Jeff Bingaman United States Senator from New Mexico

Mr. BINGAMAN. Mr. President, the Indian Health Care Improvement Act was first enacted in 1976. It has enabled us to develop programs and facilities and services that are models of health care delivery with community participation and with cultural relevance.

We have accomplished a substantial amount under the Indian Health Care Improvement Act. American Indians and Alaska Natives today have lower mortality rates from diseases, such as heart disease and cerebrovascular disease, malignancy, and HIV infection, than they did before. Under the Indian Health Care Improvement Act, the infant mortality rate has decreased since 1976 from 22 per 1,000 to 8 per 1,000.

In spite of the notable improvements, there are still shocking health disparities that remain for Indian people. Let me give you some examples from my home State of New Mexico. 

First, let me say that over 10 percent of our population in New Mexico is American Indians. We have the second highest percentage of Native Americans of any State in the country. 

Native American women in New Mexico are three times as likely to receive late or no prenatal care compared to national rates. Native American New Mexicans are more than three times more likely to die from diabetes compared to other New Mexicans. Death rates for Native American New Mexicans from motor vehicle crashes are more than double those of non-Indians. That is largely explained because American Indians on tribal lands have accidents that are far from trauma centers, and therefore they do not have rapid access to lifesaving care. 

These disparities in mortality rates contribute to a shortened life expectancy for Indians compared to other Americans. National statistics show that Indians live, on average, 6 years less than do other Americans. That discrepancy is as high as 11 years for some South Dakota tribes. 

The Indian Health Service is one of the primary sources of health care for Native Americans. For years, the Indian Health Service has struggled to meet the needs of the Indian population, but in doing so they have faced enormous challenges. There are aging facilities, staff shortages, funding shortfalls, and all of these present challenges to the Indian Health Service. When facilities and staff are not sufficient to meet the needs, contract health services need to be purchased at the prevailing rates. Funds supporting contract health services generally run out by about midyear, and that leaves the Indian Health Service with no alternative but to ration care. 

Life-and-limb saving measures are selected by necessity over such things as health promotion and disease prevention. 

So what resources would be adequate to meet these challenges? To answer that question, I call my colleagues' attention to information that has been provided by the Congressional Research Service. 

Let me put up a chart that makes the comparison that I think is useful. This is a graphic illustration of 10 years of health care expenditures per person in various of the programs we support. The top line, the red line, is Medicare, primarily individuals 65 or older in this country. Medicaid is the level of funding per capita we provide under Medicaid. The Indian Health Service number is this blue line which is the lowest line on the chart. The sum of all public and private sources of health care dollars divided by the number of users nationally, or the average health care expenditure per American, is depicted in the green line. So we can see that the average American gets substantially more per recipient spent on them for health care services than does the average Indian American. 

In 2004, the U.S. Commission on Civil Rights produced a report entitled ``Broken Promises: Evaluating the Native American Health Care System.'' This report contained four important findings. 

No. 1, they found annual per capita health expenditures for Native Americans are far less than the amount spent on other Americans under mainstream health plans. That is exactly what this chart says. 

No. 2, they find annual per capita expenditures fall below the level provided for every other Federal medical program. And, again, that is demonstrated very well on this chart. 

No. 3, they found annual increases in Indian Health Service funding have failed to account for medical inflation rates or for increases in Indian population. 

And, No. 4, they found that annual increases in Indian health care funding are less than those for other health and human services components. 

This 2004 report concluded: 

Congress failed to provide the resources necessary to create and maintain an effective health care system for Native Americans. The Indian Health Care Improvement Act has not been reauthorized since. 

That report was done in 2004. Reauthorization of this legislation is long overdue. As many of my colleagues have already said, we need to act now to ensure its swift passage because of the very serious funding shortages within the Indian Health Service. 

Senator Thune and I are offering an amendment to provide for an expansion of section 506 of the Medicare Modernization Act, which protects Indian Health Service contract health services funding. This contract health services funding is utilized by the Indian Health Service and tribes to purchase health care services that are not available through the IHS and tribal facilities. These are health services such as critical medical care and speciality inpatient and outpatient services. 

Nationally, the Indian Health Service and tribes contract with more than 2,000 private providers in order to get these services. Unfortunately, because of the very low funding levels available for contract health services, funding often runs out in midyear, as I indicated before. 

Making this problem even worse, prior to section 506 of the Medicare Modernization Act, there was no limitation on the price that could be charged for contract health services. In many instances, providers were charged commercial rates or even higher rates for those services, far in excess of the rates that were being paid by Medicare, by Medicaid, by the Veterans' Administration, and by other Federal health care programs. 

Section 506 of the Medicare Modernization Act provided that Medicare participating hospitals had to agree to accept contract health services patients and had to agree that Medicare payment rates would serve as a ceiling for contract health services payment rates to those hospitals.