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Indian health bill gains steam, again

WASHINGTON – Native American health advocates and leaders are pressing for quick reauthorization of the Indian Health Care Improvement Act, which has now been introduced in both chambers of Congress.

“Indian country has been waiting for and asking for these updates for over 10 years,” testified Jefferson Keel, lieutenant governor of the Chickasaw Nation and president-elect of the National Congress of American Indians, at 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.”

Yvette Roubideaux, IHS director, testified that the Department of Health and Human Services strongly supports reauthorization.

The Rosebud Sioux tribal citizen said the bill, known as H.R. 2708 in the House, would renew the federal authorities which provide specific policy guidance on the delivery of health services to American Indians and Alaska Natives.

That the important House committee is paying attention is a positive sign of progress, according to some Native leaders.

But impatience is widely felt, too.

A 2004 report by the National Institutes of Health found that Indians are 550 percent more likely to die from alcoholism and 200 percent more likely to die from diabetes than other groups of people.

It’s just one of many reasons that Keel and others are pressing for quick action.

Time is running out in the current session of Congress to move the legislation, which is intended to permanently reauthorize Indian health care programs.

The act was originally authorized in 1976 and last reauthorized in 1992. It is aimed at providing health care for American Indians and Alaska Natives to help fulfill the U.S. government’s treaty and trust responsibilities to Indian country.

As Keel testified, Congress has failed to fund important provisions of the act for nearly a decade and counting.

Reauthorizing legislation was introduced in the Senate Oct. 15 by Democratic Sen. Byron Dorgan of North Dakota, who heads the Senate Committee on Indian Affairs. He said it was a matter of living up to trust responsibility.

Fifteen bipartisan co-sponsors, including Senate Majority Leader Harry Reid, D-Nev. and Sen. Lisa Murkowski, R-Alaska, joined Dorgan in offering the bill.

Rep. Frank Pallone, D-N.J., introduced similar provisions in the House in June. He has said that any health care reforms passed by Congress this year must include IHCIA reauthorization.

Rachel Joseph, a citizen of the Lone Pine Paiute-Shoshone Tribe of California and co-chair of the National Tribal Steering Committee for the Reauthorization of the Indian Heath Care Improvement Act, called the House bill “nearly perfect.”

Despite Pallone’s desire, the Senate is already far behind schedule compared to its progress passing similar legislation last year.

Plus, as Indian advocates know all too well, anything can happen – or not happen, as the case may be. The House in 2008 – with some members concerned that a political battle would ensue over abortion issues stemming from the bill – caused it to die through inaction.

On the Senate side, Dorgan seems to be applying some lessons he learned courtesy of last year’s setback.

According to legislative aides, the SCIA chair bided his time this year shaping a pared down bill that hopefully will not face dramatic hurdles.

Allison Binney, SCIA staff director, explained at the recent NCAI convention in Palm Springs, Calif., that her boss worked to develop a “streamlined” version of the bill.

The legislation contains only the provisions that tribes have identified as top priorities, she noted, adding that Dorgan expects to introduce other Indian health care bills during this session of Congress to address issues not covered by the lighter bill.

Binney also said Dorgan will try to attach the bill to other pieces of legislation in order to get it passed, just as he did with the recently passed Senate apology to Native Americans.

Beyond reauthorizing all current Indian health care programs, the Senate bill would do the following:

• Authorize programs to increase the recruitment and retention of health care professionals, such as updates to the scholarship program, demonstration programs which promote new, innovative models of health care, to improve access to health care for Indians and Alaska Natives.

• Authorize long-term care, including home health care, assisted living and community based care. Current law provides for none of these forms of long-term care.

• Establish mental and behavioral health programs beyond alcohol and substance abuse, such as fetal alcohol spectrum disorders, and child sexual abuse and domestic violence prevention programs.

• Establish demonstration projects that provide incentives to use innovative facility construction methods, such as modular component construction and mobile health stations, to save money and improve access to health care services.

• Require that the IHS budget account for medical inflation rates and population growth, in order to combat the dramatic underfunding of the Indian health system.

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House Natural Resources Committee Chairman Nick Rahall, D-W. Va., and House Education and Labor Committee Chairman George Miller, D-Calif., announced Oct. 23 that they have successfully secured provisions in the House version of the national health insurance reform package that would provide for reauthorization of the IHCIA.