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Indian health bill on brink of passage

WASHINGTON – The Indian Health Care Improvement Act, after years of waiting for congressional reauthorization, is close to passage as part of the national health care reform package.

The weekend before Christmas, Senate lawmakers attached the Indian-focused bill to the Senate’s reform package.

Sixty senators – including all Democrats and two independents – declared their support for the larger package, so it will likely be able to overcome any attempt at filibuster or other legislative challenge from Republicans, who are opposed to the bill.

The IHCIA already passed the House Nov. 7 as part of its broad-based health care reform deal.

When the legislation makes it through both chambers of Congress, as is widely expected, even by opposing Republicans, it will then go to conference committee to iron out details.

Few provisions of the Indian health legislation differ in the Senate and House versions of the bill, which means there is not likely to be major changes to that part of the deal.

Notably, the bill would permanently reauthorize the law, so Indian advocates don’t have to find themselves going back to Congress every few years to make the case for policies that a majority agrees makes sense. The bill additionally provides funding mechanisms and support for a variety of Indian health programs.

In the health care reform version of IHCIA, there were four changes to the proposed bill, which were basically “tweaks around edges,” said Barry Piatt, a spokesman for Sen. Byron Dorgan, D-N.D., the chair of the Senate Committee on Indian Affairs.

The changes will likely make some advocates unhappy, but they are “minor changes compared to what’s in there,” Piatt said.

What is lost in the deal are a proposed tax-exempt scholarship provision for individual Indians; increased dental health care offerings for Indian country; and a Medicare reimbursement formula meant to increase IHS collections.

Each of the areas will likely be re-examined as the bill makes its way through conference and perhaps via later policy clarifications, observers said.

The bill also includes language affirming that IHCIA provisions will be in compliance with the rest of the bill on abortion issues. Some Republicans had raised a last minute argument that the entire bill should be scrapped if Indian health didn’t follow the same rules against abortion.

The abortion issue in reference to the IHCIA was somewhat of a smokescreen, some Native American health experts said, as the federal ban on abortion funding has been in effect under the Hyde Amendment since 1977, and it requires IHS to comply.

A late compromise hammered out to garner the support of Sen. Ben Nelson, D-Neb., gives states the choice to ban abortion coverage in insurance exchanges the legislation creates. The deal will separate premiums from insurance plans that pay for abortion from federal money.

IHS funding cannot be used for abortions, and the Nelson agreement doesn’t change policy substantively for IHS on this issue, said Jim Roberts, a policy analyst with the Northwest Portland Area Indian Health Board.

That the IHCIA ultimately became part of the nation’s reform health care bill was not always the most favored path toward passage – and some thought it to be a risky strategy considering the controversial nature of national health care reform, especially in the past months.

For years, many Indian advocates have argued that the legislation should be a stand-alone bill, as it includes provisions that are unique and important for Native Americans. No one wanted to see those provisions watered down under the weight of other non-Indian provisions – an obstacle that seems to have been avoided with the current legislation.

But supporters of the bill said the writing was on the wall earlier this year: many Indian-friendly advocates were spending all their energy on the greater health legislation, so there would likely be little gumption left after the long debate and struggles to do another health-focused bill.

“Given that the health care bill is close to passage, the disadvantage would be to have it in a stand-alone bill,” said Joe Finkbonner, executive director of the Northwest Portland Area Indian Health Board.

Roberts said having IHCIA attached to reform legislation is appropriate and makes sense.

Tom Rodgers, a tribal affairs lobbyist with Carlyle Consulting, also said that by having IHCIA as part of the reform package, the larger deal served to provide the Indian bill cover on the abortion issue.

Last year, when the IHCIA passed the Senate, Sen. David Vitter, R-La., helped insert abortion language into the stand-alone legislation that made it unattractive to House Speaker Nancy Pelosi, D-Calif., and others; the House ended up not moving on the bill in 2008.

Rodgers, a citizen of the Blackfeet Tribe, served as an important inside player in helping communicate the legislative reality to national Indian organizations, including the National Congress of American Indians. He was asked in December 2008 by Senate Finance Committee Chairman Max Baucus, D-Mont., to serve on the committee’s National Health Care Reform Advisory Stakeholder’s Panel.

Dorgan, who sponsored IHCIA in the Senate, reflected that the bill being attached to the national health care reform package was a “major breakthrough.”

Even if the health care bill failed for some unexpected reason, Dorgan was confident he could still help get it passed as stand-alone legislation, but said its inclusion opened up an additional track for moving it – a track that is likely to result in congressional approval sooner than would occur if it existed solely as stand-alone legislation.

The National Indian Health Board was cautiously optimistic about the development.

“This is only the first step in a series that will need to be accomplished before the IHCIA is signed into law,” said a statement released by the organization.

“However, the Senate leadership and the Obama administration deserve recognition for understanding the importance of the IHCIA to the well-being of Native Americans. Including it in the Senate health care reform bill will mean health care reform will be for all Americans.”