Indian health bill's renewal still being diagnosed

By Natasha Kaye Johnson
Diné Bureau

WINDOW ROCK — Every year, tribal officials fight an uphill battle to try to ensure that legal documents signed with the federal government are upheld and carried out.

For almost six years, tribal leaders have been pushing Congress to reauthorize the Indian Health Care Improvement Act, which is considered to be the cornerstone legal authority for the provision of health care to American Indians and Alaska Natives.

The Indian Health Care Improvement Act, Public Law 94-437, expired on September 30, 2000, and was extended through 2001 in anticipation that Congress would consider the reauthorizations pending proposals. Since 2001, the Congress has conducted 11 hearings on the reauthorization proposals, and while there have been various versions of the bill considered by the Congress since then, the reauthorization of the IHCIA has yet to be completed by the 109th Congress.

Because the act has yet to be passed, Anslem Roanhorse, Executive Director for the Navajo Nation Division of Health, said it has been difficult to maximize services in Indian Health care.

"We have to keep reminding them (of their legal obligation)," he said. "Some just don't understand."

Each year, American Indians and Alaska Natives are faced with various health care issues, and just like other programs, must readjust titles within the Act in order to deliver the highest quality care. However, because the act has been put on the back burner for so many years, the health care delivery system in the United States has evolved, but Indian health programs still operating under outdated authorities have not been able to keep up with changes.

And with election year here and a new Congress getting ready to step in, tribal officials are on the edge of their seats and are hopeful that the current Congress will reauthorize the act.

Tuesday afternoon Roanhorse said that there was an attempt to get the bill "hotlined" by Congress, so that the act would get directly to the floor, but those efforts failed. Roanhorse was one of many tribal leaders who was supposed to have a telephone conference call with Congress in Washington D.C, but tribal officials were told that the call was canceled again, making it the second cancellation in two weeks.

"The longer you wait, the people who don't advocate for Indian health care, (they) try to pick at it," said Roanhorse, adding that some members of Congress believe that there should be a co-pay or premiums.

Roanhorse said there have been no services cut yet, but that Congress is just trying to work on some new requirements for the act that would address Medicaid.

"There's still people who think that (American Indians and Alaska Natives) have responsibility in sharing costs," said Roanhorse. "Every so often somebody raises that."

Officials have presented data that the Act must be reauthorized in order for health disparities that threaten the future of Indian Country. According to IHS statistics, American Indian and Alaskan Native populations have tuberculosis and alcoholism mortality rates six times higher than the rest of the U.S. population, and mortality rates in diabetes that are three times higher than the U.S. population.

An up hill battle
The authority of IHCIA comes from the Snyder Act of 1921, which is the basic and first legislative authority for Congress to appropriate funds specifically for health care provided by the Indian Health Service.

The IHCIA of 1976 was passed into law based upon findings that the health status of American Indians ranked far below that of the general population. The Act declared that it was the Nation's policy to elevate the health status of the Indian population to a level that reflected the general U.S. population. Since its first passage in 1976, the Act has been reauthorized four times.

In 1998 and 1999, IHS actively consulted with Indian country on amendments to the existing Act to provide Tribal and Urban Indian health programs with the programmatic and administrative capabilities to provide high quality care to their constituents. During the summer of 1999, a National Steering Committee on the reauthorization of the IHCIA was established to review the recommendations received during the consultation process, to reconcile differences in the recommendations from the various areas of Indian Country and to complete a legislative draft that reflected the final recommendations.

Later that year in October, the NSC forwarded their legislative proposal to the leadership of the Executive and Legislative Branches, as well as to the tribal governments and urban Indian health programs. The House Committee on Resources and the Senate Committee on Indian Affairs both introduced legislation that was almost identical to the NSC draft.

Both chambers have had hearings on the reauthorization proposals since 2000 and both reported the reauthorization bills out of committee on September 22, 2004.

During the second session of the 108th Congress, the IHS and the Department of Health and Human Services worked with the congressional committees to resolve areas of concern with the pending legislative proposals; however, time ran out before a bill could be finalized that would address the Department's concerns.

A reauthorization proposal was then reintroduced in the Senate in the 109th Congress and was favorably reported with amendments by the Senate Committee on Indian Affairs on October 27, 2005.

Since then, the IHS and Department have been working with the Senate committee staff to order to ascertain the impact of the bill and to develop an administrative position on the proposal.

Square one again
"If the bill doesn't get passed (this September), they could try to get the bill until November election," said Roanhorse.

Roanhorse said it could be years until the bill is passed, but tribal officials are still remaining optimistic that the bill will be passed with the 109th Congress. If not, Roanhorse said that pushing for the bill in the 110th Congress would be like starting from square one all over again.

It was anticipated that reintroduction of a House companion bill may occur in the second session, but it has yet to happen. Tribal officials are also speculating that if a Democratic Congress is elected in this coming year, the bill will may have an easier time getting passed; however, the bill was not passed when there was a Democratic Congress during the Clinton Administration.