But they're saying it's not going away and so we have to maintain vigilance on this issue. We came together before in July, when Republicans better care reconciliation act threaten to roll back health care for native communities without bill's defeat we hope the debate over legislation to jeopardize health care for native communities was behind us and we hope we could begin to work and earn us in a bipartisan way to Is the real health care problems that Americans face, giving this new threat. My Indian Affairs Committee colleagues and I must remind this chamber once again that the federal government bears a solemn trust and treated responsibility and obligation to ensure that native Americans received quality health care each version of Republican repeal. We have seen so far violates that trust responsibility by taking health care away from Hundreds of thousands of native Americans and advocating the federal government's native health care responsibilities. If any of these proposals pass native Americans, health and lives will be endangered. These efforts must be stop everyone familiar with Indian country knows that the Indian health service is severely underfunded. Don't get sick after June A familiar refrain on many reservations. Pueblo villages limited funding meant medical services were often ration to only emergency care or life and lamb. I just patients were not guaranteed access to comprehensive medical services, specialized services or preventive care. The affordable care act and the medicaid expansion change. This equation and change dramatically the law It has increase third party billing revenues to I just more than 25 percent and medicaid funding for I just has increased nearly 50 percent tribal and urban health facilities have been able to move away from health care rationing. Medicaid expansion has provided health insurance to an additional 290000 native Americans from 492 tribes almost 90 percent of all tribes. This includes 45 thousand 600 tribal members from my home state of new Mexico uninsured rates and Indian country have decreased from 53 percent to 39 percent and many tribal communities on insured rates are even lower at the Santa the. Mango pueblo in new Mexico 22 percent of key walk pueblo health corporations, patients or on insured in 20 13 and 20 16 the uninsured rate was down to seven percent of the Santa fe. I just This unit, in new Mexico eighty four percent of our patients now have some sort of insurance on the turtle mountain reservation in North dakota they've seen a 14 percent reduction in on insured tribal members at the portland Indian health Center, the rate of uninsured has gone from 56 percent to a percent solely due to medicaid expansion. This is impressive. Let me just say that again gone from 56 percent on insured to eight percent Medicaid expansion is help make up for this historic under funding and I just services third party billing revenue through medicaid now makes up to 35 percent of the key pueblo health corporations total budget for the hickory apache tribe in new Mexico medicaid makes up more than 75 percent of their third party billing revenue and it the whole crown point. I just hospital 50 percent of their budget comes from medicaid third party billing revenue for Seattle, urban Indian Health clinic operated by the Seattle Indian health board, medicaid and Medicare expansion have resulted in a revenue increase of a hundred and 46 percent since 20 12 and medicaid expansion has allowed. I chest to expand services and build new facilities. He will pueblo health Corporation is use some of its third party billing to offer new specialty care services like strap tricks and Daya treat and to build new clinic space Santa fe. I just use its additional funds to build new examination rooms for Santa clara. Pueblo establish a Mobile health unit for San felipe pueblo and update out patient rooms at the main clinic in Santa fe. The Seattle urban Indian clinic uses its additional revenue to expand patient services to include a pilot opioid addiction program in the words of the National Council On Indian health, medicaid expansion has been and unqualified success. The brought new hope to native families and communities, but this latest Republican plan well, on, do this success. Thank goodness it's been withdraw and that plan. They claim that they will preserve medicaid expansion eligibility rules for tribes. This offers a fault hope, like most people on medicaid Members go on and off the rolls as their income fluctuates proposals like Grand cassie would require that they be continuously enrolled in medicaid expansion and work to receive benefits if not, they will be drop permanently from the program section. One 28 of Grand cassidy is also being push as helpful the Indian country. This section expands. I just as federal rate to non-native providers, but really it is available Tampa by off state leaders concerned about massive cuts to the medicaid program. It will not improve health care. Tribal facilities that will undercut the chest and it will undermine the tribal self-determination by by passing tribal and put in the federal medicaid reimbursement process and there are 30000 native Americans who now have private individual health insurance thanks to the every Republican plan so for Our strips away the cost sharing subsidies and tax credits that help make private insurance affordable for many of these tribal members and for millions of working Americans, Republican bill does nothing to help these native Americans keep their health insurance. The sponsors can try to dress this bill up, but the glaring reality is the trumpcare to would be terrible for Indian country and fact it is worst for trying Https than any other proposed repeal plan so far it's no surprise. The prominent native organizations, the National Indian health, berber, the National Congress of American Indians and the National Council on urban Indian health oppose graham cassidy and proposals like it, they join virtually all major patient advocate and medical organizations in their opposition in Looting, the American heart Association, American cancer society, American long Association and the American medical Association. Eighty percent of the American people disapprove of the Republicans attempts to under mind health care, ram cassidy is woefully out of touch with the American people and especially with the Indian country. I'm glad this bill won't receive a vote. This week. Mister President just like Of millions of our fellow Americans, tribes, tribal organizations and individual native Americans all around the country are worried. What Republicans will do to their health care. I receive the record 15000 calls e-mails and letters from constituents about healthcare. This year almost all of them have been opposed to the Republicans relentless attacks on healthcare and not a single try has reached out to my office and support of this bill These attacks are happening behind close doors. There was only one rush hearing and it was yesterday there's no formal congressional budget office analysis and there has been no meaningful consultation with tribes. Although many of us have call for that there has been no consultation. It is difficult to adequately describe the recklessness cruelty and cynicism and the Republicans rush to tear down The Senate health, education, labor and pensions Committee started a bipartisan effort to address the real health care needs in this country. But Republicans frozen once gram. Cassidy was introduce and I'm really hoping now that is chairman. Lamar Alexander and vice chairman, patty murray, can get back to the bipartisan work that needs to be done other time sensitive largest Asian with broad bipartisan support, like re authorization of the children's health insurance program and the special diabetes program for Indians which need to be enacted before the end of September, were pushed aside. Congress needs to change focus. We need to work across the aisle to meet the needs of the American people and we need to improve native American health care. We have come a long way under the affordable care act and the medicaid expansion, but we are far from being able to declare victory. I aca Colleagues from Arizona, senator Mccain, given the enormous impact of health care on the lives of Americans and our economy, we need to find bipartisan solutions through the regular order partisan repeal of the is not right for Indian country or for America and now. Mr President, I would you'll the floor to my colleagues from North dakota uh senator heitkamp. I worked many years as attorney general with Center heitkamp. She was a great champion during those years for native Americans and specifically for native American When and she's been, an incredible advocate on the affordable care act and the good that it has done for native American soldiers under heitkamp mister President, the Senate in North dakota can make you mister President in to my great College um one of the nicest people here, senator utah who um always leaves with this brain but we know that is hard isn't far, far behind and he's been a tremendous leader and a tremendous advocate and um a tremendous collaborate There, on on this all important issue, I think first we have to acknowledge how grateful and thankful we are that the Republican um bill as we had known as grandpa