I 
108TH CONGRESS 
1ST SESSION H. R. 2597
To amend the Native Hawaiian Health Care Improvement Act to revise 
and extend that Act. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 25, 2003
Mr. ABERCROMBIE (for himself and Mr. CASE) introduced the following bill; 
which was referred to the Committee on Energy and Commerce 
A BILL 
To amend the Native Hawaiian Health Care Improvement 
Act to revise and extend that Act.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Native Hawaiian 
Health Care Improvement Reauthorization Act of 2003’’. 
SEC. 2. AMENDMENT TO THE NATIVE HAWAIIAN HEALTH 
CARE IMPROVEMENT ACT. 
The Native Hawaiian Health Care Improvement Act 
(42 U.S.C. 11701 et seq.) is amended to read as follows:
‘‘SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
‘‘(a) SHORT TITLE.—This Act may be cited as the 
‘Native Hawaiian Health Care Improvement Act’. 
‘‘(b) TABLE OF CONTENTS.—The table of contents 
of this Act is as follows:
‘‘Sec. 1. Short title; table of contents. 
‘‘Sec. 2. Findings. 
‘‘Sec. 3. Definitions. 
‘‘Sec. 4. Declaration of national Native Hawaiian health policy. 
‘‘Sec. 5. Comprehensive health care master plan for Native Hawaiians. 
‘‘Sec. 6. Functions of Papa Ola Lokahi and Office of Hawaiian Affairs. 
‘‘Sec. 7. Native Hawaiian health care. 
‘‘Sec. 8. Administrative grant for Papa Ola Lokahi. 
‘‘Sec. 9. Administration of grants and contracts. 
‘‘Sec. 10. Assignment of personnel. 
‘‘Sec. 11. Native Hawaiian health scholarships and fellowships. 
‘‘Sec. 12. Report. 
‘‘Sec. 13. Use of Federal Government facilities and sources of supply. 
‘‘Sec. 14. Demonstration projects of national significance. 
‘‘Sec. 15. Rule of construction. 
‘‘Sec. 16. Compliance with Budget Act. 
‘‘Sec. 17. Severability.
‘‘SEC. 2. FINDINGS. 
‘‘(a) GENERAL FINDINGS.—Congress finds that—
‘‘(1) Native Hawaiians begin their story with 
the Kumulipo, which details the creation and inter-
relationship of all things, including the evolvement of 
Native Hawaiians as healthy and well people; 
‘‘(2) Native Hawaiians—
‘‘(A) are a distinct and unique indigenous 
people with a historical continuity to the origi-
nal inhabitants of the Hawaiian archipelago 
within Ke Moananui, the Pacific Ocean; and
‘‘(B) have a distinct society that was first 
organized almost 2,000 years ago; 
‘‘(3) the health and well-being of Native Hawai-
ians are intrinsically tied to the deep feelings and at-
tachment of Native Hawaiians to their lands and 
seas; 
‘‘(4) the long-range economic and social 
changes in Hawaii over the 19th and early 20th cen-
turies have been devastating to the health and well-
being of Native Hawaiians; 
‘‘(5) Native Hawaiians have never directly relin-
quished to the United States their claims to their in-
herent sovereignty as a people or over their national 
territory, either through their monarchy or through 
a plebiscite or referendum; 
‘‘(6) the Native Hawaiian people are deter-
mined to preserve, develop, and transmit to future 
generations, in accordance with their own spiritual 
and traditional beliefs, their customs, practices, lan-
guage, social institutions, ancestral territory, and 
cultural identity; 
‘‘(7) in referring to themselves, Native Hawai-
ians use the term ‘Kanaka Maoli’, a term frequently 
used in the 19th century to describe the native peo-
ple of Hawaii;
‘‘(8) the constitution and statutes of the State 
of Hawaii—
‘‘(A) acknowledge the distinct land rights 
of Native Hawaiian people as beneficiaries of 
the public lands trust; and 
‘‘(B) reaffirm and protect the unique right 
of the Native Hawaiian people to practice and 
perpetuate their cultural and religious customs, 
beliefs, practices, and language; 
‘‘(9) at the time of the arrival of the first non-
indigenous people in Hawaii in 1778, the Native Ha-
waiian people lived in a highly organized, self-suffi-
cient, subsistence social system based on communal 
land tenure with a sophisticated language, culture, 
and religion; 
‘‘(10) a unified monarchical government of the 
Hawaiian Islands was established in 1810 under Ka-
mehameha I, the first King of Hawaii; 
‘‘(11) throughout the 19th century until 1893, 
the United States—
‘‘(A) recognized the independence of the 
Hawaiian Nation; 
‘‘(B) extended full and complete diplomatic 
recognition to the Hawaiian Government; and
‘‘(C) entered into treaties and conventions 
with the Hawaiian monarchs to govern com-
merce and navigation in 1826, 1842, 1849, 
1875, and 1887; 
‘‘(12) in 1893, John L. Stevens, the United 
States Minister assigned to the sovereign and inde-
pendent Kingdom of Hawaii, conspired with a small 
group of non-Hawaiian residents of the Kingdom, 
including citizens of the United States, to overthrow 
the indigenous and lawful government of Hawaii; 
‘‘(13) in pursuance of that conspiracy—
‘‘(A) the United States Minister and the 
naval representative of the United States 
caused armed forces of the United States Navy 
to invade the sovereign Hawaiian Nation in 
support of the overthrow of the indigenous and 
lawful Government of Hawaii; and 
‘‘(B) after that overthrow, the United 
States Minister extended diplomatic recognition 
of a provisional government formed by the con-
spirators without the consent of the native peo-
ple of Hawaii or the lawful Government of Ha-
waii, in violation of—
‘‘(i) treaties between the Government 
of Hawaii and the United States; and
‘‘(ii) international law; 
‘‘(14) in a message to Congress on December 
18, 1893, President Grover Cleveland—
‘‘(A) reported fully and accurately on those 
illegal actions; 
‘‘(B) acknowledged that by those acts, de-
scribed by the President as acts of war, the 
government of a peaceful and friendly people 
was overthrown; and 
‘‘(C) concluded that a ‘substantial wrong 
has thus been done which a due regard for our 
national character as well as the rights of the 
injured people required that we should endeavor 
to repair’; 
‘‘(15) Queen Lili‘uokalani, the lawful monarch 
of Hawaii, and the Hawaiian Patriotic League, rep-
resenting the aboriginal citizens of Hawaii, promptly 
petitioned the United States for redress of those 
wrongs and restoration of the indigenous govern-
ment of the Hawaiian nation, but no action was 
taken on that petition; 
‘‘(16) in 1993, Congress enacted Public Law 
103–150 (107 Stat. 1510), in which Congress—
‘‘(A) acknowledged the significance of 
those events; and
‘‘(B) apologized to Native Hawaiians on 
behalf of the people of the United States for the 
overthrow of the Kingdom of Hawaii with the 
participation of agents and citizens of the 
United States, and the resulting deprivation of 
the rights of Native Hawaiians to self-deter-
mination; 
‘‘(17) in 1898, the United States—
‘‘(A) annexed Hawaii through Resolution 
No. 55 (commonly known as the ‘Newlands 
Resolution’) (30 Stat. 750), without the consent 
of, or compensation to, the indigenous people of 
Hawaii or the sovereign government of those 
people; and 
‘‘(B) denied those people the mechanism 
for expression of their inherent sovereignty 
through self-government and self-determination 
of their lands and ocean resources; 
‘‘(18) through the Newlands Resolution and the 
Act of April 30, 1900 (commonly known as the 
‘1900 Organic Act’) (31 Stat. 141, chapter 339), 
Congress—
‘‘(A) received 1,750,000 acres of land for-
merly owned by the Crown and Government of 
the Hawaiian Kingdom; and
‘‘(B) exempted the land from then-existing 
public land laws of the United States by man-
dating that the revenue and proceeds from that 
land be ‘used solely for the benefit of the inhab-
itants of the Hawaiian Islands for education 
and other public purposes’, thereby establishing 
a special trust relationship between the United 
States and the inhabitants of Hawaii; 
‘‘(19) in 1921, Congress enacted the Hawaiian 
Homes Commission Act, 1920 (42 Stat. 108, chap-
ter 42), which—
‘‘(A) designated 200,000 acres of the 
ceded public land for exclusive homesteading by 
Native Hawaiians; and 
‘‘(B) affirmed the trust relationship be-
tween the United States and Native Hawaiians, 
as expressed by Secretary of the Interior 
Franklin K. Lane, who was cited in the Com-
mittee Report of the Committee on Territories 
of the House of Representatives as stating, 
‘One thing that impressed me . . . was the fact 
that the natives of the islands . . . for whom in 
a sense we are trustees, are falling off rapidly 
in numbers and many of them are in poverty.’;
‘‘(20) in 1938, Congress again acknowledged 
the unique status of the Native Hawaiian people by 
including in the Act of June 20, 1938 (52 Stat. 
781), a provision—
‘‘(A) to lease land within the extension to 
Native Hawaiians; and 
‘‘(B) to permit fishing in the area ‘only by 
native Hawaiian residents of said area or of ad-
jacent villages and by visitors under their guid-
ance’; 
‘‘(21) under the Act of March 18, 1959 (48 
U.S.C. prec. 491 note; 73 Stat. 4), the United 
States—
‘‘(A) transferred responsibility for the ad-
ministration of the Hawaiian home lands to the 
State; but 
‘‘(B) reaffirmed the trust relationship that 
existed between the United States and the Na-
tive Hawaiian people by retaining the exclusive 
power to enforce the trust, including the power 
to approve land exchanges and legislative 
amendments affecting the rights of beneficiaries 
under that Act; 
‘‘(22) under the Act referred to in paragraph 
(21), the United States—
‘‘(A) transferred responsibility for adminis-
tration over portions of the ceded public lands 
trust not retained by the United States to the 
State; but 
‘‘(B) reaffirmed the trust relationship that 
existed between the United States and the Na-
tive Hawaiian people by retaining the legal re-
sponsibility of the State for the betterment of 
the conditions of Native Hawaiians under sec-
tion 5(f) of that Act (73 Stat. 6); 
‘‘(23) in 1978, the people of Hawaii—
‘‘(A) amended the constitution of Hawaii 
to establish the Office of Hawaiian Affairs; and 
‘‘(B) assigned to that Office the author-
ity—
‘‘(i) to accept and hold in trust for the 
Native Hawaiian people real and personal 
property transferred from any source; 
‘‘(ii) to receive payments from the 
State owed to the Native Hawaiian people 
in satisfaction of the pro rata share of the 
proceeds of the public land trust estab-
lished by section 5(f) of the Act of March 
18, 1959 (48 U.S.C. prec. 491 note; 73 
Stat. 6);
‘‘(iii) to act as the lead State agency 
for matters affecting the Native Hawaiian 
people; and 
‘‘(iv) to formulate policy on affairs re-
lating to the Native Hawaiian people; 
‘‘(24) the authority of Congress under the Con-
stitution to legislate in matters affecting the aborigi-
nal or indigenous people of the United States in-
cludes the authority to legislate in matters affecting 
the native people of Alaska and Hawaii; 
‘‘(25) the United States has recognized the au-
thority of the Native Hawaiian people to continue to 
work toward an appropriate form of sovereignty, as 
defined by the Native Hawaiian people in provisions 
set forth in legislation returning the Hawaiian Is-
land of Kaho‘olawe to custodial management by the 
State in 1994; 
‘‘(26) in furtherance of the trust responsibility 
for the betterment of the conditions of Native Ha-
waiians, the United States has established a pro-
gram for the provision of comprehensive health pro-
motion and disease prevention services to maintain 
and improve the health status of the Hawaiian peo-
ple;
‘‘(27) that program is conducted by the Native 
Hawaiian Health Care Systems and Papa Ola 
Lokahi; 
‘‘(28) health initiatives implemented by those 
and other health institutions and agencies using 
Federal assistance have been responsible for reduc-
ing the century-old morbidity and mortality rates of 
Native Hawaiian people by—
‘‘(A) providing comprehensive disease pre-
vention; 
‘‘(B) providing health promotion activities; 
and 
‘‘(C) increasing the number of Native Ha-
waiians in the health and allied health profes-
sions; 
‘‘(29) 
those 
accomplishments 
have 
been 
achieved through implementation of—
‘‘(A) the Native Hawaiian Health Care Act 
of 1988 (Public Law 100–579); and 
‘‘(B) the reauthorization of that Act under 
section 9168 of the Department of Defense Ap-
propriations Act, 1993 (Public Law 102–396; 
106 Stat. 1948); 
‘‘(30) the historical and unique legal relation-
ship between the United States and Native Hawai-
ians has been consistently recognized and affirmed 
by Congress through the enactment of more than 
160 Federal laws that extend to the Native Hawai-
ian people the same rights and privileges accorded to 
American Indian, Alaska Native, Eskimo, and Aleut 
communities, including—
‘‘(A) the Native American Programs Act of 
1974 (42 U.S.C. 2991 et seq.); 
‘‘(B) the American Indian Religious Free-
dom Act (42 U.S.C. 1996); 
‘‘(C) the National Museum of the Amer-
ican Indian Act (20 U.S.C. 80q et seq.); and 
‘‘(D) the Native American Graves Protec-
tion and Repatriation Act (25 U.S.C. 3001 et 
seq.); 
‘‘(31) the United States has recognized and re-
affirmed the trust relationship to the Native Hawai-
ian people through legislation that authorizes the 
provision of services to Native Hawaiians, specifi-
cally—
‘‘(A) the Older Americans Act of 1965 (42 
U.S.C. 3001 et seq.); 
‘‘(B) the Developmental Disabilities Assist-
ance and Bill of Rights Act Amendments of 
1987 (42 U.S.C. 6000 et seq.);
‘‘(C) the Veterans’ Benefits and Services 
Act of 1988 (Public Law 100–322); 
‘‘(D) the Rehabilitation Act of 1973 (29 
U.S.C. 701 et seq.); 
‘‘(E) the Native Hawaiian Health Care Act 
of 1988 (42 U.S.C. 11701 et seq.); 
‘‘(F) the Health Professions Reauthoriza-
tion Act of 1988 (Public Law 100–607; 102 
Stat. 3122); 
‘‘(G) the Nursing Shortage Reduction and 
Education Extension Act of 1988 (Public Law 
100–607; 102 Stat. 3153); 
‘‘(H) the Handicapped Programs Technical 
Amendments Act of 1988 (Public Law 100–
630); 
‘‘(I) the Indian Health Care Amendments 
of 1988 (Public Law 100–713); and 
‘‘(J) the Disadvantaged Minority Health 
Improvement Act of 1990 (Public Law 101–
527); 
‘‘(32) the United States has affirmed that his-
torical and unique legal relationship to the Hawaiian 
people by authorizing the provision of services to 
Native Hawaiians to address problems of alcohol