Daniel Inouye

Mr. INOUYE

Mr. INOUYE. Mr. President, I just want to say I support my chairman on this matter. I congratulate Senator Byrd for bringing this to our attention because it is an important matter that concerns all Americans. I hope this proposal by Chairman Stevens will be acceptable to all Members of the Senate. I yield the floor.

Mr. INOUYE

Mr. INOUYE. Yes.

Mr. INOUYE. Mr. President, I move to reconsider the vote.

Mr. INOUYE

Mr. INOUYE. Mr. President, I ask unanimous consent that Ms. Kathleen Pierce, a legislative fellow assigned to my office, be afforded floor privileges during the consideration of this measure.

Mr. INOUYE

Mr. INOUYE. Mr. President, I rise to express my very strong support for this measure. The committee has produced a bipartisan bill which reflects well on the committee and on the Senate. It has often been said that foreign policy debates should stop at the water's edge. This bill holds true to that principle. This bill provides for our Nation's defense without letting politics drive the recommendations. I commend our chairman, the Senator from Alaska, for the bill being brought to the Senate this afternoon. This important measure provides the spending necessary for the Defense Department for fiscal year 2004. The total in the bill is about $369 billion, as noted by the chairman. It is $3.2 billion below the amount requested by the President, but it is the same as the subcommittee's 302(b) allocation. Mr. President, I don't intend to reiterate all of the details the chairman has outlined. Suffice it to say that the bill fully funds our military personnel programs, including the authorized pay raise. It provides sufficient funding to meet our readiness requirements for the coming year, and it also increases funding for DOD's critical transformation programs. I wish to inform all of my colleagues that consistent with the administration's request, no funds are included in this bill for the ongoing operations in Afghanistan and Iraq. A portion of the fiscal year 2003 supplemental funds provided this year will remain available in the coming year to help offset these needs. But I believe it should be made clear that an additional supplemental funding will most likely be required in the next fiscal year. Only a dramatic improvement in the situation in Iraq and in Afghanistan would obviate the need for additional funding for these purposes. I want to offer my personal thanks to the chairman for increasing funding in support of the Army's Stryker brigades and the C-17. These two programs are critical to the military's transformation plans. The added funding will greatly assist DOD in meeting its goals. The Chairman has presented us with a very good bill, and I encourage all of you to support it wholeheartedly. I wish to join my chairman and the Members of the Senate in extending our gratitude and admiration for the men and women who are serving us this day. I hope this measure in some small way will indicate to them our gratitude and our great admiration. I thank the Chair.

Mr. INOUYE. I move to lay that motion on the table. The motion to lay on the table was agreed to.

Mr. INOUYE

Mr. INOUYE. I move to lay that motion on the table. The motion to lay on the table was agreed to.

Mr. INOUYE

Mr. INOUYE. Mr. President, our distinguished colleague, the Honorable Ted Stevens, was presented with the Arleigh Burke Award on June 11, 2003, by the Center for Strategic and International Studies. The award, named after the famed Admiral, who was the longest serving Chief of Naval Operations, recognizes Senator Stevens's leadership in the fields of strategy, resources, and maritime affairs, as well as his hard work and selfless dedication to promote public service and the ideals of freedom. When Senator Stevens accepted the Burke Award, he delivered a thoughtful speech that underscored Admiral Burke's conviction that duty to country is more important than duty to the Commander-in-Chief, and that we should oppose the concentration of power. I ask unanimous consent that Senator Stevens's speech be printed in the Record.

Mr. INOUYE

Mr. INOUYE. Mr. President, today, Senator Akaka and I are introducing legislation that would provide for 100 percent coverage under Medicaid for the payment of health services rendered to Native Hawaiians by either Federally qualified health centers or Native Hawaiian health care systems. This provision would treat our State's Native Hawaiians comparably with Alaskan Natives and American Indians under the current Medicaid law. We purposely focused upon Federally qualified health centers and Native Hawaiian health care systems, because they are highly cost effective ways of providing these extraordinarily necessary primary care and preventative services. I ask unanimous consent that the text of this bill be printed in the Record.

Mr. INOUYE

Mr. INOUYE. Mr. President, today, Senator Akaka and I are introducing legislation that would provide for 100 percent coverage under Medicaid for the payment of health services rendered to Native Hawaiians by either Federally qualified health centers or Native Hawaiian health care systems. This provision would treat our State's Native Hawaiians comparably with Alaskan Natives and American Indians under the current Medicaid law. We purposely focused upon Federally qualified health centers and Native Hawaiian health care systems, because they are highly cost effective ways of providing these extraordinarily necessary primary care and preventative services. I ask unanimous consent that the text of this bill be printed in the Record.

Mr. INOUYE

Mr. INOUYE. Madam President, on June 11, 2003, I had the honor and privilege of attending the retirement ceremony at Fort Myer, VA, for GEN Eric Shinseki, who served with distinction during his 4 years as Army Chief of Staff. A native of Hawaii who rose through the ranks while devoting 38 years of his life to defending our Nation, General Shinseki ended his career as the highest ranking Asian-American in the history of the United States military. His farewell speech was a message of thanks, a reminder of the need for shared values, and an underscoring of the importance of inspired leadership and the dangers of arrogance. I ask that General Shinseki's speech, as well as the remarks that Acting Secretary of the Army Les Brownlee made during General Shinseki's retirement ceremony, be printed in the Record.

Mr. INOUYE

Mr. INOUYE. Mr. President, I rise this moment to speak in favor of an amendment proposed by my dear friend from New Mexico, Senator Bingaman. I find it rather uncomfortable and sad that my remarks may be counter to that of my colleague from New Mexico, my dear friend, Mr. Domenici, and my colleague, the chairman of the Indian Affairs Committee. Mr. President, as you know, there is a longstanding relationship between the United States and the sovereign Indian nations that won exercise, exclusive dominion, and control over lands that now comprise our great country. The large body of Federal Indian law is known as trust responsibility, and it was first given expression by the Chief Justice of the United States Supreme Court, John Marshall, in 1832. This relationship is premised upon the sovereignty of the Indian nations, a sovereignty that existed well before the U.S. Government was formed, and it is memorialized in the United States Constitution. This trust relationship that has always formed the course of dealings between the U.S. and Indian tribes is well understood and beyond debate. The United States holds legal title to lands that it held in trust for Indian tribes. Accordingly, activities affecting Indian lands and resources have always been subject to approval by the Secretary of the Interior Department, acting as the principal agent for the United States. That is the law of the land. In the Congress, we have always understood the United States trust responsibility as being derived from treaties, statutes, regulations, executive orders, rulings, and agreements between the Federal Government and Indian tribal governments. We have legislated on this basis. The courts have issued rulings on this basis. And until recently the executive branch has premised policy on this basis and promulgated regulations on this fundamental principle of law. However, in the arguments before the U.S. Supreme Court earlier this year, the Government took the position that the duties of the U.S., as trustee for Indian lands and resources, exist only as they may be spelled out in statute, and are legally enforceable only if a statute provides a remedy for any breach of the trust. The Supreme Court accepted the Government's argument that the duties of the trustee must be spelled out in statute, but ruled that as long as the Government had complete management control over the trust land or trust resources at issue, then the trustee's duties could be legally enforced and there could be a damage remedy for a breach of the Government's trust duties. Tribal governments are also paying keen attention to the arguments that are being advanced by the Government in pending legislation over the management of funds which are held in trust by the United States for individual Indians and Indian tribes. Most of us have heard of the assertions in this case in which it maintained that the Government is unable to account for more than $2 billion in Indian trust funds. With the Government's advocacy for a new perspective on the United States trust responsibility, it is readily apparent why the eyes of Indian country are sharply focused on the tribal provisions of this bill and the amendments that are the subject of our discussion today. Native America wants to see what position the Congress will adopt as it relates to the ongoing viability of the trust relationship. They are closely scrutinizing our words and our actions in the context of this measure to determine whether they signal a departure from the traditional and well-established principles of the United States trust responsibility. That is why I believe it is incumbent upon us to make sure we understand what is at stake in this debate. There has always been, and likely always will be, a tension between a greater measure of tribal control and a diminished Federal presence in Indian country, one that has to be reconciled in each distinct area. But the reality is that as long as the United States holds legal title to Indian lands, the Federal Government and tribal governments will have to work together on these matters. Not all tribal governments have managed their resources, and not all of those who do seek to develop those resources. But for those that do, we well understand that they would want to reduce the amount of time that is customarily involved in securing the Secretary's approval of leases of tribal land and grants of right of way over Indian lands. Can this be accomplished without altering or diminishing the trust relationship? I believe it can. The tribal industry resource agreements that are authorized, the amendment that we consider today, can serve as an instrument for defining and adapting this relationship to accommodate the unique circumstances of each tribe's energy resource development objectives. But should the United States trust responsibility for Indian lands and resources be waived? I am not aware of any tribal government that supports an unlimited waiver of the United States trust responsibility. Certainly, one of the largest land-based tribes in the United States, the Navajo Nation, has made it clear that it will not countenance such a waiver. Indian country has a long history and a long memory. That history documents the sad reality that there have been too many times in the past when those who did not have the best interests of Indian country in mind have exploited tribal lands and resources and then walked away. In those instances, tribal governments and the United States shared a common interest in addressing the damage to tribal lands and in pursuing those who caused the damage. Mr. President, I think it is clear that the provisions of this title as currently formulated, and if not further amended, will foreclose the cause of action when there is damage to tribal lands. So I join my colleague, Senator Bingaman, in sponsoring this amendment because I believe strongly in Federal Indian responsibility for Indian lands, and the resources must be maintained and strengthened, not diminished. I yield the floor.

Mr. INOUYE

Mr. INOUYE. Mr. President, today I introduce the United States Military Cancer Institute Center of Excellence Research Collaborative Act of 2003. This legislation seeks to formally establish the United States Military Cancer Institute, Center of Excellence and seeks support for the collaborative augmentation of research efforts in cancer epidemiology, prevention, and control. The mission of the Institute is to provide for the maintenance of health in the military by enhancing cancer research and treatment, and to study the epidemiological causes of cancer among various ethnic groups. By formally establishing the USMCI as a Center of Excellence it will better unite military research efforts with other cancer research centers. Cancer prevention and treatment for the military population is a significant issue, thus the USMCI was organized to coordinate the military cancer assets already established. The USMCI has a comprehensive database on its beneficiary population of 9 million people. The military's nationwide tumor registry, the Automated Central Tumor Registry, has acquired more than 180,000 cases in the last 14 years, and a serum repository of 30 million specimens from military personnel collected sequentially since 1987. This population is predominantly Caucasian, African-American, and Hispanic. The Director of the USMCI, Dr. John Potter, is also a Professor of Surgery at the Uniformed Services University of the Health Sciences, USUHS. A highly talented cancer epidemiologist, Dr. Kangmin Zhu, has also been recruited to lead the USMCI Prevention and Control Programs. The USMCI currently functions in the Washington, D.C. area, and its components are located at the National Naval Medical Center, the Malcolm Grow Medical Center, the Armed Forces Institute of Pathology, and the Armed Forces Radiobiology Research Institute. Currently there are more than 70 research workers, both active duty and Department of Defense civilian scientists, in the USMCI. The USMCI intends to expand its research activities to military medical centers across the Nation. Special emphasis will be placed on the study of genetic and environmental factors in carcinogenesis among the entire population including Asian, Causasian, African-American and Hispanic populations. I ask unanimous consent that the text of this bill be printed in the Record.

Mr. INOUYE

Mr. INOUYE. Mr. President, today I introduce the United States Military Cancer Institute Center of Excellence Research Collaborative Act of 2003. This legislation seeks to formally establish the United States Military Cancer Institute, Center of Excellence and seeks support for the collaborative augmentation of research efforts in cancer epidemiology, prevention, and control. The mission of the Institute is to provide for the maintenance of health in the military by enhancing cancer research and treatment, and to study the epidemiological causes of cancer among various ethnic groups. By formally establishing the USMCI as a Center of Excellence it will better unite military research efforts with other cancer research centers. Cancer prevention and treatment for the military population is a significant issue, thus the USMCI was organized to coordinate the military cancer assets already established. The USMCI has a comprehensive database on its beneficiary population of 9 million people. The military's nationwide tumor registry, the Automated Central Tumor Registry, has acquired more than 180,000 cases in the last 14 years, and a serum repository of 30 million specimens from military personnel collected sequentially since 1987. This population is predominantly Caucasian, African-American, and Hispanic. The Director of the USMCI, Dr. John Potter, is also a Professor of Surgery at the Uniformed Services University of the Health Sciences, USUHS. A highly talented cancer epidemiologist, Dr. Kangmin Zhu, has also been recruited to lead the USMCI Prevention and Control Programs. The USMCI currently functions in the Washington, D.C. area, and its components are located at the National Naval Medical Center, the Malcolm Grow Medical Center, the Armed Forces Institute of Pathology, and the Armed Forces Radiobiology Research Institute. Currently there are more than 70 research workers, both active duty and Department of Defense civilian scientists, in the USMCI. The USMCI intends to expand its research activities to military medical centers across the Nation. Special emphasis will be placed on the study of genetic and environmental factors in carcinogenesis among the entire population including Asian, Causasian, African-American and Hispanic populations. I ask unanimous consent that the text of this bill be printed in the Record.

Mr. INOUYE

Mr. INOUYE. Mr. President, today I introduce the Registered Nurses' Safe Staffing Act of 2003. I'm introducing this bill on behalf of the American Nurses Association's Chief Executive Officer and President Linda Stierle, MSN, RN, CNAA and Barbara A. Blakeney, MS, APRN, BC, ANP respectively. For over 4 decades I have been a committed supporter of nurses and the delivery of safe patient care. While enforceable regulations will help to ensure patient safety, the complexity and variability of today's hospitals require that staffing patterns be determined at the hospital and unit level, with the professional input of registered nurses. More than a decade of research demonstrates that nurse staff levels and the skill mix of nursing staff directly affect the clinical outcomes of hospitalized patients. Studies show that when there are more registered nurses, there are lower mortality rates, shorter lengths of stay, reduced costs, and fewer complications. A study published in the Journal of the American Medical Association found that the risks of patient mortality rose by 7 percent for every additional patient added to the average nurse's workload. In the midst of a nursing shortage and increasing financial pressures, hospitals often find it difficult to maintain adequate staffing. While nursing research indicates that adequate registered nurse staffing is vital to the health and safety of patients, there are no standardized, public reporting or the enforcement of adequate staffing plans. The only regulations addressing nursing staff exists vaguely in Medicare Conditions of Participation which states: ``The nursing service must have an adequate number of licensed registered nurses, licensed practice, vocational, nurse, and other personnel to provide nursing care to all patients as needed''. This bill will require Medicare Participating Hospitals to develop and maintain reliable and valid systems to determine sufficient registered nurse staffing. Given, the demands that the healthcare industry faces today, it is our responsibility to ensure that patients have access to adequate nursing care. However, we must ensure that the decisions in which to provide this care are made by the clinical experts, the registered nurses caring for these patients. Support of this bill supports our nation's nurses during a critical shortage, but more importantly, works to ensure the safety of their patients. I ask unanimous consent that the text of this bill be printed in the Record.

Mr. INOUYE

Mr. INOUYE. Mr. President, today I introduce the Registered Nurses' Safe Staffing Act of 2003. I'm introducing this bill on behalf of the American Nurses Association's Chief Executive Officer and President Linda Stierle, MSN, RN, CNAA and Barbara A. Blakeney, MS, APRN, BC, ANP respectively. For over 4 decades I have been a committed supporter of nurses and the delivery of safe patient care. While enforceable regulations will help to ensure patient safety, the complexity and variability of today's hospitals require that staffing patterns be determined at the hospital and unit level, with the professional input of registered nurses. More than a decade of research demonstrates that nurse staff levels and the skill mix of nursing staff directly affect the clinical outcomes of hospitalized patients. Studies show that when there are more registered nurses, there are lower mortality rates, shorter lengths of stay, reduced costs, and fewer complications. A study published in the Journal of the American Medical Association found that the risks of patient mortality rose by 7 percent for every additional patient added to the average nurse's workload. In the midst of a nursing shortage and increasing financial pressures, hospitals often find it difficult to maintain adequate staffing. While nursing research indicates that adequate registered nurse staffing is vital to the health and safety of patients, there are no standardized, public reporting or the enforcement of adequate staffing plans. The only regulations addressing nursing staff exists vaguely in Medicare Conditions of Participation which states: ``The nursing service must have an adequate number of licensed registered nurses, licensed practice, vocational, nurse, and other personnel to provide nursing care to all patients as needed''. This bill will require Medicare Participating Hospitals to develop and maintain reliable and valid systems to determine sufficient registered nurse staffing. Given, the demands that the healthcare industry faces today, it is our responsibility to ensure that patients have access to adequate nursing care. However, we must ensure that the decisions in which to provide this care are made by the clinical experts, the registered nurses caring for these patients. Support of this bill supports our nation's nurses during a critical shortage, but more importantly, works to ensure the safety of their patients. I ask unanimous consent that the text of this bill be printed in the Record.

Mr. INOUYE

Mr. INOUYE. Mr. President, 13 years ago this month, our late colleague, the Honorable Spark Matsunaga of Hawaii, died while serving in office, abruptly cutting short a distinguished 28-year career in the United States Senate and the House of Representatives. His legacy should not be forgotten, particularly since in recent months, the war has dominated discussions in our Chamber and throughout the world. Sixty years ago, circumstances compelled Senator Matsunaga to become a warrior, and he acted with bravery and valor that resulted in our country awarding him the Bronze Star and two Purple Hearts. Even as a war hero, however, Senator Matsunaga knew the importance of peace and believed that the peaceful resolution of disputes should always be our primary goal. ``After serving as a soldier, he went into public service to find a way to end war,'' his son, former Hawaii State Senator Matt Matsunaga, once said. Like other prominent Americans such as Woodrow Wilson, Jennings Randolph, and Everett Dirksen, Senator Matsunaga envisioned a ``Department of Peace'' that ideally would be on equal footing with the Department of Defense. In 1979, he was successful in having a provision added to an education appropriations bill that called for the establishment of the Commission on Proposals for the National Academy of Peace and Conflict Resolution. Senator Matsunaga chaired the newly created nonpartisan panel, which became known as the Matsunaga Commission. After numerous public hearings and meetings with scholars, government, and military officials, and representatives from religious and ethnic organizations, the Commission recommended the creation of a national peace academy. Subsequently, Senator Matsunaga spearheaded a bipartisan drive that led to the passage of a bill that was signed into law by President Reagan establishing the United States Institute of Peace in Washington, D.C. The Institute's mission is to ``support the development, transmission, and use of knowledge to promote peace and curb violent international conflict.'' Following Senator Matsunaga's death in 1990, the University of Hawaii paid tribute to him by establishing the Matsunaga Institute for Peace, where scholars could study and advise on ways to settle regional and international disputes without turning to violence. Senator Matsunaga's belief in peace began early. In 1930, as a student at the University of Hawaii, he wrote a short essay, titled ``Let Us Teach Our Children to Want Peace'': Wants are the drives of all human action. If we want peace we must educate people to want peace. We must replace attitudes favorable to war with attitudes opposed to war. Parents should protect the child from experiences with materials of warfare. Teachers should let the generals fall into the background and bring into the foreground leaders in social reform as heroes. We must help our young men to see that there are other types of bravery than that which is displayed on the battlefield. If in our teaching we emphasize the life and work of out great contributors instead of our great destroyers, people will come to realize that moral courage is bravery of the highest type, and America will be called the Champion of Peace. Senator Matsunaga lived by those words throughout his life. I ask my colleagues to join me in paying tribute to the late Senator Matsunaga.

Mr. INOUYE

Mr. INOUYE. Mr. President, I want to express my appreciation to Chairman Grassley and Senator Baucus for the inclusion of the hospital support organization provision to the CARE Act. This provision is important to all teaching hospital support organizations, including those in Hawaii. The provision would treat borrowing by these support organizations as qualified exceptions under the unrelated business income rule for debt acquisition. As a requirement for tax exemption status, nonprofit hospitals must provide significant charity services. They do this mainly by treating Medicaid and Medicare patients and by running an open emergency room that treats anyone without regard to payment. For example, Medicare and Medicaid admissions comprise nearly 60 percent of all admissions at the largest private, nonprofit hospital in my State. The demand for indigent or charitable hospital care will continue to grow especially in an economic down turn. A number of charitable hospitals, such as the Queen's Medical Center in the State of Hawaii, also provide residency training as teaching hospitals for our future doctors. In addition, they must extend staff privileges to all qualified physicians in nearly all specialties. Accordingly, they cannot be selective as to their patients or to their staff physicians. To pay for these charitable services nonprofit hospitals must use their endowment income as well as fees from other patients. For-profit enterprises can easily borrow or raise the capital to build the most up-to-date facilities to compete for the high-profit patients. In comparison, charitable hospitals face lower reimbursements for Medicaid and Medicare patients, while at the same time they struggle to cope with rising costs for wages, supplies and insurance. In order to meet the growing demand for indigent care, many charitable hospitals postpone updating their equipment and defer modernizing their facilities. As a result, there is a growing trend for charitable hospitals to sell off their facilities to for-profit operations because they can easily secure the required capital to update or expand the facilities. In the past, Congress has allowed nonprofit schools, colleges, universities, and pension funds to invest in real estate with borrowed funds, and the income from real investments has allowed these institutions to meet their financial needs. Accordingly, with this provision, teaching hospitals' support organizations would also be allowed to borrow in order to repair and improve the real property held in the portfolio assets of their endowments, thereby increasing the value of the real property segment of their endowments. The resulting increase of income can then help cover the growing costs for more charitable services. Again, I thank Chairman Grassley and Senator Baucus for the support they have given me

Mr. INOUYE

Mr. INOUYE. Mr. President, today I rise to honor all our military families by introducing a Resolution to designate November 2003, as National Military Family Month. As we all know, memories fade and the hardships experienced by our military families are easily forgotten unless they touch our own immediate family. Today, we have our men and women deployed all over the world, engaged in this war on terrorism. These far-ranging military deployments are extremely difficult on the families who bear this heavy burden. To honor these families, the Armed Services YMCA has sponsored Military Family Week in late November since 1996. However, due to frequent ``short week'' conflicts around the Thanksgiving holidays, the designated week has not always afforded enough time to schedule observance on and near our military bases. I believe a month long observation will allow greater opportunity to plan events. Moreover, it will provide a greater opportunity to stimulate media support. A Concurrent Resolution will help pave the way for this effort. I ask my colleagues to join me in supporting this tribute to our military families. I request unanimous consent that the full text of my resolution be printed in the Congressional Record.

Mr. INOUYE

Mr. INOUYE. Mr. President, I rise today to introduce a bill to reauthorize the Native Hawaiian Health Care Improvement Act. Senator Akaka joins me in sponsoring this measure. The Native Hawaiian Health Care Improvement Act was enacted into law in 1988, and has been reauthorized every four years since that time. The Act provides authority for a range of programs and services designed to improve the health care status of the Native people of Hawaii. With the enactment of the Native Hawaiian Health Care Improvement Act and the establishment of Native Hawaiian health care systems on most of the islands that make up the State of Hawaii, we have witnessed significant improvements in the health status of Native Hawaiians, but as the findings of unmet needs and health disparities set forth in this bill make clear, we still have a long way to go. For instance, Native Hawaiians have the highest cancer mortality rates in the State of Hawaii--rates that are 21 percent higher than the rate for the total State male population and 64 percent higher than the rate for the total State female population. Nationally, Native Hawaiians have the third highest mortality rate as a result of breast cancer. With respect to diabetes, in 2000, Native Hawaiians had the highest mortality rate associated with diabetes in the State--a rate which is 138 percent higher than the statewide rate for all racial groups. When it comes to heart disease, the mortality rate of Native Hawaiians associated with heart disease is 68 percent higher than the rate for the entire State, and the mortality rate for hypertension is 84 percent higher than that for the entire State. These statistics on the health status of Native Hawaiians are but a small part of the long list of data that makes clear that our objective of assuring that the Native people of Hawaii attain some parity of good health comparable to that of the larger U.S. population has not yet been achieved.

Mr. INOUYE

Mr. INOUYE. Mr. President, I move to reconsider the vote.

Mr. INOUYE

Mr. INOUYE. Mr. President, I rise today to introduce a bill to reauthorize the Native Hawaiian Health Care Improvement Act. Senator Akaka joins me in sponsoring this measure. The Native Hawaiian Health Care Improvement Act was enacted into law in 1988, and has been reauthorized every four years since that time. The Act provides authority for a range of programs and services designed to improve the health care status of the Native people of Hawaii. With the enactment of the Native Hawaiian Health Care Improvement Act and the establishment of Native Hawaiian health care systems on most of the islands that make up the State of Hawaii, we have witnessed significant improvements in the health status of Native Hawaiians, but as the findings of unmet needs and health disparities set forth in this bill make clear, we still have a long way to go. For instance, Native Hawaiians have the highest cancer mortality rates in the State of Hawaii--rates that are 21 percent higher than the rate for the total State male population and 64 percent higher than the rate for the total State female population. Nationally, Native Hawaiians have the third highest mortality rate as a result of breast cancer. With respect to diabetes, in 2000, Native Hawaiians had the highest mortality rate associated with diabetes in the State--a rate which is 138 percent higher than the statewide rate for all racial groups. When it comes to heart disease, the mortality rate of Native Hawaiians associated with heart disease is 68 percent higher than the rate for the entire State, and the mortality rate for hypertension is 84 percent higher than that for the entire State. These statistics on the health status of Native Hawaiians are but a small part of the long list of data that makes clear that our objective of assuring that the Native people of Hawaii attain some parity of good health comparable to that of the larger U.S. population has not yet been achieved.

Mr. INOUYE

Mr. INOUYE. Mr. President, today, Tunisia commemorates the 47th anniversary of its independence from France. Our two countries share a long friendship that began in 1797, when Tunisia was one of the first countries to sign a Treaty of Peace and Friendship with the United States. In 1956, when Tunisia gained independence from France, the United States was one of the first countries to recognize Tunisia's independence. This long relationship has served as the backdrop for our increased cooperation in the efforts to combat international terrorism. Our shared commitments to peace, security, and stability in the world will remain the most important principles guiding our relationship throughout the 21st century. I am pleased by Tunisia's commitment to further strengthen the democratic values that our two countries share as the foundation for free and open societies, and I am confident its leaders will continue to work toward promoting greater political freedom and respect for human rights throughout the region. I wish the Tunisian people the best as they celebrate their country's successful transition from colony to republic. I look forward to many more years of cooperation and friendship between the United States and Tunisia.

Mr. INOUYE

Mr. INOUYE. Mr. President, I rise in support of the amendment proposed by my leader, the Senator from South Dakota. I think it is important to review briefly the history that brought us to this point today. A few hundred years ago, before the first Europeans landed on the shores of what is now the United States, the Indian nations exercised dominion and control over 550 million acres of the land which became America. By the time of the Revolutionary War, relations with the Indian tribes were well established, and it was the Native people of this land who provided food to General George Washington and his troops that sustained them throughout the harsh winter at Valley Forge. Native warriors fought beside the revolutionary soldiers, and their valuable contributions to the success of the war for independence was widely chronicled. Later, as our Founding Fathers undertook the task of developing a constitution for a new Nation, it was the governmental structure of the Iroquois Confederacy that they chose as the model for our democracy and the foundation of our government. In contemporary times, more Indian men and women, on a per capita basis, have put on the uniform of our country and placed themselves in harm's way in defense of our country than any other ethnic group. This dedication to a nation that has many sad and sorry chapters in its history of relations with the Native people of this land is remarkable. Nonetheless, Indian people have served in the Armed Forces of the United States in greater numbers than any other segment of the population, on a per capita basis, in World War II, the Korean War, the Vietnam War, the Gulf War and Desert Storm, and in every military action in which our country has been engaged in modern times. These are the people whose ancestors ceded 500 million acres of land to America, in exchange for certain fundamental commitments on the part of the United States, including the provision of health care. So, as has been observed more than once in this Chamber, the Native people of the United States has paid their dues. They have sacrificed their sons and daughters, mothers and fathers, uncles and aunts in the defense of our Nation. And through their treaties with the United States, and their cession of millions of acres of land to the United States, the Native people of this land purchased the first prepaid health plan in America. The question that we are confronted with today is: What promises did the United States make to the Native people of America in treaties and what responsibilities did the United States undertake in subsequently enacted Federal laws, and how do those commitments measure up to what is provided to other Americans today in the arena of health care services? I believe that the reason my colleague from South Dakota has come forward today with his amendment is that he sees in his home State of South Dakota the same dynamic that we see across Indian country--a health care system that is woefully underfunded and alarmingly understaffed, with facilities that are in such a state of disrepair that many of them have been condemned. As a veteran and as ranking member of the Defense Appropriations subcommittee, I have had the opportunity to compare the investments our Nation makes in the health care provided to our veterans, to our men and women in active duty service and their dependent, and to our Federal employees. I think these comparative expenditures should interest our colleagues--for they tell the story and paint a dramatic picture of disparities that are so large and frankly, so shocking, that we would be negligent and irresponsible were we to fail to address them. Let's look at veterans. The Veterans' Administration expended $5,214 for medical care for each eligible veteran in 2001. In 1999, Medicare expended $5,915 per eligible Medicare enrollee. The average medical expenditure in the United States on a per capita basis in 1999 was $5,065 per patient. For Medicaid enrollees, $3,879 was expended for each eligible Medicaid patient in 1998. For inmates in Federal prisons, $3,803 were expended for health care services provided to each inmate in 1999. Just a little less--$3,725--was provided to Federal employees in 1999 for health care services under an eligible Federal health care plan. Compare all of these figures with that provided to patients of the Indian Health Service in 2002--a shocking $1,914 per patient for medical care and $619 for nonmedical care such as preventive health care services. So if you are an Indian person and you are in need of health care services, you would have twice as much provided for your health care as a Federal prison inmate than you would as a law-abiding Native citizen of the United States. If you were a veteran, 60 percent more would be dedicated to providing health care to you, and if you were eligible for Medicare, the percentage would be even higher. This is the relative nature of the manner in which we carry out our commitments to the Native people of this land. Now let's look at some health statistics of the Native American population. If you are an Indian or an Alaska Native, the likelihood that you will die from diabetes is 390 percent higher than for other Americans. As a Native person, your chances of dying from tuberculosis are 500 percent higher than other Americans. And if you are a newborn or an infant Native child, your mortality rate is 25 percent higher than other infants. Rates of cardiovascular disease are twice those for the general public and they continue to increase while the incidence of cardiovascular disease is going down amongst the general population. To complete this picture, we also need to look at the health care system that is designed to serve the needs of Native people. Health care in Native America is provided through the Indian Health Service system of hospitals and clinics, through tribally operated hospitals and clinics, through urban Indian health care programs, and through government contracts with private hospitals and health care providers. In some of the most heavily populated areas of Indian country, particularly California, Oregon, and Washington State, there are no Indian Health Service hospitals and clinics, so Native people in those states must rely on either a tribal health care system or on contract health care services. But because of the severe constraints that have been imposed on funds available for the purchase of contract health care services, those who must seek care outside the Indian Health Service system have to prove that their condition is either life-threatening or that they may lose a limb in the absence of treatment. So if you have severe diabetes and resultant kidney damage, for example, as a Native person you wouldn't be eligible for kidney dialysis until you were at death's door. Physicians would instruct us that by that time, it is often too late to save the life of a patient. In this category alone, there is a shortfall of $20.6 million of what is needed for contract health care services. To bring the 55 most poorly funded tribal health care systems up to 40 percent of the identified health care needs, it would require $34 million. And to bring tribal communities across the Nation up to just 60 percent of the identified health care needs, it would require $388 million. The Indian Health Service is also charged with providing safe water and sanitation facilities for Indian communities, but there is a $1.753 billion backlog in sanitation facilities. For basic primary health care services--services which most Americans take for granted because their access is unlimited--for Native people the need that is unmet is $6.336 billion. For Indian people suffering from cancer, the health care service need that is currently unmet is $294 million. For those Native patients with heart disease, the unmet need for health care services is $369 million. Native Americans with diabetes have an unmet need for health care treatment of $452 million. I could go on and on with such tragic statistics--and if they were just numbers it might be a different matter--but each of these statistics represents thousands of Native people who are going without the most fundamental health care. These are the people who have given this country their land so that we could build a new nation. These are the people who have sacrificed their lives in the defense of our country. These are the people who have given the most and who are in turn, provided the least. Most of the Indian Health Service hospitals are over 30 years old. They are so badly in need of repair and replacement that the minimum unmet need is $610 million. Year after year, the costs associated with providing care--salaries of doctors and nurses and other health care professionals serving Indian country--fail to keep pace with those employed in the Department of Defense and Veterans' Administration health care systems, or with medical inflation rates. Not surprisingly, these valued professionals leave Indian country for more pay, better working conditions, and as caring people--for the promise that the patients they see on a daily basis won't have to wait until their lives are hanging in the balance before they can receive care. If treaties mean anything--and the U.S. Supreme Court has repeatedly held that treaties are the highest laws of the land--then this Nation has not only a moral duty but a legal obligation to fulfill its treaty commitments to the Native people of this land. And I think that these numbers make it abundantly clear why the amendment proposed by my friend from South Dakota is conservative. It won't meet all of the health care needs in Indian country, but it would be a good beginning in addressing conditions that are devastating and tragic by any measure--conditions which portray a shameful picture that a benevolent and prosperous nation appears to care so little about its First Americans.

Mr. INOUYE

Mr. INOUYE. Mr. President, almost eight years ago, I stood before you to introduce a bill ``to provide an opportunity for the Pottawatomi Nation in Canada to have the merits of their claims against the United States determined by the United States Court of Federal Claims.'' That bill was introduced as Senate Resolution 223, which referred the Pottawatomi's claim to the Chief Judge of the U.S. Court of Federal Claims and required the Chief Judge to report back to the Senate and provide sufficient findings of fact and conclusions of law to enable the Congress to determine whether the claim of the Pottawatomi Nation in Canada is legal or equitable in nature, and the amount of damages, if any, which may be legally or equitably due from the United States. Last year, the Chief Judge of the Court of Federal Claims reported back that the Pottawatomi Nation in Canada has a legitimate and credible legal claim. Thereafter, by settlement stipulation, the United States has taken the position that it would be ``fair, just and equitable'' to settle the claims of the Pottawatomi Nation in Canada for the sum of $1,830,000. This settlement amount was reached by the parties after seven years of extensive, fact-intensive litigation. Independently, the court concluded that the settlement amount is ``not a gratuity'' and that the ``settlement was predicated on a credible legal claim.'' Pottawatomi Nation in Canada, et al. v. United States, Cong. Ref. 94-1037X at 28 (Ct. Fed. Cl., September 15, 2000) (Report of Hearing Officer). The bill I introduce today is to authorize the appropriation of those funds that the United States has concluded would be ``fair, just and equitable'' to satisfy this legal claim. If enacted, this bill will finally achieve a measure of justice for a tribal nation that has for far too long been denied. For the information of our colleagues, this is the historical background that informs the underlying legal claim of the Canadian Pottawatomi. The members of the Pottawatomi Nation in Canada are one of the descendant groups--successors-in-interest--of the historical Pottawatomi Nation and their claim originates in the latter part of the 18th Century. The historical Pottawatomi Nation was aboriginal to the United States. They occupied and possessed a vast expanse in what is now the States of Ohio, Michigan, Indiana, Illinois, and Wisconsin. From 1795 to 1833, the United States annexed most of the traditional land of the Pottawatomi Nation through a series of treaties of cession--many of these cessions were made under extreme duress and the threat of military action. In exchange, the Pottawatomis were repeatedly made promises that the remainder of their lands would be secure and, in addition, that the United States would pay certain annuities to the Pottawatomi. In 1829, the United States formally adopted a Federal policy of removal--an effort to remove all Indian tribes from their traditional lands east of the Mississippi River to the west. As part of that effort, the government increasingly pressured the Pottawatomis to cede the remainder of their traditional lands--some five million acres in and around the city of Chicago and remove themselves west. For years, the Pottawatomis steadfastly refused to cede the remainder of their tribal territory. Then in 1833, the United States, pressed by settlers seeking more land, sent a Treaty Commission to the Pottawatomi with orders to extract a cession of the remaining lands. The Treaty Commissioners spent two weeks using extraordinarily coercive tactics-- including threats of war--in an attempt to get the Pottawatomis to agree to cede their territory. Finally, those Pottawatomis who were present relented and on September 26, 1933, they ceded their remaining tribal estate through what would be known as the Treaty of Chicago. Seventy-seven members of the Pottawatomi Nation signed the Treaty of Chicago. Members of the ``Wisconsin Band'' were not present and did not assent to the cession. In exchange for their land, the Treaty of Chicago provided that the United States would give to the Pottawatomis five million acres of comparable land in what is now Missouri. The Pottawatomi were familiar with the Missouri land, aware that it was similar to their homeland. But the Senate refused to ratify that negotiated agreement and unilaterally switched the land to five million acres in Iowa. The Treaty Commissioners were sent back to acquire Pottawatomi assent to the Iowa land. All but seven of the original 77 signatories refused to accept the change even with promises that if they were dissatisfied ``justice would be done.'' Treaty of Chicago, as amended, Article 4. Nevertheless, the Treaty of Chicago was ratified as amended by the Senate in 1834. Subsequently, the Pottawatomis sent a delegation to evaluate the land in Iowa. The delegation reported back that the land was ``not fit for snakes to live on.'' While some Pottawatomis removed westward, many of the Pottawatomis-- particularly the Wisconsin Bank, whose leaders never agreed to the Treaty--refused to do so. By 1836, the United States began to forcefully remove Pottawatomis who remained in the east--with devastating consequences. As is true with many other American Indian tribes, the forced removal westward came at great human cost. Many of the Pottawatomi were forcefully removed by mercenaries who were paid on a per capita basis government contract. Over one-half of the Indians removed by these means died en route. Those who reached Iowa were almost immediately removed further to inhospitable parts of Kansas against their will and without their consent. Knowing of these conditions, many of the Pottawatomis including most of those in the Wisconsin Bank vigorously resisted forced removal. To avoid Federal troops and mercenaries, much of the Wisconsin Bank ultimately found it necessary to flee to Canada. They were often pursued to the border by government troops, government-paid mercenaries or both. Official files of the Canadian and United States governments disclose that many Pottawatomis were forced to leave their homes without their horses or any of their possessions other than the clothes on their backs. By the late 1830s, the government refused payment of annuities to any Pottawatomi groups that had not removed west. In the 1860s, members of the Wisconsin Band--those still in their traditional territory and those forced to flee to Canada--petitioned Congress for the payment of their treaty annuities promised under the Treaty of Chicago and all other cession treaties. By the Act of June 25, 1864, 13 Stat. 172, the Congress declared that the Wisconsin Band did not forfeit their annuities by not removing and directed that the share of the Pottawatomi Indians who had refused to relocate to the west should be retained for their use in the United States Treasury. H.R. Rep. No. 470, 64th Cong., p. 5, as quoted on page 3 of memo dated October 7, 1949. Nevertheless, much of the money was never paid to the Wisconsin Band. In 1903, the Wisconsin Band--most of whom now resided in three areas, the States of Michigan and Wisconsin and the Province of Ontario-- petitioned the Senate once again to pay them their fair portion of annuities as required by the law and treaties. Sen. Doc. No. 185, 57th Cong., 2d Sess. By the Act of June 21, 1906, 34 Stat. 380, the Congress directed the Secretary of the Interior to investigate claims made by the Wisconsin Band and establish a roll of the Wisconsin Band Pottawatomis that still remained in the East. In addition, the Congress ordered the Secretary to determine ``the[] [Wisconsin Bands] proportionate shares of the annuities, trust funds, and other moneys paid to or expended for the tribe to which they belong in which the claimant Indians have not shared, [and] the amount of such monies retained in the Treasury of the United States to the credit of the clamant Indians as directed the provisions of the Act of June 25, 1864.'' In order to carry out the 1906 Act, the Secretary of Interior directed Dr. W.M. Wooster to conduct an enumeration of Wisconsin Band Pottawatomi in both the United States and Canada. Dr. Wooster documented 2007 Wisconsin Pottawatomis: 457 in Wisconsin and Michigan and 1550 in Canada. He also concluded that the proportionate share of annuities for the Pottawatomis in Wisconsin and Michigan was $477,339 and the proportionate share of annuities due the Pottawatomi Nation in Canada was $1,517,226. The Congress thereafter enacted a series of appropriation Acts from June 30, 1913 to May 29, 1928 to satisfy most of money owed to those Wisconsin Band Pottawatomis residing in the United States. However, the Wisconsin Band Pottawatomis who resided in Canada were never paid their share of the tribal funds. Since that time, the Pottawatomi Nation in Canada has diligently and continuously sought to enforce their treaty rights, although until this congressional reference, they had never been provided their day in court. In 1910, the United States and Great Britian entered into an agreement for the purpose of dealing with claims between both countries, including claims of Indian tribes within their respective jurisdictions, by creating the Pecuniary Claims Tribunal. From 1910 to 1938, the Pottawatomi Nation in Canada diligently sought to have their claim heard in this international forum. Overlooked for more pressing international matters of the period, including the intervention of World War I, the Pottawatomis then came to the U.S. Congress for redress of their claim. In 1946, the Congress waived its sovereign immunity and established the Indian Claims Commission for the purpose of granting tribes their long-delayed day in court. The Indian Claims Commission Act (ICCA) granted the Commission jurisdiction over claims such as the type involved here. In 1948, the Wisconsin Band Pottawatomis from both sides of the border--brought suit together in the Indian Claims Commission for recovery of damages. Hannahville Indian Community v. U.S., No. 28 (Ind. C1. Comm. Filed May 4, 1948). Unfortunately, the Indian Claims Commission dismissed Pottawatomi Nation in Canada's part of the claim ruling that the Commission had no jurisdiction to consider claims of Indians living outside territorial limits of the United States. Hannahville Indian Community v. U.S., 115 Ct. C1. 823 (1950). The claim of the Wisconsin band residing in the United States that was filed in the Indian Claims Commission was finally decided in favor of the Wisconsin Band by the U.S. Claims court in 1983. Hannahville Indian Community v. United States, 4 Ct. C1. 445 (1983). The Court of Claims concluded that the Wisconsin Band was owed a member's proportionate share of unpaid annuities from 1838 through 1907 due under various treaties, including the Treaty of Chicago and entered judgment for the American Wisconsin band Pottawatomis for any monies not paid. Still the Pottawatomi Nation in Canada was excluded because of the jurisdictional limits of the ICCA. Undaunted, the Pottawatomi Nation in Canada came to the Senate and after careful consideration, we finally gave them their long-awaited day in court through the congressional reference process. The court has now reported back to us that their claim is meritorious and that the payment that this bill would make constitutes a ``fair, just and equitable'' resolution to this claim. The Pottawatomi Nation in Canada has sought justice for over 150 years. They have done all that we asked in order to establish their claim. Now it is time for us to finally live up to the promise our government made so many years ago. It will not correct all the wrongs of the past, but it is a demonstration that this government is willing to admit when it has left unfulfilled an obligation and that the United States is willing to do what we can to see that justice--so long delayed--is not now denied. Finally, I would just note that the claim of the Pottawatomi Nation in Canada is supported through specific resolutions by the National Congress of American Indians, the oldest, largest and most- representative tribal organization here in the United States, the Assembly of First Nations, which includes all recognized tribal entities in Canada, and each and every one of the Pottawatomi tribal groups that remain in the United States today. I ask unanimous consent that the text of the legislation be printed in the Record.