WASHINGTON – In a second consecutive salute to the unmet needs of Indian health care, the Senate has given preliminary approval to an additional $1 billion for the IHS budget for fiscal year 2009, which commences Oct. 1.
Sen. Byron Dorgan, D-N.D., continuing a determined campaign to upgrade IHS services, told an audience of hundreds at a National Congress of American Indians meeting in Washington March 4 that the same attempt had failed previously, but pledged to keep trying. Persistence began to pay off March 13, when the Senate voted 69 – 30 to approve Amendment 4198, offered by Dorgan to Senate Concurrent Resolution 70 on the federal budget. The amendment would increase the IHS budget to $5.3 billion in FY ’09.
The unexpectedly lopsided vote followed one by an even larger margin in the chamber Feb. 26, with 83 in favor of and 10 against reauthorizing the Indian Health Care Improvement Act (Senate Bill 1200), another Dorgan priority.
Dorgan maintains the added $1 billion is an essential ingredient in the formula for upgrading IHS care to its Indian clients. ”My top priority as chairman of the Senate Indian Affairs Committee has been to improve Indian health care, first by passing the Indian Health Care Improvement Act [S. 1200],” Dorgan said, as quoted in a March 13 release from his Washington office. ”Now we need to fund it.”
The final text of S. Amdt. 4198 had not been issued by the Government Printing Office at press time (the delay is unremarkable, given the many bills – some of them quite lengthy – sent from Congress to the GPO prior to the March 17 recess week on Capitol Hill, just in advance of ”appropriations season”). But Dorgan has often raged on the Senate floor against ”rationed health care,” a reference to the annual shortfall in contract health services funding that enables IHS and tribal providers to pay for patient care and medical (often surgical) procedures they can’t provide.
The refrain in Indian country is ”don’t get sick after June” because the IHS contract health service account has usually run out by then, if not before, the Dorgan release noted, indicating that part of the additional $1 billion would bolster contract services. The March 13 release added that mental health care and repair or construction of Native health care facilities, ”which are crumbling across Indian country,” would also see increases.
Dorgan characterized Senate adoption of his amendment as ”another step forward for Indian health care in recent weeks,” but one that leads to other steps still to come.
The federal budgeting process takes place in four phases: a presidential budget proposal followed by congressional modifications; authorization of programs; appropriation of funding; and the enactment process.
When the Senate passed S. 1200 Feb. 26, it authorized for appropriations a reauthorization – an update, in layman’s terms – of the Indian Health Care Improvement Act. It did the same for the Dorgan amendment. Both are part of the resolution on the overall budget, Senate Concurrent Resolution 70, that passed the Senate March 14 by a vote of 51 – 44.
The House of Representatives passed its own resolution on the budget, House Concurrent Resolution 312, March 13 by a vote of 212 – 207. It does not include the Dorgan amendment for an additional $1 billion to IHS.
The next step in the federal budgeting process for FY ’09 is appropriations. Budget resolutions, often described as ”blueprints” for appropriations, are non-binding – they lay out a spending plan for authorized programs but do not appropriate funds to be spent. The fine points of appropriations are negotiated in conference committees, appointed by Democratic and Republican party leadership in both chambers to reconcile differences between House and Senate versions of the budget resolutions. To become law, any bill must pass both chambers of Congress in an identical version. A budget, and its appropriations, becomes final upon the president’s signature after enactment by Congress.
The close votes on the budget resolutions in both the House and Senate signal spirited conference committees on appropriations. Both the IHS authorized budget of $4.3 billion for FY ’09, and the additional $1 billion authorized by the Senate adoption of the Dorgan amendment, will have to make it through the House-Senate conferencing process in order to receive appropriations. The IHS budget is an annual standing item; the additional $1 billion is a new item.
A Dorgan spokesman said of the amendment, ”The next step is keep working to make sure it’s included in any conference language.”
