Limits on health cuts don't prevent pain if Super Committee stumbles

Tribal leaders around the country are worried about deep cuts if the congressional Super Committee fails to head off automatic cuts. The concern extends to health programs.

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A nurse checks the blood pressure of a child in an Indian Health Services clinic.

Tribal leaders around the country are worried about deep cuts if the congressional Super Committee fails to head off automatic cuts. The concern extends to health programs.

Tribal leaders went to Capitol Hill earlier this month to make the case to protect American Indian and Alaska Native programs from the deep federal spending cuts that are about to hit.

Tribal Unity Impact Week included meetings, lobbying on Capitol Hill, and increased visibility about the impact of these cuts in Native American communities. “Tribes and tribal entities have patiently participated in the political process, but recognizing the urgency of these pressing issues, we are now increasing our call for congressional action,” says the letter signed by 12 leaders from the nation’s leading tribal and Native organizations. “We call on U.S. Congress members to stand with us today, so we might stand together stronger, in the future.”

Indeed, many members of Congress did just that, standing with tribal leaders. Indian Country always has friends in the Congress — people who are willing to go to great lengths to try and help out. (By the same token, there are always members of Congress who go out of their way to make life more difficult.)

But what makes this era so different is that the process trumps the power of individual members of Congress. The deal to increase the federal debt, officially the Budget Control Act of 2011, requires $917 billion worth of cuts federal spending over the next 10 years. And if the Super Committee, and then Congress on an up or down vote, fails to enact an additional $1.2 trillion in cuts by Jan. 15, then across-the-board spending cuts would start in fiscal year 2013.

That means an individual member of Congress — even a congressional committee — cannot put money back into the budget after it has been stripped by the Super Committee or the across-the-board action.

How big are those automatic cuts? The Centers for Budget and Policy Priorities estimate that non-defense programs would be hit with cuts of 9.3 percent — as well as 2 percent for the maximum cut in certain health care areas, including much of the Indian Health Service. (CBPP uses a different formula than the Congressional Budget Office. CBO estimates that budget cuts will range from 7.8 percent in 2013 to 5.5 percent in 2021.)

To get a sense of what that means for Indian Country, scroll through any tribal directory and look for the programs funded by the federal government. Now imagine a shrinkage of roughly 10 percent for programs such as police, courts, credit, domestic violence intervention, early childhood, environmental protection, housing, schools, elderly nutrition, wildlife management and more. This comes at time when services are in high demand because of the state of the economy.

A nearly 10 percent budget cut, however, is often even deeper than that because money must be found to pay for the immediate costs of layoffs and other obligations.

And while the budget control act protects some health care programs, that’s not the whole story. Consider the Indian Health Service budget itself. The total appropriations this year through the continuing resolution (or a “temporary” spending law) is roughly $4 billion (program collections from insurance programs are not included here). The administration’s request is for $4.6 billion next year — but that’s unlikely because neither the Democrats nor the Republicans have enough votes to actually pass a budget in the House or the Senate. What’s more likely is another continuing resolution ... so the 2 percent cut would therefore come from that base, not the president’s request.

If you go back and chart the federal government’s appropriations for American Indian programs, there’s a steady increase virtually every year in the 20th century. However in 1932 spending on Indian programs dropped from $26 million to $22 million in 1933 or 15 percent. Then in 1934 those programs were cut again to $19 million or a 13 percent cut from the year before.

The early days of the Great Depression were bleak in Indian Country. It’s a history not worth repeating.


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