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Disappointment on Indian health care reauthorization front

WASHINGTON – All the optimism in the world from tribal leaders, American Indian organizations and some members of Congress couldn’t help the overdue reauthorization of the Indian Health Care Improvement Act from happening in 2008.

The progress of the legislation – which focuses on the federal government’s responsibility for meeting the health needs of American Indians and Alaska Natives – looked up in February when the Senate passed a version of the bill that senators hoped could be negotiated with the U.S. House of Representatives to create final legislation.

As the year progressed, however, it was clear that something was wrong in the House. Congress members were not acting on the bill, and American Indian health care advocates became increasingly alarmed.

Robert McSwain, IHS director, foreshadowed in a May Indian Country Today interview that things were tough going in the House. “[T]here are issues in the House that folks have. It’s a bigger body [than the Senate]. ... so you have more views to be expressed, more committees of jurisdiction. … it seems to bog down a bit.”

McSwain predicted the drop deadline for reauthorization would be June or July of this year, given the many priorities on Congress’ plate and the fact that it was an election year.

As the summer months passed without action, optimism waned, and it was soon clear to many that the bill was dead. The National Indian Health Board officially declared efforts to enact the bill “shut down” in Congress on Sept. 29.

It was ultimately learned that House leadership decided not to offer the bill for vote due to an amendment forbidding the use of federal funds to pay for abortions under the reauthorization. The language had been added to the Senate version of the bill by Sen. David Vitter, R-La., and House Republicans also wanted to attach the amendment to the House version.

Not long after defeat became a reality, introspection set in, with some even blaming American Indian groups, including the National Congress of American Indians, for not playing hard ball on the abortion amendment in an election year. A lobbyist familiar with the situation told ICT the biggest strategic error on behalf of NCAI was not realizing that Democratic supporters would not take a stand against pro-lifers to encourage the bill’s passage.

Some tribal advocates ended up saying that NCAI officials failed to anticipate the vast problem the Vitter amendment posed, and should have worked harder with congressional allies to ultimately get that language quashed, so as not to become a sticking point in the House. Some argued that NCAI should have made more of Vitter’s attempt to narrow the focus of the broad health bill to moral grounds when he himself was embattled throughout 2007 in a highly immoral situation involving his past relations with at least one prostitute while married.

When confronted with these questions, Jacqueline Johnson Pata, executive director of NCAI, said that given the politics involved in the situation, the only way to get the bill passed through the Senate’s Republican Steering Committee was to codify the abortion amendment — although NCAI, opposed the amendment. She noted intense lobbying efforts on behalf on the bill by NCAI.

Whatever could or couldn’t have been done better, advocates are now pinning their hopes on 2009 as the year for reauthorization. Already, many are excited that President-elect Barack Obama chose former Democratic Sen. Tom Daschle to serve as his secretary of Health and Human Services. Daschle has long been supportive of American Indian issues, and NIHB officials said in November they hope he will help ensure passage of the reauthorization.

Sen. Byron Dorgan, D-N.D., also promised in a recent ICT editorial to use his chairmanship of the Senate Indian Affairs Committee “to keep working to fundamentally reform and improve health care for Native Americans.”

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