Byron Dorgan

Mr. DORGAN

Mr. DORGAN. I suggest the absence of a quorum.

Mr. DORGAN. Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. DORGAN. I know my colleague, Senator Coburn, is here. He is going to offer an amendment. I should tell you how pleased I am. Senator Coburn indicated he would be here around 2 o'clock. He was good enough to come this morning at 9:30 and engage in discussion on this bill. But we have discussion about virtually everything about the bill on the floor of the Senate, Indian health care. The fact is we have had all kinds of amendments that have nothing to do with the bill. I hope we can finally get this moving. I had spoken this morning of some people whose experience with the Indian health care system and the lack of health care for American Indians has been devastating. Some people died as a result of not having access to adequate care that we would take for granted in our country. Let me mention my colleague from Oklahoma is on the floor and is going to discuss one of his amendments. You know, we have a trust responsibility. We have a responsibility to keep a promise we have made in treaty after treaty for Indian health care. I do not think there is a disagreement on the floor of the Senate about that. There is no disagreement that we have a responsibility, that responsibility is in writing in all kinds of treaties. So we have made the promise; we have not kept the promise. Let me make one final point. There is no group of Americans who have served this country in greater percentage of their population than American Indians. You take a look at the percentage of veterans who have served this country in wars and during peacetime, no population has had a greater percentage of people who have gone to serve America than American Indians. I told my colleagues once previously about a Sunday morning in Fargo, ND, at the veterans health care facility, veterans hospital, where a veteran named Edmond Young Eagle was dying of lung cancer. I did not know it that day, but he would die 7 days later of lung cancer. He was a man who lived on an Indian reservation. When called by his country, he served in Africa during the Second World War, at Normandy, throughout Europe, served with great distinction. He came back. He never had very much, lived a tough life, didn't have many relatives. At the end of his life his sister asked if I could get his medals he had earned but never received. I did. I took them on a Sunday morning to the veterans hospital in Fargo, to this man who was in his mid- to late-seventies, a World War II veteran, had a tough life, never had very much, was dying of lung cancer. We cranked up his hospital bed to a seated position. He was a very sick man but very well aware of what was going on. I pinned a row of medals on his pajama top at the veterans hospital. The doctors and nurses from the hospital packed into his room. This proud man said to me, as I pinned his medals on his pajama top: This is one of the proudest days of my life. This is a man who had a difficult time in life. He never had very much but served his country when asked in Africa, in Europe, fought for his country. Many years later, just prior to his death, he was recognized by his country, as I told him: A country that is grateful for your service. There are so many who have provided so much service from Indian reservations, from Indian nations. We have made a solemn pledge to the Indians--we signed it into treaties; we have it as a trust responsibility--we will provide for your health care. As my colleague from Oklahoma said this morning, take a look at Medicare, Federal prisons, Indian health, a whole range of things. Just to take Federal prisons as an example, we spend twice as much per person providing health care for prisoners as we do meeting our responsibility to provide health care for American Indians. That is a disgrace. It has to change. I can't tell you how pleased I am to see my colleague from Oklahoma because we have had so many amendments that have so little to do with the underlying bill. I know my colleagues have offered a number of amendments that deal directly with it. I yield the floor.

Mr. DORGAN. Mr. President, I thank my colleague for coming and debating the amendment. I understand he has to leave. The Senator from Oklahoma certainly is right, it is not more money necessarily that is only going to solve the problem. But I guarantee you that less money will not solve the problem. If we are 40 percent short of money needed now, I guarantee you that the same amount of money will not solve the problem. The amendment he has offered has a provision that says we are going to do something different, we are going to do something that is unique, and, by the way, you cannot spend any more money than you are now spending in a system that is already 40 percent short of money. How can we have an amendment that restricts the amount of funding? When he says that--he started this morning by saying we are $2 billion short. It is interesting, I do not necessarily disagree with the proposition of trying to find choices, providing an insurance card, or some other mechanism by which we create some competition with the Indian Health Service. But this may be much better for Oklahoma than it might be for other States. If you have an Indian Health Service area where you are in an Indian reservation 80 miles from the nearest hospital, and the only health care capability you have is to go to the Indian Health Service, well, you know what, we better have adequate funding for that, at least current funding for that. If you add another program on top of this for other Indians who can go somewhere else in a metropolitan area and be able to present a card, because they have now taken money out of the system and purchased their own insurance--you allow that to happen, then the American Indian who is living on the reservation with the current Indian Health Service clinic there has less money. How does that work to help the folks who are stranded with no competition? It seems to me the way this is written, with a restriction that says there cannot be any additional resources beyond that which currently exist--and, by the way, the President wants to cut that. We have wide-scale health care rationing going on in this country, with people dying because of it, and the President's budget cuts it. My colleague says: I will support--quoting him--increased funding, increased authorization. But the amendment he authors actually restricts the amount of money available. In order to do something new, if you are going to restrict the amount of money available to what is available now--if you are going to do something new--it is going to come from some place. I will tell you where it is going to come from. It is going to come from clinics out in those reservations where there is no choice. There is only one opportunity for somebody who has broken an arm or developed an illness or disease and needs to go someplace quickly to find health care. They are going to go to the local Indian health clinic. This money is going to come out of their hide because this amendment offered provides a restriction that no additional resources can exist. I do not denigrate the idea offered by the Senator from Oklahoma. But this clearly is not something that would be helpful to a lot of American Indians. In fact, I believe it would be hurtful to a lot of American Indians who are the ones who have no choice--who have no choice at all--but must try to get their emergency care and must try to get their basic health care met at those clinics. I mentioned this morning a woman named Harriet Archambault whose health care was in McLaughlin, SD, in a satellite clinic of the Indian health care facility for the Standing Rock Tribe in Fort Yates, ND. That was her health care: the McLaughlin, SD, satellite clinic. They can handle 10 people in the morning and 10 people in the afternoon. That is it. If you are not on the list of 10, that is it, and you cannot make a reservation. You come and you sign in. Well, she came five times, drove 18 miles one way each time. Five times she came, and 5 times she was too late to be in the top 10. She could not stay because she was taking care of her grandchildren. She was the daycare provider for her grandchildren. Her medicine had run out for hypertension and high blood pressure in mid-October. Five times she got up early in the morning to drive nearly 20 miles, and she did not get there in time. There were 10 people on the list ahead of her. One month later she died. She tried five times and never got there, in a remote satellite location. The fact is, people are dying. Children are dying. Elders are dying. There is not nearly enough money to keep the promise this country made to American Indians. The amendment offered today is one I am very interested in working with the Senator from Oklahoma on in a significant reform package in which we dramatically increase the resources to keep our promise, and then try to provide some competition and some choice. I am interesting in doing that, frankly. I am not interested in passing an amendment that says, let's do this in a way that restricts funding for others, which is what this amendment does. There is a specific restriction on funding, and that means there is going to be less funding for those clinics, including the satellite clinics. That is not something I am willing to entertain. But, again, I appreciate finally getting an amendment offered. My colleague indicated he will be back. I indicated earlier we are at parade rest because one of our colleagues apparently has an objection, through his staff, through leadership, and he is off, apparently, at a meeting downtown, and has a speech, and he will be back sometime around 3:30 maybe. But in the meantime, through his staff, we are told we are not able to move on anything. I have a managers' package that is agreed to, I believe, and I want to send it to the desk in a moment. My understanding is, we cannot move to embrace it despite the fact it would be a unanimous consent, because one of our colleagues is downtown and will not be back for an hour and a half. That will make him gone for 3 hours. In the meantime, we sit here with our hands in our pockets trying to figure out how on Earth we explain this is a body that is supposed to get something done. I said this morning I have often called this place 100 bad habits, despite the fact I feel enormously privileged to be here. I love the Senate. But I am not very happy about the way this place works today because we deal with an important issue that is life or death to some people, and we are having a difficult time. Senator Murkowski has worked on this bill with me for a long period of time. Before her, Senator McCain worked on this legislation. We are finally on the floor of the Senate, and because of things that have nothing at all to do with this bill, we are standing here frozen because somebody is gone, apparently.

Mr. DORGAN. Mr. President, I am happy to.

Mr. DORGAN. Mr. President, this is this third day we have been on the floor of the Senate. Our hope was this would be the day in which we complete action by late this afternoon. Obviously, it does not appear that way.

Mr. DORGAN. Mr. President, I am told one of our colleagues, who is upset about something, has gone off to give a speech downtown at a meeting and will not return for a while. His staff indicates we are not to move without his consent, and he won't provide consent until he comes back, if then.

Mr. DORGAN. Madam President, with the permission of the Senator from Oklahoma, let me ask if he might also discuss his second amendment.

Mr. DORGAN. Thank you very much.

Mr. DORGAN. Madam President, we look at this and, in many ways, see the same side. I think the Senator from Oklahoma and I see a situation in which gripping poverty exists in many areas, joblessness, inadequate health care. The Senator from Oklahoma is correct there are circumstances--I have been there, I have seen them--where the health care is wonderful. I toured a clinic recently and the doctor--a wonderful doctor at that clinic working for the Indian Health Service, who is very dedicated and by all accounts a terrific doctor--said to me: You know, we are waiting for this new x-ray equipment that is supposed to come. The waiting room is full, by the way. The building is in disrepair, it is an old building, but the doctor is giving me a tour, and he says: We are waiting for this x-ray machine which is really going to help us out. I said: How long have you been waiting? He said: Two years. I said: What is the trouble? He said: Well, I wish I knew. It is paperwork. Can't get it through the regional office. The money is there. The money is there for it, but we can't get the regional office to get the paperwork done to get the x-ray machine. So the Senator from Oklahoma and I both know there are circumstances where there is unbelievable bureaucracy that is almost shameful, and nothing gets done. There are other areas where there is sterling medical care by men and women who, in that service, get up every morning and say: I want to make a difference in the lives of people. So all of that exists. The point I have been trying to make most of today is when you have 40 percent of the health care needs unmet, we are in a desperate situation. We need to fix that. The Senator from Oklahoma has talked a lot about reform, and I am very anxious, when we get this bill done--we will get it out of the Senate, we will get it to conference, and hopefully get it signed into law by the President. We will, for the first time in nearly a decade, have advanced an improvement in Indian health care. I am very anxious to turn immediately--and the Senator serves on our committee--to work with him and Senator Murkowski from Alaska to say: All right, now, let's put this on a different course with a much bolder, a much bigger bite, to try to figure out how we dramatically improve health care. That would not be done unless we have substantial additional income as well. But income is not going to solve the problem by itself. You need reform. It is interesting. When the Senator talked earlier today about giving American Indians the opportunity to go someplace with a card and say: Here is my health care coverage--I am in favor of that. But that card would not do much good for somebody who is sick and is living, for example, in Fort Yates, ND, because the only option they have is to go to that Indian Health Service or they can get in the car and drive a fairly long way to find a hospital someplace. So we need to address these issues. I want the Indian Health Service to be better, to be more effective, to provide better health care for American Indians, and I want to reform the entire system to see if we can establish competition where competition will work. I know Senator Coburn will readily agree there are places in the country where you can't even talk about real competition because you are living way out, way away from any other facilities, and all that exists is the Indian health care facility. If I might make one additional point I understand why--I quoted Chief Joseph this morning. I understand why American Indians are a little skeptical. They have been lied to, cheated. They have had their agreements in writing, and they haven't been worth the paper on which they are written. It is pretty unbelievable when you think about it. We have all seen this, the promises that were made but never, ever kept. The purpose of today and the purpose of our work is to say: You know what. These were the first Americans and we have certain obligations to them and we must do a better job of meeting those obligations. So I don't know that I was particularly responsive to the Senator from Oklahoma, but both of us want the same thing, we end up wanting exactly the same goals out of this debate. And my hope is, working together during the next couple of years we will take two steps, both in the right direction and both in a constructive way to help American Indians.

Mr. DORGAN. Madam President, I ask unanimous consent that when we do vote at 4:30, we vote on amendment No. 4036 first and amendment No. 4032 second, and that there be 2 minutes between the votes, a minute on each side, and that there be no intervening second-degree amendments.

Mr. DORGAN. Well, it sounds that way. But we will see. Again, it is very frustrating. We have worked very hard to bring this legislation to the floor of the Senate. I know a lot of people are counting on the Congress to do the right thing. My hope is we can move forward. I think we have about four amendments we have cleared. We have a managers' package that is cleared. We will get votes on the Coburn amendment, which is germane, right on target, on the bill. So there is no reason we cannot move forward and get this piece of legislation done.

Mr. DORGAN. Mr. President, I yield the floor.

Mr. DORGAN. Mr. President, my understanding is that we were going to voice vote this amendment. Senator Mikulski is in the room, and she will want to call up her amendment No. 4023. My hope is that we could agree to these two amendments en bloc by voice vote.

Mr. DORGAN. Mr. President, both amendments have been cleared. I ask for a favorable consideration of the two amendments.

Mr. DORGAN. Mr. President, I suggest the absence of a quorum.

Mr. DORGAN. Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. DORGAN. Mr. President, I ask unanimous consent that the Senator from Hawaii, Mr. Akaka, be recognized for 7 minutes as in morning business.

Mr. DORGAN. Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. DORGAN. Mr. President, I have a unanimous consent request that has been cleared on both sides, to clear some amendments that are agreed to. I ask unanimous consent that the pending amendment be set aside so that I may call up the following amendments en bloc: Coburn, No. 4078, as modified; Vitter, No. 4038; Bingaman, No. 4083.

Mr. DORGAN. Mr. President, Senator Coburn has indicated to me that the pending Coburn amendments will not be dealt with further. Therefore, on his behalf, I ask that the Coburn amendments be withdrawn. I believe Senator Murkowski is with the same understanding. He came to both of us. He offered some of his amendments. He got us to accept other amendments without a vote. We appreciate very much his cooperation. But the other pending amendments that were accepted originally to be en bloc, we ask they be withdrawn.

Mr. DORGAN. I thank the Senator from Massachusetts for his support.

Mr. DORGAN. Yes. The intent of the provision in the managers' amendment to the bill is to maintain current law. Generally, when Indian health facilities are constructed or renovated, Davis-Bacon prevailing wage rates apply. However, pursuant to current Federal law and longstanding policy of the Department of Labor, Indian Health Service, and Bureau of Indian Affairs, when Indian tribes and tribal organizations construct or renovate federally funded Indian health facilities using their own employees, Davis-Bacon prevailing wage rates do not apply. Our intention in the managers' amendment is to maintain the status quo of current law and policy in these regards.

Mr. DORGAN. Correct, it does not change current law. It is our intent that the prevailing wage provisions in both the Indian Health Care Improvement Act and the Indian Self-Determination and Education Assistance Act will continue to apply when Federal funds are used for the construction and renovation of Indian health facilities, except where such work is carried out by tribal or tribal organization employees.

Mr. DORGAN. That is correct, that is why the managers' amendment restates current section 303 verbatim.