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Why the Worry About IHCIA Repeal is Overblown

WASHINGTON—Can something permanent be taken away? When it comes to Congress, Indians definitely think so.

The White House and Democratic legislators have moved to calm fears that last year’s so-called “permanent” reauthorization of the Indian Health Care Improvement Act will be quickly repealed as part of the Republican Congress’ mission to cutback the overall healthcare reform law.

In a recent interview with Indian Country Today, retiring Senate Committee on Indian Affairs Chairman Byron Dorgan, D-N.D., predicted that there would be no rollback.

“There’s not going to be a repeal of the healthcare bill," Dorgan said. “They may well try to take parts of it away. But no one that I’m aware of has said they want to take away the Indian Health Care Improvement Act."

Dorgan was speaking to the concerns of Native Americans who believe that the reauthorization of the Indian health legislation is in jeopardy. IHCIA, reauthorized last year after a decade of delay, provides a mechanism for federal funding a variety of Indian health programs.

“In any event, the House has become a Republican House, but even if they were of the mind to repeal the whole healthcare bill, and they got it passed, the president would veto it, and they could not override it,” Dorgan added. “So, there is not a threat to the Indian Health Care Improvement Act. It’s not going to be threatened."

The Senate would need 60 votes to override a presidential veto, and no analysts believe the chamber has that kind of support for repeal.

Dorgan’s predictions have been backed up by promises from White House officials, who say IHCIA is safe. Pete Rouse, the exiting White House Chief of Staff told ICT in December that the president would consider sending a strong signal that Title X, the IHCIA, is off limits.

“I think the president certainly would,” Rouse said. “The permanent authorization of the Indian Health Care Improvement Act was a big priority.” He said the sorry state of Indian health was representative of one of the federal government’s “broken promises” to Indians, adding: “The president is totally committed to this. This is not an issue that he would compromise on, or back off on."

Indeed, the Obama administration expressed strong commitment to IHCIA throughout 2010, and the president himself was a co-sponsor of the legislation when he served in the Senate.

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Even given the strong signals of support from Democrats in Congress and the White House, some Indian advocates are worried about what the Republican House will do.

Indian writer Mark Trahant, who has long focused on health matters, wrote in a recent column that Republicans are playing a dangerous game when it comes to Indian health.

“If there is a repeal of the health care reform bill, there also will be a repeal of the 'permanent' status found in the Indian Health Care Improvement Act. The two laws are one,” wrote Trahant.

“Republicans promised a frugal government. If that’s really what they want, then the Indian health system should be fully funded because it’s the most efficient health care delivery system in the country."

Trahant noted, too, that the reauthorization amounts only to a congressional sign of support for the tenets of the bill—appropriations are still required, and no one is predicting that those will come easily in these lean times.

Marie Howard, former Democratic staff director of the Office of Indian Affairs of the House Committee on Natural Resources, echoed the caution, saying she is concerned about the agenda of the House GOP.

“One of their first acts will be to repeal the Indian Health Care Improvement Act along with the national health care legislation,” Howard said. “This could have a devastating effect on Native communities."

If there is any hope of Republican protection of IHCIA on the House side, it comes in the form of Rep. Don Young, R-Alaska. He was recently named chair of the Resource Committee’s Subcommittee on Indian and Alaska Native Affairs, and will have a say over matters involving Indian health legislation. In the past, he supported the IHCIA, so his current position will be closely scrutinized.

“I believe improving Indian Health Care is an important issue, which is why I have helped introduce the Indian Health Care Improvement Act in the past several Congresses,” Young said in a June 2009 statement. “This bill would revise the previous Indian Health Care Improvement Act (IHCIA) and extend health care services for American Indians and Alaska Natives.”

At the time, Young promoted several aspects of the legislation, including its ability “to provide the opportunity for Indians to set forth their health care priorities and make goals that reflect what they need.” He noted, too, that American Indians and Alaska Natives have a life expectancy that is much lower than the national average.