September 10, 2020

Senator Warren Joins Senators Tina Smith & Lisa Murkowski in Bipartisan Legislation to Help Tribal Nations Combat COVID-19, Other Public Health Crises

The Tribal Health Data Improvement Act would strengthen data sharing between Tribal Nations, Tribal Epidemiology Centers and the CDC

Bill Text (PDF)

Washington, D.C. — Today United States Senator Elizabeth Warren (D-Mass.) joined Senators Tina Smith (D-Minn.) and Lisa Murkowski (R-Alaska) to introduce bipartisan legislation to help tribal nations access public health data and address health disparities that hit American Indian and Alaska Native (AI/AN) communities especially hard. The Tribal Health Data Improvement Act would strengthen data sharing between tribal nations, Tribal Epidemiology Centers (TECs) and the Centers for Disease Control and Prevention (CDC) so tribal nations can more effectively address public health challenges. 

Tribal nations and TECs are routinely denied access to important health data systems, despite having clearance to do so. Accessing federal and state public health data is critical for engaging in preventative public health work and combatting current health crises. Structural barriers to accessing data have been especially problematic during COVID-19, which has disproportionately hurt AI/AN communities. This bill clarifies that tribal nations and TECs, as public health authorities, should be granted access to the data they request.


AI/AN communities also face stark health disparities across multiple health conditions including diabetes, cancer, liver disease and kidney disease. But these inequities are underestimated due to inaccurate data at the state and federal level, which too often misclassifies or undercounts AI/AN individuals. This bill would address this problem by directing federal and state public health authorities to identify best practices for the collection of health data on race and ethnicity.  


Specifically, the Tribal Health Data Improvement Act would:

  • Require the Department of Health and Human Services to give direct access to public health data to tribal nations, the Indian Health Service (IHS), and TECs

  • Require the CDC to develop guidance for States and local health agencies to improve the quality and accuracy of birth and death record data for American Indians/Alaska Natives

  • Require the CDC to enter into cooperative agreements with tribal nations, tribal organizations, urban Indian organizations, and TECs to address misclassification and undersampling of American Indians/Alaska Natives on birth/death records and in health care/public health surveillance systems

  • Encourage states to enter into data sharing agreements with tribal nations and TECs to improve access to public health data


In addition to Senators Warren, Smith, and Murkowski, the legislation is supported by Senators Jon Tester (D-Mont.), Steve Daines (R-Mont.), and Kevin Cramer (R-N.D.).


The Tribal Health Data Improvement Act is endorsed by the National Indian Health Board (NIHB), National Council of Urban Indian Health (NCUIH), and Seattle Indian Health Board.

“The National Indian Health Board (NIHB) strongly supports the Tribal Health Data Improvement Act. Nationwide, there is a paucity of accurate and reflective public health data concerning American Indians and Alaska Natives (AI/ANs) stemming from high rates of misclassification and undersampling of AI/ANs in state and local disease surveillance systems. The COVID-19 pandemic, and its disproportionate impact on Indian Country, has shed an urgent light on these long-standing challenges and deficiencies in AI/AN public health data. This bill would break down barriers in Tribes’ and Tribal Epidemiology Centers’ access to federal public health data, which is important in controlling COVID-19 in hard-hit Tribal communities. It would also fund Tribal governments and Tribal organizations to work with state and local health agencies and require that they improve their data systems to accurately capture birth and death rates for AI/ANs, which has posed an issue long before COVID-19 but became even more evident as our Tribal members are succumbing to the virus. NIHB urges immediate action to pass this critical legislation.” -- Stacy A. Bohlen, Chief Executive Officer of the National Indian Health Board

Senator Warren has been very active in working to ensure Indian Country has the resources it needs and is owed to combat the COVID-19 pandemic. She introduced the Tribal Medical Supplies Stockpile Access Act (S. 3514), legislation that would guarantee that the IHS, tribal health authorities, and urban Indian organizations have access to the Strategic National Stockpile, a federal repository of drugs and medical supplies that can be tapped if a public health emergency could exhaust local supplies. Senator Warren cosponsored Senator Tom Udall's (D-N.M.) CDC Tribal Public Health Security and Preparedness Act (S. 3486), which would enable tribal nations and tribal organizations to apply directly to the CDC for Public Health Emergency Preparedness program funds. She joined two letters to the Treasury Department and the Small Business Administration, urging them to make the Paycheck Protection Program (established by the CARES Act) available to all tribal small businesses, as the statute required.

She announced the COVID-19 Emergency Manufacturing Act (S. 3847), legislation that will provide COVID-19 products at no cost to federal, state, local, and IHS and tribal health programs. Senator Warren joined Senator Smith in urging Treasury Secretary Mnuchin to immediately disburse $8 billion in critical relief funds to eligible tribal governments. She joined Senator Kamala Harris (D-Calif.) on a letter asking that future COVID-19 legislation provide additional funding for IHS, tribal health programs, and urban Indian health organizations. She announced the Coronavirus Containment Corps Act (S. 3848), legislation that will establish a federal contact tracing program. The bill requires consultation with tribal health authorities and funding for IHS. She and Congresswoman Deb Haaland (D-N.M.) requested that the U.S. Commission on Civil Rights examine the federal government's response to the impact of COVID-19 in Indian Country; the Commission agreed to that request. The two legislators also coauthored an op-ed calling for a more robust federal response to the pandemic's effects on tribal populations. Together they also introduced the DIGITAL Reservations Act (S. 4331),  historic legislation that would affirm tribal nations' and Native Hawaiian organizations' ownership of broadband spectrum over their lands to deploy wireless internet services-an especially urgent priority during the pandemic.


She has also worked with the Massachusetts Delegation in making requests to President Trump  to direct the Federal Emergency Management Agency (FEMA) to waive all of the traditional cost-share requirements for all COVID-19-related assistance for the Commonwealth's two federally recognized tribal nations, the Wampanoag Tribe of Gay Head (Aquinnah) and the Mashpee Wampanoag Tribe.