Finance Committee sends health care reauthorization to Senate

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WASHINGTON - With an opening quotation from Thomas Jefferson and a closing appeal to the tribunal of American family values, Sen. Max Baucus and the Senate Finance Committee set the stage for a showdown vote in the Senate on the reauthorization of the Indian Health Care Improvement Act.

By a voice vote Sept. 12, the committee passed a cluster of provisions that address the American Indian and Alaska Native health care issues within the Senate Finance Committee's jurisdiction. The provisions mainly serve to improve American Indian and Alaska Native access to Medicare, Medicaid and the State Children's Health Insurance Program. ''We intend this bill to become part of the larger Indian health bill,'' Baucus said. The main committee of jurisdiction over that larger bill, the Senate Committee on Indian Affairs, passed S. 1200 to the full Senate on May 10.

Sen. Harry Reid, D-Nev., the Senate majority leader, has agreed to schedule floor time for a vote on S. 1200, reauthorizing the Indian Health Care Improvement Act. At a later rally for the bill in the Capitol building, Baucus acknowledged that the White House opposes S. 1200. As his fellow Democrat from Montana, Sen. Jon Tester, stated in thunderous terms at the same rally, that means the bill's backers may have to round up enough votes to overcome a presidential veto. In any case, most analysts of the bill's chances believe enough Republicans will have to cross the aisle to provide 60 votes in support - enough to overcome a filibuster or other tactics Republicans may deploy to prevent the bill from coming to a final vote.

But no account would be complete without providing some sense of the low-key drama that preceded the Finance Committee vote. Most of it centered on the prospects for a quorum on the committee - 11 members. With a new fiscal year only weeks away and the war in Iraq commanding close attention, congressional members are exceedingly busy these days. The business meeting of the committee had been scheduled for 10 a.m. By 10:30, a lobbyist said afterward, he wasn't sure any senators would show up. He wasn't alone. Several people said afterward, in separate conversations, that they worried a quorum wouldn't ever materialize. But Baucus and Democratic Sens. Jay Rockefeller of West Virginia, Kent Conrad of North Dakota and Charles Grassley of Iowa were among the first to show up, and Baucus got the meeting under way with some of the oratory that still characterizes Congress at its best.

''In his 1802 address to Indian nations, Thomas Jefferson said, 'Made by the same Great Spirit and living in the same land with our brothers ... we consider ourselves as of the same family; we wish ... to cherish their interest as our own.'

''But when it comes to the health care of our Native American brethren, the government has hardly cherished their interests as our own.''

After taking note of the dire statistics on Native health, arguing the need for reauthorization, acknowledging the 66,000 American Indians in Montana and insisting on health care for urban Indians, Baucus again struck a Jeffersonian note: ''We owe the first inhabitants of this nation better access to quality health care. We owe them medical care consistent with the medical care found in mainstream hospitals and clinics. We owe them the same medical care that we provide to the other members of our family.''

Grassley addressed some of the bill's nuts and bolts. ''This legislation provides relief for Medicare, Medicaid cost-sharing premiums if that Indian comes to Medicaid by contract or referral. This is a fair and balanced policy that those Indians would not be subject to cost-sharing or premiums if their care was provided by an Indian health care provider. ... Finally the legislation requires reporting of data on Indians served, the status of their health care, and efforts being made to upgrade facilities that may not be in compliance with Social Security Act requirements. This is invaluable information that will aid us in ensuring that we're providing quality care to Indians.'' Grassley concluded his remarks on the health care bill by acknowledging the efforts put into it by Baucus, Sens. Byron Dorgan, D-N.D., and Lisa Murkowski, R-Alaska, on the Senate Committee on Indian Affairs, and especially remembering the late Sen. Craig Thomas of Wyoming, ranking member of the SCIA until his death earlier this year. ''The work that has gone into today's mark-up [business meeting] has been a bipartisan process involving both committees, and the assistance of these members has been invaluable.''

Grassley turned to humor as the committee continued short of a quorum, offering to speechify until committee members showed up.

But about 20 minutes into the meeting, Sens. Blanche Lincoln, D-Ark., and Ron Wyden, D-Ore., became the 10th and 11th members to take their seats, and Baucus called for a vote.

Now suspense shifted to the prospect of blocking amendments. Sen. Jon Kyl, R-Ariz., has opposed high-profile Indian-specific legislation in the past, but not today. Northwest tribes have argued for changes to health facility construction-funding formulas, but Sen. Maria Cantwell, D-Wash., said nothing.

As Baucus declared the health care provisions had passed, most of the more than 100 American Indians and Alaska Natives in the hearing room burst into prolonged applause. Moments like that are few and far between on Capitol Hill, a lobbyist commented later. Still later at the rally, Baucus said he savored it.