WASHINGTON, D.C. -- The Senate overwhelmingly agreed Tuesday to renew long-overdue Indian health legislation that would fund medical services through 2017 and improve the quality of care provided in Indian Country.

"This is a big, big deal," said Indian Affairs Committee Chairman Byron Dorgan, D-N.D., after the vote. "This will save lives."

Senators from Montana and Wyoming worked on the bill and praised its 83-10 passage. The Indian Health Care Improvement Act was last approved in 1992. It has been expired since 2000, although the Indian Health Service has continued to provide health care with funding approved annually by Congress.

The bill would allow construction and modernizing of health clinics, recruit more Indians into health professions, expand the range of screenings offered, boost funding for hospice and behavioral needs programs, increase monitoring of communicable diseases and make it easier for Indians to be reimbursed for costs.

It would authorize about $35 billion over 10 years for Indian health care programs. But the appropriations committees still would have to approve that money. The full House has not yet taken up its version of the legislation.

Numerous senators said the legislation would only serve as a first step and that new and more aggressive reforms will be needed.

"I have met with representatives and leaders from each of the seven reservations in Montana multiple times, and every time they point out to me that the most important issue is health care, or the lack of it," said Sen. Jon Tester, D-Mont., in a recent floor speech.

Tester, who sits on the Indian Affairs panel, said American Indians and Alaska natives have a lower life expectancy than all other racial groups in America. He said IHS only provides 55 percent of the funding necessary to meet the health care needs of the people using its system.

The late Sen. Craig Thomas, R-Wyo., helped put together the bill while he served as vice chair of the Indian Affairs panel. Sen. Mike Enzi, R-Wyo., said the measure includes some portions of legislation he helped write during the last Congress.

"(The bill) will solve immense problems for tribes throughout the United States, it will move health care forward for all that are involved and it will make a huge difference," Enzi said in a floor speech. "It's past due."

Enzi said he had some objections to the original bill but that his concerns had been addressed. The White House had threatened to veto the bill, but senators agreed to change certain provisions on wage and labor requirements.

Finance Committee Chairman Max Baucus, D-Mont., helped write part of the bill that would improve reimbursement procedures, bolster outreach programs, and eliminate co-payments for patients of the Indian Health Service who rely on Medicare, Medicaid and SCHIP.

"This bill will help cut red tape and make it easier for Native Americans in Montana and across the country to have access to better health care," Baucus said in a statement.

Sen. Tom Coburn, R-Okla., offered several amendments trying to alter the bill, although only one passed, and objected to the overall legislation.

"Today the Senate voted to ignore the extensive problems within our Indian Health Services and reauthorized the same, broken system," he said in a statement. "Without addressing wait lines, rationing and inferior quality in our current system we are violating our trust obligations to tribal members across the country."

Dorgan said the federal government has a trust responsibility to provide health care in Indian Country that was guaranteed in treaties and has been reaffirmed by the U.S. Supreme Court.

"We have failed miserably to hold up our end of the bargain," he said. "This is a bill that requires us to keep our word."

He said that the money for Indian Health Care often runs out by June, after which no one can be treated unless life or limb is at risk. That results in health-care rationing on reservations, he said.

Several senators noted that the federal government spends more money for health care of prisoners than it does for Indians.

Dorgan and Tester held a field hearing on the bill last year on the Crow Reservation in Montana. On the Senate floor, they both recalled tribal members telling stories of 5-year-old children and other seriously ill patients not getting care they needed.

Several amendments were added on the Senate floor. One offers a formal apology to American Indians for historic wrongs by the U.S. government. Others would prohibit the use of federal funds for abortions or for programs that discourage gun ownership.

The bill would revise requirements in a range of areas including mammography, patient travel costs, school health education programs, health facilities and sanitary waste disposal facilities.

It would also revise the direct billing system and requirements for reimbursements of health care costs from third parties, and work to enroll more Indians in Medicaid and SCHIP.

The measure would allow federal dollars to be spent on home- or community-based care for hospice, assisted living and long-term care. It would also authorize grants for health, educational and training scholarships and revises recruitment and retention programs for health professionals.

It would address behavioral health needs, providing for programs to address suicide, domestic violence, sexual abuse and substance abuse. It also would revise or establish guidelines for programs dealing with diabetes and communicable diseases.