WASHINGTON – Getting the Indian Health Care Improvement Act attached to a national health care reform deal that passed both chambers of Congress was supposed to mean steady sailing to passage. But with the election of Scott Brown to the Senate, victory has been complicated.

Brown, a Republican who pulled off an upset by winning the late-Sen. Ted Kennedy’s seat Jan. 20, campaigned partly on a pledge to oppose the Democrats’ reform package.

When Brown won his contest against Massachusetts Attorney General Martha Coakley, he ended up costing the Democrats their 60-seat Senate advantage. They needed 60 seats to fend off any last-minute filibuster attempts of health care reform by the Republicans during the final phase of the bill.

Because advocates inside and outside of Congress pushed to have the Indian health bill attached to the package, its immediate fate ended up being tied to unsteady legislation.

Democrats had been counting on their filibuster-proof advantage to work out kinks between versions of the legislation that previously passed the House and Senate.

Ironically, there were no major differences in the Indian health portions of the bills in the chambers, so it wouldn’t have been a sticking point. But there were substantial differences in other sections.

And then there were political realities to contend with. Soon after the election of Brown, some Democrats began to waiver in their support for the bigger deal, suggesting a final vote on it should wait until he is seated. Some appeared worried that public support for the bill had grown tepid, upping the political risk.

But congressional leadership seemed keen on pushing forward, trying to get the bill passed before Brown was seated by having the House simply approve the Senate version, and working out differences later. The strategy had its own risks, as some progressive House members have said the Senate version is too moderate, and there was no guarantee it would sail through.

Another option considered in the Senate was to use a legislative strategy known as reconciliation to pass the bill by a simple majority – 51 votes. Senate leaders have been slow all along to take that path because it carries its own political risks, as Republicans can say they played tricks with costly legislation.

With the IHCIA held hostage to the political process, hindsight questions have been raised – namely, would it have had a chance at smoother passage by being a stand-alone bill? Indian leaders had long pushed for that route, but the tea leaves in 2009 seemed to indicate that being a part of the reform package would provide shelter on contentious issues, including abortion.

Senate Committee on Indian Affairs Chairman Byron Dorgan, D-N.D., has long contended that it is not a one or the other situation. Even in light of the Brown situation, Dorgan’s staffers stuck by that ideology.

“Sen. Dorgan has already offered it as a stand-alone bill,” said Barry Piatt, a spokesman for the senator.

“That’s how he introduced it. He has always pursued this on two tracks – as stand-alone legislation, and as part of the health care reform legislation.”

Piatt added that what happened in Massachusetts really has “no impact” on the passage of the Indian health law.

Dorgan may be confident that the Senate can get it done either way, but success in the House is less of a guarantee. When the Senate passed IHCIA in 2008, the House did not follow suit, largely due to issues over abortion language.

Sen. Lisa Murkowski, R-Alaska, was quick to make that point.

“The fate of Indian health care reauthorization remains up in the air,” the SCIA member said soon after Brown’s election.

“In 2008, the Senate working on a bipartisan basis sent the House of Representatives a bipartisan bill which could easily have been passed and signed into law by President Bush.

“Speaker Pelosi killed that bill. Now we find ourselves in a position where the Indian health care bill is snarled in a mammoth piece of legislation which the American people oppose by significant margins. A bill whose high cost could trigger massive reductions in federal spending and place the financial health of the Indian health care delivery system in jeopardy. I think the right thing to do would have been to take the Indian Health Care Improvement Act up as a stand-alone bill – to finish the good work we started in 2008.”

Sen. John Thune, R-S.D., said the health care package, which includes the IHCIA, will undoubtedly be slowed as a result of Brown’s election.

Indian health advocates have said it’s a difficult situation, but many are confident that the Indian health legislation will soon become law.

“If Congress can get the deal done using the process they set out to in the next week, I believe the IHCIA will survive,” said Jim Roberts, a policy analyst with the Northwest Portland Area Indian Health Board.

“Unfortunately, I don’t expect the House to carte blanche adopt the Senate bill with the assurance that technical tweaks can be made in future legislation.”

Roberts said that if the health care reform bill gets moved on a reconciliation track, it could mean trouble for the IHCIA, as costs will become a factor in reconciliation. That could mean the costs of the Indian health bill could be negotiated down, or it could be removed altogether.

Roberts noted that stand-alone legislation still exists in both the House and Senate.

As a stand-alone bill, IHCIA would still need to clear various committees in the House, while the Senate version is already on the floor.