Statement on Signing the Indian Health Amendments of 1992

Today I am signing into law S. 2481, the "Indian Health Amendments of 1992." S. 2481 reauthorizes appropriations for health services for American Indians and Alaska Natives.

S. 2481 continues Indian scholarship and training programs, thereby assuring an available source of health care professionals to serve American Indian and Alaska Native communities. In addition, the bill expands primary and preventive health programs, emphasizing mental as well as physical health. The bill's other significant new or expanded activities include the encouragement of Native Americans to enroll in Medicare and Medicaid, continued services to urban Native Americans, and expansion of substance abuse programs.

S. 2481 also contains specific health care objectives drawn from the U.S. Public Health Service's "Healthy People 2000" report and ties the allocation of resources to these objectives. This new approach will prove useful in measuring progress toward the goal of raising the health status of American Indians and Alaska Natives to the highest possible level.

Although S. 2481 clearly contains a number of provisions to improve the health of Native Americans and Alaska Natives, it also includes provisions that are problematic. For example, the bill prohibits third-party collections from self-insured health plans for services provided by the Indian Health Service (IHS). This prohibition actually reduces the number of Native Americans and Alaska Natives who can be served and sets an undesirable precedent. In addition, the establishment of yet more categorical authorities in S. 2481, especially grants for specified tribes or tribal organizations, is counterproductive to a rational allocation of limited resources.

Finally, S. 2481 also includes a "Buy American" provision that directs the IHS to comply with the requirements of the Buy American Act with respect to its construction procurements. This provision will not apply to the extent that I determine it would violate the Nation's international obligations under the General Agreement on Tariffs and Trade or any other international agreement to which this country is a party.

George Bush

The White House,

October 29, 1992.