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Advocates consider next step on health care bill

WASHINGTON – The Indian Health Care Improvement Act reauthorization bill, turned back by the Bush administration and its congressional allies in the 108th, the 109th and now the 110th Congress, will continue to be a priority for Indian country next year, according to the bill’s leading organizational advocates and lobbyists.

Rachel Joseph, of the National Steering Committee on Reauthorization, and Kitty Marx, legislative director of the National Indian Health Board, both said it’s premature to commit to a strategy before the makeup of the next Congress and the new president are known.

“I have long thought politically that a more Democratic Congress will yield a better result,” added Gregory Smith, a lobbyist with Smith & Brown-Yazzie.

The federal budget will also remain a factor, Joseph said. “We could get the best bill in the world, and without appropriations, it wouldn’t improve our health care.”

As matters stand now, 18 percent of the federal budget is committed to discretionary spending, Smith said. “Despite the fact that the entire federal budget is out of control, that’s the part that gets squeezed. And unfortunately, most Indian funding comes from that part of the budget.”

Budget considerations undermined the bill this year, as a reduced bill had to pass in the House of Representatives while the now-international crisis in credit access began to play out. “It was insane, lobbying calls while Wall Street was in meltdown,” said Jim Crouch, executive director of the California Rural Indian Health Board. “It was hard to think they [lawmakers] were paying any attention to us.”

But in the last analysis, abortion was the issue the bill couldn’t overcome, according to Joseph, Marx, Smith and Tom Rodgers of Carlyle Consulting, another of the bill’s leading lobbyists. “We had the votes,” Joseph said. “We just didn’t see daylight” – that is, House leadership wouldn’t bring the bill to a vote so close to an election because the National Right to Life Committee had threatened to “score” the results, targeting the bill’s backers for anti-abortion opposition during their campaigns.

Sen. David Vitter, R-La., attached the amendment in the Senate as a “poison pill,” Crouch said, noting the hypocrisy: Vitter, a “family values” Republican, has been linked to prostitutes in the so-called “D.C. Madam” scandal.

Abortion has never been an issue for the IHCIA reauthorization bill proper, Marx said, and it won’t be next year. “We’re not going to get into a fight with the National Right to Life Committee. That’s not our issue. They need to take their issue somewhere else. We’ll fight back if they try to hijack our bill again.”

Crouch said he’s discouraged by the bill’s failure, given its many champions on Capitol Hill, the hard work of tribal leaders and organizations, and the countless hours that went into refining its provisions. “But we still couldn’t get it to a vote in the House. We couldn’t get it out of the Senate without damage.”

He expects to regroup and convene again with others following the elections. “Here’s what I think we need to do. We need to fundamentally rethink what it is we want to do.”

In past Congresses, the bill has been brought forward as one large, stand-alone bill – an easy target for opponents, some have argued. Crouch said he can continue to support that approach “if indeed we have a sea-change of an election. ... I haven’t given up hope.”

Another alternative is to package the bill’s provisions as smaller, separate bills that can be attached to “appropriate vehicles” – i.e., other bills that are unlikely to be voted down. That strategy came into play only at the end of the 110th Congress, Marx said, when it became clear the Vitter amendment would prevent the bill’s movement as a stand-alone bill.

With national health care reform sure to be debated next year no matter who becomes president, Rodgers said the reauthorization bill in its entirety should be rolled into the anticipated national reform bill – a major vehicle that won’t be voted down and that will be protected from fiscal pressures as well, he noted.

In the likelihood the larger bill goes to a conference committee, to iron out differences between House and Senate versions, the right “Indian country-friendly” committee of jurisdiction can be recruited to make sure its IHCIA-specific title isn’t stripped out in conference, he added.