WASHINGTON – The Senate approved legislation Tuesday designed to ease health care problems on American Indian reservations by boosting screening and mental health programs and increasing tribal access to Medicare and Medicaid.

The legislation, approved 83-10, would boost programs at the federally funded Indian Health Service, prompt new construction and modernization of health clinics on reservations, and attempt to recruit more Indians into health professions. It would cost about $35 billion over 10 years.

Senate Indian Affairs Committee Chairman Byron Dorgan, D-N.D., said the bill is a first step in addressing a crisis in American Indian health care. The system is underfunded and inefficient, Dorgan said.

Rates of most leading causes of death for American Indians are much higher than those for the rest of the country. Rates of alcoholism, drug use, diabetes, cardiovascular disease and suicide are especially high.

Senate Majority Leader Harry Reid, D-Nevada, said American Indians have access “to some of the least adequate health care in America.”

“Far too many native children are diagnosed with diabetes, suffer from abuse and neglect, or die prematurely because of accidents or illness that could be prevented or cured,” he said.

The bill also contains a resolution sponsored by Sen. Sam Brownback, R-Kansas, that formally apologizes to American Indians for centuries of government mistreatment. The resolution acknowledges a long history of government misconduct against Indians, including forced relocation from tribal lands, theft of tribal assets and the breaking of treaties and covenants.

Earlier this month, the Senate adopted an amendment removing some sections of the bill that faced strong objections from the Bush administration. The White House issued a veto threat in January, objecting to expanded labor provisions in the legislation.

Some say the bill doesn’t go far enough.

Oklahoma Sen. Tom Coburn, a Republican and a doctor, called for a much broader overhaul of the system and labeled the legislation “morally bankrupt.” He argued that the money may not be there for new programs, saying the bill is like “taking out a new loan on a car when you can’t afford food for your family.”

Coburn offered an amendment that would have given American Indians more latitude in choosing clinics. That amendment was rejected, 67-28.

“Why are we putting off fixing the system?” he asked. “So we could tell everyone that we did something when in fact we did nothing.”

The Senate adopted amendments to the bill that would limit abortion funding for Indian health clinics and ensure that the health dollars do not pay for gun prevention programs.

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