[Senate Report 118-34]
[From the U.S. Government Publishing Office]
Calendar No. 80
118th Congress } Report
SENATE
1st Session } 118-34
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URBAN INDIAN HEALTH CONFER ACT
_______
May 30, 2023.--Ordered to be printed
_______
Mr. Schatz, from the Committee on Indian Affairs,
submitted the following
R E P O R T
[To accompany S. 460]
[Including cost estimate of the Congressional Budget Office]
The Committee on Indian Affairs, to which was referred the
bill (S. 460) to amend the Indian Health Care Improvement Act
to establish an urban Indian organization confer policy for the
Department of Health and Human Services, having considered the
same, reports favorably thereon without amendment, and
recommends that the bill do pass.
PURPOSE
The purpose of S. 460 is to amend the Indian Health Care
Improvement Act (IHCIA) to require the Department of Health and
Human Services (HHS) and its agencies and offices to confer
with urban Indian organizations (UIOs)\1\ regarding matters
that would impact health care for American Indians and Alaska
Natives (AIANs) living in urban areas.
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\1\The term ``urban Indian organization'' refers to a nonprofit
corporate body situated in an urban center, governed by an urban Indian
controlled board of directors, and providing for the maximum
participation of all interested Indian groups and individuals, which
body is capable of legally cooperating with other public and private
entities for the purpose of performing the activities. 25 U.S.C.
Sec. 1603(29).
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BACKGROUND
The Indian Health Service (IHS) supports contracts and
grants to 41 UIO programs in cities across the nation to ensure
the highest possible health status for urban AIANs and provide
resources necessary to effect that policy pursuant to the
IHCIA.\2\ UIOs are a critical part of the three-prong IHS
system, which also includes direct service IHS facilities and
Tribal programs, and they provide health care services to most
AIANs.\3\
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\2\25 U.S.C. Sec. 1602(1).
\3\Seventy percent of AIAN people reportedly live outside of Tribal
jurisdictions. Legislative Hearing on H.J. Res. 55, H.R. 441, H.R.
2402, H.R. 4881, and H.R. 5221 Before the H. Subcomm. On Indigenous
Peoples of the U.S., H. Comm. on Natural Resources, 117th Cong. (2021)
(statement of Walter Murillo, President, National Council of Urban
Indian Health).
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``Urban confer'' is an adaptation of the government-to-
government Tribal consultation process between Tribes and the
federal government. It allows IHS to engage with UIOs to ensure
the United States is fulfilling its trust responsibility to
AIANs living in urban areas. Congress first established IHS's
UIO confer policy through reauthorization of the IHCIA in
2010.\4\
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\4\25 U.S.C. Sec. 1660d.
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NEED FOR LEGISLATION
S. 460 would expand the urban confer process and require
all agencies and offices within HHS to confer with UIOs on
policies and initiatives related to healthcare for urban AIANs,
furthering the fulfillment of the trust responsibility to urban
AIANs.
SUMMARY OF THE BILL
This bill requires HHS and agencies and offices within the
Department to confer with UIOs on issues concerning the IHCIA
and other provisions of law relating to Indian health care.
LEGISLATIVE HISTORY
Senators Smith (D-MN) and Mullin (R-OK) introduced S. 460
on February 15, 2023. It was referred to the Committee on the
same day. On March 23, 2023, Senator Lujan joined S. 460 as a
cosponsor. On March 29, 2023, the Committee met at a duly
convened business meeting to consider S. 460 with three other
bills. The Committee passed three of the four bills, including
S. 460, en bloc by voice vote and ordered the bills to be
reported favorably.
Representatives Grijalva (D-NM), Stansbury (D-NM), and
Davids (D-KS), introduced H.R. 630, an identical bill, on
January 30, 2023. On the same day, it was referred to the House
Committee on Natural Resources (HNR) and the House Committee on
Energy and Commerce (E&C). On February 21, 2023, the bill was
further referred to the HNR Subcommittee on Indian and Insular
Affairs. Representatives Stansbury (D-NM), Davids (D-KS), Case
(D-HI), McCollum (D-MN), Lee (D-CA), Cohen (D-TN), Huffman (D-
CA), Leger Fernandez (D-NM), Stanton (D-AZ), Bonamici (D-OR),
Smith (D-WA), Hayes (D-CT), Peltola (D-AK), Garcia (D-IL), and
Kilmer (D-WA) and Delegate Holmes Norton (D-DC) subsequently
joined as cosponsors.
117th Congress. On September 10, 2021, Representatives
Grijalva (D-AZ), McCollum (D-MN), Cole (R-OK), Bass (D-CA), and
Young (R-AK), and Delegate Holmes Norton (D-DC) introduced H.R.
5221, the Urban Indian Health Confer Act. The House of
Representatives referred the bill to HNR and E&C on the same
day. On September 13, 2021, H.R. 5221 was further referred to
the HNR Subcommittee for Indigenous Peoples of the United
States (SCIP) and the E&C Subcommittee on Health.
Representatives Joyce (R-OH), Gallego (D-AZ), Huffman (D-CA),
Garcia (D-IL), and Smith (D-WA) subsequently joined the bill as
co-sponsors.
On October 5, 2021, SCIP held a legislative hearing.
Representatives Cohen (D-TN), Davids (D-KS), Leger Fernandez
(D-NM), Bonamici (D-OR), and Stansbury (D-NM) subsequently
joined H.R. 5221 as cosponsors. On October 13, 2021, SCIP
discharged the bill, and on the same day, HNR held a mark-up
session and ordered H.R. 5221 to be reported by unanimous
consent. Representatives Case (D-HI), Stanton (D-AZ), Mullin
(R-OK), and Hayes (D-CT) subsequently joined the bill as
cosponsors.
On November 1, 2021, HNR reported H.R. 5221, and E&C
discharged the bill, which was then placed on the Union
Calendar. On November 2, 2021, pursuant to H. Res. 486, the
House passed H.R. 5221 under suspension of the rules.
The Senate received the bill on November 3, 2021 and
referred the matter to the Senate Committee on Indian Affairs.
On July 20, 2022, the Committee held a hearing on H.R. 5221. It
took no further action on the bill before the conclusion of the
117th Congress.
Senators Smith (D-MN) and Lankford (R-OK) introduced S.
4323, an identical companion bill, on May 26, 2022. The Senate
referred the bill to the Committee on Indian Affairs on the
same day. The Committee took no further action on S. 4323
before the conclusion of the 117th Congress.
SECTION-BY-SECTION ANALYSIS OF S. 460 AS ORDERED REPORTED
Section 1--Short title
This section sets forth the short title as the ``Urban
Indian Health Confer Act.''
Section 2--Urban Indian Organization Confer Policy
This section amends section 514 of the Indian Health Care
Improvement Act to direct the Secretary of the Interior to
confer, to the maximum extent practicable, with urban Indian
organizations in carrying out the requirements of the Act and
other laws relating to Indian health care.
COST AND BUDGETARY CONSIDERATIONS
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
S. 460 would require the Department of Health and Human
Services (HHS) to confer with urban Indian organizations
regrading matters pertaining to the Indian Health Care
Improvement Act and other provisions of law relating to Indian
health care. According to the Indian Health Service (IHS),
there are 41 urban Indian organizations that provide primary
care services to urban Indian populations and others in 22
states nationwide. The urban Indian organizations are not part
of the IHS service delivery network but receive grant funding
from IHS. Current law only requires IHS to confer with urban
Indian organizations and the bill would require other agencies
within HHS to confer with them as well. CBO estimates that
enacting S. 460 would not affect direct spending or revenues
and would have an insignificant effect on spending subject to
appropriation for HHS staff to confer periodically with urban
Indian organizations.
The CBO staff contact for this estimate is Robert Stewart.
The estimate was reviewed by Chad Chirico, Deputy Director of
Budget Analysis.
Phillip L. Swagel,
Director, Congressional Budget Office.
REGULATORY AND PAPERWORK IMPACT STATEMENT
Paragraph 11(b) of rule XXVI of the Standing Rules of the
Senate requires each report accompanying a bill to evaluate the
regulatory and paperwork impact that would be incurred in
carrying out the bill. The Committee believes that S. 460 will
have minimal impact on regulatory or paperwork requirements.
EXECUTIVE COMMUNICATIONS
The Committee has received no communications from the
Executive Branch regarding S. 460.
CHANGES IN EXISTING LAW
On February 11, 2021, the Committee unanimously approved a
motion to waive subsection 12 of rule XXVI of the Standing
Rules of the Senate. In the opinion of the Committee, it is
necessary to dispense with subsection 12 of rule XXVI of the
Standing Rules of the Senate to expedite the business of the
Senate.
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