The debate that drags on

How long will the health care reform debate drag on? The Hill newspaper says “deep into December and possibly beyond by a lengthy floor debate.”

If that seems like a long time, consider that the reauthorization of the Indian Health Care Improvement Act has been pending since 1999.

Last week hearings were held in the U.S. House of Representatives to move that legislation forward. Again.

Rep. Frank Pallone, Jr., chairman of the House Energy and Commerce Subcommittee on Health, opened hearings on the Indian Health Care Improvement Act Amendments of 2009 by once again saying that, yes, there is a federal obligation to provide health care, and, no, the United States doesn’t deliver.

“Putting all the legal aspects aside, I think the trust responsibility can be summed up by saying that something is owned to American Indians for the lands that were both voluntarily given to the United States and forcefully taken, as well as the atrocities that were committed against their peoples,” Pallone said. “But the federal government has consistently failed to live up to this responsibility in almost every respect.”

The IHCIA would improve standards for cancer screening; authorize IHS to operate hospice, long term care and assisted living centers; upgrade epidemiology centers; create convenient care demonstration projects and integrate mental health, social services, domestic child abuse; suicide prevention and substance abuse suicide into the delivery system.

These days federal legislation of any kind is complicated (usually hundreds or thousands of pages) and it often has a built-in expiration date, requiring Congress to act and reauthorize the law. The original Indian Health Care Improvement Act was signed into law by President Gerald Ford – and expired at the end of September 2000. The original funding mechanism for the Bureau of Indian Affairs and the Indian Health Service is the 1921 Synder Act. The law is only one page – and it does not expire.

The language of that act is instructive. It gives the BIA (and now the IHS) the authority to spend money “for the benefit, care, and assistance of the Indians throughout the United States.” That includes money for “relief of distress and conservation of health.”

I should add: A “permanent” authorization for the conservation of health because that’s what is needed again.

“It’s time to make the Indian Health Care Improvement Act a permanent federal law,” testified Rachel Joseph on Oct. 20 before the House subcommittee. Joseph was speaking on behalf of the National Tribal Steering Committee for the Reauthorization of the Indian Health Care Improvement Act and the National Indian Health Board.  “The theory that ‘sunset’ dates are needed to spur Congress to periodically review and update major laws has not worked in the IHCIA context.”

Joseph said the proof of the need is the decade long legislative fight for that reauthorization “despite intense work and advocacy from throughout Indian Country.”

The Senate version of the IHCIA would make the law permanent.

However there is now a second track is to include the IHCIA as a part of the larger health reform legislation. New Mexico Rep. Martin Henrich said last week he was successful with that approach because health insurance reform “cannot leave Native Americans behind.”

If this process looks confusing, that’s because it is. The actual language of the House bill remains in draft form and remains subject to revision and continued negotiation.

There is no longer debate about whether there will be a health care bill. The Associated Press put it this way:  “The questions are when, how — and who can compromise. Democratic leaders expect their members, looking ahead to next year’s elections, to vote for a health care bill despite any misgivings. But the vote-counters have no real way of knowing until each chamber produces a bill. That's why negotiators have slogged through months of hearings, hundreds of amendments and meetings with members that require interminable listening, waiting, reassuring, cajoling and answering questions from the recalcitrant.”

The challenge for Indian Country is to become more than a footnote to that larger debate.

Mark Trahant is a Kaiser Media Fellow examining the Indian Health Service and its relevance to the national health care reform debate. He is a member of Idaho’s Shoshone-Bannock Tribes. Comment at www.marktrahant.com