How Sequester Cuts Are Undermining Tribal Health Care

The New York Times editorial board published a column Thursday slamming Congress for the disproportionate impact that sequestration will have on native tribes’ access to health care services, asserting that the “federal government cannot use its budget nihilism to avoid its moral and legal obligations.” Considering the dismal health care demographics of American tribal populations and the Indian Health Service’s (IHS) already-paltry funding, their outrage may be justified.

The IHS was formed in 1955 and tasked with overseeing health care services for American Indians and Alaskan Natives. Unfortunately, a combination of factors including anemic funds and oversight failures has left IHS in perennial disarray, prompting a 2010 Senate panel to conclude that it suffered from “chronic mismanagement,” unfilled vacancies in top positions, and subpar medical facilities at risk of losing their accreditation.

According to Indian Country Today, things began looking up in 2008 when appropriations for benefits such as the Contract Health Service — which funds medical services outside of the regular tribal health network — and the Improving Patient Care program were increased substantially, opening up tribes’ access to preventative screenings and affordable primary care, as well as boosting patient satisfaction by nearly 20 points.

Unfortunately, that all came to a screeching halt with sequestration. The budget cuts were only supposed to affect discretionary spending, while entitlements for the needy, such as Medicaid and nutritional assistance, were meant to be spared from austerity. But IHS funding doesn’t fall under this protected category. Rather, IHS believed that its funds would be shielded by a 1980s law barring Congress from cutting its budget by more than 2 percent — as it turns out, IHS was dead wrong:


IHS Director Yvette Roubideaux and her staffers had said at various tribal meetings and in letters throughout 2011 and early 2012 that “the worst-case scenario would be a 2 percent decrease from current funding levels” for IHS, rather than the 9 percent that was forecasted for most federal agencies if the sequester went into effect.

But Indian country began to learn late last year that Roubideaux’ predictions were wrong. IHS would be cut on March 1 at the same rate as every other non-protected agency. And since IHS was late to the game in planning for the larger cut, it didn’t work as aggressively at saving and protecting its resources as it could have. Also — and perhaps most egregiously — it fed tribes misinformation that cost them months of planning and advocacy time. “It’s unfortunate that we all relied on [IHS’s] earlier interpretation, because we could have addressed this earlier with the administration — especially the OMB — and the Congress,” said Jim Roberts, a policy analyst with the Northwest Portland Indian Health Board.

“Had IHS communicated the correct information in the previous fiscal year, tribal care providers that receive IHS funding would have been able to modify their budgets so they would have had more resources for this year — and thus the cuts to tribal citizens wouldn’t be as steep,” added Lloyd Miller, an Indian affairs lawyer with Sonosky Chambers who has worked on many lawsuits involving the agency. “The earlier tribal providers could have been planning for disaster, the better. In this case, tribes lost a whole year.”

Public health issues already disproportionately impact Native tribes in America. Over one third of all Native Americans lack health insurance coverage; tribes have higher rates of smoking and alcoholism than other populations; and over 13 percent of Natives self-report being in “fair” or “poor” health — a much higher figure than most other racial groups. Unfortunately, congressional dysfunction may end up adding more problems to the list.