert that the National
Security Agency (NSA) or the Federal Bureau of Investigation
(FBI) ``may begin surveillance immediately'' in an emergency
situation. FISA requires far more, and it would be illegal to
proceed as you suggest. Before surveillance begins the
Attorney General must determine that there is probable cause
that the target of the surveillance is a foreign power or an
agent of a foreign power and that FISA's other requirements
are met. As explained above, the process of compiling the
facts necessary for such a determination and preparing
applications for emergency authorizations takes time and
results in delays. Again, it makes no sense to impose this
requirement in the context of foreign intelligence
surveillance of targets located overseas. Because of the
hurdles under FISA's emergency authorization provisions and
the requirement to go to the FISA Court within 72 hours, our
resource constraints limit our use of emergency
authorizations to certain high-priority circumstances and
cannot simply be employed for every foreign intelligence
target.
It is also inaccurate to state that because Congress has
amended FISA several times, there is no need to modernize
FISA. This statement runs counter to the very basis for
Congress's passage last August of the Protect America Act. It
was not until the passage of this Act that Congress amended
those provisions of FISA that had become outdated due to the
communications revolution we have experienced since 1978. As
we explained, those outdated provisions resulted in dangerous
intelligence gaps by causing constitutional protections to be
extended to foreign terrorists overseas. It is critical that
Congress enact long-term FISA modernization to ensure that
the Intelligence Community can collect effectively the
foreign intelligence information it needs to protect the
Nation. The bill passed by the Senate would achieve this
goal, while safeguarding the privacy interests of Americans.

liability protection

Your assertion that the failure to provide liability
protection for those private-sector firms that helped defend
the Nation after the September 11 attacks does not affect our
intelligence collection capability is inaccurate and contrary
to the experience of intelligence professionals and to the
conclusions the Senate Select Committee on Intelligence
reached after careful study of the matter. It also ignores
that providing liability protection to those companies sued
for answering their country's call for assistance in the
aftermath of September 11 is simply the right thing to
do. Through briefings and documents, we have provided the
members of your committee with access to the information
that shows that immunity is the fair and just result.
Private party assistance is necessary and critical to
ensuring that the Intelligence Community can collect the
information needed to protect our country from attack. In its
report on S. 2248, the Intelligence Committee stated that
``the intelligence community cannot obtain the intelligence
it needs without assistance'' from electronic communication
service providers. The Committee also concluded that
``without retroactive immunity, the private sector might be
unwilling to cooperate with lawful Government requests in the
future without unnecessary court involvement and protracted
litigation. The possible reduction in intelligence that might
result from this delay is simply unacceptable for the safety
of our Nation.'' Senior intelligence officials also have
testified regarding the importance of providing liability
protection to such companies for this very reason.

[[Page S1103]]

Even prior to the expiration of the Protect America Act, we
experienced significant difficulties in working with the
private sector because of the continued failure to provide
liability protection for such companies. These difficulties
have only grown since expiration of the Act without passage
of the bipartisan Senate bill, which would provide fair and
just liability protection. Exposing the private sector to the
continued risk of billion-dollar class action suits for
assisting in efforts to defend the country understandably
makes the private sector much more reluctant to cooperate.
Without their cooperation, our efforts to protect the country
cannot succeed.

pending legislation

Finally, as you note, the House passed a bill in November
to amend FISA, but we immediately made clear that the bill is
unworkable and unacceptable. Over three months ago, the
Administration issued a Statement of Administration Policy
(SAP) that stated that the House bill ``falls far short of
providing the Intelligence Community with the tools it needs
to collect effectively the foreign intelligence information
vital for the security of the Nation'' and that ``the
Director of National Intelligence and the President's other
senior advisers would recommend that the President veto the
bill.'' We adhere to that view today.
The House bill has several grave deficiencies. First,
although numerous senior intelligence officials have
testified regarding the importance of affording liability
protection for companies that assisted the Government in the
aftermath of September 11, the House bill does not address
the critical issue of liability protection. Second, the House
bill contains certain provisions and serious technical flaws
that would fatally undermine our ability to collect
effectively the intelligence needed to protect the Nation. In
contrast, the Senate bill deals with the issue of liability
protection in a way that is fair and that protects the
national security. In addition, the Senate bill is carefully
drafted and has been amended to avoid technical flaws similar
to the ones in the House bill. We note that the privacy
protections for Americans in the Senate bill exceed the
protections contained in both the Protect America Act and the
House bill.
The Department of Justice and the Intelligence Community
are taking the steps we can to try to keep the country safe
during this current period of uncertainty. These measures are
remedial at best, however, and do not provide the tools our
intelligence professionals need to protect the Nation or the
certainty needed by our intelligence professionals and our
private partners. The Senate passed a strong and balanced
bill by an overwhelming and bipartisan margin. That bill
would modernize FISA, ensure the future cooperation of the
private sector, and guard the civil liberties we value. We
hope that you will support giving your fellow members the
chance to vote on this bill.
Sincerely,
Michael B. Mukasey,
Attorney General.
J.M. McConnell,
Director of National Intelligence.

Mr. KYL. Mr. President, in addition to that, the Department of
Justice has issued a news release dated February 23 that is titled
``Statement by the Department of Justice and the Office of the Director
of National Intelligence Regarding Cooperation with Private Partners,''
which press release makes it very clear that we are having a very
difficult time in dealing with the telecommunications companies that
are assisting the U.S. Government in the absence of a law which
properly provides for liability protection for them and sets out the
ground rules for their intelligence collection.
I ask unanimous consent to have printed in the Record the statement
to which I just referred.
There being no objection, the material was ordered to be printed in
the Record, as follows:

Statement by the Department of Justice and the Office of the Director
of National Intelligence Regarding Cooperation With Private Partners

As stated in the joint letter from the Attorney General and
the Director of National Intelligence dated February 22, the
Department of Justice and the Intelligence Community have
been working assiduously to mitigate the effects of the
uncertainty caused by the failure to enact long-term
modernization of the Foreign Intelligence Surveillance Act of
1978. We learned last night after sending this letter that,
as a result of these efforts, new surveillances under
existing directives issued pursuant to the Protect America
Act will resume, at least for now. We appreciate the
willingness of our private partners to cooperate despite the
uncertainty. Unfortunately, the delay resulting from this
discussion impaired our ability to cover foreign intelligence
targets, which resulted in missed intelligence information.
In addition, although our private partners are cooperating
for the time being, they have expressed understandable
misgivings about doing so in light of the on-going
uncertainty and have indicated that they may well discontinue
cooperation if the uncertainty persists. Even with the
cooperation of these private partners under existing
directives, our ability to gather information concerning the
intentions and planning of terrorists and other foreign
intelligence targets will continue to degrade because we have
lost tools provided by the Protect America Act that enable us
to adjust to changing circumstances. Other intelligence tools
simply cannot replace these Protect America Act authorities.
The bipartisan Senate bill contains these authorities, as
well as liability protection for those companies who answered
their country's call in the aftermath of September 11. We
hope that the House will pass this bill soon and end the
continuing problems the Intelligence Community faces in
carrying out its mission to protect the country.

Mr. KYL. Finally, Mr. President, the Director of National
Intelligence, Admiral McConnell, was on a television program in which
he made some points related to this issue. Among other things, he said:

We cannot do this mission, we cannot do this activity
without the help of the private sector.

Upon expiration of the Protect America Act ``the private sector
partner said, `Well, wait a minute, are we now protected?' So we went
through a discussion for the entire week. Now, this is the problem. We
may have the authority to conduct surveillance, and we do, for example,
on al-Qaida, but you can't make that actionable if you don't have
something specific to load in our systems to target. So when we wanted
to load new information, the private partners said, `We're not prepared
to do that.' So we negotiated all week to be able to come to closure.''
The point he is making is, we are in a situation right now of grave
vulnerability. Intelligence is not being collected, so there is no law
under which it can be collected. The private parties with whom we must
work to collect that intelligence are in a position of great
vulnerability because of lack of liability protection, as a result of
which there can undoubtedly arise a question as to whether they will
continue to be able to perform this service for us. That is why we ask
the House of Representatives to take up the Senate-passed legislation
and to pass it as soon as possible and send it to the President so this
vulnerability of which the Director has spoken can come to an end and
we can resume collection of intelligence on our terrorist enemies.
The PRESIDING OFFICER (Mr. Menendez). The Senator from North Dakota.
Mr. DORGAN. Mr. President, I will make a few comments, and then
Senator DeMint, by unanimous consent, will be recognized. He will have
the time that he desires to speak about his two amendments that we will
vote on this evening.
I begin quickly by saying that we have had a lot of help to get this
bill this far: Senator Reid, first of all, for allowing us and being
persistent in getting this bill to the floor and to keep it here.
Senator Kyl has worked closely with us. Senator Murkowski, the ranking
member, has worked very hard to help me get this bill from our
committee to the floor. Senator Kennedy and Senator Enzi and so many
others have worked with us to try to make a difference on this
legislation.
Let me describe why there is an urgency. We have a trust
responsibility for Indian health care. That is different from other
responsibilities. A trust responsibility means we took the land from
the indigenous Americans, from the first Americans. We took their land
but signed treaties and said: Tell you what, we will give you a deal.
Here is our responsibility: We will provide health care for you. That
was interpreted much later as a trust responsibility.
Let me show what we do on Indian health care compared to other
responsibilities we have. This describes how much we spend per person
on Medicare, veterans, Medicaid, and so on. We actually spend twice as
much money to provide health care for Federal prisoners, those
incarcerated in Federal prisons, as we do to meet our responsibility
for health care for American Indians. We have a responsibility for
both, but we spend twice as much for Federal prisoners' health care as
we do for American Indians.
It is not as if there is not a need. American Indians have a 600
percent higher rate of tuberculosis, a 510 percent rate of alcoholism,
and diabetes is off the charts. There are about one-third of doctors
for Indians versus other populations, and one-fourth of

[[Page S1104]]

nurses for Indians as other populations. There is a much higher rate of
sudden infant death syndrome. Cervical cancer is four times higher. The
suicide rate among Indian teens is 10 times higher in the northern
Great Plains, and it is triple in the rest of the country. The
statistics are endless. We have a full-scale health care crisis.
This bill in itself will not fix all that is wrong, but it is the
first time in 8 years we are finally getting this bill reauthorized. It
should have been done 8 years ago. It is now being done, and it is
important.
I have described this bill through the eyes of two girls--one age 5,
the other age 14, both dead. Let me describe them. Their relatives and
parents have allowed me to use their names so that we understand what
this is about and what this urgency is.
First, I will explain Ta'Shon Rain Littlelight, a beautiful 5-year-
old Indian girl from the Crow Reservation in Montana. Ta'Shon Rain
Littlelight died, and the last 3 months of her life was in unmedicated
pain. This little girl went to an Indian health clinic again and again
to be diagnosed as having a condition of depression, and she was
treated for depression. It turns out she had terminal cancer. She was
finally rushed to Billings, MT, then rushed to Denver, CO, and
diagnosed as having terminal cancer when it was undiagnosed many months
before, and it may well have been able to be treated.
When they finally diagnosed this 5-year-old girl, who loved to dance
the Indian dances, as having terminal cancer, she asked her mom if she
could go to Disney World and see Cinderella's castle and the Make-a-
Wish Foundation allowed her to go to Orlando, FL, to see Cinderella's
castle.
They got there and checked into a motel, and that evening, in her
mother's arms, Ta'Shon Rain Littlelight said: Mommy, I'm sorry I'm
sick. I will try to be better. She died that night in her mother's
arms. She never got to see Cinderella's castle.
This little girl deserved health treatment, deserved a health system
that we would expect for our children, a good diagnosis, first-class
health treatment. She did not get it, and she is dead.
So is Avis Littlewind. Avis was 14. Avis Littlewind committed
suicide. She lay in her bed for 90 days in a fetal position, missing
school, missing everything. Her sister had committed suicide. Her dad
took his own life. This young girl age 14 was lying in a fetal position
for 3 months and somehow nobody missed her. No mental health treatment
was available. Nobody seemed to identify this little girl was in
trouble. And then she hung herself. She felt hopeless and helpless and
took her life.
A 14-year-old girl is gone. A 5-year-old girl is gone. But it is
thousands, thousands of people suffering with a health care system that
is not working. It is not working the way we would expect it to work
for us and for our families, and it does not work for Native Americans,
the first Americans, for whom we have a trust responsibility and to
whom we made a promise. That is why we must get this bill done. We will
have a cloture vote at 5:30 p.m.
We will have two amendments this evening by Senator DeMint, a couple
of amendments tomorrow morning, and final passage, and there will be a
celebration by people who have waited a long time for this legislation
to move through the Senate.
Mr. President, I know my colleague, Senator DeMint, has been waiting
patiently. I yield the floor, and my guess is that Senator Murkowski,
the ranking member, will wish to be recognized following Senator
DeMint.
The PRESIDING OFFICER. The Senator from South Carolina.
Mr. DeMINT. Mr. President, I appreciate the words of the chairman on
the need to improve Indian health care. It is clear from the Government
Accounting Office study that there is no doubt Indian health is
suffering and there are many reforms that are desperately needed. I
wish to talk about several amendments we proposed that we think will
help the bill. One is related to what Senator Dorgan was just talking
about and the fact that there is just not enough money currently to
provide the health care that is needed for many Indians across the
country today.
Unlike a lot of other Federal support for health care, Indian health
care provides 100 percent coverage to all members of tribes across the
country, regardless of income level. The problem that creates at a time
when we are offering new programs and reforms is we are not offering
enough money to actually support all the programs that are in this new
bill.
My amendment No. 4073, which we call the Indian gaming amendment,
would allocate the scarce resources to the poorer tribes by excluding
some of the richer tribes that benefit from class III or casino-style
gambling.
Many of us have looked at the statistics. Revenues from Indian casino
gambling have surpassed $12 billion, and many members of these tribes
will receive income from these casinos from $30,000 to over $300,000.
There are clear discrepancies in the income in the tribes across the
country, and in designing Indian health care reform, it is important
that we recognize that fact.
In 2001, there were 290 Indian casinos across 28 States that brought
in more than $12.5 billion with more than $5 billion in profit. To put
this in context, the average family in South Carolina makes around
$50,000 a year. These families, sometimes on their own, sometimes
through their employers, have to pay and help pay for their health care
and many times deductibles and copays. The average income in the tribes
that have casino gambling is generally much higher than that amount.
Yet we are providing free health care for these tribes.
This amendment would exclude from the new programs in the underlying
bill those tribes with casino gambling, class III gambling, which would
take the money that is provided in the bill and allocate it to the
poorer tribes, which uses just basic common sense. If we have a limited
amount of money to go around, let's target those tribes with the
greatest poverty and the greatest need and allow those tribes with the
highest incomes to participate in purchasing their own health care.
That is amendment No. 4073. We will vote on that amendment today.
Let me address another amendment that will be voted on today; that
is, amendment No. 4070 which recognizes that some of the programs in
the bill that are designed for injury prevention or safety have
actually been used in the past by Government agencies to promote
antifirearm programs, gun buyback programs, or programs that generally
stigmatize the ownership of guns for collecting, hunting, or self-
defense.
This amendment provides that none of the funds in the bill may be
used to fund antifirearm programs, gun buyback programs, or programs
aimed at discouraging or stigmatizing the private ownership of firearms
for collecting, hunting, or self-defense. That is basically the
language in the bill.
We know from programs we have looked at before--we have legislation,
for instance, that we passed that would prohibit the Centers for
Disease Control from doing exactly the same thing; that is, using money
that is supposed to be used for safety programs or other injury
prevention and actually use it to promote a political agenda which is
an anti-second-amendment agenda. This is another amendment we will vote
on today.
So two amendments we will be voting on today after the cloture motion
vote is the Indian gaming amendment that would exclude those tribes
that have the revenue from casinos, as well as the other amendment
which would prohibit funds from being used to stigmatize the ownership
of guns.
Mr. President, I wish to address another amendment which is pending
to this bill, which is what we call the health savings account choice.
This amendment would simply make another choice available to Indians in
the purchase of their health care. Right now, they have most of the
options that we have at the Federal level in our Federal employees
plan, but they do not yet have a health savings account option which we
have added to our Federal programs. This simply would allow Indians the
same choice that we have. They could purchase a PPO or other plans--
managed care, HMO, or with this amendment, they could also have a
health savings account with a high-deductible plan.

[[Page S1105]]

I encourage my colleagues to support this amendment. I am actually
working with the chairman on the possibility that this amendment could
be accepted and avoid a vote on the amendment tomorrow; otherwise, we
will be voting on it tomorrow before final passage.
I wish to make a few comments on a second-degree amendment that I
added to one of these amendments the week before we left last week
which we call the Semper Fi amendment. This is an amendment that is not
germane and will fall after cloture but still deserves some
comment. The Semper Fi amendment is named in honor of the marine motto,
which means ``always faithful,'' and it is a bill which I introduced
after the Berkeley, CA, city council voted to refer to our marines as
unwelcome intruders and had proposed that they leave town--that their
recruiting office actually leave town. When I heard of this, it
immediately angered me and we developed this bill which would simply
take away about $2 million of wasteful Federal earmarks, which were not
voted on in the Senate or the House, but were added as what we call
report language. We are not trying to take away all their Federal
funding but simply to say, if they are not going to respect our marines
or their mission, which part of it is recruiting, then certainly they
should not be the beneficiary of taxpayer-funded earmarks, and
certainly those that aren't necessary.

When I first introduced this bill, it was more to make a point and
maybe rattle the cages of the city council, because I know all the
people in Berkeley don't feel this way. If anyone looked at the video--
and it was one of the most watched videos on YouTube--you could see
person after person stepping up and maligning our marines and the job
they are doing, not only in Iraq but throughout history, and referring
to them as murderers and thugs, unthinkable things being said about the
same marines who provided them their freedom of speech.
Some have said by my introducing this bill I am against freedom of
speech, and that is not it at all. In fact, the anti-American group
Code Pink had been demonstrating for months in front of the marine
recruitment office there in Berkeley, and I have no problem with that.
They have every right. But they wanted more than freedom of speech,
they wanted the power of the local government behind them, to give them
an advantage over those who supported the marines, supported their
mission, and supported our country. So the city council voted to give
Code Pink a free parking place in front of the marine recruitment
office, and also voted to give them a permit to use a bullhorn, a
megaphone, to shout down any who would want to come into that
recruitment office. That is not free speech. That is a government-
sponsored political agenda that took the side of a few liberal
demonstrators against traditional Americans and the marines who have
fought for our freedom of speech.
My amendment got a fair amount of attention and a lot of supporters
here in the Senate, which I appreciate. The same bill was also
introduced in the House by a number of Republicans. I have been
surprised at the response we have gotten--literally thousands of phone
calls and e-mails and letters. What this has exposed to me is it is not
only a single event, but it has exposed a raw wound not only of our
marines but everyone serving in uniform, and their families.
I have heard it when I have been in Iraq, more than once, when I ask
our soldiers, marines, and airmen what they need, and the response has
often been: Don't forget us. The letters and e-mails I have gotten have
indicated the same thing, that finally some are standing up for those
who are fighting for our freedoms.
I was surprised by the response. I have gotten letters at home from
mothers who have sent me pictures of their marines, thanking those of
us who have stood up for their marines. I have agonized over the fact
that they need someone to stand up for them.
But when I go back and see what was said in this Chamber and the
House Chamber, and what governments such as the city of Berkeley have
done, it should come as no surprise to us that there are doubts in the
minds of those who put on the uniform that we support them, that we
believe in what they do, and that we support their constitutional
mission to recruit and to talk about what we offer in our services.
People--Americans--are concerned about this.
We have tried to get the Semper Fi act on the floor for an up-or-down
vote, and we have not been able to do so. We tried to pass it by
unanimous consent, which got 100 percent Republican support but was
blocked on the Democratic side. I added it to an amendment to this
bill, to try to get a vote, but it will fall after we vote for cloture.
I promise the marines and all those in uniform that I am going to
continue to persist until we get a vote on this, because it is not just
about this amendment, it is not just about those who support it, it is
about letting those who put on the uniform and who are willing to fight
for our freedoms know we stand behind them. When any government, at any
level, takes a position against them, it is our responsibility here in
the Congress to stand up for those marines and those fighting men and
women and not to allow them to be taken advantage of and intimidated
and bullied by some local government such as we saw in Berkeley.
I have been happy to see some local governments across the country
actually pass resolutions in support of the marine recruiters, and I
appreciate any across this country who stand and make a statement on
behalf of those who are fighting for our freedom. Again, I emphasize
that anyone who wants to speak out in protest against marine
recruiters, against the Iraq war, or anything, it is their free right.
But when government, whether it is a local government or a State
government, takes a position against our Federal constitutional
amendment to defend this country, which requires the recruitment of
marines, soldiers, airmen, and Coast Guard, that is part of our job. It
is not freedom of speech when a local government takes a position
against what we are charged to do here at the Federal level.
I encourage all those parents, all those in uniform, that the
majority of those here in the Senate, in the House, and across this
country respect and appreciate what you are doing every day. I got back
from Iraq last week, with 2 days on the ground, and I know I speak for
all my colleagues when I say I was never prouder of my country and what
I do here than when I stood with those in uniform who are sacrificing,
in many instances, more than a year away from their family, and some on
second and third tours. They are fighting for us and we need to stand
up for them. I am going to continue to persist until my colleagues give
me a chance to stand with our marines and to support the Semper Fi
bill.
Mr. President, I yield the floor, and I reserve the remainder of my
time.
The PRESIDING OFFICER (Mr. Whitehouse). The Senator from Alaska.
Ms. MURKOWSKI. Mr. President, at this time I yield 7 minutes to the
Senator from Wyoming.
The PRESIDING OFFICER. Without objection, it is so ordered. The
Senator from Wyoming is recognized.
Mr. ENZI. Mr. President, I thank the Senator from Alaska.
I rise in support of renewing and reinvigorating the Indian health
care programs. For too long we have neglected our duty to review this
program and ensure that it continues to efficiently deliver high-
quality health care. As part of that effort in the last Congress,
Senator McCain and I and Senator Dorgan and Senator Murkowski
introduced comprehensive legislation that would do that, and I am
pleased that a great portion of the bill we are discussing today
includes provisions of that bill, which was S. 4122.
In crafting that legislation last Congress, we kept in mind the 80/20
rule in working between the Health, Education, Labor and Pensions
Committee and the Indian Affairs Committee. We used this 80/20 rule--or
the 80-percent rule--which is that 80 percent of the time we are going
to agree on a topic and it is only 20 percent of the time that we
disagree. So to gain broad support we focused on that 80 percent to
ensure it was a strong bipartisan piece of legislation. It is a piece
that is long overdue. This should have been reauthorized years ago. It
leaves out some important things that are necessary for the tribes in
administering Indian health.

[[Page S1106]]

A few weeks ago, I did mention a few remaining concerns I had with
the underlying Indian health care bill, and thankfully, due to the work
of many in this Chamber, and particularly Senator Dorgan and Senator
Murkowski, I no longer have concerns with the underlying legislation.
The improvements to the bill required minimal language changes, but
they do have huge policy implications. I am glad we are better able to
clarify the scope of Federal liability coverage. By doing so, we no
longer imply that the Federal Government could be telling Americans how
to practice their own religious beliefs. For this and the issue of
urban Indians, we were able to find a third way, a middle ground, on
the appropriate role for providing services to urban Indians.
I am also pleased to hear that at least two outstanding issues within
the Finance Committee's title of this bill have also been resolved. I
thank Senator Kyl for all his efforts in the area to create better
Medicaid copays and better citizenship documentation. I realize others
may not see these compromises as the perfect solution. However, they
are moving us in the right direction on these key topics. As I remind
people around here a lot, there is no such thing as a perfect piece of
legislation.
The 80 percent this bill contains will solve immense problems for
tribes throughout the United States. It will move health care forward
for all who are involved, and it will make a huge difference. It is
past due. We still can work on other issues that are outstanding that
we hear mentioned around the Chamber in the debate, but this piece of
legislation needs to pass. It needs to pass now. It should have passed
a year and a half ago.
We almost passed it at the end of that session, until we got the
scoring, and the scoring used the wrong bill. They did not use the bill
Senator McCain and I and Senators Murkowski and Dorgan put together.
They used a different bill, and the cost came in extremely high. And it
would, under that bill. It wasn't this bill. It wasn't what we worked
on.
It has taken us another year and a half to get to the point where we
can pass a bill that will solve the problems for the tribes and keep
this program moving forward in a very positive way. I am glad we will
be able to pass this legislation out of the Senate, and I look forward
to working with others to get this bill signed into law.
Mr. President, I yield the floor.
The PRESIDING OFFICER. The Senator from Alaska.
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

[[Page S1107]]

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.
The PRESIDING OFFICER. The clerk will call the roll.
The bill clerk proceeded to call the roll.
Mr. DORGAN. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. DORGAN. I ask unanimous consent that the vote sequence beginning
at 5:30 today be as follows:
Cloture on the Dorgan-Murkowski substitute amendment; DeMint
amendment No. 4070; and DeMint amendment No. 4073.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. DORGAN. Mr. President, I ask unanimous consent that the votes
following the first vote be 10-minute votes, with 2 minutes equally
divided for debate.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. DORGAN. Let me explain that the legislation, the Indian Health
Care Improvement Act, does a number of things. We have talked about the
urgency for it, but it expands cancer screenings, for example; it
expands monitoring and prevention programs for communicable and
infectious diseases; it expands recruitment and scholarship programs
for those nurses and doctors who serve American Indians; it seeks to
address the epidemic of teenage suicides on some Indian reservations;
it enhances and expands the current diabetes screening efforts; it
tries to address the shortage of health care professionals; provides
for home- and community-based services and hospice care; also
authorizes convenient care services; and authorizes programs to address
domestic violence and sexual abuse.
In short, it is a piece of legislation that attempts to modernize the
Indian health care system that has been waiting to be reauthorized now
for 8 years. So this is a piece of legislation that I think is going to
make a difference in the lives of Americans who have expected and have
been promised good health care and have, for a long time, not received
it.
While we are waiting for colleagues who may wish to speak prior to
5:30, I ask unanimous consent to speak for 3 minutes in morning
business.
The PRESIDING OFFICER. Without objection, it is so ordered.

Strategic Petroleum Reserve

Mr. DORGAN. Tomorrow, we have a hearing in the Senate Energy
Committee that deals with the issue of the Strategic Petroleum Reserve,
called SPR, and the Administration's oil fill policies. In the 1970s,
we have created a Strategic Petroleum Reserve to put oil underground to
save it in case of a national security concern. It would be for an
emergency so we would have some that is saved and would be available to
take out of the underground caverns and use it in these circumstances.
This is the basis of our strategic petroleum reserve. It is now almost
97 percent filled. Over its 30-year lifetime, the barrels that have
been put into the Strategic Petroleum Reserve have averaged about a $27
a barrel. Yet, right now, when oil is trading at $100 a barrel and
gasoline prices are going through the roof, we are putting 50,000 to
60,000 barrels a day underground into the Strategic Petroleum Reserve
that is already almost 97 percent full.
How are we doing that? Our Government carries that out through
royalty-in-kind transfers. This oil is primarily coming from the Gulf
of Mexico through the drilling and the production

[[Page S1108]]

that occurs there. We are receiving this oil in kind in lieu of
royalties paid to the government for its production. So rather than put
that oil into the supply system, get the money for it, and reduce the
Federal deficit, we are effectively sticking that money underground in
a hole. At a time when oil is $100 a barrel and gas is $3 to $3.50 a
gallon, we are taking 50,000 to 60,000 barrels a day and sticking it
underground. Is somebody missing a few tubes here? I don't understand
it. The wiring must be wrong for people who think that is the right
thing to do. This is exactly the wrong time to be sticking oil
underground when oil is $100 a barrel. Yet I have tried very hard to
get this changed, and I have been unable to do so.
We have a hearing tomorrow where we have representatives coming from
the Department of Energy as well as other witnesses. I will have an
opportunity, if I am not here on the floor--and I hope I am not--to
question them. I have recently introduced legislation--S. 2598, the
Strategic Petroleum Reserve Fill Suspension and Consumer Protection Act
of 2008. I will try very hard to move this bill on anything that moves,
especially a supplemental appropriations bill, to make sure we stop
this as soon as possible.
I chair the Senate Energy and Water Appropriations Subcommittee that
funds the Department of Energy. When I write my bill this spring, I
will be able to put a provision that stops filling the SPR in my bill.
But that bill likely won't be effective until towards the end of the
year. By that time, they will have continued to put all of this oil
underground to its full capacity and also boost the gas prices for the
American driver. I don't understand what they could be thinking.
As a part of this fill policy, they are putting underground a
disproportionate amount of sweet light crude. That is a subset of the
oil produced in the U.S. We had testimony before a joint Energy and
Government Affairs/Homeland Committee hearing last year by an expert,
Dr. Phillip Verleger, who said that even the small amount of sweet
light crude they are putting underground is having a disproportionate
impact on the markets and may be increasing the price of gasoline by 10
percent.
If there are some wires crossed someplace, I urge the Department of
Energy to track those wires down and get them squared away. Let's start
thinking straight. Do not be sticking oil underground when oil is $100
a barrel. That takes oil out of our supply. It means supply is
diminished, even if it is a seemingly small amount as DOE contends. It
means the price goes up.
This is a classic supply-demand question. All of us have studied
economics. I taught economics in college ever so briefly. I was able to
overcome that experience, nonetheless. But we all understand the
supply-demand relationship. If you take oil out of what otherwise would
be 50,000 or 60,000 additional barrels in the supply, you put upward
pressure on gasoline prices. That is especially true if you take the
subset of sweet light crude coming from the Gulf of Mexico and stick it
underground at exactly the time it ought be to be in the supply
pipeline.
Tomorrow, we will have the opportunity to have a public discussion
with the Department of Energy and representatives with other opinions.
If they don't do what is, in my judgment, obvious, I intend to move my
legislation forward. I have introduced this bill with about six
cosponsors. I certainly hope many others will join me to put the brakes
on what the Department of Energy is now doing.
It is completely counterintuitive to anything one would expect that
should be done at a time when oil is bouncing around at $100 a barrel
and you have to get a loan to gas up your car these days. My hope is we
can get the Department of Energy to think straight about this issue of
putting oil underground in the SPR.
It felt good to say that because I have been thinking about it all
weekend. There is so much we need to do that just represents a deep
reservoir of common sense. This is one of those steps. My hope is we
will make some progress on it.
Mr. COCHRAN. Mr. President, I am pleased to be a cosponsor of the
Indian Health Care Improvement Act.
Under the terms of many treaties and agreements, the U.S. Government
has the responsibility to provide health care and other benefits to
Native Americans.
The Indian Health Care Service estimates that it provides only about
60 percent of the health care that is needed in Indian Country: an
amount that is less than half of what we spend on the health care needs
of Federal prisoners. Tribes with the resources, attempt to make up the
difference. In most cases, the result is inadequate to meet the needs
of our Native American population.
In my State, the Mississippi Band of Choctaw Indians has made
progress in improving its health care, and the overall health of its
population, over the last 30 years. But, the sad fact is that health
care on the reservation is not adequate.
There are 9,600 members of the tribe and there are only 4 doctors.
Their small hospital has only 14 beds.
Over the last 5 years, there has been a 30.4-percent increase in the
number of patients from the Mississippi Band of Choctaw Indians who
accessed the health care system. During that same time period there was
a 41.4-percent increase in the number of ambulatory visits.
According to the Centers for Disease Control, 7 percent of Americans
have diabetes. By comparison, 20.5 percent of Choctaws have diabetes,
one of the highest percentages of any tribe in the country. Over the
last 5 years, there was a 62.3-percent increase in the number of
patients diagnosed with diabetes.
Statistics for other tribes are similar. Some include alarming
incidences of suicide, high infant mortality rates and practically
nonexistent mental health care.
Some in the Senate have suggested that those tribes that have made
progress with economic development initiatives, specifically through
gaming, ought not be eligible for Indian Health Care Services. I don't
agree. The tribe in my State should not be penalized for its modest
economic success.
The tribe is responsible for the safety of not only its members but
those who visit. It maintains roads, schools, courts, law enforcement,
fire fighting, housing, and other services we expect from local and
State governments.
It has a poverty rate of approximately 30 percent. Forty years ago
there was a near 100 percent unemployment rate of tribal members.
There is no health care system near the tribe that has the capacity
to serve tribal members. Even now, treatment facilities for dialysis,
heart patients, and serious medical conditions are 80 miles away.
I urge the Senate to support the Indian Health Care Improvement Act.
I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The bill clerk proceeded to call the roll.
Mr. DORGAN. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.

Cloture Motion

The PRESIDING OFFICER. Under the previous order, pursuant to rule
XXII, the Chair lays before the Senate the pending cloture motion,
which the clerk will state.
The legislative clerk read as follows:

Cloture Motion

We, the undersigned Senators, in accordance with the
provisions of rule XXII of the Standing Rules of the Senate,
hereby move to bring to a close debate on the Dorgan
substitute amendment No. 3899 to S. 1200, the Indian Health
Care Improvement Act Amendments.
Harry Reid, Russell D. Feingold, Kent Conrad, Richard
Durbin, Amy Klobuchar, Patty Murray, Maria Cantwell,
Jon Tester, Jeff Bingaman, Carl Levin, Max Baucus,
Byron L. Dorgan, Barbara Boxer, Dianne Feinstein,
Debbie Stabenow, Ken Salazar, Daniel K. Akaka.

The PRESIDING OFFICER. By unanimous consent, the mandatory quorum
call is waived.
The question is, Is it the sense of the Senate that debate on
amendment No. 3899, offered by the Senator from North Dakota, Mr.
Dorgan, to S. 1200, shall be brought to a close?
The yeas and nays are mandatory under the rule.
The clerk will call the roll.

[[Page S1109]]

The bill clerk called the roll.
Mr. DURBIN. I announce that the Senator from Maryland (Mr. Cardin),
the Senator from New York (Mrs. Clinton), the Senator from Hawaii (Mr.
Inouye), the Senator from Massachusetts (Mr. Kerry), the Senator from
Louisiana (Ms. Landrieu), the Senator from Illinois (Mr. Obama), and
the Senator from Michigan (Ms. Stabenow) are necessarily absent.
I further announce that, if present and voting, the Senator from
Maryland (Mr. Cardin) would vote ``yea.''
Mr. KYL. The following Senators are necessarily absent: the Senator
from Tennessee (Mr. Alexander), the Senator from North Carolina (Mr.
Burr), the Senator from Texas (Mr. Cornyn), the Senator from Arizona
(Mr. McCain), the Senator from Virginia (Mr. Warner), and the Senator
from Mississippi (Mr. Wicker).
Further, if present and voting, the Senator from Tennessee (Mr.
Alexander) and the Senator from Texas (Mr. Cornyn) would have voted
``yea.''
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The yeas and nays resulted--yeas 85, nays 2, as follows:

[Rollcall Vote No. 28 Leg.]

YEAS--85

Akaka
Allard
Barrasso
Baucus
Bayh
Bennett
Biden
Bingaman
Bond
Boxer
Brown
Brownback
Bunning
Byrd
Cantwell
Carper
Casey
Chambliss
Coburn
Cochran
Coleman
Collins
Conrad
Corker
Craig
Crapo
Dodd
Dole
Domenici
Dorgan
Durbin
Ensign
Enzi
Feingold
Feinstein
Graham
Grassley
Gregg
Hagel
Harkin
Hatch
Hutchison
Inhofe
Isakson
Johnson
Kennedy
Klobuchar
Kohl
Kyl
Lautenberg
Leahy
Levin
Lieberman
Lincoln
Lugar
Martinez
McCaskill
McConnell
Menendez
Mikulski
Murkowski
Murray
Nelson (FL)
Nelson (NE)
Pryor
Reed
Reid
Roberts
Rockefeller
Salazar
Sanders
Schumer
Sessions
Shelby
Smith
Snowe
Specter
Stevens
Sununu
Tester
Thune
Voinovich
Webb
Whitehouse
Wyden

NAYS--2

DeMint
Vitter

NOT VOTING--13

Alexander
Burr
Cardin
Clinton
Cornyn
Inouye
Kerry
Landrieu
McCain
Obama
Stabenow
Warner
Wicker
The PRESIDING OFFICER. On this vote, the yeas are 85, the nays are 2.
Three-fifths of the Senators duly chosen and sworn having voted in the
affirmative, the motion is agreed to.
Mr. DORGAN. Mr. President, I move to reconsider the vote, and I move
to lay that motion on the table.
The motion to lay on the table was agreed to.

Amendment No. 4080

Mr. DORGAN. Mr. President, I make a point of order that the DeMint
amendment No. 4080 is not germane postcloture.
The PRESIDING OFFICER. The point of order is sustained. The amendment
falls.

Amendment No. 4070 to Amendment No. 3899

The PRESIDING OFFICER. Under the previous order, there will now be 2
minutes of debate equally divided prior to a vote on amendment No. 4070
offered by the Senator from South Carolina, Mr. DeMint.
Who yields time?
Mr. DeMINT. Mr. President, the underlying Indian health care bill
allows Federal funds to be used for certain health promotion activities
which include injury prevention, personal safety, and violence
prevention. My amendment would simply say that none of these funds in
the bill may be used to fund any firearm programs, gun buyback
programs, or programs aimed at discouraging or stigmatizing the private
ownership of firearms for collecting, hunting, or self-defense
purposes, which are important to the Indian community. So that is my
amendment.
The PRESIDING OFFICER. The Senator from North Dakota is recognized.
Mr. DORGAN. Mr. President, I have no objection to the amendment. I
know of no cases in which Indian health funds have been used for
firearms programs. So I have no objection to the amendment and intend
to vote for it.
The PRESIDING OFFICER. The question is on agreeing to the amendment.
Mr. DeMINT. Mr. President, I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second? There appears to
be a sufficient second.
The clerk will call the roll.
The legislative clerk called the roll.
Mr. DURBIN. I announce that the Senator from Maryland (Mr. Cardin),
the Senator from New York (Mrs. Clinton), the Senator from Hawaii (Mr.
Inouye), the Senator from Louisiana (Ms. Landrieu), the Senator from
Illinois (Mr. Obama), and the Senator from Michigan (Ms. Stabenow) are
necessarily absent.
Mr. KYL. The following Senators are necessarily absent: the Senator
from Tennessee (Mr. Alexander), the Senator from Texas (Mr. Cornyn),
the Senator from Arizona (Mr. McCain), the Senator from Virginia (Mr.
Warner), and the Senator from Mississippi (Mr. Wicker).
Further, if present and voting, the Senator from Tennessee (Mr.
Alexander) and the Senator from Texas (Mr. Cornyn) would have voted
``yea.''
The PRESIDING OFFICER (Mr. Sanders). Are there any other Senators in
the Chamber desiring to vote?
The result was announced--yeas 78, nays 11, as follows:

[Rollcall Vote No. 29 Leg.]

YEAS--78

Akaka
Allard
Barrasso
Baucus
Bayh
Bennett
Bingaman
Bond
Brown
Brownback
Bunning
Burr
Byrd
Cantwell
Carper
Casey
Chambliss
Coburn
Cochran
Coleman
Collins
Conrad
Corker
Craig
Crapo
DeMint
Dodd
Dole
Domenici
Dorgan
Ensign
Enzi
Feingold
Graham
Grassley
Gregg
Hagel
Harkin
Hatch
Hutchison
Inhofe
Isakson
Johnson
Kerry
Klobuchar
Kohl
Kyl
Leahy
Levin
Lieberman
Lincoln
Lugar
Martinez
McCaskill
McConnell
Murkowski
Murray
Nelson (FL)
Nelson (NE)
Pryor
Reid
Roberts
Rockefeller
Salazar
Sanders
Sessions
Shelby
Smith
Snowe
Specter
Stevens
Sununu
Tester
Thune
Vitter
Voinovich
Webb
Wyden

NAYS--11

Biden
Boxer
Durbin
Feinstein
Kennedy
Lautenberg
Menendez
Mikulski
Reed
Schumer
Whitehouse

NOT VOTING--11

Alexander
Cardin
Clinton
Cornyn
Inouye
Landrieu
McCain
Obama
Stabenow
Warner
Wicker
The amendment (No. 4070) was agreed to.
Mr. DORGAN. Mr. President, I move to reconsider the vote, and I move
to lay that motion on the table.
The motion to lay on the table was agreed to.

Amendment No. 4073 Withdrawn

The PRESIDING OFFICER. Under the previous order, there will be 2
minutes of debate equally divided prior to a vote in relation to
amendment No. 4073 offered by the Senator from South Carolina, Mr.
DeMint.
Mr. DORGAN. Mr. President, on behalf of the sponsor, I ask unanimous
consent that amendment No. 4073 be withdrawn.
The PRESIDING OFFICER. Is there objection?
Without objection, it is so ordered.
Mr. DORGAN. Mr. President, I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Mr. DORGAN. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. DORGAN. Mr. President, with the withdrawal of the last amendment,
there will be no further votes tonight. My understanding is the next
vote starts at 10 tomorrow morning. The withdrawal of the second
amendment on which we were going to have a recorded vote means there
will be no further recorded votes necessary this evening.
Mr. REID. Mr. President, the only question is, I have not had a
chance to confer with my distinguished Republican colleague, Senator
McConnell. We will make a decision as to what time we should start in
the morning. There is a lot of committee business

[[Page S1110]]

going on, and I want to visit with Senator McConnell first.
Mr. DORGAN. Mr. President, I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Mr. SMITH. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.

Amendment No. 3897

Mr. SMITH. Mr. President, I rise today to speak in favor of my
amendment No. 3897. The amendment is cosponsored by Senators Cantwell,
Murray, Crapo, and Wyden. It clarifies section 301(F) of the Indian
health bill regarding innovative approaches to funding Indian Health
Services facilities construction.
The amendment would allow those innovative approaches to include an
area distribution fund. Such a fund would allow the IHS to take a
portion of facility construction dollars and cede that money to all 12
IHS areas throughout the country.
To be clear, my amendment neither creates an area distribution fund
nor does it require the IHS to do so; rather, we are simply giving IHS
the authority to do what is needed to bring equity to the system.
Currently, the vast majority of Federal funding for construction and
modernization of tribal health care facilities goes to tribes in less
than 10 States. In fact, my home State of Oregon, among many other
States, has never received funds to build an Indian Health Services
hospital. This is a function of the current flawed construction formula
and of the regrettably low levels of funding for IHS, particularly its
facilities construction budget.
These two wrongs, however, do not make a right. To correct this, it
will take a two-part process: one part to increase funding for IHS and
its construction budget, but this is an appropriations issue. Another
is to amend the language in the Indian health bill to create some level
of parity in the way IHS funds construction projects, and that is an
authorizing issue.
As we debate today about the authorization of health care funding, I
stand here to represent all the tribes that do not have access to
funding to improve or build health care facilities because of an
archaic formula. If tribes do not have access, no amount of
appropriations will make a difference. We have to create the access,
and my amendment would do just that. Again, it would authorize, not
require, the IHS to use an area distribution fund.
The amendment would not rob one IHS area to pay for another. It
simply allows other tribes across the Nation to also be eligible for
funding. This area distribution fund is not the idea of a single
Senator or a single region of the country. It is the product of years
of work and compromise by the Indian Health Services and tribes after
Congress recognized the need to create a more equitable facilities
construction system.
This approach is supported by tribes and area health boards that
cover IHS areas representing over 400 of the 562 federally recognized
tribes that are based in 39 States. For Members and staff currently
listening to my floor statement, allow me to read a list of the States
where IHS areas want the type of flexibility provided by my amendment.
To my colleagues in the Senate, if they have the privilege of
representing Native Americans, I hope they will listen to find out if
their State is mentioned because, right now, if they are mentioned,
they are not getting any construction dollars. It is that simple.
The Nashville area, which serves 28 States, includes these States:
Maine, Pennsylvania, Virginia, West Virginia, New Hampshire, Vermont,
Maryland, Ohio, Massachusetts, Rhode Island, Connecticut, North
Carolina, South Carolina, New York, New Jersey, Delaware, Kentucky,
Indiana, Tennessee, Georgia, Florida, Alabama, Illinois, Missouri,
Arkansas, Louisiana, Texas, and Mississippi. Then the Bemidji area
which serves three States: Minnesota, Wisconsin, and Michigan; the
Alaska-California areas which serve those States; the Oklahoma area
which serves Oklahoma and Kansas; the Portland area which serves
Oregon, Washington, and Idaho. Additionally, many tribes in Nevada also
support this amendment.
The State of the Presiding Officer was mentioned, and so was mine.
Mr. President, you are getting no construction dollars because of the
way this is managed.
Last May, during an Indian Affairs Committee meeting, we were doing a
markup on the Indian Health Care Improvement Act. I filed a much more
prescriptive amendment which would have mandated funds for the area
distribution fund. I withdrew that amendment in good faith because I
wanted to work with the chairman and the vice chair and my other
colleagues to find a win-win compromise on this issue. Since then
tribes have put in hundreds of hours of work to find a compromise that
could benefit all of Indian country. I have since scaled back my
original amendment to reflect and recognize this compromise between the
majority of the IHS areas.
Unfortunately, my efforts to reach a compromise before floor action
were not successful. Yet I believe this issue is better left to the
Indian Health Services than Members of Congress. That is why my
amendment would simply give them the flexibility to work this out on
their own in consultation with the tribes. Opposition to my amendment
is based on the notion that IHS funds will remain at the slow drip they
are now for the foreseeable future. I wish to change that. I want IHS
facility funds to grow and to flow to every area that needs them. But
then again, that is an appropriations issue and not an authorization
issue, the business before us.

I have already written to the administration in support of increased
IHS funding, and I intend to follow up on that request with the
Appropriations Committee. I am hopeful that request will be met and
that some of those funds would make their way to the 43 tribes in the
Pacific Northwest or to the 25 tribes in the Nashville IHS area or the
40 tribes in the Oklahoma IHS area or the 109 tribes in the California
IHS area, among others across the Nation. My amendment preserves that
possibility for every State and every Native American in Indian
Country.
On numerous occasions, Chairman Dorgan has invoked the words of Chief
Joseph, who said: ``Good words do not last long unless they amount to
something.'' Chief Joseph said those words after being chased by the
U.S. Cavalry out of the Wallowa Valley of Oregon, through the States of
Washington, Idaho, Wyoming, and Montana toward Canada. Chief Joseph
also rightfully said: ``I am tired of talk that comes to nothing.''
I feel the same way. Eight years ago, Congress asked IHS and the
tribes to revise the failed system for allocating facilities funding.
The compromise they reached may amount to nothing without my amendment.
That is why I feel so strongly about this issue. It is not just about
one region or a group of regions, this amendment is about holding true
to the government-to-government relationship the United States holds
with all tribes.
I ask my fellow colleagues to support this amendment to ensure that
all Native American Indians receive the health care they need--the
health care they deserve.
I yield the floor.
The PRESIDING OFFICER. The Senator from North Dakota.
Mr. DORGAN. Mr. President, let me very briefly say that I understand
the point Senator Smith is making. There is not enough money for the
facilities in these programs. There is a $3 billion backlog for
facilities. I am not able to support his amendment, however, and the
difficulty is to create an area-wide distribution fund right this
moment, at a time when we have a priority list and some tribes have
been waiting on that priority list for a long period of time for the
construction that was to begin in their area. I think that would be the
wrong approach.
But I do think we ought to, in a more comprehensive way, on the
Indian Affairs Committee, with the help of Senator Smith and Senator
Murkowski and my colleagues, we ought to try to work through this to
figure out how we do a better job of getting the funding for the
construction that is necessary. I have been to so many facilities that
are terrible facilities in terrible disrepair, and they are desperately
in need of reform and change and new

[[Page S1111]]

construction, and we have to get about the business of doing it. But I
regret I can't support this amendment. He is raising the right
question, just providing the wrong solution, in my judgment.
The PRESIDING OFFICER. The Senator from Alaska.
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.
The PRESIDING OFFICER. The Senator from North Dakota.
Mr. DORGAN. Mr. President, we were expecting to clear two unanimous
consent requests, but I am told that, at the moment, the minority side
has yet to clear them. If we are not able to clear them at the moment,
perhaps we will be able to clear them first thing in the morning before
we go to the votes that will be scheduled tomorrow.
I think we are at a point where we have about two or three votes
remaining and then final passage tomorrow. And that should occur
probably close to midday, which will be a pretty happy occasion for a
lot of folks who have waited a long time for this legislation to pass
the Senate.
I know a couple of my colleagues are waiting to do a colloquy, so if
we are not yet cleared, I think we will try to clear both these
unanimous consent requests tomorrow morning. Our colleagues, I believe,
are not on this subject, so at this point I will defer and we will come
back to this tomorrow morning.
I yield the floor.
The PRESIDING OFFICER. The Senator from Rhode Island.
Mr. REED. Mr. President, I ask unanimous consent to speak as in
morning business and also to engage in a colloquy with my colleague
from Oregon.
The PRESIDING OFFICER. Without objection, it is so ordered.

Childhood Cancer

Mr. REED. Mr. President, I initially wish to make a few comments, and
then I will yield to my colleague from Oregon. Today, I rise to honor
two young heroes and their families. Ben Haight of Rhode Island and
Boey Byers of Oregon were two remarkable young people whose lives were
cut short by cancer, but whose hopes were not.
Of course, when a child has cancer, it deeply affects the parents,
siblings, friends, and extended family. In fact, a pediatric illness
affects the entire family. Even those who don't bear the damage of the
illness bear the pressures, the strains, and the frustrations over
dealing with the serious illness of a child. These two young children
were extraordinary. We mourn their loss and at the same time we
celebrate their lives.
Ben Haight was only 4 years old when he was diagnosed with
neuroblastoma. He fought valiantly, enduring chemotherapy, two bone
marrow transplants, and total body radiation. Ben did not let cancer
stop him from living life. I am told he would dictate his treatment
schedules to his doctors: ``No treatments during science class; have to
be out by 3 to go to Cub Scouts, baseball or soccer.''
Even at a young age, Ben knew a lot about what was important in life.
He cared about others and wanted to help. He held a bandaid drive at
school to donate colorful bandaids to the hospital, which used plain
bandaids to save money. Ben knew that patients enjoyed picking out a
``cool'' bandaid and that this simple pleasure offered them a brief
respite from the rigors of their disease.
Ben's cancer went into remission, but after 2 years it came back. The
doctors gave him 3 months to live, but he was tough. He fought for 2
more years. Ben was 9 years old when he died.
I never had a chance to meet Ben, but I have had the honor of meeting
his wonderful family. His family has turned the tragedy of losing their
son into a message of hope for other families.
Just before Ben died, he and his family enjoyed a special activity
together--swimming with dolphins. Now, the Haight family's mission is
to do all they can to fight cancer and to provide one child a year with
the opportunity to swim with dolphins.
I think there is a sort of symbolic link here between his family and
these dolphins. His father was a career enlisted man in the U.S. Navy,
a chief in our submarine service. Of course, submarines use the
dolphins as the symbol of their service branch. This is a family who
has served the Nation in uniform and who continues to serve the Nation
by fighting hard for other families who are afflicted by childhood
cancer.
Now, Boey Byers was, in her words, a warrior against cancer, and I
was very saddened to learn she has recently passed way. A few months
ago, I had the privilege of speaking with Boey over the phone. She was
full of life and spirit and struck me as very polite, poised, and wise
beyond her years. I wanted to thank Boey for all she was doing to try
to help other kids with cancer. Her passion in life was to find a cure
for her warrior friends, as she called them, so they didn't have to
suffer anymore and so they could live out their dreams and contribute
to this great country.
We must remember there are thousands of children like Ben and Boey
across the country. Each year, there are about 9,500 new cases of
pediatric cancer, the leading cause of death by disease among children
in the United States. While the incidence of cancer in children is
increasing, the causes are largely unknown.
The National Cancer Institute--the NCI--currently spends about $170
million a year on pediatric cancer research, but most of the money goes
toward laboratory research and preclinical testing. While it is
important to test treatments in a test tube, Petri dish, or on animals,
it is equally important to test treatments on humans in clinical
trials.
For example, a recent clinical trial found that for children with
neuroblastoma, less intensive chemotherapy is as effective as more
intensive and toxic chemotherapy.
In 2002, an NCI peer review group of scientists recommended about $50
million in funding for pediatric cancer clinical trials. That level was
never funded, and since then it has been cut, despite biomedical
inflation and the increasing incidence of childhood cancer.
Unfortunately, declining funding has stopped promising clinical trials.
Pediatric cancer researchers expect only flat funding for clinical
trials this year.
We can do better. The Conquer Childhood Cancer Act invests $30
million a year to expand pediatric cancer research and develop
pediatric cancer clinical investigators. The bill also creates a
national childhood cancer registry to track pediatric cancer.
Researchers would be able to contact patients within weeks, enroll them
in research studies, and follow up with them over time. Similar
registries are already in place in Europe. If Europe can do it, we can
do it, and we should do it.
This bill awaits action by the full Senate. It recently reached a
significant milestone, garnering its 51st cosponsor. So even before any
vote, we know for sure a majority of the Senate supports the bill. It
has broad bipartisan support, with 14 Republican cosponsors and the
support of both the majority and minority leaders.
Regrettably, a small minority is blocking this bill, and I call on
the Senate to carry out the will of the majority and pass the bill. It
is my hope

[[Page S1112]]

that in doing so we will intensify our fight against childhood cancer,
so that one day the hopes of Ben and Boey, and thousands of children
like them, will be realized.
Mr. President, I yield now for the purpose of a colloquy with my
colleague from Oregon.
The PRESIDING OFFICER. The Senator from Oregon.
Mr. WYDEN. Mr. President, first, I wish to commend my friend from
Rhode Island for persistently and energetically prosecuting this cause,
because having gotten to know Boey at home and visiting her in the
hospital, I think all of us will understand it is hard to conceive of
anything more tragic than seeing a young person's life claimed by
cancer.
Senator Reed has been educating the Senate on this issue of
importance, of research of this disease. I got to know Boey, and that
is why I am glad he referred to her as a warrior. I would just tell my
colleagues that if Boey had been an elected official, she would have
been the chair of the Warrior Caucus because this very young child
really did not know how to rest in the effort to try to get this
legislation passed and to help our youngsters.
When she was taken from us, she had battled cancer not once but
twice. The first time, she had beaten her cancer into remission. She
lost her second battle, but she simply never rested. The day that I saw
her last in the hospital, what we spent our time on was Boey and I
walking down the halls with Boey trying to cheer up the other
youngsters who were at the hospital. She put aside her own pain and
fear that cancer would claim her life because she wanted to be, as
Senator Reed has noted so eloquently, a warrior for all of the other
children who have been suffering.
I am pleased to be out here with Senator Reed. I think this is
another example of the entire country coming together to try to stand
up for these kids. As Senator Reed has noted, when cancer strikes, it
strikes a whole family. That was the certainly the case with Boey. Her
loving parents, Rob and Rachel, her older brothers, Chris and Joe--all
of us have continued to think about Boey and all she did to brighten
our lives and particularly stand up for our children.
So for purposes of this evening, I simply wanted to ask my friend one
question. This Senate can certainly have spirited debates about a lot
of issues. Senators can have differences of opinion on a variety of
questions, and we come from different parts of the land. The Senator
from Rhode Island represents a State 3,000 miles from mine where Boey
lives. But I am still troubled why the Senate cannot come together and
pass this legislation. I think Senator Reed has made the case and made
it well. He has clearly reached out to colleagues on both sides of the
aisle. Surely, there should be nothing partisan about legislation such
as this that will be so meaningful to children and their families.
For purposes of this evening, I wanted to get a sense from my
colleague of what else he felt we ought to be trying to do to pass this
important legislation and get it on its way to the President.
Mr. REED. I thank the Senator. One of the things we are doing this
evening is once again highlighting the critical importance of this
legislation, the impact it would make in the lives of children and
families across the country. And your voice is a strong voice for not
only this legislation but for issues affecting health care and children
in this country.
I think we are picking up speed, but we need the cooperation of
virtually all of our colleagues, not to pass the bill--we have 51
votes--but to get it on the floor. That is not something unusual here
in the Senate. But I think this is the type of legislation that should
not be caught up in the kind of procedural rules that we all use.
I am going to try to reach out and explain personally what is at
stake, how we have tried to make changes, how we have pursued a
bipartisan approach. I hope we can be persuasive enough to get this
legislation on the floor for a vote. I do not think the opposition,
frankly, is the concept and the mechanisms we are talking about.
Certainly it is not opposition to helping families and children who
have cancer. I think it is caught up in other issues. We would like to
disentangle those issues and focus on what we can for children who have
cancer.
I think that is one of Boey's works.
Mr. WYDEN. One of her many, and you can see her enthusiasm literally
popping out of the drawing. She was an incredibly passionate woman. You
have stated it well. I know of no Members of the Senate who get up in
the morning and say they want to be hostile to children who are
suffering this way. I think a piece of legislation such as this gets
lost in the clutter of the Senate calendar and the business of the
Senate.
All of us have staffers who handle health legislation and staffers
who are serving as legislative directors. I think for purposes of
tonight, particularly given your eloquent remarks, I hope the phone
will ring off the hook in your office tomorrow with Senators and
staffers calling and making clear they want to know more about this
legislation and hopefully be cosponsors so we can get it passed.
Mr. REED. I am encouraged also. It is incumbent upon supporters like
myself and yourself to begin to reach out, which I think we are both
committed to doing, and doing it personally to try to get through. I
think my sense is a lot like yours. It is not an issue that people are
objecting to; it is caught up in bigger issues. And sometimes we just
have to step back and understand that the big issues will still be
there and the points can still be made, but we can get this bill done.
I noticed the warriors in Boey's drawing at the White House. My hope
is one day the President in the White House is going to sign this bill.
She will be there, and Ben will be there in spirit because they are the
warriors, and the young men and women who are helping us in our
mission.
So that is my hope. I think we can do that. We are going to try. If
it is because we have not been as explicit or as communicative as we
should have been with all of our colleagues, that is something we will
correct very quickly.
Mr. WYDEN. I will do everything I can to help. I think the Senator
has said it well. In a sense, his work acknowledges something we all
see every time we are home, and that is that health care has always
been the biggest issue here at home.
The Senator from Rhode Island is someone I admire in so many areas,
relating to international affairs, with great expertise, and obviously
there are many pressing concerns around the world. But the reality is,
here at home, if our loved ones and our families do not have their
health, it is hard to do anything else. I know in the case of Boey and
the wonderful family, Rob and Rachel and her brothers, they were
consumed by this. They all threw everything they had into trying to be
there to comfort Boey, to get her the treatment she needed. So we ought
to do this for the kids, and we ought to do this for the families.
There are a lot of other issues we will be tackling both in health care
and around the Senate schedule. This is something we ought to do now.

Mr. REED. I agree. I think it is something we can do. The effort is
to bring people together and move from 51 to 61 to 71 to 100. I think
we can.
Mr. WYDEN. Well said.
Mr. REED. We have begun in earnest months ago, and we are picking up
the pace. I thank the Senator for his wise and kind words.
I yield the floor.
The PRESIDING OFFICER. The Senator from Kansas.
Mr. BROWNBACK. Mr. President, I ask consent to speak for 10 minutes
in support of the Vitter amendment. I believe there is a time agreement
for 30 minutes on each side of the Vitter amendment.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. BROWNBACK. Mr. President, if my colleagues need to interrupt, I
would be happy to yield to them.
I yield to the Senator from North Dakota.
Mr. DORGAN. I ask unanimous consent that the vote sequence with
respect to S. 1200 tomorrow be as follows: Vitter amendment No. 3896,
Smith amendment No. 3897, DeMint amendment No. 4015, DeMint amendment
4066, and final passage of S. 1200; further, that the cloture motion
with respect to S. 1200 be withdrawn, with no debate time in order
except for 2 minutes prior to each vote; that after the first vote,
vote time be limited to 10 minutes each; all other provisions of the
previous order remaining in effect.

[[Page S1113]]

The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. DORGAN. Mr. President, I further ask unanimous consent that on
Tuesday, February 26, upon disposition of S. 1200, there be a period of
morning business until 12:30 p.m., with Senators permitted to speak
therein, with the time equally divided and controlled between the two
leaders or their designees, with Senator Feingold controlling 20
minutes of the majority time, if available; that at 2:30 p.m., there be
20 minutes of debate prior to a vote on the motion to invoke cloture on
the motion to proceed to S. 2633, with the time divided and controlled
between the leaders, with the majority leader controlling the final 10
minutes prior to the vote; that upon the use of that time, the Senate
then vote on the motion to invoke cloture on the motion to proceed to
S. 2633, with other provisions of the previous order remaining in
effect.
My understanding is that this has been cleared on both sides.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. DORGAN. Mr. President, let me do one small piece of business with
the bill before the Senator from Kansas proceeds.

Amendments Nos. 4019, as Modified, and 4021 to Amendment No. 3899

Senator Murkowski and I wish to have considered two unanimous consent
requests that were originally to have been included in the previous
unanimous consent by which we conducted business today. One is
amendment No. 4021, and one is amendment No. 4019, as modified.
I send both amendments to the desk and ask that they be considered en
bloc and agreed to.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendments (No. 4019, as modified, and 4021) were agreed to, as
follows:

Amendment No. 4019, as modified

On page 298, after line 25, insert the following:

``SEC. 71_. TESTIMONY BY SERVICE EMPLOYEES IN CASES OF RAPE
AND SEXUAL ASSAULT.

``(a) Approval by Director.--
``(1) In general.--The Director shall approve or
disapprove, in writing, any request or subpoena for a sexual
assault nurse examiner employed by the Service to provide
testimony in a deposition, trial, or other similar proceeding
regarding information obtained in carrying out the official
duties of the nurse examiner.
``(2) Requirement.--The Director shall approve a request or
subpoena under paragraph (1) if the request or subpoena does
not violate the policy of the Department to maintain strict
impartiality with respect to private causes of action.
``(3) Treatment.--If the Director fails to approve or
disapprove a request or subpoena by the date that is 30 days
after the date of receipt of the request or subpoena, the
request or subpoena shall be considered to be approved for
purposes of this subsection.
``(b) Policies and Protocol.--The Director, in coordination
with the Director of the Office on Violence Against Women of
the Department of Justice, in consultation with Indian Tribes
and Tribal Organizations, and in conference with Urban Indian
Organizations, shall develop standardized sexual assault
policies and protocol for the facilities of the Service.

Amendment No. 4021

(Purpose: To require a study of tribal justice systems)

On page 347, after line 24, add the following:

SEC. 104. GAO STUDY OF TRIBAL JUSTICE SYSTEMS.

(a) In General.--Not later than 1 year after the date of
enactment of this Act, the Comptroller General of the United
States shall conduct, and submit to Congress a report
describing the results of, a study of the tribal justice
systems of Indian tribes located in the States of North
Dakota and South Dakota.
(b) Inclusions.--The study under subsection (a) shall
include, with respect to the tribal system of each Indian
tribe described in subsection (a) and the tribal justice
system as a whole--
(1)(A) a description of how the tribal justice systems
function, or are supposed to function; and
(B) a description of the components of the tribal justice
systems, such as tribal trial courts, courts of appeal,
applicable tribal law, judges, qualifications of judges, the
selection and removal of judges, turnover of judges, the
creation of precedent, the recording of precedent, the
jurisdictional authority of the tribal court system, and the
separation of powers between the tribal court system, the
tribal council, and the head of the tribal government;
(2) a review of the origins of the tribal justice systems,
such as the development of the systems pursuant to the Act of
June 18, 1934 (25 U.S.C. 461 et seq.) (commonly known as the
``Indian Reorganization Act''), which promoted tribal
constitutions and addressed the tribal court system;
(3) an analysis of the weaknesses of the tribal justice
systems, including the adequacy of law enforcement personnel
and detention facilities, in particular in relation to crime
rates; and
(4) an analysis of the measures that tribal officials
suggest could be carried out to improve the tribal justice
systems, including an analysis of how Federal law could
improve and stabilize the tribal court system.
The PRESIDING OFFICER. The Senator from Kansas.

Amendment No. 3896

Mr. BROWNBACK. I rise to discuss the Vitter amendment to the Indian
Health Care Improvement Act No. 3896. It is an important amendment. I
am a cosponsor.
I want to give a bit of outline on this provision. This codified
within the Indian Health Care Improvement Act a provision that is
referred to as the Hyde amendment that has been public law for some 25
years. Congressman Henry Hyde, whom both the Presiding Officer and
myself served with in the House of Representatives, who passed away
last year, was a giant on the issue, bringing the issue of life to the
Congress, to the country.
The so-called Hyde amendment prohibits taxpayer funding for abortions
other than in case of rape, incest, and the life of the mother. This is
a provision which has really not been contested for some period of the
time because while we have a contentious debate about abortion in the
United States, the level of the contention of the debate is much lower
regarding taxpayer funding of abortion when it involves anything other
than rape, incest, life of the mother. That has generally been agreed
to in this body, that we should not use taxpayer money in those
particular situations.
What the Vitter amendment does is take that particular provision and
puts it in the Indian health care bill and says that we should not fund
abortions through the Indian health care provisions or Indian health
care facilities other than in cases of rape, incest, or the health of
the mother. Federal taxpayer dollars should not be used. Most people
agree. They may be pro-choice, they may be pro-life, but they are
saying still--most people in this country do not want their Federal
taxpayer dollars used for this purpose. And what we are doing in this
particular provision is codifying within the Indian Health Care
Improvement Act this provision. The Hyde amendment is normally put in
the Labor-HHS appropriations bill. It has typically not been put within
the Interior appropriations bill where Indian health care is normally
funded.
Indian health care legislation being an authorizing piece of
legislation, I think it is important that we codify this particular
provision. This will be a key vote. It will be a key vote on people's
views toward taxpayer funding of these types of abortions other than in
cases of rape, incest and the life of the mother. I would hope that
most of our colleagues would say, even if they are pro-choice: Well, I
do not think that is something we should be doing with Federal taxpayer
dollars. I would hope a number of people would look and say: This is
such a contentious debate and so many people in the country do not
agree with abortion and particularly do not want their dollars, their
taxpayer dollars used to fund selective abortions, that people say:
Okay, you are right, an individual may be pro-choice, but I do not
think we ought to do that in this particular situation, and would then
vote for the Vitter amendment.
It is very carefully drafted. It is narrowly cast. It is a policy
issue where there has been agreement between the House, the Senate, and
the President. There has been agreement on the Hyde amendment provision
for over 20 years, particularly cast on this contentious issue.

That is why I hope colleagues will look at this carefully and say: I
have supported Hyde amendment-type language in the past. This makes
sense. It is a commonsense provision.
I hope my colleagues will support the Vitter amendment because of
this particular provision and will agree that it makes sense to them as
well.
Overall, it is a contentious issue, but this particular provision
should not be. I urge my colleagues to look at it carefully and see if
they could not support the Vitter amendment. I strongly urge its
passage.

[[Page S1114]]

I ask unanimous consent that any time I did not use be kept on the
Vitter amendment.
I yield the floor and suggest the absence of a quorum.
The PRESIDING OFFICER. Without objection, it is so ordered.
The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Mr. THUNE. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. THUNE. Mr. President, I am pleased we are making headway and are
approaching finality and conclusion in regard to the Indian Health Care
Improvement Act. I give great credit to Senator Dorgan from North
Dakota and Senator Murkowski from Alaska for their persistence in
working with the leaders on both sides to get this legislation moved
and ultimately adopted.
It has been a long time since we have had the Indian Health Care
Improvement Act reauthorized. I think it goes back to about 2001. So
this is a long overdue step toward attempting to improve health care
throughout Indian Country, and I applaud the work that has been done. I
hope tomorrow we can dispose of the final amendments that remain and
get to a final vote on this legislation so we can begin to address what
are some very serious needs regarding Indian Country and health care.
I wish to specifically acknowledge a couple of amendments--one that
is still pending and one that has been adopted.

Amendment No. 3896

First, Mr. President, I wish to speak to the Vitter amendment, which
is going to be voted on tomorrow. If adopted, this amendment would
codify longstanding policy against the funding of abortions with
Federal Indian Health Service funds.
Senator Vitter's amendment would permanently apply to the IHS the
policy set forth by the Hyde amendment, which prohibits the Federal
funding of abortions and has been national policy since 1976. For over
30 years, Democratic and Republican administrations, the U.S. Supreme
Court, and bipartisan Congresses have all upheld and affirmed this
essential policy. In addition to maintaining this legislative
precedent, amendment No. 3896 includes important exceptions to save the
life of the mother or in cases of rape or incest.
Now, some of my colleagues may ask why statutory codification of this
policy is necessary. Let me assure them it is necessary to ensure this
decades-long legislative precedent does not fall needlessly through
procedural and political cracks.
Without this amendment, there is no true assurance that Federal IHS
funds will not be used to pay for abortions on demand in the future. As
everyone in this Chamber knows, the language of future HHS
appropriations bills depends upon a host of political and legislative
contingencies which can shift suddenly and unpredictably.
This amendment would extend and codify good policy--policy that
protects the vulnerable rather than restricting rights. The Federal
Register contains scores of national policies that are in place to
protect women, young children, and citizens of minority status from
harm.
Abortion is a practice that can harm women physically, emotionally,
and spiritually. Statistics clearly demonstrate that abortion in this
country falls disproportionately on minority populations, including
Native Americans.
By supporting this amendment, we affirm life. As a nation we have
come a long way in protecting the unborn since the Supreme Court's
decision in Roe v. Wade. However, we still have a long way to go in the
fight to protect life in this country. I believe there is an essential
human dignity attached to all persons, including the unborn, and I will
continue working with my colleagues in the Congress to promote a
culture of life in this Nation.
As a cosponsor of this amendment, I offer my strong support of
amendment No. 3896, and I urge my colleagues to support it.
I hope when the vote comes up tomorrow, we will have a good, strong
bipartisan vote in support of this amendment.
Mr. President, I see the majority leader has come on the floor. I
yield to him at this time. I assume he has some business to dispose of.
The PRESIDING OFFICER. The majority leader is recognized.
Mr. REID. Mr. President, I very much thank my distinguished friend
from the State of South Dakota who has, certainly, intimate knowledge
of Native Americans. His State, I think, has one of the largest
reservations in the country and one of the poorest all at the same
time.

____________________