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Health care reauthorization act fails

WASHINGTON – Lead organizations and lobbyists have admitted the defeat of efforts to reauthorize the Indian Health Care Improvement Act.

Declaring efforts to enact the bill “shut down” in Congress, the National Indian Health Board stated on its Web site Sept. 29 that it will continue to pursue strategies for enacting the reauthorization bill during what little remains of the current 110th Congress. But already by the evening of Sept. 26, a longtime lobbyist on Indian health issues, speaking on condition of anonymity when anything could still happen, said key congressional committee staff had put its chances of passing at slim to none.

By then, as recounted by NIHB, attempts to attach the bill (H.R. 1328 in the House of Representatives) to a “continuing resolution” on the budget – i.e., a measure to fund the federal government until Congress can pass a national budget – had faltered.

The bill’s chances didn’t improve over the weekend of Sept. 27 – 28. In the process of trying to move smaller parts of a larger bill that has faltered through the legislative system separately, the bill’s advocates tried to strip out Title II of the larger bill – the section providing enhanced Native access to Medicare, Medicaid and the State Children’s Health Insurance Program – as a stand-alone bill. “Kind of like taking apart an automobile,” as Blackfeet lobbyist Tom Rodgers of Carlyle Consulting described it. But when that process gets started, he said, it’s not long before the separate parts add up to less than the sum of the whole.

“Unfortunately,” NIHB summarized on its Web site (, “House [l]eadership was not able to fund the first five years of the bill in an amount of $53 million.”

That was for the proposed stand-alone bill comprised of Title II. Though the Congressional Budget Office had estimated the original reauthorization bill to cost $129 million over 10 years, funding had become a problem for the bill as Congress arranged the well-known $700 billion bailout bill for the financial credit system, along with at least $1 billion in tax giveaways and a $25 billion loan package for Detroit automakers.

On Sept. 24, as conditions in credit access built toward the $700 billion crisis, Rep. Tom Cole, R-Okla., enrolled Chickasaw, urged passage of H.R. 1328. Budgetary pressures in 2009 could work against even modest new expenditures, he warned.

But House leadership had decided not to offer the bill for a vote in the first instance because of the abortion issue. An amendment forbidding the use of federal funds to pay for abortions under the reauthorization had been added to the Senate version of the bill by Sen. David Vitter, R-La. House Republicans, despite what NIHB calls Indian country’s consistent position that abortion is inappropriate to an Indian health bill and already restricted under current law on federal funding, now wanted to attach the Vitter amendment to the House version.

In addition, NIHB relates, the National Right to Life Committee threatened to “score” votes on the bill as pro- or anti-abortion if the amendment were not permitted. Because the committee would score a vote on the amendment in any case, the political calculus boiled down to this for House leadership: to bring the bill forward would be to register a vote on abortion little more than a month before every member of the House faced the voters on Nov. 4.

Lawmakers are generally allergic to making choices so close to an election, Rodgers explained. The abortion amendment “dominated and clouded the whole debate,” he added.

He cited another reason for the bill’s setback. “Indian country needs to have more allies on the [House] Energy and Commerce Committee. It is basically an urban committee which does not reflect historical ties to Indian country.”

Indian country, especially health care advocates and professionals, must work to address the problem substantively and procedurally as Nov. 4 approaches, he said. “That’s what elections are for. ... You do that by embracing your friends and punishing your enemies, and that can only be done by hard work.”

 Other principal committees of jurisdiction on the bill – House Natural Resources under Rep. Nick Rahall, D-W.Va.; Senate Indian Affairs under Sen. Byron Dorgan, D-N.D.; and Senate Finance under Sen. Max Baucus, D-Mont. – performed “exceptionally well” on the bill’s behalf, Rodgers said.

As the 110th Congress approached recess, the failure of the Indian Health Care Improvement Act reauthorization left an angry mood among its advocates. “They’re bitter, very bitter,” said Gregory Smith, of Smith and Brown-Yazzie LLP in Washington, D.C. The National Congress of American Indians had made the bill its top legislative priority. NIHB, the National Council of Urban Indian Health, the National Steering Committee on Reauthorization of the Indian Health Care Improvement Act, the California Rural Indian Health Board, a host of other organizations and tribes, tribal leaders and individual Native people, lawmakers and legislative staff and lobbyists by the score have poured their efforts into refining the bill and passing it, many of them for years running.

They’ll try again next year, Rodgers said, with new strategies for the new political landscape of the next Congress.

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