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Senate panel advances Indian health care measure

A Senate panel approved a measure to improve Indian health care on Thursday amid considerable debate on a controversial dental program in Alaska.

Sen. Tom Coburn (R-Oklahoma), a new member of the Senate Indian Affairs Committee, led the charge against a program that allows dental aides in Alaska villages to perform irreversible surgical procedures. He accused the federal government of shirking its treaty and trust responsibilities to Native people by failing to fully fund the Indian Health Service.

"If we can't provide adequate care, then we are going to provide less than adequate care," he said of a program that would "set the trend" for treating American Indians and Alaska Natives unfairly.

Coburn was joined in the effort by an unusual ally -- Sen. Maria Cantwell (D-Washington). Although she sits on the other side of the aisle, she agreed that the program was the wrong solution to a real problem.

"Access isn't the only issue," she said. "We should be thinking about quality of care. Let's get Indian health what they deserve."

But Coburn's proposal to limit the program was met with some strong opposition. Sen. Lisa Murkowski (R-Alaska) and other members of the committee, including Sen. John McCain (R-Arizona), the chairman, and Sen. Byron Dorgan (D-North Dakota), the vice chairman, spoke against the amendment.

Citing a "dental crisis" among Alaska Natives, Murkowski said it is nearly impossible to recruit and hire dentists to work in rural parts of the state. She said the program, which was developed in New Zealand and has been adopted in 41 countries, is needed due to limited access to full dental services.

"I have people in my villages," she told the committee, "that still don't have access to a dentist. ... We have young kids who are toothless at age 12 and 14."

McCain agreed that Indian health care needs more money. But he challenged Coburn, a practicing physician, to come up with the resources to bring more dentists to Alaska Native villages.

"I won't support it without finding the money," he said when Coburn suggested that IHS offer cash incentives for dentists willing to relocate to Alaska.

McCain also pointed out that Dorgan, earlier this year, sought to add $1 billion to the IHS budget but was defeated in the Senate. "We simply can't get the money to do this," Dorgan said.

Despite the disagreement, McCain struck a compromise that limits the program to Alaska after several senators expressed concerns about language that would have allowed it to expand throughout Indian Country. "I see no reason why we should expand it," McCain said.

And McCain agreed to allow Coburn to have input into a study of the Alaska program. Coburn said his training as a physician is needed in order to present an accurate report of potential problems.

All the committee members agreed, by a unanimous voice vote, to these changes and to an unrelated amendment offered by Sen. Mike Crapo (R-Idaho). But they defeated Coburn's amendment to limit the types of procedures the dental health aides would be able to perform. Besides Cantwell, only Sens. Craig Thomas (R-Wyoming), Gordon Smith (R-Oregon) and Richard Burr (R-North Carolina), a new member of the committee, supported Coburn. Everyone else who was present or sent a vote by proxy voted against the proposal.

Coburn previously tried to add more money to the IHS budget. In June, he proposed to add $121 million to diabetes and substance abuse programs but was defeated on the Senate floor.

"The disease in the IHS is that we are not funding it adequately enough," he said yesterday.

In approving S.1057, the Indian Health Care Improvement Act Amendments, committee members hoped to change the situation, at least in terms of services offered to American Indians and Alaska Natives. They said the bill would modernize the Indian health system by establishing behavioral health, long-term care, suicide prevention and other initiatives, in addition to addressing health care disparities.

"What percentage of the need are we serving in terms of Indian health care?" Dorgan asked. "Forty percent of the need goes unserved."

Dorgan and McCain used the meeting to criticize the Bush administration for holding up the bill for two years. They said they have repeatedly asked the Department of Health and Human Services and the Department of Justice for their views only to be stonewalled.

"I'm not at all pleased with what is coming to us from DHHS," Dorgan said.

McCain said he was wants to get the bill passed by the Senate despite objections from the administration. "It's really a dereliction of our duty as a government that we should not reauthorize this legislation since 1992," he said. The original act was passed in 1976.

In other business, the committee approved three bills:
S.1003, the Navajo-Hopi Land Settlement Amendments of 2005, a bill that would end the government's relocation of Navajo and Hopi families. McCain said the Navajo Nation opposed ending the program.
S.1892, an Indian trust measure to give tribes more time to bring lawsuits against the United States for alleged losses to their trust fund accounts. McCain said tribes and the administration support the measure.
S.1219, a bill to authorize certain tribes in the State of Montana to enter into a lease or other temporary conveyance of water rights to meet the water needs of the Dry Prairie Rural Water Association, Inc.

McCain delayed action on S.692, a bill to provide for the conveyance of certain public land in northwestern New Mexico by resolving a dispute associated with coal preference right lease interests on the land, due to lack of information. Sen. Pete Domenici (R-New Mexico), the bill's sponsor, attended the meeting yesterday but left before it came up for consideration.

Relevant Links:
Indian Health Service -
National Indian Health Board -