Lisa Murkowski

Ms. MURKOWSKI

Ms. MURKOWSKI. Madam President, I ask unanimous consent to set aside the pending amendment and call up amendment No. 3906. This is the amendment of Senator Martinez of Florida. I ask that it be made the pending amendment.

Ms. MURKOWSKI. Madam President, reserving the right to object--and I will object--I am certainly a supporter of LIHEAP, but I object at this time.

Ms. MURKOWSKI. Mr. President, I understand that the Senator from Oregon, Mr. Smith, is on his way to the floor, so when he arrives, I will yield such time to him as he needs. I know he wants to speak to an amendment. I wish to take just a couple of minutes this morning to respond to some of the comments made by the Senator from Oklahoma. Clearly, he is very passionate about Indian health care and making sure that we do right by our treaty obligations and that we do right by all American Indians and Alaska Natives when it comes to their health care needs. He cited some of the obvious. Unfortunately, the statistics are real. In fact, the statistics may be even more devastating than he has indicated because we know that a lot of times our statistics aren't as reliable as we may want, and, in fact, they are worse than what we have seen. When he spoke to prenatal care, when he spoke to the incidence of diabetes and substance abuse and suicides, we know they are horrific statistics. We recognize we must do more. I, too, applaud him for bold action, for reform in a system that has been unwieldy and bureaucratic and stovepiped in so many areas. Senator Barrasso yesterday brought forward an amendment that asks for a GAO study to look to the efficiency. There are some other amendments that have been introduced that also task us with evaluating to make sure we are doing right by the programs that are put in place, how the funding is directed to them, and are we doing what we need to be doing. I think it is fair to say that we recognize it is not sufficient, it is not enough. We do need to be doing more, and certainly, as the chairman of the Indian Affairs Committee has mentioned, we have to put our money where our mouth is. We have to put our money toward those programs. We have to make sure we put the resources there to make the difference. The Senator from Oklahoma spoke about the rationed care. It is not rationed care because we just don't want to give it; it is rationed care because of the lack of resources, and that is very real and something that must be dealt with, and it must be dealt with in a very strong way. The Senator from Oklahoma really spoke as well to the issue of prevention, and it was his opinion in his comments that this Indian Health Care Improvement Act doesn't go far enough, that we need to be doing more in the area of prevention. He speaks to a part of me that I feel very strongly about. When we talk about health care in this country, whether it is in Indian Country or in the United States as a whole, it has been referred to as not a system of health care, it is a system of sick care. We take care of you after you are sick. It is no different within the Indian health system. That does have to change. We must focus on the prevention. We know this. We are seeing this. We are working here in the Congress to change those policies to help put greater focus on prevention because we know for a fact that we can reduce costs if we focus on prevention. Now, the Senator from Oklahoma has indicated that there isn't enough here in the Indian Health Care Improvement Act in the area of prevention. I want to mention some of the initiatives that are included in the legislation that will make a difference, that will reduce health care costs, and that will provide for greater access. It is in the area of prevention. Diabetes--we have all listened to the stats. They are absolutely unacceptable. We have to be doing more when it comes to diabetes prevention. We must be doing more to keep the elderly woman whom he was discussing off of the dialysis machine. We have to have the focus there. So included within the legislation is a focus on diabetes prevention. We also look to the issue of domestic violence and sexual assault. Again, in these areas, our statistics with our American Indians and our Alaska Natives are absolutely unacceptable. Are we doing enough in the area? No, we need to do more. It has been mentioned we have not reauthorized the Indian Health Care Improvement Act in some 10 years. Think about what has happened in this country in terms of health care and how we provide health care, how we focus on prevention in the last 10 years, the technologies that are made available to us, and also the areas of focus. Behavioral health is something about which in my State of Alaska we have been forced to be innovative. We do not have the psychologists and the psychiatrists who are available in all of our little communities. We have been forced to utilize a telehealth system, and we are absolutely making some remarkable progress. But through this Indian Health Care Improvement Act and what we are allowing for, we can allow for expanded opportunities to help, such as in the area of behavioral health. I have a whole list of other programs that are also included-- programs to control blood pressure, immunizations, youth suicide prevention, injury prevention, sudden infant death syndrome training, tobacco cessation programs. These are all programs that go right to the heart of prevention. These are initiatives that will help us reduce our costs, that will help us keep people from becoming ill in the first place, keep people from losing a limb due to diabetes, keep young people from having to live a life afflicted with FAS or FASD. There are initiatives contained within this legislation that need to be authorized, need to be updated and included to allow American Indians and Alaska Natives the same opportunity for preventive care that we find wherever we go in the country in a community hospital or in the clinic down the street. We have to make sure these programs are included. Mr. President, I see Senator Smith has arrived. In recognition of his time limitations today, I yield to him so he can speak to an amendment he is proposing.

Ms. MURKOWSKI

Ms. MURKOWSKI. Mr. President, I rise in support of the amendment and of the Senator from Montana in this effort. We are using a pretty devastating word here--scourge--but that is what we are talking about when we talk about methamphetamine use as it has come into this country and, more particularly, how it has devastated the American Indian and the Alaska native populations. What more can we be doing? What else can we do to shine the spotlight, to activate those who need to be activated in how do we make a difference? Some would suggest a sense of the Senate that encourages this action entering into a memorandum of understanding between agencies, they should be doing that anyway. They should be. They should be doing it. They should be working to streamline. They should be working to better coordinate. They should be making that difference. Let's encourage them even further by a statement such as the Senator from Montana has suggested. We need to do far more when it comes to meth use and abuse. We need to do far more when it comes to drug abuse in general. I appreciate the focus and attention to this particularly deadly scourge, that of methamphetamine. I will stand with the Senator from Montana and support the amendment.

Ms. MURKOWSKI

Ms. MURKOWSKI. Mr. President, I rise today to join in a colloquy with fellow Alaska Senator Ted Stevens to honor a giant of the Alaska Native rights and Native corporation movement, and an individual who has served his State and Nation for decades with great distinction, Mr. Willie ``Iggiagruk'' Hensley.

Ms. MURKOWSKI. And before then, as Senator Stevens well knows, since he too served in the Alaska State Legislature at that time, Mr. Hensley served as both a State Representative in Alaska for 4 years, as House majority leader, and as a State senator, for 4 years from 1971-75 and again for a term starting in 1987, representing his home region of northwest Alaska. Mr. Hensley was born, in Kotzebue, AK, a small village about 40 miles north of the Arctic Circle. He and his family lived in the Noatak River delta where they lived by subsistence hunting, fishing and trapping. While home schooled through the Harrison Chilbowee Academy, he studied for 2 years at the University of Alaska in Fairbanks before receiving his B.A. degree in political science with a minor in economics in 1966 from George Washington University. He then conducted postgraduate studies in law at the University of New Mexico. It was in 1966 that he wrote a paper in a constitutional law course entitled, ``What Rights to Land Have the Alaska Natives: The Primary Issue.'' The paper covered the background of public land issues in Alaska and forcefully made the case for Alaska Native claims to aboriginal lands, that coming 7 years after Alaska had won statehood. The paper, which laid out steps Alaska Natives should take to win their land claims, became an important underpinning of the Alaska Native rights movement that culminated in passage of the Alaska Native Claims Settlement Act in 1971. The Act provided Alaska Natives with 44 million acres of Alaska and nearly $1 billion in funds and cemented Mr. Hensley's reputation as one of the most capable young Native leaders of Alaska.

Ms. MURKOWSKI. I understand that Mr. Hensley has recently completed his first book, a memoir entitled, ``50 Miles from tomorrow: A Memoir of Alaska and the Real People,'' which will be published later this year. Mr. Hensley, who joined Alyeska Pipeline Corp. years after Alaska's Prince William Sound oil spill, has worked tirelessly for the past decade to guarantee that Alaska's oil has flowed south without serious incident and without environmental damage or harm to the wildlife that is so important to Alaskans' way of life. He has worked tirelessly for the benefit of Alaska and all Alaskans. While he clearly has earned his retirement, Alaskans know that Willie will stay involved in issues that are vital for the economic betterment of his native State. I and I am sure Senator Stevens can't thank him enough for all of his efforts, his wisdom and wise counsel and his dedication to making Alaska a better place.

Ms. MURKOWSKI

Ms. MURKOWSKI. Mr. President, I rise this afternoon to discuss legislation that I have introduced that will fix an inequity in the Social Security disability insurance system. This inequity rises from Federal law that places an arbitrary 5-month waiting period on when an individual who has been diagnosed with a terminal illness is eligible for disability compensation provided through Social Security benefits. Currently, under title II of the Social Security Act, Federal law requires a 5-month waiting period from when the patient is diagnosed until the disability benefits begin. Monthly cash benefits, about $980 on average, will be provided to the disabled individual to help offset medical or any other expenses and will also help diminish the financial hardships that are faced by those workers. The monthly cash benefits that are available to the individuals can help not only offset the medical or other expenses, but they can really help to diminish financial hardships that are faced by the workers, by the families, who really may have very little or oftentimes no resources to fall back upon during the early months of a disability. This legislation came about as a result of a telephone call received in my Anchorage office to the head of my constituent services. She received a call from a constituent in Alaska by the name of Robert James. He indicated he had been diagnosed in November with stage 4 lung cancer, and he was given, at that time, 3 to 6 months to live. He called my office asking for help. He wanted to know how, as someone who had just been diagnosed with a terminal illness, he might be eligible for disability compensation provided through Social Security benefits. And so my constituent service director, after listening to his story, went through everything to try to figure out a way to help this individual, only to learn that the process, the law as it sets out now, provides for a 5-month waiting period. Although Mr. James has insurance coverage through his employer, he is unable to work because of his disability. He is going to incur thousands of dollars, probably hundreds of thousands of dollars in medical bills because of this arbitrary 5-month waiting period. If he had only been given the opportunity to demonstrate his case for financial hardship to the Social Security Commissioner, he and his family may have qualified for this cash benefit offset. What my legislation would do is give the Social Security Commissioner the ability to waive the 5-month waiting period on a case-by-case basis for terminally ill individuals who would have to demonstrate the financial hardship. In Mr. James's case, as I indicated, he is employed, works for the cargo department of a major airline in Alaska, but he would have to demonstrate there is financial hardship as a consequence of this terminal diagnosis. It makes you wonder why this 5-month period. The capriciousness of a 5-month waiting period is evidenced by looking at the legislative history. In 1972, the House Ways and Means Committee report sought to reduce the waiting period from at that time 6 months to 5 months. At the time the Senate Finance Committee was pushing for a shorter period. They were pushing for a 4-month period. So back in 1972, you had a 6-month period. Some wanted it to go to 4 months. Eventually they agreed upon a 5-month waiting period. But it begs the question: Should it be 4 months, 5 months? Should it only be 1 month? My legislation would give the Social Security Commissioner the discretion to waive the waiting period if the terminally ill individual can demonstrate a financial hardship. This will alleviate the financial burden or help to offset the financial burden of a terminal illness on the disabled individuals and their families and will also provide for a financial offset for paying medical bills after he or she is deceased. I would ask that in honor of my constituent, Mr. Jones, my colleagues support this bill because there are people who become disabled. We know they are unable to work. They need that monthly support to help offset the costs of their terminal illness. For this reason, it is imperative that the Social Security Commissioner have that ability on a case-by-case basis to make a determination for disability benefits. Mr. James's chemotherapy costs, we understand, are about between $10,000 and $15,000 per monthly session, and this does not include the other medical bills he is facing. I ask my colleagues to join me in supporting this legislation so that Robert James and Americans like Mr. James have the ability to qualify for disability benefits to offset these costly expenses without having to complete an arbitrary 5-month waiting period.

Ms. MURKOWSKI

Ms. MURKOWSKI. Mr. President, I rise this afternoon to discuss legislation that I have introduced that will fix an inequity in the Social Security disability insurance system. This inequity rises from Federal law that places an arbitrary 5-month waiting period on when an individual who has been diagnosed with a terminal illness is eligible for disability compensation provided through Social Security benefits. Currently, under title II of the Social Security Act, Federal law requires a 5-month waiting period from when the patient is diagnosed until the disability benefits begin. Monthly cash benefits, about $980 on average, will be provided to the disabled individual to help offset medical or any other expenses and will also help diminish the financial hardships that are faced by those workers. The monthly cash benefits that are available to the individuals can help not only offset the medical or other expenses, but they can really help to diminish financial hardships that are faced by the workers, by the families, who really may have very little or oftentimes no resources to fall back upon during the early months of a disability. This legislation came about as a result of a telephone call received in my Anchorage office to the head of my constituent services. She received a call from a constituent in Alaska by the name of Robert James. He indicated he had been diagnosed in November with stage 4 lung cancer, and he was given, at that time, 3 to 6 months to live. He called my office asking for help. He wanted to know how, as someone who had just been diagnosed with a terminal illness, he might be eligible for disability compensation provided through Social Security benefits. And so my constituent service director, after listening to his story, went through everything to try to figure out a way to help this individual, only to learn that the process, the law as it sets out now, provides for a 5-month waiting period. Although Mr. James has insurance coverage through his employer, he is unable to work because of his disability. He is going to incur thousands of dollars, probably hundreds of thousands of dollars in medical bills because of this arbitrary 5-month waiting period. If he had only been given the opportunity to demonstrate his case for financial hardship to the Social Security Commissioner, he and his family may have qualified for this cash benefit offset. What my legislation would do is give the Social Security Commissioner the ability to waive the 5-month waiting period on a case-by-case basis for terminally ill individuals who would have to demonstrate the financial hardship. In Mr. James's case, as I indicated, he is employed, works for the cargo department of a major airline in Alaska, but he would have to demonstrate there is financial hardship as a consequence of this terminal diagnosis. It makes you wonder why this 5-month period. The capriciousness of a 5-month waiting period is evidenced by looking at the legislative history. In 1972, the House Ways and Means Committee report sought to reduce the waiting period from at that time 6 months to 5 months. At the time the Senate Finance Committee was pushing for a shorter period. They were pushing for a 4-month period. So back in 1972, you had a 6-month period. Some wanted it to go to 4 months. Eventually they agreed upon a 5-month waiting period. But it begs the question: Should it be 4 months, 5 months? Should it only be 1 month? My legislation would give the Social Security Commissioner the discretion to waive the waiting period if the terminally ill individual can demonstrate a financial hardship. This will alleviate the financial burden or help to offset the financial burden of a terminal illness on the disabled individuals and their families and will also provide for a financial offset for paying medical bills after he or she is deceased. I would ask that in honor of my constituent, Mr. Jones, my colleagues support this bill because there are people who become disabled. We know they are unable to work. They need that monthly support to help offset the costs of their terminal illness. For this reason, it is imperative that the Social Security Commissioner have that ability on a case-by-case basis to make a determination for disability benefits. Mr. James's chemotherapy costs, we understand, are about between $10,000 and $15,000 per monthly session, and this does not include the other medical bills he is facing. I ask my colleagues to join me in supporting this legislation so that Robert James and Americans like Mr. James have the ability to qualify for disability benefits to offset these costly expenses without having to complete an arbitrary 5-month waiting period.

Ms. MURKOWSKI

Ms. MURKOWSKI. Mr. President, I suggest the absence of a quorum.

Ms. MURKOWSKI

Ms. MURKOWSKI. Mr. President, I thank the chairman of the committee for his great cooperation on this very important issue. I know we had all hoped--certainly my constituents had hoped, and I think my colleagues as well, as so many around the country who have been waiting years--literally waiting a decade--for reauthorization of this Indian Health Care Improvement Act. We are pleased that we are on the floor. We would like to see this moved through the process as quickly as possible. We understand the issues we have in front of us and what we have to do in order to get this through, but I appreciate the great leadership of the chairman of the Indian Affairs Committee and of so many who have worked to advance this legislation. I thank Chairman Dorgan for reminding all of us of the great contributions we have had from so many of our American Indians, Alaska Natives, when it comes to serving our country. I think if you look at the demographics and look at it on a per-capita basis, we see higher numbers, certainly in Alaska, of our Alaska Natives serving in the military than any other populations in the State, serving admirably over the years, whether they be the Eskimo Scouts or whether they be the group serving from the National Guard which recently returned from Kuwait. I had an opportunity a couple of months ago to meet those Alaskans who were returning. I met up with them in Camp Shelby and had an opportunity to talk to the men who were returning from Kuwait after well over a year. They had been in the desert. Most of these soldiers came from villages from around the State. There were some 80 villages-- communities--that were represented amongst this particular unit. Many of them, when they returned back home to Alaska after coming from the desert and going home to the snow, would be returning to very small towns and very small villages that are not connected by any form of a road system. During the winter months, you have connection because the rivers are now frozen and you can take a snow machine to get from one small village to another and hopefully out to a larger hub community. But the reality is so many of these fine men who have served our country are going back to areas where health care options are very limited. Yesterday I had an opportunity to show my colleagues a couple of pictures. There is one of the health clinic in Atka. We also had a picture of the health clinic in Arctic Village. As you look at the pictures, you can see the health clinics are small and they are clearly broken down. They are older facilities. They are very limited in terms of what they can provide. But this is what we have out in these villages. These soldiers who are returning need to go to the VA for services. They don't have a VA out in Chevak. They don't have a VA facility out there in Atka. They have the Atka Village Health Clinic. This is a two-story clinic, so it is by all standards perhaps better than some of the others in some of our villages. But what we have seen in a State like Alaska where access to care is so very limited, is the IHS facility essentially ends up being the entity that will provide for that level of care for that serviceman, for that veteran, because to get from Atka to Anchorage, to the Anchorage Native Medical Center, is costly. Sometimes the VA picks up the travel, sometimes not. It depends on your income eligibility. If there isn't any--if the Government is not there to pick up your costs, not only do you have the cost of air travel, which can be upwards of $1,000 for your roundtrip fare, but you have your expenses while you are in the city--in town. So we look at what is provided to so many in our small clinics around the State. Now, is it right that the clinic should have to pick up or basically carry the water or carry the bag for the VA? Not necessarily, no. But is this where we can provide for a level of care that is in the village for the individual, with their family, and ultimately reducing so many of the travel costs that are there? Absolutely. So I say this to my colleagues, so people can understand that oftentimes what we are dealing with in terms of access when you are in a State where it is so rural, where you don't have roads, or the cost to travel is prohibitive, we have to be more creative in how we provide for the level of care. In Alaska, we think we are being more creative with that. But with the reauthorization of the Indian Health Care Improvement Act, it allows and facilitates greater sharing, greater cooperation, ultimately greater collaboration, that leads to greater cost savings. I want to take a couple moments this evening--it has been mentioned by our colleague from Colorado, and certainly the chairman mentioned the provision we have in the substitute amendment regarding violence against Indian and Alaska Native women. I mentioned in my comments yesterday that we have seen some successes in Indian health, even with the very stark health statistics that have been repeated by so many on this floor. There is one area, though, where I do not believe we have made any progress, and one I am very pleased we are addressing in this bill, and that matter is the terrible violence that faces native women and children. Back in September of 2007, the Committee on Indian Affairs held an oversight hearing on the prevalence of violence against Indian women. We had several witnesses, very compelling witnesses, at that hearing, one of whom was from Alaska, a woman by the name of Tammy Young, and she represented the Alaska Native Women's Coalition Against Domestic Violence and Sexual Assault. She testified about the intensity of such prevalence and the need for remedies to properly address the problem. In my State, we have one major city. Anchorage holds about almost half the population of this State. The Alaska Native people make up 8 percent of the total population of Anchorage. But the percentage of Alaska Native victims in Anchorage alone was 24 percent. You can see the disparity in these numbers. Alaska has one of the highest per- capita rates of physical and sexual abuse in the Nation. In Alaska, an Alaska Native woman has a likelihood of rape that is four times higher than a nonnative woman in the State. Our statistics are horrendous. They are deeply troubling. But we know it is not only in Alaska that there is this danger of violence that faces our Native women. Statistics show that Native women around the country are two to three times more likely to be raped than women from other populations in the United States. As I say, in Alaska it is four times higher. But even if this fact were not as disturbing as it is, it gets even worse because so many of these women who have had this violence upon them also face the prospect that the rapist may not be brought to justice. This is for a variety of reasons. At the hearing we had a witness indicate that the health services within the Native communities simply lacked the proper infrastructure, the proper resources, to even conduct the forensic exams and therefore assist in the prosecution of the perpetrators. It is as simple as not having rape kits available in the IHS facilities in that village or that community on that reservation, simply not having the forensic equipment, not having it there. Why don't you have it there? It is a funding issue apparently. But you have a situation where you have a woman who has been violated. She comes seeking help, and she can't even have a proper exam so they can collect the evidence so she may then go on and try to prosecute the perpetrator. In addition, it is the training. We simply do not have enough who are trained in the proper collection of the evidence. Back in 2005, we in Congress passed aggressive programs and services for the reauthorization of the Violence Against Women Act, or VAWA. The witnesses who were there at the hearing back in September advocated that we build on the foundation of VAWA. That is what this legislation does. It provides for just that. It includes programs to address domestic and sexual violence that are critical to shoring up this health infrastructure, that are necessary to support a successful prosecution, whether it is providing for rape kits at the Indian clinics and hospitals or the training for the health professionals to become the sexual assault examiners. Pretty basic stuff. But if you don't have it there, if you cannot collect the evidence, if you don't have the trained medical professionals to help facilitate that, these victims will be victimized again by simply knowing that the system has let them down. In addition, the legislation will also require the Secretary of HHS to establish protocols and procedures for health services to victims of violence, as well as to coordinate with the Attorney General in identifying areas for improvement within the health system to support these prosecutions. I believe this aspect of the legislation is extremely important for so many. Again, our statistics in this area are devastating, unacceptable. There is more we can do about it, and this is one small step. Mr. President, I want to talk about one aspect of the Indian health care reauthorization. I don't believe many of my colleagues have spoken to the underlying policy of self-determination and self-governance, but that is such an integral part of this reauthorization. The Federal policy of self-determination was conceived by President Nixon in the early 1970s, and it has been nurtured or improved upon by almost every administration since then. The legislation, S. 1200, embraces these policies in a very profound manner. Indian self-determination represents one of our Nation's first enlightened Federal Indian policies. It has been by far the most successful policy in improving the lives of American Indians and Alaska Native people. This policy has been embodied in Federal legislation for over 30 years in the Indian Self-Determination and Education Assistance Act. S. 1200 facilitates the important interplay between the Indian health care delivery system within the Department of Health and Human Services and the policy of Indian self-determination and self-governance. Beginning in the 1990s, there were a growing number of Indian tribes and Alaska Natives who have taken over the IHS programs. They have made them more efficient and responsive and, I would say, more relevant to the local needs. In Alaska, I think we can point to what has happened in the area of self-governance as a good example, a positive example of how the Native people have embraced this policy of self-determination and self- governance. In April 2003, the Committee on Indian Affairs held a hearing on an earlier version of this bill. We had a gentleman there from Seldovia Village, President Don Kashevaroff. He testified about how Alaska Natives began compacting IHS programs in 1997 and how, within 6 years, they had compacted virtually all of the IHS programs within the State of Alaska. Now, within my State, the Indian health care system is almost entirely a Native-driven system. Senator Stevens, my colleague, spoke to this in his comments on the Senate floor yesterday. When you take into account that in Alaska there are about 230 separate Native villages, you manage the numbers there, and despite this large number of separate sovereign governments spread out across a State with enormous distances from each other, spread out from the State's metropolitan area, they were able to create a highly efficient and integrated health care delivery system. I showed you the pictures earlier of the clinics in Arctic Village. Behind me in the photo is the Alaska Native Medical Center, located in Anchorage. Quite different. Yet what we have there in Anchorage at the ANMC is a model for others to view. In Alaska, we have 180 small community health centers, about 180 of what you saw with the Arctic Village clinic, and they provide primary care. We have 25 subregional midlevel care centers. There are four multiphysician health centers, six regional hospitals, and one tertiary care facility. The Alaska Native Medical Center in this picture is that one tertiary care facility. So in the entire State, the Alaska Native Medical Center is the one that provides that tertiary care. This system was made possible through the Indian Self-Determination Act. This health care system is tailored to meet the very unique needs of the Native people. I don't believe it would have been possible within the administrative structure of the Indian Health Service itself. Now, I don't want to spend all my time just talking about the situation in Alaska because the success story that you see there is by no means limited to my State. Self-governance is being embraced in several other areas of the country as well: in the Pacific Northwest, the Southwest, in Oklahoma, and in other parts of the country. I think it is important to note that many tribes and tribal organizations have supplemented their IHS programs with their own resources where possible. The Indian Health Service has documented the fact that Federal Indian health programs are only meeting approximately 60 percent of the need. You have heard that time and time again as we have discussed this. Only about 60 percent of that need is met. The hearings on Indian health held by the committee and information from a 2005 GAO report demonstrated that this underfunding has led to rationing health care within the Indian community. Of course, the unfortunate result of this underfunding is exactly as you have heard many of my colleagues say. It results in many American Indians either foregoing any kind of treatment or delaying receiving medical care, which in turn, then, leads to disease progression. But ultimately it leads to higher costs, greater costs to the system. I want to point out that several tribes have stepped up with their own resources to enter joint ventures with the Federal Government or to even supplement the Federal dollars in an effort to bridge that 60 percent gap we keep talking about between the Federal funding and the level of need. I want to show a few of the examples. In the Cherokee Nation in Northeast Oklahoma, we have a self- governance tribe with one of the largest service populations in the country. The Cherokees have just constructed a new clinic in Muskogee, OK, using their own tribal dollars. This facility serves Indian people in northeastern Oklahoma, including members of the Osage, Muskogee Creek, Choctaw, and numerous other tribes. We also have the Muckleshoot Tribe in Auburn, WA, which built this facility in 2005 at a cost of nearly $20 million using its own tribal dollars. The Muckleshoot facility is located near the I-5 corridor in Washington and also provides very tailored care for its patients. As you can see from the picture, they try to cater to some of the younger patients as well. Another Oklahoma tribe in southeastern Oklahoma is the Choctaw Nation, which used their own tribal dollars to construct a 54,000- square-foot facility at a cost of $13.5 million. In this facility the average monthly patient encounter over the past 12 months has been over 3,800 patients. Out in Oregon, located in Chiloquin, we have the Klamath Tribe Health Center built in 2004, paid for through a unique partnership between the Klamath Indian Tribe and the IHS, as a health center that primarily serves the Klamath Tribe. It serves a tribal population of 2,890 individuals and cost $3.6 million to construct. The last one I want to share with you comes out of Bylas, AZ, and the San Carlos Apache Tribe has constructed this two-building complex on its reservation, which is about 130 miles east of Phoenix. As the main source of primary care for Indians there, this clinic provides dental, behavioral health, optometry, laboratory, pharmacy, health education, and preventive care, among other services. I use these examples to demonstrate some of the many cases where tribal ingenuity and resourcefulness have changed the Indian health care system for the better. I think this is illustrative of what can happen when the tribes are given the flexibility to plan, to develop, and to determine the future for their own people. We promote that ingenuity in this bill through the amendment to the Indian Self- Determination Act, which will make it possible to bring private sector money into Indian communities to supplement--again, I repeat ``supplement,'' not supplant--the Federal resources that are appropriated by Congress. S. 1200 establishes the Native American Health and Wellness Foundation, the primary purpose of which will be to support the mission of the Indian Health Service by supplementing the Federal resources with private funds and, hopefully, bringing the level of funding for Indian health care closer to that level of need. Mr. President, I will conclude my remarks this afternoon by repeating that within the Indian health system, you have great disparity. You have seen some of the pictures of beautiful facilities and some pictures of facilities that are in desperate need of help. We have heard stories that just break your heart of people who were denied services, of people whose illness was only compounded because of failures within the system. But we have also heard some statistics that give us cause for hope that we are making headway within the system in terms of some of the chronic diseases and how we might approach them. Through the Indian health care reauthorization, we focus on those areas that will allow us to do better, whether it is in the area of behavioral health, additional screenings, those programs that focus on prevention, those programs that focus on wellness, so that we can, A, lower our cost of health care but, B, to really allow American Indians and Alaska Natives to have a quality of health care that is at least on par with what you would get if you went to a non-IHS facility. We have not advanced legislation that would update the Indian Health Care Act since 1992. As I have said, all one needs to do is think back to what we were doing in 1992 in terms of health care. Think how far we have come with the technology. Think how far we have come with the techniques that are utilized. Let's not leave the Indian health care system 10, 20 years ago. Let's allow them to come into a level of service that we care to enjoy. I mentioned one way we in Alaska are able to deal with the issue of access. In a large State with a small population who are not connected by roads, we have to rely on telehealth. Telemedicine has allowed us to provide for a level of care, whether it is checking out an infant's ear to make sure how bad that ear infection is or whether it is literally videoconferencing with a suicidal teenager and counseling to make sure he is not going to do something precipitous, that he knows he has somebody who is there for him. Our technology allows us to do that, but our legislation needs to be put in place to allow us to take full advantage of the changes in these intervening years. Again, I stand with my colleague, the chairman of the Indian Affairs Committee, and urge our colleagues, if they have amendments, if there are still issues outstanding, let's work through those, let's get the amendments, but let's work through any remaining issues. We owe it to all our constituents around the country to provide for a better level of care. With this legislation, it is one small step forward. I yield the floor.

Ms. MURKOWSKI

Ms. MURKOWSKI. Mr. President, I so appreciate the passion and the advocacy of my colleague, the Senator from North Dakota, and working together on the Indian Affairs Committee on an issue in which I think both of us believe very strongly. Both of us believe in the commitment we have to the American Indians and the Alaska Natives, particularly insofar as providing them with a level of access to health care. That commitment is one that in far too many areas we have failed, and that is why it is so important that we are able to advance, as the first legislation of this new year, the Indian Health Care Improvement Act of 2007. We just celebrated the birthday of Martin Luther King, and as a nation we think about that time in our history when we were not proud of how we treated one another based on color of skin and ethnicity. We know that in many parts of this country, we still have far to go, but we are making progress. Yet, as we look to how the American Indians, the Alaska Natives, and so many in our Native communities have been treated when it comes to the basics in health care, that is an area where I think we need to look very critically and say we can and we must do more. When I first became the vice chair of this committee, Chairman Dorgan and I sat down, and he said to me: Lisa, what are your priorities for the Indian Affairs Committee? What is it that you would like to see advanced? He told me what his priorities were. It is awfully nice being able to walk into that new relationship and agree that the most important thing we could do was to work together in a bipartisan effort to advance legislation that has been working through the process for a number of years, for a number of Congresses, and to successfully move that through the Congress. We have worked on this bill through three committees of jurisdiction--the Indian Affairs Committee, the Finance Committee, and the HELP Committee--before finally bringing this here to the Senate Floor. I believe this legislation brings new hope for Indian health. It represents a step forward, a step toward the goal of providing our first Americans with health care that is on par with other Americans. It is not the end-all and be-all, but it is a first step, and I am encouraged that we have the opportunity to produce this legislation in support of that goal. As my colleague has noted, this day has been far too long in coming. Efforts to enact comprehensive reform for the Indian Health Care Improvement Act began in 1999. This act was extended for 1 year back in 2001 through legislation introduced by Senator Thune when he was a Member of the House of Representatives. Since then, the Indian Affairs Committee has shepherded several reauthorization bills through multiple Congresses, through multiple hearings, through multiple markups, but it has yet to be reauthorized despite the very good efforts of a great many. This bill would reauthorize and would amend the Indian Health Care Improvement Act and applicable parts of the Indian Self-Determination and Education Assistance Act, as well as the Social Security Act. The Indian Health Care Improvement Act provides a basic framework for delivery of health care services to American Indians and Alaska Natives. As Senator Dorgan has indicated, this is a Federal responsibility arising from the Constitution, arising from the treaties and from Federal court cases. The act itself, first enacted back in 1976, was last comprehensively reauthorized in 1992. Think about the status of health care back in 1992 and what has changed. Certainly, in my State of Alaska, we have been able to do so much more in our remote areas because of what we are able to do through Telehealth. Well, back in 1992, I can guarantee you we were not doing then what we are doing now. It is so vitally important that we provide for this authorization to update a system by passing this bill. We recognize there are still some outstanding issues that need to be resolved. I would like to think they are not central parts to this bill, and I am very confident we can deal with them if our colleagues work with us in the same very bipartisan way that we on the committee have done to advance this. Now, Chairman Dorgan has given good background in terms of an overview, the need for reauthorization, and he has highlighted it with stories that touch our hearts, as they should. I wish to elaborate a little bit further on the legislation, how it developed, and give that overview as well as some of the key improvements we have in S. 1200. To really understand the framework of the Indian health care system under this act, you have to keep in mind that there is very significant interplay between this act and the Indian Self-Determination and Education Assistance Act. The Indian Self-Determination and Education Assistance Act provides the process whereby Indian tribes and the tribal organizations contract or compact to take over administration of programs from the Indian Health Service. It is the interplay between these two statutes that provides a great deal of the backdrop for many of the principles that underlie this reauthorization. The act essentially governs programs for the recruitment and retention of Indian health professionals, for health promotion and disease prevention, for facilities, urban Indians, and a comprehensive behavioral health system. The act also governs important authorizations which increase access to care where there is third-party reimbursement. It also sets forth the administrative organization for the Indian Health Service. Finally, it contains reporting requirements and other regulatory authority for the Secretary of the Department of Health and Human Services. The bill is intended to improve Indian health care in three areas: First, by increasing access to health care; second, by updating the authorized services and programs; and third, by facilitating innovative financing systems to help support Indian health. So let's talk about the increase in access to care. In Alaska, we are talking about access to care all over the State. Geographically, as you know, we are very large, populations are very small, and providers are very limited. And this is throughout all systems, not necessarily just the Indian Health Service. This legislation includes programs to increase outreach and enrollment in Medicare, Medicaid, and SCHIP. We need to have aggressive outreach in order to ensure that the Native people who are eligible for these programs participate in them and so that they can navigate through a relatively challenging enrollment process. We recognized the critical importance of the Medicare, the Medicaid, and the SCHIP programs for Indian patients. There was an Indian woman by the name of Ski who lives in southwestern Oklahoma. Along with her husband, she takes care of her three grandchildren and her great- granddaughter. About 4 years ago, Ski's doctor, after checking her x rays, found a large spot on her lungs. They also diagnosed her with thyroid cancer. Sadly, though, the IHS Contract Health Service, which is intended to provide for the kind of specialty care Ski needed, notified her that the funds aren't available to pay for it. This is very similar to some of the stories my colleague has mentioned. Without this additional care, Ski, who is the primary caregiver for her grandchildren and great-grandchild, wondered if she would be around to watch her children and great-grandchild grow up. Fortunately, Ski won't have to face the prospect of living without health care because she did receive it--not through the Contract Health Service but through Medicare. It was these resources which allowed Ski to undergo the biopsy which ruled out lung cancer and to see a pulmonologist and receive testing on a regular basis for the pulmonary fibrosis she was eventually diagnosed to have. She had complete removal of her cancerous thyroid and since that time has been able to receive the follow-up treatments, the testing, and the examinations, all of which we know are very costly but which Medicare helped to cover so that Ski can continue her life raising her family. She is fortunate and, unfortunately, somewhat of a rarity. Many Indian patients do not have Medicare or Medicaid to help them even though they may be eligible. In the legislation we have, S. 1200, it will help those Indian patients in accessing Medicare, Medicaid, and SCHIP through the outreach and the enrollment programs as well as other means. Now, accessing third-party reimbursement also helps Indian health providers. The Makah Tribe is a good example of why we should include the provisions to assist tribes in participating in Medicare, Medicaid, and SCHIP. The Makah Tribe is in Washington State, and they are located on a very picturesque 44-square-mile Indian reservation filled with rich forests, wildlife, birds, and plant life--a very beautiful area. From their home, tribal members can cross the Strait of Juan de Fuca and during the summers go fishing or boating in the Pacific. Although their home is a place of amazing beauty, it is also a very remote part of the State which presents some daunting challenges to the delivery of health services to the tribal members. It has been reported that the tribe operates a small ambulatory clinic with over 2,000 users and only two doctors. Due to the remoteness of the clinic, the tribe has difficulty recruiting health care professionals, including dentists. Over 70 miles away you have the nearest town with a full-service hospital, Port Angeles. But those 70 miles can be treacherous to negotiate. It is a winding road, a difficult road. There are several instances when the road has been washed out by storms, leaving no access to or from the reservation. So there is no surprise that Port Angeles, being a larger town and a more accessible town, has salaries that are more attractive than the reservation. The Makah Tribe administers the health care services through a self- governance compact for which the tribe should receive contract support costs. However, those contract support costs do not cover all of the indirect costs of health care services. So this impacts the tribe's ability to provide for competitive salaries and to provide for that full array of health care services. But despite all of those challenges, the Makah Tribe has remained resourceful. They are in the process of improving their third-party reimbursements, in particular the Medicare Part B access for eligible people on the reservation. It is these additional reimbursements that assist the tribe in essentially hedging against the insufficient contract support costs. So when you hear of situations like what we are seeing with the Makah, recognize this legislation will serve to benefit the tribal health providers as well as the Indians who are served by allowing for, again, the additional reimbursement for improving access to care. The legislation will also improve access by removing barriers to such enrollment such as the waivers of Medicaid copays and allowing the use of tribal enrollment documentation for Medicaid enrollment. These are very important to provisions in this legislation. I hope we will hear more of the good stories, the stories like Ski's, rather than the very damning stories we hear of the system currently. Now, in updating health care services in Native communities, the bill establishes permanent authority for home and community-based services, and these are services which have been operating in the State of Alaska with very impressive results. I mentioned just a few minutes ago Alaska's size. Many know Alaska Natives have to travel enormous distances away from their home communities to obtain any level of specialized care. Some people think we make this map up, just to show Alaska's shape over the continental United States--but this is actually true to size--the State of Alaska does stretch from just about Florida into Arizona and beyond, from Canada down to the southern area. Geographically, we are huge. We have another chart that indicates how the distances for an individual coming from, let's say, Unalaska down here where Arizona is on the map. Unalaska is not only our State's largest fishing port, it is the largest, in terms of volume of fish, fishing community in the United States of America. For an individual who is coming from Unalaska, which just has a small clinic, to come to Anchorage, which is where all of the points converge in the middle of the map, it is the equivalent of essentially going from Arizona to Kansas for your medical appointment to come to the Alaska Native Medical Center where you can see a specialist. To give another example, the residents of Barrow, at the northern most part of the State, also have to travel to Anchorage to obtain specialty medical services in the Alaska Native Medical Hospital. That is the distance of coming from the Canadian border down to Kansas for medical services. If you are coming out of the southeastern part of our State, in many of our island communities, again, you are moving from essentially Alabama or Florida into Kansas. The distances we deal with to provide access to care are realities for us in the State that other people cannot relate to. We are not talking 100 miles, we are talking several hundred miles. When you put it in context that way, you recognize it is not just the time and the distance traveled, but it is the expense and the distance traveled. Mr. President, as I was mentioning the distances that we deal with, I mentioned the time to travel, the expense to travel, but think about the situation if perhaps you are elderly, you are ill, or perhaps you do not know what is wrong, and you have to leave your village to go to our cities, our largest cities, which is very intimidating for many of our Alaska Natives in the first place. They are away from their family, they are away from their community members, they are away from their traditional foods, they are away from their traditional activities. Many of our elders do not speak English, so they are coming into town where the language is different. Think about how well you would heal or how well you would feel in truly a strange and foreign place like this. Well, the Yukon-Kuskokwim Health Corporation located out in Bethel, Alaska, in western Alaska, decided this is unacceptable, to have to pull everybody from the villages so far away. And they developed a village and a regional service structure to help the elders, to help the Alaska Native patients with chronic diseases to continue living in their homes or in their community rather than being sent hundreds of miles away to receive special nursing care. It was their pilot program to take over all home and community-based care in their region, which resulted in a reduction in service waiting time for the disabled and the elders in the region and truly improved the patients' health status level. This legislation may enable other tribal programs around the country to also engage in home and community-based care which would allow Indian patients to remain in their homes rather than face a lengthy hospital stay or nursing home stay in a distant and, again, a strange location. Our legislation also consolidates and coordinates the various tribal health programs into a more comprehensive approach. As we well know, alcohol and drug abuse among many of our Native communities, and methamphetamine abuse, has reached epidemic proportions in some communities. We had a gentleman, the former chairman of the Northern Arapahoe, Mr. Richard Brannan. He testified before our joint hearing before the 109th Congress, and then again during the 110th, and told us truly a heart- breaking story of the tragic and painful and terrible unnecessary death of a beautiful little Indian girl at the hands of methamphetamine- addicted individuals. Chairman Brannan sought our help in providing both prevention and treatment for the drug and alcohol addictions that ravage Native communities. I am pleased that this bill will authorize such assistance and more to help prevent these tragedies from happening to other Indian children. Now, also during the committee hearing on the methamphetamine plague, we received testimony from tribal leaders about the devastation this terrible drug has brought to their communities. Kathleen Kitcheyan, the former tribal chairwoman of the San Carlos Apache Tribe in Arizona, described a very personal loss, a tragic loss of a grandson to drugs. And she stated that on her reservation, they have methamphetamine users who are as young as 9 years old. Think about what is happening to our children. Think about drug abuse and the addictions. But to know that children as young as 9 years old are being made the victims, we should all be alarmed when we hear stories like this. And what is equally horrifying are the residual effects of methamphetamine abuse on children. The former chairwoman testified how babies were being born on the reservation, born addicted to methamphetamine, with physical deformities. She stated that on her reservation a 22-year-old methamphetamine user tried to commit suicide by stabbing himself with a 10-inch knife. So many terrible stories. There were 101 suicide attempts on her reservation during the year 2004, 101 attempts that were directly related to meth. Now, I have described that we are seeing methamphetamine users as young as 9, but it also afflicts the middle-aged as well as the elderly. Once meth has taken hold, few can escape without considerable help. The Indian Health Service estimates it takes well over 60 days in treatment programs in order to overcome these addictions. So just separating a methamphetamine addict from the drug for a period of a few weeks or even a month is not nearly enough to provide effective treatment, not nearly enough to break the addiction. The methamphetamine addicts need the long-term treatment necessary to allow their mental and their physical state to heal and to recover. For the children, the IHS has 11 federally funded youth regional treatment centers with 300 beds overall. In addition, there are an estimated 47 or perhaps 48 tribal and urban residential programs for adults. One program, the Native American Rehabilitation Association in Portland, OR, which is an urban Indian facility, can also house the patient's family so the patient can also receive the very necessary family support during the recovery. These programs authorized under the Indian Health Care Improvement Act, and more importantly the Indian and Alaska Natives who are suffering from meth addiction, will benefit from the updates to the behavioral health program in this bill. Now, we heard from Chairman Dorgan that the Indian health system is funded at approximately 60 percent of the need. And with the new health hazards, whether it is methamphetamine or whatever the hazard is, that face our Native communities, we have to be innovative in finding solutions and resources in building upon the foundations that are set forth in the Indian Health Care Improvement Act. This legislation will establish the Native American Wellness Foundation, a federally chartered foundation to facilitate mechanisms to support but not supplant the mission of the Indian Health Service. It is modeled after legislation which passed the Senate in the 108th Congress. I am pleased to say we will have an opportunity to advance it in this legislation as well. I wish to mention two key provisions that have been briefly mentioned. This is regarding the issue of violence against Native women. In the substitute we hope to advance later, we will provide for authorization of prevention and treatment programs for Indian victims and the perpetrators of domestic and sexual violence. We will also provide critical incentives for Indian health providers to obtain certification and training as sexual assault nurse examiners or in other areas to serve victims of violence. Both these provisions build upon very important work this Congress did in the Violence Against Women Act, by addressing some of the systematic shortcomings to improve prosecutions, such as forensic examinations. I will speak on this a bit later. One of the things we heard in testimony before the committee was that in many of our IHS facilities, they did not have rape kits available. They could not collect the forensic evidence. If you don't have the evidence, you cannot proceed with prosecution. When you hear stories such as this and ask for confirmation that, in fact, this is the situation, that we simply don't have the kits available--it is confirmed--it is no wonder women feel helpless in even seeking assistance after a violent act such as a rape. In addition, simply not having the training for the nurses at the clinics, these are areas of critical shortcomings and ways we can help to make a difference. There are many good things in this bill, but I do wish to impress upon Members this is truly a national bill. It works to benefit Indians and Indian health programs in communities across the spectrum. I have mentioned that it has been a product that has been in the works for years, a very determined effort on the part of Native health leaders truly from all corners of our Nation. There are over 560 Indian tribes in this country, with 225 of those tribes in Alaska alone. Our Indian tribes and Indian health care system span the Nation from Maine to Florida, California to Washington, and, of course, to Alaska up North. According to recent information from IHS, over 1.6 million American Indians and Alaska Natives receive services in this system at over 600 facilities. These facilities are all over the board, in terms of what they can provide, ranging from inpatient hospitals, general clinics, and health stations. There are some that look beautiful and there are some that you look at and say: We can do far better. I mentioned earlier many Natives in the State travel into Anchorage from outlying areas to receive care at the Alaska Native Medical Center. As you can see behind me, it is a large, beautiful facility. It is designed to provide for that advanced level of care and specialty for Alaska Natives from around the entire State. But as one travels away from Anchorage, and you get off the road system out into the bush, the facilities vary in size and certainly in service and are certainly much more modest. We have a picture of the clinic in Atka, AK. It is a little rough around the edges, certainly, but they are able to provide for the basic needs in that region. I checked to identify some of the other challenges the folks in Atka face, in terms of their costs. This is a village where gas is selling for $5.09 a gallon, and home heating oil is going for $4.99 a gallon. We have a picture of the clinic at Arctic Village which is located more in the central or interior part of the State. I checked with them this weekend on the price of gas per gallon. It is 7 bucks a gallon. Their home heating oil costs are $6.36 a gallon. So it is expensive to live out there. It is expensive to heat your home. When you are ill or need help, this clinic is where you go in Arctic Village. We know the need is extensive. The Indian health care system has to provide everything from basic medical to dental to vision services and medical support systems. It has to include the laboratory, nutrition, pharmaceutical, diagnostic imagining, medical records. Obviously, they are not providing that there at Arctic Village. Senator Dorgan had mentioned the history of the Indian health care system. I will not take the time today to speak to that. I do, before taking a break, wish to take time to talk about some of the updates to the current Indian health care system we have in this legislation. As I mentioned, there have been enormous changes to the medical system since the last reauthorization of the Indian Health Care Act in 1992. So in order to update and provide for an improvement in the overall status of the American Indian and Alaska Native health and well-being, we have to make sure our facilities access is better. Chairman Dorgan mentioned some of the health statistics and mortality rates we see among American Indians and Alaska Natives. We know these populations are dying at higher rates than others within the U.S. population. On tuberculosis, for American Indians and Alaska Natives the rate is 600 percent higher; alcoholism, 510 percent higher; diabetes, 229 percent higher; unintentional injuries, 152 percent higher; homicides, suicides higher. The statistics are all so troubling as we look to what we are providing and whether we are seeing improvement. As I say that, we have seen some gains. With passage of the Indian Health Care Improvement Act of 1976, there were some pieces of good news insofar as decreases in mortality rates over the past 35 years. The average death rate from all causes for the American Indian and Alaska Native population dropped 28 percent between 1974 and 2002. We have seen gastrointestinal disease mortality reduced. Even though the death rate for Indians is 600 percent higher than the rest of the United States, we have seen tuberculosis mortality reduced 80 percent, and cervical cancer mortality has been reduced. Infant mortality has been reduced 66 percent. We are seeing good news there. The problem is, we started at such high levels. So, the statistics are still unacceptable. In addition, we have population growth and economic factors which are creating strong pressure on American Indian and Alaska Native communities and their health care facilities. From 1990 to 2000, the population grew at a rate of 26 percent among the American Indian and Alaska Native populations. Compared to the total U.S. population, it grew by 13 percent. But we know the health care funding for Native people simply has not kept up with the expanding population and inflation. This effective reduction in health care funding creates our current health status level. We see the survival rate improving, but all we need to do is look at the charts, look at the statistics. We know Indians and Alaska Natives still suffer disproportionately from a number of health problems. We know, for instance, in the area of diabetes, the rates are unacceptably high. While we recognize the Indian Health Service is trying to get this diabetes crisis under control--they are providing diabetes care to greater numbers of Native people than ever before, and we see some success--is it adequate? Is it sufficient? Another area where we are seeing some success is in the area of vaccinations. We are getting higher vaccination rates for adults over 65. These have been instrumental in helping with some of our health statistics. Screenings, such as for fetal alcohol syndrome, have been helping to reduce the burden of preventable disease. One of the aspects we face in increasing efficiencies within the delivery of the health care system, we know we have to use new technologies, new techniques, and these are contemplated and outlined in many areas of the legislation before us. I will go back to Alaska as an example of a State that faces very unique challenges in providing for quality health care to the residents in rural Alaska. The majority of the 200 rural Alaska Native villages are not connected to a road system. We don't have the roads. We are 47 out of 50 in ranking of States for the number of road miles, but we rank first out of 50 for overall land mass. We simply don't have a road system to speak of in much of Alaska. When you don't have a road system, you fly. We fly in small bush planes. During the summer months, we rely on skiffs and riverboats to get around. But for the most part, we fly. It is not luxury travel. It is a basic need. From the chart I have behind me, you can't see the names of all the towns there, but it is there to demonstrate what we deal with as a State. When you look at the IHS budget in Alaska, you may be surprised to see the travel budgets are unusually large, oftentimes larger than staff budgets. That gets people's attention. Are we going out to conferences? No. This is how we get around in the State of Alaska and how we move our patients, those who need to get to that medical specialist. We move them by airplane. Up in the north there you see a community of Barrow. Nuiqsut is a small village outside of Barrow. They have a small clinic. Barrow has a larger one. But in order to receive any level of specialty care, an Alaska Native would have to fly about 700 miles south to Anchorage to the Alaska Native Medical Center. The cost of that particular flight is $1,100 for that person coming out of Nuiqsut. Over to the west, out on St. Lawrence Island, an individual who is ill in Savoonga and needs to come into Anchorage for medical care is going to pay about $1,000. This is round trip, not that that makes it any better. Down south of Anchorage, off of Kodiak Island--and if you look at the red lines, it looks as if it must be much closer to Anchorage and therefore less costly--if you are coming from Old Harbor on Kodiak Island, your airfare is going to be about $1,350 round trip to get you to and from. So when we factor in the budgets of doing business, travel costs are enormous. This is all about access. We also recognize it is not just the cost. Oftentimes during the winter--this time of year--travel is shut down completely. For some of our communities, because of weather conditions, fuel barges have not been able to get into the community, and they have had to fly fuel in to provide for the diesel generation that provides the power in these villages. Whether it is the ice, the wind, the snow, oftentimes it is just too dangerous to make the trip into town. Blue Cross has estimated that it is 300 times more expensive to operate a hospital or a clinic in Alaska than it is in the continental United States. These are the expenses we deal with. In the last 10 years, we have seen access to medical specialists and health care improve. Working with my colleague, Senator Stevens, we have seen a revolution in terms of how health care is delivered to our rural villages with the development of an advanced telehealth network. With 99 percent of the telehealth initiative coming from IHS funding and managed by the Alaska Native Tribal Health Care Consortium, the Alaska Federal Health Care Partnership is a collaboration with the Department of Veterans Affairs, the Department of Defense, and the U.S. Coast Guard. They teamed up together to develop the Alaska Federal Health Care Access Network. They developed a special telehealth cart, and they deploy these carts to small villages in rural Alaska. They are able to provide a very wide variety of clinical services, including cardiology, community health aid training, dental and oral health, dermatology, ear, nose and throat care, as well as emergency room services. They had a demonstration cart here a couple years back to just kind of show us what it is they were doing. I had just come off a trip up north, and I was due to fly again very soon. My ears were all plugged up. I said: Well, show me how this works. Just standing right there, they put a little monitor in my ear, and they were talking to a doctor in Anchorage. He said: You just have a little inflammation there. You are fine to fly. What we are able to do with telehealth is to connect many of our Alaska Natives in a very cost-effective way for them to have access to qualified health care specialists without necessarily leaving their village. We continue to evaluate the cost savings we are seeing as a consequence of this telemedicine. The preliminary data suggests that 37 percent of the time, telemedicine prevented the need for a patient and family escort to travel. That saved an estimated $4.4 million in travel costs. So if you can save $4 million in travel, because we have the technology in front of us, it is a savings for all of us. Tribal health providers in Alaska with their Federal counterparts have been extremely innovative in addressing the unique health care challenges of our State. The Alaska Federal Health Care Access Network has been working with the IHS service areas to expand quality and affordable health care to American Indians across the United States. The new opportunities, such as expanded telehealth, found in S. 1200 serve important purposes in promoting good investments. Indian tribes and tribal organizations have performed admirably in developing their health care services and facilities. These types of efforts should be rewarded and encouraged by passage of this bill. There are some other items I would like to speak to, and I may come back to them at another point in time. But before I conclude for now, I want to mention the importance of the program in the sanitation facilities area. I could probably stand all day justifying the need for the reauthorization, but one area that has been demonstrated to be one of those very important functions in reducing health disparities is the Sanitation Facilities Program. This program governs the construction, operations, and maintenance of sanitation facilities providing clean water and sanitary disposal systems to Indian and Alaska Native communities. For us in Alaska, the issue of sanitation is one we have been struggling with for far, far too many years. One in three families--one in three families--in rural Alaska has no sanitation facilities. We are not talking about upgraded sanitation facilities; we are saying no sanitation facilities. What we have in many of our villages, still, unfortunately, is a system we refer to as the honey-bucket system. It is not a very refined system. In fact, it is a system that, for those of us in the State, we look at with shame and say: For Alaska Natives, for Alaskans to have to rely on this as their sanitation system is offensive. It is close to Third World conditions, and here we are in the United States of America, and you have a system where human waste is collected in a bucket and hauled outside and dumped in a collection facility. In some areas, it is less than a collection area; it is dumped in a lagoon. You can walk through some of these communities, and you have waste that is spilled along the wayside. I have in the Chamber this picture of these two little Native boys. It is like the equivalent of taking out the trash--taking out the honey bucket. If you do not think this does not contribute to some of our health issues in rural Alaska, you have not looked at the facts. In testimony before the committee, we had Steven Weaver. He is from the Alaska Native Tribal Health Consortium. Steve Weaver has been very instrumental working with us in order to eliminate the honey bucket. But he spoke at that hearing to the challenges families face in communities without sanitation facilities. He said: Other folks in America have the convenience of running water and inside flushing toilets, but in too many of our Native communities we have to haul the clean water into the homes and then haul the honey buckets out of the homes as part of the household chores, part of the daily living. I was in a community several years back and visited the health clinic there. It was a very small health clinic. It was one of the villages that still do not have running water. There was a honey bucket in the corner of the health clinic. When you think about the need for sanitation, particularly in your clinic, and you realize there is no running water and the human waste must be discarded by walking it out the door, the health consequences in communities without running water, without sewer are very real. The Alaska Native Tribal Health Consortium reported that infants in communities without adequate sanitation are 11 times more likely to be hospitalized for respiratory infections in comparison to all U.S. infants and 5 times more likely to be hospitalized for skin infections than those in communities with adequate sanitation. We have about 6,000 homes without potable water, about 18,650 homes that need improvements or upgrades for water, sewer, or solid waste. This legislation, S. 1200, will maintain the Sanitation Facilities Program. For us in a State such as Alaska, this is vitally important. Mr. President, at this time I am prepared to defer to Senator Gregg. He has been waiting some time. I do have additional comments I will make throughout the day, but I yield the floor at this time.

Mrs. MURKOWSKI

Mrs. MURKOWSKI. Mr. President, I wished to echo the comments of my colleague and my chairman on the Indian Affairs Committee. Reauthorization of this Indian Health Care Improvement Act is something that is long overdue. When we sat down as the chairman and vice chairman of this committee to assess the priorities of the committee, it was absolutely clear the one thing we could do now to help make a difference in the lives of American Indians and Alaska Natives was to improve the health care system, the delivery, and the access. The last time this was updated, if you will, was 1992. Think about what has happened in health care and the technologies and the techniques since 1992. We owe it to our constituents across the country--not just in Alaska, where we have 225 tribes, but from California to Maine, from the Dakotas down to Florida--we owe it to all our constituents to finally see this reauthorization through. We do acknowledge there are some issues that are as yet unresolved, but it is not as if we have not had the time to resolve them. The time is now to make it happen. I, too, would urge the Senate to work together, as the chairman and I have, in a very cooperative, very bipartisan manner to figure out how we move this legislation through the Senate to the House so it is finally enacted into law. With that, I yield the floor.

Ms. MURKOWSKI

Ms. MURKOWSKI. Madam President, on behalf of Senator Coburn, I object.

Ms. MURKOWSKI

Ms. MURKOWSKI. Madam President, I wish to take a few moments to speak on the issue of Medicare reimbursements for physicians, particularly those in rural and frontier States. We have moved forward a temporary fix of Medicare reimbursement for physicians, essentially for 6 months. I wish to speak to the issue for Alaska and other rural parts of the country. In Alaska, many of our Medicare beneficiaries, even without this potential 10-percent reimbursement cut, lack the ability to see a primary care physician unless they have the means somehow to pay out of pocket for doctor visits. Without congressional action on a long-term strategy--longer than 6 months--to increase Medicare reimbursements, these cuts threaten access to care as fewer and fewer doctors are able to afford seeing Medicare patients. An American Medical Association survey shows that 60 percent of physicians reported they would be forced to limit the number of new Medicare patients they treat if the impending reimbursement cuts go through. I get so many calls on a daily basis from seniors asking me to fix Medicare. They want to be able to continue to see their doctor. I know I am not the only Member who receives these calls. It is unfortunate, but America's seniors every year are thrust in the middle of this Medicare reimbursement debate out of fear that they are going to lose their health care provider to Medicare cuts. In 2003, with great fanfare, we provided a Medicare prescription drug benefit. At that time, I asked the question: We can have a wonderful drug benefit, but what good is the benefit if there is no physician to write the prescription? The Presiding Officer knows how big a State it is; she has had the opportunity to come for a visit. We are bigger than California, Texas, and Montana combined. ``Rural'' in Alaska has a new meaning. The physician shortage crisis in Alaska has been magnified because of our geography, distance, and size. What many people might not realize is what is happening to our population. We have always been viewed as a young pioneering State where the average age is the early 20s and predominantly male--a wilderness image. But we have grown and matured. Our elderly population is the fastest growing senior population per capita in the Nation behind Nevada. That is a statistic which would surprise many people. The Mat-Su Valley, an area just north of Anchorage, is the fifth fastest growing region among seniors nationally. Yet, think about that statistic and compare it with what is happening with our physician ratio. Alaska has the sixth lowest ratio of physicians to population in the United States. Outside of the Anchorage area, our ratio of physicians to population is the worst in the Nation. To put it into context, we had a field hearing the first part of the year to understand how bad the situation is as far as access to care. To reach the national average of physician-to-patient ratio, Alaska needs a net increase of 980 physicians statewide or 49 more physicians per year. I go into some of these hospitals, VA clinics, and community health centers. They have been waiting years trying to find not only doctors but all within the medical profession, whether it is outpatient therapists all the way up to cardiologists. Fairbanks, our second largest city, got its first cardiologist this year. According to the Anchorage Daily News, our largest newspaper, it costs 65 cents on the dollar to care for a patient in Alaska, and yet Medicare only reimburses 22 to 35 cents on the dollar. In addition to low reimbursement, we have other factors that drive the cost up. We have higher salaries, a higher cost of living, higher equipment costs, and higher transportation costs. Higher energy costs add to that. We had a field hearing earlier in the year and had an individual testify before the committee. He was later quoted in the Anchorage Daily News: The costs [to practice] were so exorbitant and the fees for reimbursement were so low for Medicare patients, at the end of the day I could actually owe money for working a ten-hour day. The sustained growth rate formula which has been in place since 1997 calls for nearly 40 percent in cuts over the next 8 years, even as practice expenses continue to increase. So how do we expect to entice more physicians to practice and care for our seniors, our veterans, if we threaten to cut Medicare reimbursements every year? We know the time for Congress to act is now. I ask my colleagues, those on the Finance Committee, let's work on legislation that will provide a long-term reimbursement fix to ensure continuous care for the elderly, who may otherwise be left without access to care in the neediest of times. This is something we all must work to advance.

Ms. MURKOWSKI

Ms. MURKOWSKI. Madam President, I want to follow on the comments of my colleague from New Jersey in recognizing those who allow this body to function so efficiently and to also give special recognition to the pages. Given the schedule they have, we are likely not going to be seeing much more of this particular group as they finish up for the holidays and their exams, and then move back to their respective States and their communities. But to all of you who have given so much to so many of us, to make our jobs a little bit easier, we thank you. Thank you very greatly. I believe this is an episode in your life that you will long remember, and hopefully it will be a good and positive experience for all of you. Thank you for your contribution.

Ms. MURKOWSKI

Ms. MURKOWSKI. Madam President, yesterday was a day of tribute to one of our colleagues, a gentleman who has served his State and this country admirably for many years. I have not had the privilege to serve in the Senate with our colleague for as long a period as many of those who spoke yesterday, but I think we know it doesn't take long to realize how important has been the contribution of the Senator from Mississippi to this institution. I listened yesterday to so many of the kind words. I heard repeated time after time: statesman, leader of an institution, truly a statesman. We all know of Trent Lott's tremendous dedication to the institution that is Congress, 34 years of public service between the House and Senate, his creation of the whip organization in the House that emphasized Member-to-Member contacts and outreach that are so important in building relationships, election to the Senate in 1988, Senate majority leader in 1996, and then Republican whip earlier this year. We don't want to lament the loss of a tremendous asset, but we need to always remember to celebrate those accomplishments, learn from them. I learned that if there was a problem that needed to be resolved, you could go to Trent to resolve it. When there was a compromise that needed to be brokered, Trent could figure out how to make that happen. I learned that when there was a shortage of tomatoes at the Lott household, Trent knew he could just go a couple doors down the street and find some tomatoes in a friendly neighbor's yard. My husband and I have been neighbors with Trent and Tricia these past 5 years. As neighbors, we share a lot of things. We share a lot of leaves. He blows the leaves down the sidewalk to my house, and my husband will blow the leaves back down to his house--good, friendly neighbors. I have always appreciated that. Truly, whether it is the quick conversation between Members during votes or whether it is the closed-door sitdown when he comes to the office and says: Lisa, I want to talk to you about this, Trent knows the pulse of the Senate. I would watch him on the floor. He was like a butterfly. He would come over and alight next to somebody, have a quick conversation, a talk, and then he would move over to another area and do the same thing, kind of going from person to person, always working but always friendly and always working to find a path forward. His ability to develop those relationships and work out a deal to everyone's satisfaction is a skill I certainly look to as a model for how the Senate should operate. It is with great fondness that I wish my friend, my colleague, my neighbor well in his future endeavors. I wish him and Tricia well and truly love as they embark on their next adventure. We do know there will be adventures. I thank him for his friendship, his service to this Nation and to this institution. I thank the Chair and yield the floor.

Ms. MURKOWSKI

Ms. MURKOWSKI. Yes.

Ms. MURKOWSKI

Ms. MURKOWSKI. Mr. President, I have not had the privilege to serve in the Senate with our colleague, Senator Lott, for as long of a period of time as many of those who have spoken today. But it doesn't take that long to realize just how important the Senator from Mississippi's contribution to this institution has been. We all know of his tremendous dedication to the institution that is Congress. Thirty-four years of public service between the House and Senate. His creation of the whip organization in the House that emphasized Member-to-Member contacts and outreach to the other party. Election to the Senate in 1988, as the Senate majority leader in 1996, and then as the Republican whip earlier this year. But rather than lament the loss of a tremendous asset, I would like to celebrate his accomplishments. When there is a problem to be resolved, Trent can resolve it. When there is a compromise that needs to be brokered, Trent will broker it. And when there is a shortage of tomatoes at the Lott household, well, Trent always knew he could find a few extra in the garden a few doors down. My husband and I have been fortunate these past 5 years to be neighbors with Trent and Tricia. We share many things as neighbors--I blow the leaves down the sidewalk to his yard, and he blows them back to mine. Jokes aside, whether it was the quick conversations between Members during votes, or a closed door sit down discussion on the issues, Trent knew the pulse of the Senate. He works like a butterfly--going from Member to Member on the floor, lighting for a moment to discuss an idea or resolve an issue and then going on to another. Always friendly, always working to find the path forward. His ability to develop those relationships and work out a deal to everyone's satisfaction is a skill that I certainly look to as a model for how the Senate should operate. So it is with great fondness that I wish my friend and colleague well in his future endeavors. I wish him and Tricia well as they embark on the next stage of their adventures. Trent, thank you for your friendship, and for your service to this Nation and this institution.

Ms. MURKOWSKI

Ms. MURKOWSKI. Mr. President, During this holiday season, I would like to recognize the soldiers and veterans from Alaska who have given so much and continue to give so much. I would like them to know that their sacrifices in Afghanistan and Iraq have not gone unnoticed by their fellow Alaskans. When I was in Iraq I had the pleasure of meeting soldiers and National Guardsmen from Anchorage, Fairbanks, Seward, Soldotna, Eagle River, Slana, and Wasilla. Hearing their stories and commitment made me incredibly proud to be an Alaskan. Every day, Alaskans write my office praising the service men and women who have returned and those still in combat. Sometimes it is just a short message conveying their support, while other times is a long heartfelt letter praising our heroes and expressing solidarity with them for the sacrifices they have made. I truly believe that the fact that Alaska has the largest number of veterans per capita says a lot about our State's character. Alaskan veterans are some of the most exemplary in the Armed Forces. The 172nd Stryker Brigade in particular had their tour in Iraq extended to 16 months, but when their country asked them for more they remained strong and proud. Just last week I received an e-mail from the commander of the 172nd. He informed me that on December 12 Sgt. Gregory Williams from the 172nd was presented the Distinguished Service Cross, the second highest award for valor, for his actions in combat while in Baghdad. Despite being injured himself when their vehicle was struck by a bomb, Sergeant Williams was able to return fire and help a wounded comrade to safety. To date, there have been only eight Distinguished Service Crosses awarded since the war began in 2001. We Alaskans often enjoy doing things our own way. In Iraq, one Alaskan marine discovered he had hidden talents he never imagined when his innovative approach to searching out insurgents earned him the Navy and Marine Corps Commendation Medal. SGT Aaron A. Henehan led his squad to search out and detain 18 ``blacklist'' or high-value insurgents while on his third tour in Iraq. An adventurous young man, Sergeant Henehan was barely out of high school and anxious to see the world when he first thought of signing up to serve his country. September 11 and the outbreak of war did not cause his decision to waiver an inch. Sergeant Henehan deployed in April of 2003 and spent his first tour in the town of Babylon in Najaf Province. He served his country well, like many who fought alongside him, and began to learn the undercurrents and inner workings of Iraqi society. He returned for a second tour to Husaybah, near Iraq's border with Syria in August 2004. At the time Husaybah was a dangerous town. Sergeant Henehan served his second tour in Iraq with distinction again but still felt he needed to do more. Before deploying for his third and final tour in February of 2006 he told friends and family back home that he yearned to make a difference in Iraq, a sentiment many American soldiers and guardsmen share with him. He spent a lot of time between his second and third tours thinking about what he could do differently, how he could learn from his experience and achieve a better result. Combining his marine training with information he learned from a retired LAPD officer deployed to Iraq to teach our troops urban tactics, Sergeant Henehan approached his third tour with what he referred to as a ``beat cop mentality.'' He wanted to approach the problem of rounding up insurgents as if he were a native of the area. He spent his free time studying the tribal history and geography of Husaybah for hours at a time. The ability to put his plan in motion, Sergeant Henehan says, was made possible in part by Operation Steel Curtain, which had cleared Husaybah block by block, and set up outposts called ``firm bases'' throughout the city. Upon returning for his third tour, Sergeant Henehan immediately noticed that after this push, while not always willing to openly support the coalition forces, many Iraqis felt safe enough to give him tips on where the insurgents were hiding. This change in mentality, coupled with Sergeant Henehan's knowledge of family and tribal connections, allowed him to determine which people to ask about each of the 18 high value insurgents he located. He knew exactly who would be willing to tip him off about a social rival or historic foe. Traveling with an interpreter, Sergeant Henehan had a talent for remembering names and personal details. He took every opportunity he could to talk with the locals and learn about the town's social organization and tribal boundaries, often returning several times to talk with the same families to gain their trust. Bringing with him candy, doctors, and his good humor, he would knock on doors and politely ask to chat. Entire families opened up to him. Sometimes it would start with a toy given to a child; sometimes it was a heartfelt conversation with a shopkeeper. The response he got astonished everyone, including the insurgents hiding out in the town. The 12 marines in his squad called him a fair, but tough leader who they felt very safe with. His intense and proactive preparation for the more than 80 combat missions which he led and his personal attention to each of his 12 soldiers' well-being gave them a sense of security. They too noted how his relaxed Alaskan exterior quickly helped earn him the respect of the townspeople. Even more remarkably, Sergeant Henehan's reputation for being fair and caring allowed him to detain all 18 high-value insurgents without any real violence. These 18 also led him to their associates, significantly disrupting insurgent operations in that part of Al Anbar Province. Sergeant Henehan remained behind after his unit returned to the States to train new troops about how he learned to wage urban warfare while gaining the trust of the townspeople. The downturn in violence in Al Anbar can be linked, in part, to his efforts and efforts of those like him. Sergeant Henehan is currently attending a California community college and plans to transfer to a larger State school after completing his distribution credits. He wants to major in computer programs and even talks of one day creating video games that more accurately portray what war in the modern era is like. He has already begun organizing photographs from his three tours to use as backdrops. Clearly his talent for careful planning and his desire to share his knowledge and experiences with others did not leave with his donning of civilian clothes. I wish him the best in all his future endeavors, just as I wish the best for all of our Alaskan veterans and those now serving.

Ms. MURKOWSKI

Ms. MURKOWSKI. Mr. President, per rule XLIV of the Standing Rules of the Senate, I certify that I proposed an amendment to H.R. 2419, the farm bill, that addresses income averaging for amounts received in connection with the Exxon Valdez litigation. This amendment is a limited tax benefit.

Ms. MURKOWSKI

Ms. MURKOWSKI. I would like to thank the chairman and the ranking member of the subcommittee for providing one of the largest increases in funding for community health centers which include migrant health centers, health centers for the homeless, and public housing health services. Community health centers particularly impact medically underserved communities which can be in urban settings like New York City or in the most frontier of all States, my home State of Alaska. I am pleased that the bill before us today recognizes the importance of community health centers and provides $2.26 billion in funding for the program. But what about staffing these facilities? While it is important that we provide money for building these centers, we simply cannot ignore the fact that many community health centers throughout America are not fully staffed. According to a Washington Post article from June of this year, many of these centers rely heavily on the National Health Service Corps. Still, this is not enough to fill the gap, according to the National Association of Community Health Centers. For lack of funding, the Health Service Corps had to turn away about 50 percent of the 1,800 doctors who applied last year. Whether in a large urban city like New York, or a frontier community like Bethel, AK, the National Health Service Corps should be properly funded so that millions of underinsured and uninsured Americans have access to health care. I believe that with an increase to the appropriations for the National Health Services Corps we will be able to achieve that and encourage my colleagues to match the House-passed funding levels.

Ms. MURKOWSKI

Ms. MURKOWSKI. Mr. President, Mongolia has made incredible strides to improve its relationship with the United States since 1987. Following the downfall of communism in that nation, our ties have grown exponentially. Mongolia has worked hard in the past two decades to create a robust and strong democracy and the United States has been a partner in that effort from its inception. Although it lies on the other side of the globe and sits between Russia and China, Mongolia has long sought close ties with the United States, with some even referring to the United States as its ``Third Neighbor.'' On the economic front, the United States-Mongolian relationship is dynamic and growing with over one hundred U.S. and U.S.-Mongolian joint ventures registered in areas ranging from oil exploration, textiles, animal husbandry, tourism, mining, and banking. The United States is also one of Mongolia's largest sources of foreign investment. While a large recipient of foreign aid, Mongolia still commits itself to giving back to the global community through its significant peacekeeping efforts in Africa and Eastern Europe, with personnel in Sierra Leone and Kosovo. Mongolia is also a strong partner in the War on Terror. Mongolia has contributed engineers, troops, and medical personnel to Operation Iraqi Freedom and has participated in training National Army artillery units in Afghanistan. Prior to 2000, Mongolia did not have a national policy of deploying forces beyond its borders. Yet they were the first coalition country to contribute an infantry battalion to Iraq. Mongolia's contributions mean a bit more to the State of Alaska. Since 2003, we have partnered with Mongolia through the Alaska-Mongolia National Guard Partnership. Our National Guard has established broad working relationships and increased exchanges with their Mongolian partners. They stand side by side with the Mongolian Armed Forces in Iraq--in fact, the Mongolian Ministry of Defense specifically requested Alaska National Guard support based on Alaska's relationship with their nation. The success that the partnership has enjoyed is a direct reflection of the willingness and eagerness on both sides to further our relations. The Alaska National Guard tells me that Mongolia is enthusiastic about their democratic reforms and is aggressively working to meet its goals. So with 2007 being the 20th Anniversary of U.S.-Mongolia relations, I am proud to introduce this resolution marking our ties and the significant progress that has been achieved between our two countries in that short time frame. I look forward to what the next 20 years will bring.

Ms. MURKOWSKI

Ms. MURKOWSKI. Mr. President, I rise today in support of a resolution that commemorates the Annual Red Ribbon Campaign. I am honored to again seek the Senate's continuing support and recognition of Red Ribbon Week, which is October 23 through October 31. In 1985, Special Agent Enrique ``Kiki'' Camarena of the Drug Enforcement Administration was kidnapped, tortured, and murdered in the line of duty by drug traffickers. Shortly after Agent Camarena's death, Congressman Duncan Hunter and high school friend Henry Lozano launched ``Camarena Clubs'' in the agent's hometown of Calexico, CA. In honor of Agent Camarena, hundreds of club members wore red ribbons and pledged to lead drug-free lives. The campaign quickly gained statewide and then national prominence. In 1988, what is now the National Family Partnership organized the first National Red Ribbon Week, an 8-day event proclaimed by the U.S. Congress and chaired by then-President and Mrs. Reagan. This campaign is now the oldest and largest drug prevention program in the Nation, reaching millions of youth through Red Ribbon Week events. Red Ribbon Week memorializes Agent Camarena, and all those who have lost their lives in the war on drugs, by educating young people about the dangers of drug abuse, promoting drug-free activities, and supporting everyone who has stood strong against illicit drugs. The red ribbon that we will wear during Red Ribbon Week is a symbol of zero tolerance for illegal drug use and our commitment to help people, especially children, make the right life decisions. In Alaska, Red Ribbon Week is a statewide celebration involving thousands of school children and other supporters. On October 22, the Municipality of Anchorage, in conjunction with the Alaska Red Ribbon Coalition and the Boys and Girls Clubs of Alaska, will host a Red Ribbon Week kickoff. The Red Ribbon Coalition is comprised of the Anchorage School District, the Alaska State Troopers, the U.S. Drug Enforcement Administration, and the U.S. Department of Justice. In addition, the Alaska National Guard and 43 Boys and Girls Clubs across Alaska will help other Alaskan communities celebrate Red Ribbon Week throughout the State. As people across the country stand together against drugs, I thank my colleagues for joining me in what will hopefully be a continuation of the tradition of congressional support and recognition of Red Ribbon Week.

Ms. MURKOWSKI

Ms. MURKOWSKI. Mr. President, on September 22, 2007, lifelong Alaskan Howard Holtan died when his plane crashed during takeoff near Whittier, AK. Howard not only was a personal friend of mine but also to the hundreds of Alaskan children he coached through the Alyeska Mighty Mites, a volunteer-operated ski racing program for children. Under Howard's guidance, my two sons developed their skills and a passion for ski racing while my husband and I volunteered as Mighty Mites parents. Howard began coaching skiing in 1971. He was the magic and the muscle behind the Mighty Mites, running the program almost singlehandedly from his personal laptop since the mid-1980s when he became the Mighty Mites director. Howard strove to introduce the fundamentals and joy of alpine ski racing to children of all abilities, while also giving kids self- confidence, a sense of accomplishment, and an appreciation for good sportsmanship. Howard ensured that lots of fun was had by all. There is no doubt that he helped make the Mighty Mites one of the most successful youth ski programs in America. In fact, Olympians Megan Gerety and Rosey Fletcher and former U.S. Ski Team members Mike Makar and Kjersti Bjorn-Roli started out as young Mighty Mites. For the ski community, it will be hard to imagine a Mighty Mites ski race without Howard's trademark ``cherub'' smile or his presence somewhere on the hill. Howard's passion for downhill skiing and dedication to Alaska's youth was almost matched by his commitment to public service--he spent 16 years working for the municipality of Anchorage, and was promoted to director of project management and engineering 8 years ago. Howard's legacy is everywhere in Anchorage as he had a hand in most of the roads and major projects in the city. Howard will be sorely missed by countless Alaskans. Not surprisingly, the Discovery Theatre at the Alaska Center for the Performing Arts overflowed with all those who came to celebrate and honor Howard's life. Howard is survived by his wife Roberta Carney; son Aaron Holtan and his wife, Carrie Holtan; daughter Kathryn Holtan, now at Washington State University; grandchildren, Erik and James; and brother Jay Holtan and his wife, Patricia O' Gorman. I would like to extend my condolences to his family and friends, and I wish his wife Roberta, who was injured in the crash, a speedy recovery.