For the second year in a row, Indian Health Service (IHS) leadership is confused how federal sequestration will impact its budget, leading to questions of responsibility and competency from Native-focused health officials.
The latest confusion centers on how the Special Diabetes Program for Indians (SDPI), a program created in 1997 by Congress for the prevention and treatment of diabetes in American Indian and Alaska Natives, will be affected under the new federal budget deal. The December congressional arrangement alleviates sequestration on many so-called discretionary Indian-focused programs, but it leaves cuts in place for some mandatory programs.
SDPI last year was classified as mandatory under White House Office of Management and Budget (OMB) rules, so the program received a 2 percent cut, translating to $3 million. That reduction was able to be absorbed by IHS through an internal reshuffling of funds, according to agency officials last year.
This year, under the budget deal hammered out for 2014 by Democratic and Republicans congressional negotiators in December, mandatory programs would be subject to the same cut. As of December 24, 2013, IHS officials believed that SDPI would face the same cut as last year, and agency leadership was communicating that information to Indian health officials and to the press. An IHS spokeswoman told Indian Country Today Media Network by e-mail on December 24 that “SDPI has been sequestered by 2 percent again as other mandatory health programs.” A question at that time left unanswered was whether IHS would be able to absorb the $3 million shortfall, as it had in 2013.
Fast forward to mid-January, with IHS now telling Indian health officials that it doesn’t know if SDPI will be subject to sequestration in 2014. They also told Indian health officials on January 15 that the agency does not know when they would have more information on this issue.
When asked by ICTMN again on January 16 if SDPI would be subject to sequestration and if so whether IHS would be able to administratively pick up the slack as it did last year, Dianne Dawson, a spokeswoman for IHS, said that the Office of Management and Budget (OMB) should be contacted for details on the 2014 budget.
OMB has not responded to requests for comment, but one thing is for sure: IHS leadership is no stranger to accusations of not knowing how federal sequestration affects their budget. Yvette Roubideaux, acting director of the agency, told Indian health officials 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 under sequestration, rather than the 9 percent that was forecasted for most federal agencies if the sequester went into effect. But that information was a misreading of the law, according to OMB, and IHS ended up being subject to higher levels of sequestration.
Indian health officials were outraged that Roubideaux had fed them wrong information, and they said it cost them the ability to prepare tribal budgets to help make up for the greater shortfall. They were also concerned with OMB’s interpretations of the law.
Questions over this issue and others involving lacking tribal consultation, transparency and funding issues have caused Democratic senators to hold up Roubideaux' re-nomination to her director position. She has been reduced to acting capacity, which has reduced morale in the agency, according to Indian-focused officials who have discussed the situation with IHS staff.
Given the new confusion surrounding the SDPI program and sequestration in 2014, Indian health officials are again angry with IHS leadership and are demanding clarification.
“I am not sure what IHS is doing anymore; we have hardly any transparency when it comes to IHS budget issues with this director and administration,” said Jim Roberts, a policy analyst with the Northwest Portland Indian Health Board, when asked about the SDPI situation in December. “I’ve never seen budget and administrative transparency worse in the history of the agency despite its mantra and their espousal that this is their priority.”
From Roberts' own reading of the law, he says that if Congress does its job and stays within the allocation caps reached under the December budget deal, there should not be a two percent reduction to the general IHS appropraition.
National Indian Health Board officials say they are investigating the situation with the agency.