Health | Politics

Mark Trahant: Tribes tested by budget cuts to Indian programs

Monday, February 28, 2011

This week represents, perhaps, the most important week of lobbying for tribal nations since the end of the termination era. At a variety of meetings in Washington, D.C., including the National Congress of American Indians, leaders from Indian Country will fan out across Capitol Hill and make the case to Congress against deep spending cuts.

A new published summary of the White House Tribal Nations Conference makes that point from tribes several times over. “Indian programs should be exempt from mandatory spending cuts,” the report says. “In particular, the Indian Health Service programs should not be reduced.”

On health care the White House report reflected that idea as well. “Recognizing that American Indians and Alaska Natives die from many illnesses at far higher rates than the rest of the population, the President stated that closing the gaps in health disparities is ‘not just a question of policy, it’s a question of our values, it’s a test of who we are as a nation.’ To help achieve this goal, in 2010 the President signed into law the Affordable Care Act, which will make quality health insurance affordable to all Americans and permanently reauthorize the Indian Health Care Improvement Act.”

In December when the White House conference took place there was a recognition that the new Congress was going to be changing all sorts of things. But what wasn’t known is that the rules of how Congress would act changed dramatically. The center of power shifted away from committee chairman, and especially appropriations sub-committees, to a smaller group in leadership.

It now looks like there will be a little time for tribal leaders to make another pitch to Congress. At least a couple of weeks. Budget Committee Chairman Paul Ryan -- who has extraordinary authority on spending proposals for the House -- said on CBS's “Face The Nation,” that it’s not likely the government will shutdown March 4. “My guess is we will probably have a short-term extension while we negotiate these things with spending cuts,” he said. The House wants some $60 billion in program cuts for the rest of this year and significant spending reductions next year.

Already the House in its budget proposed a $1.3 billion reduction in spending for community health centers. This would impact some 11 million people -- and a growing number of community health clinics serving American Indians in cities and in reservation communities, such as Utah Navajo Health Systems in Blanding, Utah. This is important because it shows that protecting Indian Health Service from budget cuts is not enough. If there are other health program cuts, such as support for clinics, it will put successful Native American operations at risk.

“Health centers provide cost-effective care for high-risk patients,” said Peter Shin of George Washington University, School of Public Health and Health Services. “Reducing health center funding impedes improvements in population health and limits the potential for significant savings in health care costs.”

Shin is co-author of a new policy brief, “Who Are the Health Center Patients Who Risk Losing Care Under the House of Representatives’ Proposed FY 2011 Spending Reductions.”

One of the problems with this type of spending cut is that it won’t save any money. It will probably cost more. When people go to a clinic the costs are controlled; on other hand, when a clinic setting is not available, then people go to the Emergency Room, a far costlier alternative.

Beyond Congress (which to me looks bleak) I would hope the administration does everything it can to make it easier for tribes to weather the current congressional atmosphere. For example: One of the proposals made at the White House session is a good one: “Federal funding should be delivered directly to Indian tribes or tribal consortia without interference from the states. Problems arise when federal funds flow through states to Indian tribes.”

On March 3 the White House will again meet with tribal leaders to follow up on issues raised at the December Tribal Nations Conference. I hope there’s a lot of thinking about how much can be done without Congress. What if more federal rules were rewritten by inserting two words, “and tribes,” after any document that outlines programs for states? This notion is especially important to spending programs that are automatic such as Medicaid. (Instead of an appropriation, Medicaid is automatic. The money is there is a person is eligible.)

Remember this is a test of our nation’s values.

Mark Trahant is a writer, speaker and Twitter poet. He is a member of the Shoshone-Bannock Tribes and lives in Fort Hall, Idaho. Trahant’s new book, “The Last Great Battle of the Indian Wars,” is the story of Sen. Henry Jackson and Forrest Gerard.