Ben Nighthorse Campbell

Mr. President, I am pleased to provide for inclusion in the Congressional Record, the final cost estimate for S. 556, the Indian Health Care Improvement Act Amendments of 2003 prepared by the Congressional Budget Office.

This estimate had not been completed in time to be filed with the Senate Report No. 108-411 on S. 556 that was filed on November 17, 2004.

S. 556 would reauthorize the Indian Health Care Improvement Act which sets forth the statutory framework for the Indian health system and was first enacted in 1976. The act was reauthorized in 1992. The goal of the 1976 act, as amended, is to raise the health status of Indians to achieve parity with that of other Americans.

American Indians and Alaska Natives rank at or near the bottom of nearly every health indicator when compared to the general U.S. population. Health studies indicate disproportionately higher mortality rates of alcoholism, between 670-770%; tuberculosis, 650%; diabetes, between 318-420% accidental injuries, 280%; suicide, 190%; and homicide, 210%, than other populations.

With the basic goals of the Act unrealized, the need for reauthorization grows greater. S. 556 would have provided an additional set of improvements to the Indian health care system--most notably, for facility construction, access to care through Medicaid cost-sharing waivers, and long-term planning through the establishment of a bipartisan commission to study the Indian health care system.

The reauthorization bill has been a work in progress since the 106th Congress when I introduced a bill to reauthorize the act. I have introduced a bill to reauthorize the act in every subsequent Congress. Over the course of the past three Congresses, the Committee has held eight hearings on the reauthorization with four hearings held in the 108th Congress alone.

I was particularly pleased to have Secretary Thompson testify before the Committee on July 21, 2004, regarding the administration's views on the proposed legislation. At this hearing, the Secretary expressed enthusiastic support of the proposed legislation and his desire to see it enacted this year.

This show of support was particularly important because we had been anticipating the administration's view for several months and were fast coming to the end of the 108th Congress.

At the hearing, Secretary Thompson committed his staff to immediately begin meeting with the bill committee staff to work on the bill. Much effort to advance this legislation had already been put forth by committee staff, tribal leaders and the Indian health community. With department staff working alongside committee staff, we anticipated swift passage of the bill.

However, swift passage did not happen and I am disappointed that the reauthorization did not get enacted this year. The committee staff worked diligently along with the administration and Indian tribal leaders until the very end of this Congress to finalize the bill for passage.

I believe that, in addition to the changes made prior to July, 2004, the committee was quite responsive to the department's concerns and suggestions in revising the bill.

In particular, the provisions for Medicare and health professional shortage areas were not included in the reported bill. The committee modified the establishment of creative funding programs such as the revolving loan funds and opted for studies for this type of funding mechanism instead--at the request of the administration.

There was substantial discussions at the eleventh hour regarding provisions governing urban Indians and non-eligible individuals. I believe the Federal responsibility to provide health care applies to individual Indians living in the urban centers, especially when it is remembered that Indians reside in urban areas primarily as a result of the Federal policy of relocation during the first half of the 20th Century.

In addition, in the course of negotiations, we were made aware of concerns dealing with the Veteran's Administration drug supply schedules and services to non-eligible individuals. A limited scope of services to certain non-eligibles has been a part of the Indian Health Care Improvement Act for years. Nevertheless, the Department and some tribes have different views of the scope of services.

In any event, the matter is being addressed in the courts. Any resolution we could offer would be better served by reviewing the decision of the courts and then thoroughly examining the matter instead of fixing what has not been determined by the courts to be a problem.

Likewise, I am concerned with what may be a desire to rollback the gains tribes have made in implementing the Indian Health Care Improvement Act and the Indian Self-Determination and Education Assistance Act.

The underlying policies and plain language of the both statutes should not be ignored and the commitment to self-governance needs to be respected when enacting any Indian legislation.

I certainly appreciated President Bush's Memorandum to Department Heads on ``The Government-to-Government Relationship with Tribal Governments'' dated September 30, 2004, in which he reiterated his support for the government-to-government relationship and tribal sovereignty. President Bush continued the long-standing policy of self- governance begun in 1970 by President Nixon.

The committee has continually upheld those principles and fought for expansions in self-governance, even over the objections of previous Administrations. I believe that retreating from those principles in enacting any Indian statutes would be inconsistent with the President's commitment as well as the will of Congress.

What I am particularly disappointed in having to set aside this year is the State Children's Health Insurance Program, SCHIP, improvements that we had worked on for several months. In mid-May, 2004, we were informed that the department lacked information regarding how many Indian children qualified for the program and how many Indian children were actually being served, despite clear statutory language mandating services to Indian children. Yet again, we find the most needy must continue to suffer until there is a serious effort to address these disparities.

There were many other Senators and committees which provided substantial assistance in seeking passage of this bill. Without the commitment and support of Majority Leader Bill Frist, we certainly could not have gotten as far as we did.

Senator Frist was constructively engaged very early on this bill and continued his support throughout the negotiations with the Administration.

Senator Stevens was also very supportive and committed to passage of this bill. His staff worked diligently also with the committee staff until the very end of the session.

Likewise, Senator Grassley also committed his staff in assisting the committee staff in developing significant improvements in the Medicaid provisions.

I cannot forget the work of Senator Hatch on this matter as well. Senator Hatch was instrumental in developing the Indian provisions in the SCHIP statute and assisted in seeking resolutions for many of the problems we found in SCHIP implementation.

I am leaving the Senate knowing that there are many issues left unresolved but I have every confidence that the Committee under the leadership of Senator McCain will continue to protect tribal sovereignty and uphold principles of tribal self-governance.

I do look forward to seeing a vigorous discussion on the reauthorization next year and believe that coordinated efforts ensure its passage.

I ask that the CBO cost estimate be printed in the Record.

S. 556--Indian Health Care Improvement Act Amendments of 2004

Summary: S. 556 would authorize the appropriation of such

sums as necessary through 2015 for the Indian Health Care

Improvement Act, the primary authorizing legislation for the

Indian Health Service (IHS). The bill also contains specific

authorizations for loans and loan guarantees for urban Indian

organizations and a commission on Indian health care. In

addition, the bill also would affect direct spending,

primarily through provisions that would make it easier for

IHS to enter into capital leases and make changes to the

Medicaid program.

CBO estimates that implementing S. 556 would cost $2.4

billion in 2005 and $31.8 billion over the 2005-2014 period,

assuming appropriation of the necessary amounts. We also

estimate that enacting the bill would increase direct

spending by $8 million in 2005, by $69 million over the 2005-

2009 period, and by $238 million over the 2005-2014 period.

S. 556 would preempt state licensing laws in certain cases,

and this preemption would be an intergovernmental mandate as

defined in the Unfunded Mandates Reform Act (UMRA); however,

CBO estimates that the costs of that mandate would be small

and would not approach the threshold established in UMRA ($60

million in 2004, adjusted annually for inflation). Other

provisions of the bill would establish new or expand existing

programs for Indian health care. It also would place new

requirements on Medicaid and the State Children's Health

Insurance Program (SCHIP) that would result in additional

spending of about $35 million over the 2005-2009 period. This

bill contains no private-sector mandates as defined in UMRA.

Estimated cost to the Federal Government: The estimated

budgetary impact of S. 556 is shown in Table 1. The costs of

this legislation fall within budget function 550 (health).

Mr. President, as a veteran who served in Korea, I have, throughout my congressional career, vigorously sought to ensure that our men and women in uniform who were listed as POW/MIA are not forgotten. I have also worked hard to promote a better understanding and appreciation of these brave men and women's extraordinary service and sacrifice by the American public.

Underscoring this commitment, I was proud to have authored a number of

important laws, including the POW/MIA Memorial flag Act of 2001, P.L. 107-323; the Bring Them Home Alive Act of 2000, P.L. 106-484; the Persian Gulf War Accountability Act of 2002, P.L. 107-258; and the Vietnam Veterans Recognition Act of 1999, P.L. 106-214. I want to take this opportunity to also commend my deputy chief of staff and legislative director, Larry Vigil, for all of his good work in getting these important initiatives passed on behalf of all Americans.

As my colleagues know, the United States has fought in many wars and thousands of Americans who served in those wars were captured by the enemy or listed as missing in action. In the 20th century wars alone, more than 147,000 Americans were captured and became prisoners of war. Of that number, more than 15,000 died while in captivity. When we add to this number, those who are still missing in action, we realize that we cannot do enough to not only remember their service, but to bring them back home alive.

Our mission is far from over. Today we continue to look for Capt. Michael Speicher from the 1991 Persian gulf war and PFC Keith ``Matt'' Maupin who went missing in action in Iraq on April 9, 2004. To that end, we must remain fully committed to leave no one behind and push for a full accounting for those who are still missing. We must spare no effort to bring them home.

The power of our democracy and the strength of our society comes from acknowledging our interdependence on each other. In our best moments we know full well that the commitment of so many in the military service has made our Nation and our lives fuller and more complete.

I commend Danny ``Greasy'' Belcher with Task Force Omega of Kentucky for his tireless efforts in bringing awareness to the POW/MIA issue and organizing national support for many of these successful legislative initiatives. I also thank Artie Muller, president of Rolling Thunder National, for his continued years of work on the POW/MIA issue and the National League of POW/MIA Families, the National Vietnam and Gulf War Veterans Coalition, VietNow and Veterans of the Vietnam War, Inc., and others.

As I conclude my tenure in the United States Senate, I challenge my colleagues and those who will follow in my footsteps to continue this valuable and necessary work to support the friends and families of those who are POW/MIA.

Mr. President, as a former Sacramento County, CA, sheriff's deputy, I have, throughout my congressional career, zealously sought to ensure the safety and effectiveness of America's Federal, tribal, State and local law enforcement officers. I have also worked hard to promote a better understanding and appreciation of law enforcement's extraordinary service and sacrifice by the American public.

Underscoring this commitment, I was proud to have authored a number of important laws, including the National Law Enforcement Museum Act (P.L. 106-492); the Law Enforcement Officers Safety Act of 2003 (P.L. 108-277); the Bulletproof Vest Partnership Act (P.L. 106-517); the Cops in School Act of 1998 (P.L. 105-302) and the resolution passed each year to designate May 15 as National Peace Officers Memorial Day. I want to take this opportunity to also commend my deputy chief of staff and legislative director, Larry Vigil, for all of his good work in getting these important initiatives passed on behalf of law enforcement.

As I conclude my tenure in the U.S. Senate, I challenge my colleagues and those who will follow in my footsteps to continue this valuable and necessary work to support those brave individuals who are putting their lives at risk each and every day for our safety and protection. There are currently some 870,000 sworn law enforcement officers serving our Nation. Each year, on average, 167 officers are killed in the line of duty--that is one officer killed somewhere in America every 53 hours. Roughly 58,000 officers are assaulted each year, resulting in about 17,000 injuries. It is the most dangerous profession in our Nation, and also one of the most important.

An inscription on the National Law Enforcement Officers Memorial, just a few blocks from here in a place called Judiciary Square, says it best: ``In valor there is hope.'' As long as there are men and women among us who are willing to put their lives on the line for others, there is indeed great hope for this Nation of ours.

But, it must be remembered that our officers cannot do their job effectively or safely without the necessary resources. This means the best possible training and equipment, especially bullet-resistant vests for every officer. Studies have clearly shown that these vests save police lives. In fact, nearly 3,000 police lives have been saved by bullet resistant vests since they first started being used some 30 years ago.

But, another vital resource that our officers need is the trust and support of the American public they serve. That is why one of my proudest achievements as a legislator and former law enforcement officer was authoring the law to establish a National Law Enforcement Museum here in our Nation's capital. The U.S. Department of Justice has determined that only about one out of five Americans has any direct contact with a law enforcement officer during the course of a normal year, and most of those contacts are traffic stops. The fact is that most of our citizens draw their conclusions about law enforcement from the fictional works of Hollywood and the often sensationalized reporting by the media. Most Americans do not truly understand, nor fully appreciate the tremendous worth of the law enforcement profession to our Nation.

But all of that will soon change when the doors of the National Law Enforcement Museum open, which is expected to happen in 2009. Finally, we will have a popular destination here in Washington, DC, devoted to telling law enforcement's true story of selfless service and supreme sacrifice. Through some of the most entertaining and stimulating exhibit ideas I have ever seen for a museum, visitors will experience what it is like to walk in the shoes of a police officer, and to make split-second, life-or-death decisions. They will understand the vital roles our officers played in every pivotal moment of our Nation's history, including the taming of the Wild West, and the wars against gangsters, drug lords and now, terrorists. In short, this museum will vastly increase public understanding and support for law enforcement, and the museum's research repository will contribute greatly to promoting police safety. It will truly be a must-see destination in our Nation's capital and, appropriately, it will be located right across the street from the National Law Enforcement Officers Memorial.

I want to commend Craig W. Floyd, the chairman of the National Law Enforcement Officers Memorial Fund, his talented staff and dedicated board of directors for working so hard to make this museum a reality, just like they made the National Law Enforcement Officers Memorial a reality in 1991. Neither of these projects would be successful, though, without the generous funding provided by citizens and corporations across this country and I am grateful to see that support pouring in for the museum.

I pledge my continued full support for this museum project and I challenge my colleagues to do the same. That means ensuring that during the public approval process the integrity and importance of this museum as a major visual presence in Judiciary Square must not be compromised in any way.

Those dedicated public servants of the law enforcement profession-- especially the more than 16,500 officers who have made the ultimate sacrifice in the performance of duty, and their families--deserve no less.