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A second look at Senate procedures on health care reauthorization

WASHINGTON - Turns out there's a reason the Senate employs a parliamentarian, indeed a whole Office of the Senate Parliamentarian, to keep track of its procedures.

As reported in ''Health care reauthorization gains ground in Senate'' [Vol. 27, Iss. 10], the Senate majority leader exercises the unique authority to circumvent holds on a bill and schedule time for it on the Senate floor. But a more complete account would have noted that ''holds,'' by which any senator can prevent a vote on any bill, only apply under unanimous consent rules. A great deal of the Senate's business, including most of its Indian-specific business, is done by unanimous consent. If only one senator applies a hold when a bill comes up for consideration by unanimous consent, unanimous consent has failed.

On the Indian Health Care Improvement Act reauthorization bill, Sens. Jim DeMint, as chairman of the Republican Steering Committee, and Tom Coburn on his own, maintain what are called ''hard holds'' - holds they are considered unlikely to stand down from. DeMint, R-S.C., doesn't like the prospect of so-called federal entitlement spending, for Indian health care or anything else; Coburn, R-Okla., considers the IHS system damaged goods and would prefer issuing insurance or insurance-like cards. Critics contend they would be of little help to Indians and Alaska Natives in remote communities that would no longer have IHS facilities nearby.

The new ethics reform bill that President Bush is expected to sign into law in September will eliminate the anonymity of holds. Technically though, as a protection for minority rights, the informal agreement among senators is that no one can remove a hold under unanimous consent rules. But the Senate majority leader, now Sen. Harry Reid, D-Nev., can outflank unanimous consent and the holds that often go with it by scheduling floor time for a bill in the regular order of business, as he has agreed to do for the Indian Health Care Improvement Act reauthorization. A number of Indian health care advocates in Washington, including Kitty Marx, legislative director for the National Indian Health Board, consider the bill likely to pass the Senate if Reid can steer it to a vote on the floor. Other lobbyists, speaking on condition of anonymity because they don't want to be associated with a negative view of the bill, note that Senate opponents will still have procedures at their disposal to stall the bill, including the ''filibuster'' - prolonged debate on a bill, designed to stall its final consideration. Reid would then need a ''super-majority'' of 60 votes to overcome the filibuster and get to an up-or-down, simple majority vote.

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First the bill has to emerge from the Senate Finance Committee, where Sen. Max Baucus, D-Mont., the chairman, has agreed to give it a ''mark-up'' meeting in September. Assuming the committee finds no new reasons to oppose that it didn't know last year, when it approved the same set of provisions in Title 2 of the overall bill, Senate Finance is considered likely to report the bill out of committee. Reid will then schedule time for debate and a vote on the floor.