American Indians would have better access to health care services, including screening and mental health programs, under legislation the Senate passed Tuesday.

The bill, 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 American Indians into health professions. It also would increase tribal access to Medicare and Medicaid.

The legislation would authorize spending about $35 billion for American Indian health care programs over the next 10 years. Senate Indian Affairs Committee Chairman Byron Dorgan, D-N.D., called it a first step in addressing a crisis in American Indian health care. The system is underfunded and inefficient, he said.

American Indians suffer much higher death rates of most leading causes than the rest of the country. Alcoholism, drug use, diabetes, cardiovascular disease and suicide rates are especially high.

Senate Majority Leader Harry Reid, D-Nev., 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," Reid said.

Similar legislation cleared the House Natural Resources Committee and a House Energy and Commerce subcommittee last year. It still must be approved by the full Energy panel and the House Ways and Means Committee before it heads to the House floor.

The Senate bill also contains a resolution sponsored by Sen. Sam Brownback, R-Kan., that formally apologizes to American Indians for centuries of government mistreatment. The resolution acknowledges a long history of government misconduct against American 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 amended the bill to exclude most abortions at American Indian health clinics and prohibit spending on programs that discourage gun ownership.