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Cautious days ahead for IHCIA in Senate

WASHINGTON – Late on the evening of Nov. 7, the reauthorization of the Indian Health Care Improvement Act overcame a major hurdle, passing the U.S. House of Representatives as part of larger health care reform legislation. Whether it can do the same in the Senate remains to be seen.

The passage of IHCIA in the House was no small feat, especially considering that it had stalled there last year – after having passed the Senate early on.

But the legislative situation has dramatically changed in the Senate, as the bill now finds itself part of a much larger nationwide health care reform debate. If the reform bill cannot pass the Senate, some Indian country leaders wonder if it has a serious chance of passing this session of Congress.

Sen. Joe Lieberman, an independent from Connecticut who caucuses with the Democrats, has already said he will filibuster the current health reform package, saying it is too costly and too large on government intervention.

Sen. Ben Nelson, D-Neb., has also said he would join a Republican filibuster of the health care bill if he thinks it’s a bad bill.

Issues of cost, extent of government control, and whether the final bill will circumvent any government subsidization of abortion are key points of contention.

It is widely believed that every bit of Democratic support will be needed to pass the larger health care reform package.

Despite a couple of already vocal Democratic naysayers – and a few that are keeping their cards close to their vests – Sen. Byron Dorgan, D-N.D., chairman of the Senate Committee on Indian Affairs, believes he can get a slimmed down IHCIA passed as part of the reform package, according to Barry Piatt, a spokesman for the senator.

But even if the greater bill stalls for some reason, Piatt said, the senator also believes he can get it passed as a standalone bill.

Therefore, Dorgan is of the mindset that there is little risk facing the bill, Piatt said.

Others are less confident.

Jefferson Keel, lieutenant governor of the Chickasaw Nation and president of the National Congress of American Indians, expressed some concerns in written testimony offered during a House Committee on Energy and Commerce hearing on Capitol Hill Oct. 20.

“We do not believe that national health insurance reform should be used as an excuse for abandoning the effort to reauthorize the IHCIA,” Keel said.

Former Republican Sen. Ben Nighthorse Campbell believes it is a mistake to attach Indian health legislation to the reform bill.

“Our bill should stand alone on its own merits,” said the citizen of the Northern Cheyenne Tribe.

“If it fails as part of the health reform package, there may not be enough momentum to get it going again.”

Nighthorse Campbell also believes a standalone IHCIA would be more filibuster-proof than the larger reform legislation. If any bill is filibustered, 60 votes are needed to overcome it.

But Tom Rodgers, a tribal affairs lobbyist with Carlyle Consulting, takes an opposing view.

Based on Rodgers’ conversations with Senate staffers, he believes few will have an appetite to go the distance on a standalone IHCIA bill after putting so much on the line for the big health care reform package.

“It might take a while to happen, but there’s still a big chance that it will go through [as part of the reform package in the Senate],” Rodgers said.

Mark Trahant, a Kaiser Media Fellow who is examining IHS and its relevance to the national health reform debate, said a case could be made either way regarding getting the bill passed as part of the reform deal. Still, he recently wrote an opinion piece saying that national reform looks dead-in-the-water due to some tough legislative hurdles.

“It’s a good 50/50 shot, and seems worth trying attaching it (the IHCIA) to the reform bill, but it is a slimmed down version,” the former Seattle Post-Intelligencer editorial page editor said.

Trahant added that without 60 votes to override a filibuster, a solely Indian health-related legislation could face obstacles from usual opponents, including Sen. Tom Coburn, R-Okla., or Sen. David Vitter, R-La.

He noted, too, that success was had in the Senate last year without any attachment to a national healthcare reform package, so it could very well happen again.

In sum, the citizen of Idaho’s Shoshone-Bannock Tribes labeled the situation as “pretty maddening.”

“Lawmakers all say that improving Indian health is a bipartisan issue, but obviously it’s not bipartisan enough to easily get 60 votes,” Trahant said.