Health bill holds its own on Senate floor

WASHINGTON – The bill to update and modernize the Indian Health Care Improvement Act emerged from two days of debate on the Senate floor with solid backing despite the threat of a veto recommendation from senior advisors to President Bush.

“I’m fairly encouraged,” said Sen. Byron Dorgan, D-N.D. “I think we’re going to get a good bill, and it will be hard for him to justify a veto.”

The White House may have misunderstood a fine point or two in basing a veto threat on wage issues, Dorgan said.

Heather Dawn Thompson, director of government affairs for the National Congress of American Indians, seconded Dorgan’s judgment. “I think there’s pretty broad agreement that it’s an easy adjustment,” she said of eliminating the stated grounds for senior administration staff to recommend a veto. In an online update from NCAI she added, “We believe that issue has been resolved, it will be fixed in the bill, and the White House will be removing its veto threat shortly.”

The statement of administration policy, issued on the initial day for Senate debate of the bill, stated strong opposition to eight other provisions and a handful of secondary items. Given the administration’s many previous opportunities to comment on the bill, its continued intransigence struck some of the bill’s advocates as ominous. “It would be greatly unfortunate if one of the final legacies of the George W. Bush administration’s Indian country policy would be a veto of the number one issue for Native Americans,” said Tom Rodgers, a lobbyist with Carlyle Consulting. “But that would be his record and he’ll have to defend it.”

The bill’s floor managers in the Senate did not call for a vote Jan. 22 and 23. Sen. Harry Reid, D-Nev., majority leader for the Democrats, committed to further floor time on the bill once the Senate finishes time-sensitive work on a Foreign Intelligence Surveillance Act.

But at mid-week Barry Piatt, Dorgan’s communications officer on the committee, said other congressional business had intervened, including complications on the FISA bill, the national economic stimulus package designed to foil a recession, President Bush’s State of the Union address, and even the Feb. 5 “Super Tuesday” presidential primaries. Reid has not pulled the bill from consideration or signaled that he might, Piatt added. But congestion on the Senate floor has delayed it.

Proposed amendments to the bill, 14 at last count, must be dealt with. “Most of them are not poison pill” amendments intended to sink the bill, Thompson said, and some of them are intended as statements. Not all of them will be voted on, she added.

NCAI will continue to oppose any amendment to the bill until a “time agreement” can be reached between Reid and Sen. Mitch McConnell, R-Ky, Senate minority leader for the Republicans. Notwithstanding support for the bill from a number of Republicans, Senate opposition to the bill comes from the GOP side of the aisle.

Once a time agreement gives structure to the debate, amendments can be considered on their merits, Thompson explained. Without a time agreement, any amendment can be offered to the bill by anyone, she said.

Among current amendments to the bill are one that would prevent federal expenditures for abortion under the bill’s auspices, another calling for a Comptroller General study of funding for the coordination of health care to Indians, another calling for innovative approaches to the funding of unmet need for Indian Health Service facilities construction, another concerning Medicare, and still others calling for a federal apology to Native Americans and for tribes to be treated as corporations under the Federal Election Campaign Act.

Senate floor time on the bill so far has been positive, said Randall Simmons, government and legislative affairs associate in the Navajo Nation’s Washington office. Floor time, in part, is for supporting statements and there were plenty of them, he added. They came, occasionally with passion, from Dorgan and Reid; from Republican Sens. Lisa Murkowski and Ted Stevens of Alaska, John Thune of South Dakota and Sam Brownback of Kansas; and from Democrats such as Patty Murray of Washington, Amy Klobuchar of Minnesota, Debbie Stabenow of Michigan, Jeff Bingaman of New Mexico, Bill Nelson of Florida, Tim Johnson of South Dakota and Ken Salazar of Colorado.

Many senators followed Dorgan’s lead in identifying better health care for Indians as a federal trust responsibility that the government has failed to fulfill.

Floor time is also for debate, of which there was none as Republicans attended an issues retreat.

As Murkowski noted at some length, much has changed in the medical field since the last IHCIA reauthorization, in 1992. The Indian Health Care Improvement Act reauthorization of 2008, S. 1200 by number, would improve cancer screening for IHS clients, as well as diabetes prevention and treatment. It contains measures that would bring modern medical resources to bear against youth suicide and domestic violence; it provides updated incentives for the recruitment and retention of medical professionals in Indian country; it advances traditional health practices and in-home care.

Dorgan repeatedly stated that he intends S. 1200 as the first step toward comprehensive reform of the Indian Health Service.