Urban Indian Health Confer Act

Madam Speaker, I move to suspend the rules and pass the bill (H.R. 5221) to amend the Indian Health Care Improvement Act to establish an urban Indian organization confer policy for the Department of Health and Human Services.

Madam Speaker, I ask unanimous consent that all Members may have 5 legislative days in which to revise and extend their remarks and include any extraneous material on the measure under consideration.

Madam Speaker, I yield myself such time as I may consume.

Madam Speaker, H.R. 5221, the Urban Indian Health Confer Act, introduced by Natural Resources Chair Raul Grijalva from Arizona will require agencies and offices within the United States Department of Health and Human Services, or HHS, to confer with Urban Indian Organizations, or UIOs, on policies and initiatives related to healthcare for American Indians and Alaska Natives.

The Indian Health Care Improvement Act established Urban Indian Organizations in response to many American Indians and Alaska Natives living in urban areas and seeking healthcare. Today, approximately 70 percent of all American Indians and Alaska Natives live in urban areas.

The Indian Health Service supports contracts and grants to 41 UIO programs that offer medical services ranging from dental care, optometry, pharmacy services, and community services, such as alcohol and drug abuse prevention, nutrition education, and counseling.

An urban confer policy at HHS will serve as the preferred method of dialogue between the agency and UIOs. Currently, the Indian Health Service is the only agency that maintains a legal obligation to confer with UIOs. This limited scope serves as a barrier for UIOs to communicate with other agencies and offices within HHS.

During the COVID-19 pandemic, the issues with this limited confer policy were, sadly, highlighted. Despite congressional and Tribal support for the inclusion of UIOs and the agency's vaccine allocations, HHS refrained from initiating communications with them. As a result, UIOs were unable to provide input on the vaccine rollout allocations until the deadline, which delayed the vaccine's distribution to many urban American Indians and Alaska Natives.

The failure to communicate with UIOs about healthcare policies that impact urban Indian communities is inconsistent with the Federal trust responsibility and contrary to sound public health policy.

H.R. 5221 will establish direct lines of communication for UIOs across the entire Department and ensure that urban American Indians and Alaska Natives are aware of significant healthcare policy changes.

I want to thank Chair Grijalva for championing this critical bipartisan legislation. I am pleased to be a cosponsor of the bill and I urge quick adoption. I reserve the balance of my time.

House of Representatives,

Committee on Natural Resources,

Washington, DC, October 26, 2021.

Hon. Robert C. ``Bobby'' Scott,

Chair, Committee on Education and Labor, House of

Representatives, Washington, DC.

Dear Chair Scott, I write to you concerning H.R. 5221, the

``Urban Indian Health Confer Act.''

I appreciate your willingness to work cooperatively on this

legislation. I recognize that the bill contains provisions

that fall within the jurisdiction of the Committee on

Education and Labor. I acknowledge that your Committee will

not formally consider H.R. 5221 and agree that the inaction

of your Committee with respect to the bill does not waive any

future jurisdictional claim over the matters contained in the

bill that fall within your Committee's Rule X jurisdiction.

I am pleased to support your request to name members of the

Committee on Education and Labor to any conference committee

to consider such provisions. I will ensure that our exchange

of letters is included in the Committee Report and the

Congressional Record during floor consideration of the bill.

I appreciate your cooperation regarding this legislation and

look forward to continuing to work with you as this measure

moves through the legislative process.

Sincerely,

Raul M. Grijalva,

Chair, Committee on Natural Resources.

Madam Speaker, I yield as much time as he may consume to the gentleman from Arizona (Mr. Grijalva), the chairman of the Natural Resources Committee.

Madam Speaker, I want to, once again, thank Ranking Member Westerman, as well as Ranking Member Don Young and Chair Grijalva, for bringing forth this legislation. It addresses immediately something that we saw that had lingered, but the pandemic shown its ugly light on what happens when we let things linger and do not deal with them. This legislation fixes that. It highlights the importance of communication, of cooperation, and the confer policy that must be adopted across all of our agencies, not only at HHS.

Madam Speaker, I urge my colleagues to support this legislation, and I yield back the balance of my time.

Madam Speaker, as stated before, today marks the first day of National Native American Heritage Month.

I want to thank the gentlewoman from New Mexico, the chair of the Subcommittee on Indigenous Peoples of the United States, Ranking Member Westerman, and Ranking Member Young for putting a package together for Congress to vote specifically on significant bipartisan pieces of legislation that deal specifically with Indian Country. I think it is noteworthy and symbolic, and as you see these pieces of legislation, very much necessary. I want to extend my thanks to all of them for that.

While it is a time to celebrate the histories and achievements of Native Americans in this country, it is also a time for Congress to fully recognize the trust and treaty obligations the U.S. Government owes to Tribal governments and to indigenous people in our country.

Ensuring equity for Tribal healthcare entities is an essential part of the Federal trust responsibility, which is the reason that I am proud to sponsor H.R. 5221, the Urban Indian Health Confer Act.

The accessible and culturally competent healthcare services that Indian Health Services provides to Tribal communities are critical to ensuring their well-being.

As stated by the chairwoman, over 70 percent of American Indians and Alaska Natives began seeking healthcare outside of Tribal jurisdictions in our cities and nonreservation communities across this country. Urban Indian Organizations, UIOs, were created to fill that gap.

Today, IHS supports 41 of these programs that offer vital medical services, including dental care, mental health support, optometry services, and social services, such as nutrition, education, and home healthcare.

Although UIOs have been recognized as critical components of the Tribal healthcare system, they continue to experience parity and recognition of purpose and the attention that they deserve for the services they provide to indigenous people and the family services they provide to nonreservation Native people across this country.

At the Department of Health and Human Services, only IHS maintains an obligation to confer with UIOs regarding any healthcare policy changes that may affect urban Indian communities. This issue became glaringly obvious during the COVID-19 pandemic, when the Department excluded UIOs in the vaccine rollout discussions, leaving urban Indian communities among the last to receive vaccine allocations through their local urban Indian centers.

As a Member of Congress who represents a UIO, the Tucson Indian Center, I am grateful for their essential work to keep Tribal communities safe and healthy, especially as we go into a post-COVID-19 pandemic era.

H.R. 5221 will establish direct lines of communication between UIOs and the Department of Health and Human Services so that UIOs have a seat at the table for all relevant Tribal healthcare policy changes.

Ensuring that UIOs achieve equity at the Department is sound public health policy and upholds the U.S. Government's Federal trust responsibility to Indian Country. H.R. 5221 represents a much-needed change.

Madam Speaker, I urge the quick adoption of this bipartisan legislation.

Madam Speaker, I yield myself such time as I may consume.

Madam Speaker, today, the Indian Health Services Urban Indian Health Program consists of 41 nonprofit programs nationwide.

These programs are funded through grants and contracts from the Indian Health Service, pursuant to the authorities of the Indian Health Care Improvement Act.

Urban Indian health organizations that participate in the program provide services such as information, outreach and referral, dental services, primary care services, community health, and other important services.

In 2010, as part of the Patient Protection and Affordable Care Act, Congress reauthorized and amended the Indian Health Care Improvement Act by adding a requirement that the Indian Health Service confer with urban Indian organizations.

In 2014, the Indian Health Service established a policy to guide when the Indian Health Service seeks input from Urban Indian Organizations on health policy matters.

Other agencies within the Department of Health and Human Services that serve American Indians and Alaska Natives, such as the Centers for Medicare and Medicaid Services, the Centers for Disease Control and Prevention, and the Substance Abuse and Mental Health Services Administration, and others, do not have policies regarding conferring with Urban Indian Organizations.

Throughout the COVID-19 pandemic, Urban Indian health organizations were provided no notice that they were required to make selections for COVID-19 vaccine distribution until the day of the deadline imposed by an agency.

This resulted in Urban Indian Organizations struggling to provide accurate responses to changing public health decisions for Indians living in urban areas.

This bill would amend the Indian Health Care Improvement Act to require all agencies within the Department of Health and Human Services to establish an urban Indian organization confer policy.

I thank the sponsor of this legislation, Chairman Grijalva, and I reserve the balance of my time.

Madam Speaker, I am ready to close, and I yield back the balance of my time.

Madam Speaker, I was regrettably unable to vote on November 2, 2021. Had I been present, I would have voted ``yes'' on all the day's legislation: rollcall No. 342 (H.R. 1975), rollcall No. 343 (H.R. 5221), rollcall No. 344 (H.R. 3616), rollcall No. 345 (S. 108), rollcall No. 346 (H.R. 4881), rollcall No. 347 (H.R. 2088), rollcall No. 348 (H.R. 3469), rollcall No. 349 (H.R. 4256), rollcall No. 350 (H.R. 3462), rollcall No. 351 (H.R. 4481), rollcall No. 352 (H.R. 4531), and rollcall No. 353 (H.R. 4515).

Members Recorded Pursuant to House Resolution 8, 117th Congress

Axne (Spanberger)

Barragan (Gallego)

Bowman (Tlaib)

Brown (Mfume)

Cardenas (Gomez)

Cohen (Beyer)

Crist (Castor (FL))

Davids (KS) (Cleaver)

DeFazio (Blumenauer)

Deutch (Rice (NY))

Doggett (Raskin)

Fletcher (Escobar)

Gaetz (Greene (GA))

Gonzalez, Vicente (Gomez)

Gottheimer (Panetta)

Hagedorn (Carl)

Kirkpatrick (Stanton)

Larsen (WA) (Connolly)

Lawson (FL) (Evans)

Meng (Jeffries)

Morelle (Rice (NY))

Ocasio-Cortez (Garcia (IL))

Palazzo (Fleischmann)

Payne (Pallone)

Pingree (Kuster)

Rush (Underwood)

Schiff (Thompson (CA))

Sires (Pallone)

Smucker (Joyce (PA))

Speier (Scanlon)

Steube (Franklin, C. Scott)

Strickland (Jeffries)

Swalwell (Gomez)

Thompson (MS) (Butterfield)

Thompson (PA)

(Reschenthaler)

Titus (Connolly)

Trone (Beyer)

Wilson (FL) (Hayes)

Madam Speaker, on that I demand the yeas and nays.