United States Senator Lisa Murkowski

On March 23, 2010, President Obama signed into law the Indian Health Care Improvement Reauthorization and Extension Act, as a part of the Patient Protection and Affordable Care Act, otherwise known as the national health care reform bill. While Senator Murkowski could not support the national health care reform bill, she has been a strong advocate for the Indian Health Care Improvement Act. As Vice Chair of the Senate Committee on Indian Affairs, during the 110th Congress, Senator Murkowski worked to pass the Indian Health Care Improvement Act in the Senate, by an 83-10 vote. However, the House of Representatives did not consider the measure during the 110th Congress.

On December 16, 2009, the Senate Committee on Indian Affairs voted favorably out of committee the Indian Health Care Reauthorization and Extension Act of 2009. Senator Murkowski won inclusion of several amendments that enhance the construction of sanitation facilities by clarifying the authority of federal agencies to transfer funds to the IHS and the authority of the IHS to accept sanitation funds from other agencies -and authorize repayment of travel costs for family members who must escort patients such as elders or young children when traveling to larger medical centers for emergency care.

The Indian Health Care Improvement Reauthorization and Extension includes important provisions for the Alaska Native health system including the permanent reauthorization of the Community Health Aide program. Community Health aides deliver basic medical care throughout Alaska's remote and rural villages. The new law provides new authorizations for more comprehensive behavior health services including community based care, residential treatment and intensive out-patient treatment, among other services. It authorizes the expansion of long-term care services provided by IHS and tribally operated hospitals to include hospice care, assisted living, and community based care and home care for elders.

The Indian Health Service, which provides funding for the Alaska's Native health system, is chronically underfunded. Estimates suggest that it funds anywhere between one half and two thirds of the need. Senator Murkowski supports across the board increases in the Indian Health Service budget as well as increases for budget lines like Contract Support Costs, Sanitation Facilities Construction and Health Facilities Construction. On September 29, 2009, Senator Murkowski was joined by 10 Senate colleagues in a letter to President Obama urging that he support tribal self governance by providing adequate support for self governance contract support costs in his FY2011 budget request to Congress. On February 1, 2010, the President released his FY2011 budget requests that included $4.4 billion, an increase of $354 million, for the Indian Health Service. $444 million was requested for contract support costs, an increase of $40 million over FY2010.

The high cost of fuel oil continues to present tremendous challenges to those living in our rural communities. Governments, tribal offices, schools, hospitals, health clinics, corporations and families are still being squeezed by the record high cost of fuel when rural communities had to purchase it for delivery last summer and fall. It is hard for anyone to survive economically when they are paying $8 to $10 a gallon for heating oil and gasoline, and when electricity generated from diesel fuel reflects those sharp price hikes. High energy costs also affect everything from the price of airfare to villages to the cost of buying groceries at stores, from the cost of running health clinics to the cost of preparing for subsistence hunts. As all commodities are flown into communities, the prices our rural residents pay for the necessities of life are unjustifiably high. Every aspect of rural life has become a challenge with the high cost of fuel.

In an attempt to lessen the pain I worked on several fronts. As ranking member of the Senate Energy and Natural Resources Committee I helped lead an effort that doubled federal funding for the Low Income Home Energy Assistance Program (LIHEAP) and that allowed more Alaskans to qualify for the aid. Also when it became clear that not all those in need were able to qualify for the aid quickly enough, I worked with the Bureau of Indian Affairs in Washington to get the BIA to send additional general assistance to struggling communities. For the longer term, I also worked in 2007 to win funding for a renewable energy deployment grant program to increase federal aid to help rural villages and utilities afford to install renewable energy projects, such as more money for wind turbines or more funding to install geothermal projects or biomass projects that offer the promise of lower electricity costs for years ahead. Hopefully the recent economic stimulus act will provide money for more of these projects to be built statewide. It is very troubling to me that as the world experiences a drop in oil prices, our rural communities are still locked into old prices until fuel can be purchased at the new lower market rates and shipped up via barge during the short summer months.

In August 2008, I conducted a Senate Committee on Indian Affairs field hearing to receive testimony on the high cost of fuel in rural Alaska, and explore sustainable energy solutions. I intend to continue to aggressively seek a long-term solution, perhaps helping to increase the stockpiling of fuel in regional tank farms that could be purchased when prices are lower. But the ultimate solution is that Alaska is blessed with an abundance of renewable energy resources; we just need to make them more available and affordable for Alaskans.

Last September, Chairman Dorgan of the Senate Committee on Indian Affairs released a draft Indian Energy and Efficiency Concept Paper for public comment. On October 22, 2009, the Committee held an oversight hearing on Indian Energy and Energy Efficiency. Currently, a draft bill is being prepared by the Senate Committee on Indian Affairs and is available on the Indian Affairs committee website.

The very existence of the Alaska Native way of life is threatened by the impacts of recent climate change. Communities such as Shishmaref, Kivalina and Newtok are literally being swept away into the sea because of coastal erosion. It is necessary that our rural communities have adequate evacuation routes in case of emergencies, but also help to deal with remediation costs and perhaps with village relocation costs. For years Senator Murkowski has been working with the U.S. Army Corps of Engineers to attempt to increase aid for villages. Several years ago, the senator sponsored and won passage of legislation that is allowing Newtok to relocate to a new village site. The ultimate solution, however, is to attempt to tackle climate change at its source. Senator Murkowski has led efforts to increase funding for renewable and alternative fuels that will emit no or less carbon dioxide, in case carbon emissions are leading to a Greenhouse Effect raising global temperatures. In 2007 Senator Murkowski co-sponsored a carbon emissions "cap-and-trade" bill that would have resulted in carbon emissions dropping 60 percent by 2050 from today's levels. But the bill also would not have harmed the nation's economy or hurt our lifestyles by increasing the cost of energy so quickly that we could not afford to live on this Great Land. Senator Murkowski will continue to fashion a climate bill that will work to reduce carbon emissions and help develop renewable and alternative fuels while protecting Alaska's way of life and the state's fragile environment.

The need for transportation infrastructure in rural Alaska is tremendous. Since 2003, Senator Murkowski has been a consistent supporter of the Indian Reservation Roads program. The Senator fully understands the frustrations caused by the Bureau of Indian Affairs and their administration of the IRR program.

The IRR program, included in the Safe, Accountable, Flexible, Efficient, Transportation Equity Act: A Legacy for Users (SAFETEA-LU) expired in 2009 and reauthorization legislation is being drafted. The Indian Affairs Committee has formulated a draft tribal transportation bill, entitled the Transportation Reauthorization of Indian Programs Act (TRIP) on the Senate Committee on Indian Affairs website. Senator Murkowski looks forward to hearing from Alaska stakeholders as Congress moves forward in the reauthorization process.