The year IHCIA became permanent

WASHINGTON – After nearly a decade of struggling to get the Indian Health Care Improvement Act reauthorized, advocates not only got the job done in 2010, they also made it permanent.

The Indian legislation had long faced hurdles on its own, largely due to congressional inaction, but adding to the complications this year was its attachment to the overall health care reform bill. As that legislation faced its own struggles, the IHCIA seemed in doubt many times.

Throughout the process, congressional staffers were telling Indian advocates that pursuing a standalone IHCIA could be futile, since much political capital was being spent on the larger bill, and there wouldn’t be much energy left for another big battle on a health issue after that. The consciousness would move on, they were told.

By March, after a long roller coaster ride, the tide against the sweeping health bill had turned with the House voting to approve, which the Senate had done before last Christmas.

The legislation ended up permanently reauthorizing IHCIA, an important move, since the law provides an array of support to IHS and other programs that aid Native American health. It was first made law in 1976 and had not been reauthorized since 2001.

Indian advocates made the case that permanent reauthorization was crucial, so they don’t have to ask Congress every few years to approve policies that a majority already agree make sense. Congress has failed many times over the years to reauthorize the law in a timely manner, so its permanent reauthorization is seen by many Indian advocates as a major victory.

New challenges may still lie ahead for the law, given that some Republican House members have indicated a willingness to repeal the greater health reform law that IHCIA is a part of 2011.

The White House said in December that IHCIA is safe, with President Barack Obama’s chief of staff, Pete Rouse, telling Indian Country Today that the president would consider sending Congress a strong signal that the Indian law is off limits.

“The permanent authorization of the Indian Health Care Improvement Act was a big priority. The president is totally committed to this. This is not an issue that he would compromise on, or back off on.”

Obama said in a statement after signing the bill into law that he co-sponsored IHCIA in 2007 when he was in Congress because he “believes it is unacceptable that Native American communities still face gaping health care disparities.”

The president added that it is the government’s responsibility to provide health services to American Indians and Alaska Natives due to the nation-to-nation relationship between the federal and tribal governments. Along those lines, the overall health bill includes an exemption of American Indians and Alaska Natives from individual penalties and cost sharing associated with the law.

Yvette Roubideaux, IHS director, said the reauthorization would help update the services the agency provides.

“We also know this is an important and historic event after all the hard work over the past decade by the tribes that we serve,” said the Rosebud Sioux citizen. “This reaffirms our responsibility to provide health care to the AI/ANs that we serve, and helps us greatly as we move forward in our efforts to change and improve the IHS.”

Joe Finkbonner, the Lummi executive director of the Northwest Portland Area Indian Health Board, said the law would help IHS bolster many of its programs, including provisions for new long-term care services, additional mental and behavioral health services, and mammography and other cancer screening.

Support is also included for additional programs for health care facility construction, including demonstration programs for modular component construction and mobile health stations. And there are new grant opportunities to prevent, control and eliminate other communicable and infectious diseases in addition to tuberculosis, including hepatitis and HIV.

Indian country is also included in some of the other, non-IHCIA sections of the reform law, including provisions focused on excluding qualified Indian health benefits from being taxed as gross income.