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Health Bill Reauthorization 'More Important Than Ever'

WASHINGTON ñ Rep. Frank Pallone Jr. has made a name for himself in Indian country as a lawmaker who stands up for tribes, even though few Indians populate his New Jersey district.

But as a member of the Resources Committee, the committee of jurisdiction in the House of Representatives on many Indian-specific issues, the New Jersey Democrat seldom misses a chance to advocate for fairness toward Indians in the formulation of policy.

A good example came early in the second session of the current 109th Congress, as it became clear that the federal budget would seek to save on health outlays by reducing Medicaid benefits and increasing the programís co-payment and premium costs.

Medicaid is the United Statesí federal/state program that helps pay for health care for the needy, aged, blind and disabled, and for low-income families with children.

At present, American Indian Medicaid beneficiaries with incomes below the poverty line are not required to pay premiums, co-payments and other forms of cost-sharing with their health care providers.

Pallone criticized the ìenormous consequencesî of the policy change for individual Indians, the IHS, and tribal and urban health care providers. ìNative American beneficiaries ... would be subject to new out-of-pocket costs,î he said. ìThis may cause them to go without much-needed care and contribute to worsening health outcomes. Native American beneficiaries will then be forced to seek care from IHS, tribal and/or urban Indian health facilities, which already suffer from severely limited resources.î

To prevent that, Pallone offered companion legislation in the House to a Senate bill of Sen. Jeff Bingaman, D-N.M., that would exempt American Indians and Alaska Natives from the ìmore pay or less serviceî demands of the budget-crunched Medicaid program.

ìBut the budget problem is there,î Pallone said. ìItís inherent in everything we do.î

Most Indian health care funding comes out of the domestic discretionary budget, that small percentage of federal expenditures that is being targeted for cutbacks through the budgeting process because larger savings would take politically daunting changes in law. The domestic discretionary budget is up for renegotiation every appropriations cycle, meaning Indian health care funds are on the firing line every year for as long as the federal budget remains in deficit mode (that is to say, for the foreseeable future).

ìOne of the things weíve talked about doing is making the IHS an entitlement, so that itís not subject to these appropriations vagaries,î Pallone said.

He has introduced stand-alone legislation to that effect, arguing that the federal budget for fiscal year 2007 (which begins in October) ìfalls well short of the level of funding that would permit American Indian and Alaska Native programs to achieve health and health system parity with the majority of other Americans.î

If entitlement status can be gained for IHS funding, Congress will have to fund the unmet health needs of Indian country. Tribal leaders have put forward a $19.7 billion ìneeds-based budgetî for the IHS, almost six times the Bush administrationís initial budget request of $3.2 billion, and sure to far exceed any amount enacted by Congress.

Pallone acknowledges steady, small budget increases to the IHS during the George W. Bush presidency, but terms them ìstill entirely inadequateî to even maintaining the current level of IHS services. The ultimate disposition of the fiscal year 2007 IHS budget remains under discussion in Congress.

In the meantime, Pallone is part of a cohort of congressional members who are backing reauthorization of the Indian Health Care Improvement Act. ìItís more important than ever,î he said of the reauthorization.

A bill introduced in the Senate, Senate Bill 1057, would revise and extend the act, updating it to address the current health care needs of Indian country. It is far from a simple reauthorization, and an IHCIA reauthorization bill being developed in the House by Rep. Don Young, R-Alaska, is not expected to be identical with the Senate bill when and if it is introduced. The two bills would have to be reconciled before a law can be enacted, raising the prospect that on a legislative calendar already shortened by the presence of November elections, IHCIA reauthorization could run out of time for the second consecutive Congress.

ìWe canít count on a last-minute flurry [of legislation passed by unanimous consent at the end of the 109th Congress], because it didnít work last time,î Pallone said.

ìAccordingly, it is important for us to move soon so time does not once again run out on this legislation. We need to move quickly to have this bill voted on in the House, reconciled with the Senate bill and sent to the presidentís desk for his signature.î

Pallone is also trying to restore funding cuts to clean drinking water programs and the Environmental Protection Agencyís Superfund program for cleaning up toxic pollution. For the first time ever, the EPA has announced that it is restoring a Superfund site to its list for priority cleanup. The site affects the New Jersey state-recognized Ramapough Lenape Indian Nation.

Among Palloneís other Indian-specific priorities in the 109th Congress are beefing up law enforcement funding for tribes and empowering them to access U.S. Department of Homeland Security programs for border patrols outside state administrative channels.

And like just about everyone else with an allegiance to Indian country, Pallone has found himself condemning the raids of the Interior Department on Indian program funds and fending off the usages made by anti-Indian interests of indicted lobbyist Jack Abramoffís misdeeds with tribal fees and donations.

Pallone attended the March 1 joint hearing of Congress announcing an attempt to settle the trust funds lawsuit, Cobell v. Norton, legislatively.

He told a National Congress of American Indians audience afterward, ìIt has become very clear to me that the Department of Interior seems more interested in delaying negotiations on a fair settlement so it can try to divide Indian country and get Congress to force a settlement that is unjust. The recent cut of $1 million ... to Indian programs to pay for attorney fees ordered by the court [in Cobell] is the latest in the unconscionable tactics used by the Department of Interior.î

As for the time of trouble brought on tribes by Abramoff, Pallone hopes tribes have overcome the worst of it.

ìObviously the Abramoff thing has been used by the opponents of Indian tribes, of Indian gaming, to get limits on gaming, to get limits on political donations ... But I think you just have to keep pointing out that tribes are the victims ... I think that weíve done a pretty good job with their advocacy conferences, where theyíve been visiting Congress and explaining themselves. I think theyíve had some success ... they can dissipate that negativity.î

WASHINGTON ñ Rep. Frank Pallone Jr. has made a name for himself in Indian country as a lawmaker who stands up for tribes, even though few Indians populate his New Jersey district. But as a member of the Resources Committee, the committee of jurisdiction in the House of Representatives on many Indian-specific issues, the New Jersey Democrat seldom misses a chance to advocate for fairness toward Indians in the formulation of policy.A good example came early in the second session of the current 109th Congress, as it became clear that the federal budget would seek to save on health outlays by reducing Medicaid benefits and increasing the programís co-payment and premium costs.Medicaid is the United Statesí federal/state program that helps pay for health care for the needy, aged, blind and disabled, and for low-income families with children.At present, American Indian Medicaid beneficiaries with incomes below the poverty line are not required to pay premiums, co-payments and other forms of cost-sharing with their health care providers.Pallone criticized the ìenormous consequencesî of the policy change for individual Indians, the IHS, and tribal and urban health care providers. ìNative American beneficiaries ... would be subject to new out-of-pocket costs,î he said. ìThis may cause them to go without much-needed care and contribute to worsening health outcomes. Native American beneficiaries will then be forced to seek care from IHS, tribal and/or urban Indian health facilities, which already suffer from severely limited resources.îTo prevent that, Pallone offered companion legislation in the House to a Senate bill of Sen. Jeff Bingaman, D-N.M., that would exempt American Indians and Alaska Natives from the ìmore pay or less serviceî demands of the budget-crunched Medicaid program. ìBut the budget problem is there,î Pallone said. ìItís inherent in everything we do.îMost Indian health care funding comes out of the domestic discretionary budget, that small percentage of federal expenditures that is being targeted for cutbacks through the budgeting process because larger savings would take politically daunting changes in law. The domestic discretionary budget is up for renegotiation every appropriations cycle, meaning Indian health care funds are on the firing line every year for as long as the federal budget remains in deficit mode (that is to say, for the foreseeable future).ìOne of the things weíve talked about doing is making the IHS an entitlement, so that itís not subject to these appropriations vagaries,î Pallone said.He has introduced stand-alone legislation to that effect, arguing that the federal budget for fiscal year 2007 (which begins in October) ìfalls well short of the level of funding that would permit American Indian and Alaska Native programs to achieve health and health system parity with the majority of other Americans.îIf entitlement status can be gained for IHS funding, Congress will have to fund the unmet health needs of Indian country. Tribal leaders have put forward a $19.7 billion ìneeds-based budgetî for the IHS, almost six times the Bush administrationís initial budget request of $3.2 billion, and sure to far exceed any amount enacted by Congress.Pallone acknowledges steady, small budget increases to the IHS during the George W. Bush presidency, but terms them ìstill entirely inadequateî to even maintaining the current level of IHS services. The ultimate disposition of the fiscal year 2007 IHS budget remains under discussion in Congress.In the meantime, Pallone is part of a cohort of congressional members who are backing reauthorization of the Indian Health Care Improvement Act. ìItís more important than ever,î he said of the reauthorization.A bill introduced in the Senate, Senate Bill 1057, would revise and extend the act, updating it to address the current health care needs of Indian country. It is far from a simple reauthorization, and an IHCIA reauthorization bill being developed in the House by Rep. Don Young, R-Alaska, is not expected to be identical with the Senate bill when and if it is introduced. The two bills would have to be reconciled before a law can be enacted, raising the prospect that on a legislative calendar already shortened by the presence of November elections, IHCIA reauthorization could run out of time for the second consecutive Congress.ìWe canít count on a last-minute flurry [of legislation passed by unanimous consent at the end of the 109th Congress], because it didnít work last time,î Pallone said.ìAccordingly, it is important for us to move soon so time does not once again run out on this legislation. We need to move quickly to have this bill voted on in the House, reconciled with the Senate bill and sent to the presidentís desk for his signature.îPallone is also trying to restore funding cuts to clean drinking water programs and the Environmental Protection Agencyís Superfund program for cleaning up toxic pollution. For the first time ever, the EPA has announced that it is restoring a Superfund site to its list for priority cleanup. The site affects the New Jersey state-recognized Ramapough Lenape Indian Nation.Among Palloneís other Indian-specific priorities in the 109th Congress are beefing up law enforcement funding for tribes and empowering them to access U.S. Department of Homeland Security programs for border patrols outside state administrative channels.And like just about everyone else with an allegiance to Indian country, Pallone has found himself condemning the raids of the Interior Department on Indian program funds and fending off the usages made by anti-Indian interests of indicted lobbyist Jack Abramoffís misdeeds with tribal fees and donations.Pallone attended the March 1 joint hearing of Congress announcing an attempt to settle the trust funds lawsuit, Cobell v. Norton, legislatively.He told a National Congress of American Indians audience afterward, ìIt has become very clear to me that the Department of Interior seems more interested in delaying negotiations on a fair settlement so it can try to divide Indian country and get Congress to force a settlement that is unjust. The recent cut of $1 million ... to Indian programs to pay for attorney fees ordered by the court [in Cobell] is the latest in the unconscionable tactics used by the Department of Interior.îAs for the time of trouble brought on tribes by Abramoff, Pallone hopes tribes have overcome the worst of it. ìObviously the Abramoff thing has been used by the opponents of Indian tribes, of Indian gaming, to get limits on gaming, to get limits on political donations ... But I think you just have to keep pointing out that tribes are the victims ... I think that weíve done a pretty good job with their advocacy conferences, where theyíve been visiting Congress and explaining themselves. I think theyíve had some success ... they can dissipate that negativity.î