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'This year' is the year for health care bill

WASHINGTON - The message sounded again and again throughout the National Congress of American Indians Tribal Nations Legislative Summit, Feb. 26 - 28: Congressional reauthorization of the Indian Health Care Improvement Act, a priority of Indian country for seven years, must take place this year. On a legislative calendar abbreviated by a host of factors, Indian country can't wait until late in the two-year 110th Congress to get a good bill before lawmakers.

Jacqueline Johnson, NCAI executive director, launched the summit on that very note at an opening press conference Feb. 26. ''I can't say it any stronger than we can't wait any longer; the bottom line is, to address these massive disparities in Indian health care. With infant mortality rates 150 percent greater for Indians than that of Caucasian infants. Indians are 2.6 times more likely to be diagnosed with diabetes. Life expectancy for Indians is five years less than the rest of the U.S. population. And suicide for American Indians and Alaska Natives is two and a half times higher than the national average.''

The reauthorization is complex, not a simple reaffirmation of a same or highly similar bill; its passage would significantly update Indian health care in a fast-paced health care environment. Even so, late-session delays in the 108th and 109th Congresses have tested the credulity of many lawmakers and advocates who have worked on the reauthorization, according to a multitude of accounts over several years. President Bush's administration has mounted regular objections to the bill's provisions, ranging from liability concerns to a recent Justice Department white paper contending the bill is race-based. But a white paper is not an official departmental position, and Johnson expressed a solid conviction that the bill will move forward.

Johnson introduced Rachel Joseph, co-chair of the National Steering Committee for the Reauthorization of the Indian Health Care Improvement Act, as a tireless advocate for the bill, logging countless hours on Capitol Hill in its behalf. Joseph acknowledged that the bill has languished, but vowed that this year will be different. ''We feel that the tribal governments have momentum. We feel that we've been able to put this issue on the radar screen of our elected officials. I think we've been able to articulate the message that health care is a trust responsibility of this government ... a long-standing trust responsibility.''

The reauthorization will provide tribes with the flexibility to modernize their health care systems, she said, citing past updates to mammography screening for breast cancer that may not be available for other forms of cancer without the reauthorization.

She added that because health care is an entitlement, Indian elders should not have to co-pay for health care.

Referring to the mechanics of vote-casting in the Senate, where the majority of Indian-specific legislation passes without objection, by unanimous consent, she said, ''Well, unanimous consent is a nice place to be, but you know there's nothing wrong with 60 votes, and that's what we're going to work for.'' Sixty votes is a magic number in the Senate - enough to overcome the delaying tactic of unlimited partisan debate, known as ''filibuster,'' that routinely dooms legislation on the Senate floor.

The message of quick action on reauthorization rolled through the three-day conference, repeated by Republican and Democratic lawmakers, NCAI staff and delegates, Washington department heads, national Indian leadership and elected tribal leaders.

Patricia Zell, of Zell and Cox Law in Washington, took the Justice Department's concerns with racial impurity in the proposed law as her departure point for a rallying cry. ''We do have a big challenge in front of us in getting the Indian Health Care Improvement Act reauthorized,'' she said. ''We've got some new challenges that have surfaced recently, but this is a battle we've got to join, and we're going to win because we've got to win it. And I look forward in whatever capacity to working with all of you to accomplish this, this year, because it's going to happen and we're going to win and we're going to beat back the forces that want to undo federal Indian law.''

Sara Garland, Zell's successor as chief of staff on the Senate Indian Affairs Committee, confirmed Johnson's urgency. ''The train's starting to move, and we're concerned that we stay with the train,'' she said, adding that the lawmaking process is on a fast track in both the Senate and the House of Representatives. ''I know the Senate Finance Committee intends to hold a hearing, as well, on its provisions in the Indian Health Care Improvement Act, and I know that the House is planning on an introduction relatively soon as well. So we've got to get this thing moving, and we need to get it moving fast.''

Garland's boss, Sen. Byron Dorgan, D-N.D., SCIA chairman, has made a case in the current Congress for importing private-sector innovations into Indian health care. Garland made it abundantly clear that the senator won't be content with theorizing about new approaches: he intends to make them law. ''I think a lot of what you're going to see in the bill are provisions you've seen before,'' Garland said. ''But there will be some new provisions. ... [Dorgan] is very interested in ensuring that folks who are served by the Indian Health Service have service after four o'clock, on weekends, and we're trying to figure out how we put this in legislative language, so that there are perhaps some new models of IHS service that would be part of this bill.''