Indian health care bill cleared for vote in Senate

Monday, October 22, 2007  

After years of delay, the Indian Health Care Improvement Act has finally been cleared for a vote on the Senate floor.

The law expired in 2000 and tribes and Indian health organizations have been working hard to reauthorize it. But the task hasn't been easy due to opposition from the Bush administration and a few Republican senators.

With Democrats in control of Congress, Indian Country is hoping 2007 will finally bring success. "The time to pass the IHCIA is now," H. Sally Smith, the chairman of the National Indian Health Board, said at a packed rally in the U.S. Capitol last month.

After being approved by the Senate Indian Affairs Committee and the Senate Finance Committee, the bill was placed on the Senate's legislative calendar. A vote could come as early as this week.

The process hasn't been entirely worked out but due to potential objections, it may be necessary for the Senate to vote on a "cloture" motion before a final vote. Any Senator could place an anonymous hold on the measure, essentially filibustering it.

In order to overcome a hold, a cloture motion requires 60 votes to pass. The 49 Democrats and two Independents in the Senate are likely to vote in favor of a cloture motion.

But only four Republicans are co-sponsoring S.1200, the Indian Health Care Improvement Act Amendments. That means the bill needs the support of at leaves five more Republicans in order to gain final passage.

A notable Republican holdout has been Sen. John McCain (R-Arizona), a 2008 presidential candidate. Although he introduced the bill when he was chairman of the Senate Indian Affairs Committee in the 109th Congress, he left his name off the current version.

That doesn't mean McCain hasn't been supportive of efforts to reauthorize the IHCIA, however. When he tried to pass his version of the bill last fall, the Department of Justice released an anonymous "white paper" that derailed it on the eve of consideration.

"I am deeply concerned about the repeated delays in passing this legislation and the seemingly unending series of obstacles thrown in the way of getting this business done," McCain said of the Bush administration's objections in December 2006.

Sen. Byron Dorgan (D-North Dakota), the current chairman of the Senate Indian Affairs Committee, tried to get to the bottom of the snafu at a hearing earlier this year. But a top DOJ official was unable to explain how, or why, the white paper was released, and who authored it.

Indian health leaders say the bill is critical to the lives of to more than 2 million American Indians and Alaska Natives. A lot has changed in health care since the bill was last reauthorized in 1992 and tribes need more flexibility to provide services for their members, according to supporters.

"Long-term care is in there, dialysis is in there," said Wehnona St. Cyr, a member of the Omaha Tribe of Nebraska who helped draft provisions of the bill through a national steering committee.

"It makes it so much easier to recruit providers," said St. Cyr's whose work at her tribe's health care center earned her a prestigious $125,000 award from the Robert Wood Johnson Foundation.

"At least we'll have the authorizing legislation that recognizes our programs," she said of provisions that would directly benefit her tribe. "We could use some support in those areas. I'm hoping that it gets passed."

Indian Health Care Improvement Act Amendments:
S.1200 | H.R.1328

Relevant Documents:
Letter to President Bush | Letter to Alberto Gonzales | DOJ White Paper

Relevant Links:
Indian Health Service - http://www.ihs.gov
National Indian Health Board - http://www.nihb.org