IHS budget is a mixed bag

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WASHINGTON - As details of the President's proposed budget for the Indian Health Service becomes public, tribal leaders and some in Congress expressed concern over possible cuts to program funding.

While the president's $2.7 billion budget for the IHS provides a total increase of 3 percent over this year's budget, proposed funding levels for maintenance and construction of health facilities were severely cut, with other programs receiving no increases.

"They have a surplus and are talking about a tax cut when they should fulfill their obligations to the tribes," said Dan McCoy, chairman of the Eastern Band of Cherokee in North Carolina. "We have a health care deficit at Cherokee. We are even trying to fund IHS programs with our own money."

With Congress finalizing the budget plan for FY2002, funding needs for the IHS have taken center stage. Although there are a number of program increases for most IHS service programs, funding for construction and maintenance of health facilities and for medical equipment are targeted. Facility construction funding would be cut by $48 million, while funding for maintenance and improvement and medical equipment would be cut by $1 million, prompting concern from some tribes like the Eastern Band of Cherokee.

"Our problems with health care keep compounding," McCoy said. "If the government has a surplus, then why are their basic responsibilities not being met?"

Funding for urban American Indian health, self-governance and tribal management, and sanitation construction would all remain at this year's levels. However, the president's budget also contains a number of increases including: $65 million for clinical services, $40 million for contract support costs, $55 million for staff pay raises and $50 million to support the transfer of Navajo Nation health services from federal to tribal management.

In the debate over this year's congressional budget resolution, approved by the president and the House and Senate, an amendment was even included and then dropped which would have provided $4.2 billion in additional funds for the IHS. The budget resolution is approved every year and provides an outline for Congress and the administration as they consider federal spending levels.

The amendment, offered by Sen. Tom Daschle, D-S.D., was passed by the Senate in early April but was dropped in final negotiations over the resolution between the House and Senate. Those negotiations concluded in May.

Daschle said that he attributed the demise of the amendment to a proposed $1.25 trillion tax cut that "crowds out" many other important priorities in the budget such as education and health care.

"I do not understand how Congress can propose a $1.25 trillion tax cut, most of which benefits the wealthiest Americans, but not see fit to fund the most basic and essential health care needs for Native Americans in South Dakota and across the country," Daschle said. "While we debate how to allocate trillions of dollars in surpluses, medical treatment for American Indians and Alaska Natives is being rationed, in spite of federal/tribal treaties guaranteeing the provision of health care."

The $1.25 trillion tax cut is smaller than the $1.6 trillion tax cut first proposed by President Bush, but the largest tax cut since Ronald Reagan's first year in office. Congressional Republicans say they expect the budget resolution to be on the president's desk by the end of May. Congressional appropriation committees will begin considering specific areas of the budget, like the IHS, this summer.

"An unfortunate aspect of this debate is that there are many in Congress who believe that Native Americans are being fully covered through the IHS as an entitlement program and that we are living up to our obligations, but the reality is that we are not," Daschle said. "I plan to take advantage of every opportunity to let my colleagues know that, every day, Native people are being denied fundamental health care services.

"I'm not giving up. It is critical that we reinstate the money. We can do this in many ways. We can pursue money through the Indian Health Improvement Act or through other legislation."

Daschle said there was a fifty-fifty chance that funding would be reinstated because of bipartisan support, but added that much work would have to be done.

He called on tribal leaders to "make the case for health care," to Congress and state what their priorities are for health care by contacting the appropriations and Indian Affairs committees.