t he said the first step is renewing the law under which health care is provided to American Indians.
He took issue with Coburn's position that the bill continues the status quo, saying it would expand services like cancer treatment and diabetes prevention, authorize hospice care and launch efforts to make clinics more accessible to Indians.
"This is one step,” he said. "The other step is to fix what's wrong with the Indian Health Service” and secure adequate funding for Indian health care.
He said it has been "like pulling teeth” to get Indian Health Service officials to say how much money is needed to provide the level of health care that is promised under the law. He said Dr. Charles W. Grim, the Oklahoman who ran the health service from 2003 until late last year, told him only about 60 percent of the health care needs are being met.
"What that says is there's full-scale health care rationing for American Indians,” Dorgan said. "It is an outrage.”
The bill does not authorize major increases in money for the Indian Health Service, which many say is chronically underfunded. However, it does call for a national commission to study how best to provide and finance Indian health care.
Congress approved a 2008 budget of $3.3 billion for the Indian Health Service, which includes $374 million to build or improve facilities. That is an increase of about $200 million over last year's agency budget.
Coburn said the agency was "resource poor and overcommitted.”
Coburn said he wasn't advocating abolishing the agency but that it needs to be part of a comprehensive overhaul of the entire U.S. health care system.
The legislation has drawn some objections from the Bush administration, including a Justice Department concern that a program for "Urban Indians” could lead to constitutional questions if they're not members of a recognized tribe. The Justice Department has also raised concerns about liability if the care didn't conform to standard medical practices.
But H. Sally Smith, chairman of the National Indian Health Board, and Joe A. Garcia, president of the National Congress of American Indians, said it was time to pass the bill.
"For nearly a decade, tribal leaders have been working to reauthorize the bill that serves as the underlying authority for the federal government's responsibility to provide health care to American Indians and Alaska natives,” the two said in a joint statement.
"We have worked on this bill for years. It has been negotiated, amended, revised, wordsmithed and compromised. It is now in the hands of Senate leadership and we want them to move the bill.”