A Note to Paul Ryan: Indian Health Funding is a Treaty Obligation, Not From The War On Poverty

Mark Trahant*

Reprinted from Trahant Reports with the author's permission, March 3, 2014, http://www.marktrahant.org/marktrahant.org/%40trahantreports_blog/Entries/2014/3/3_A_note_to_Paul_Ryan__Indian_health_funding_is_a_treaty_obligation%2C_not_from_war_on_poverty.html.

Paul Ryan is wrong. Way wrong.

On Monday the former Republican candidate for Vice President released a review of programs that attack the “war on poverty.” The House Budget Chairman said: “This 50th anniversary of the War on Poverty is an opportunity to review the record in full. And we should seize it.”

Ryan said the federal government has “measured compassion by how much we spend instead of how many people get out of poverty. We need to take a hard look at what the federal government is doing and ask, ‘Is this working?’ This report will help start the conversation. It shows that some programs work; others don't. And for many of them, we just don't know.”

The premise that underlies this report is Ryan, and Republicans, firmly held philosophy that government is not capable about solving problems. This is another push to shrink the federal government.

That said: A debate about the role of government is fair. It’s worth Republicans making their case that a smaller, stingy government would be effective. Then those candidates can take that message to the voters for affirmation (or more likely, rejection).

However when it comes to Indian health, Ryan’s War on Poverty review is factually incorrect. The Ryan report lumps the Indian Health Service in with other social programs. The history is described this way: “The IHS was officially established within the Department of Health and Human Services in 1955 (then the Department of Health, Education, and Welfare) as part of the Transfer Act. But the federal initiatives designed to increase access to health services for tribal members existed as far back as 1830.”

What the Ryan report calls a “federal initiative,” I would call a treaty obligation. Nowhere in this report is there a mention of why the federal government funds and operates Indian health programs. Nearly every treaty in the United States, the supreme law of the land, has a health care provision. A provision that has never been fully funded.

Of course the Ryan report looks at this differently, too. It said that the Office of Management and Budget “found IHS to be an effective program” and since its transfer until 1995, “the Indian Health Service reduced the years of potential life lost—a measure used to gauge overall health—among American Indians and Alaska Natives by 50 percent.”

The Ryan report’s conclusion: “However, the program could not show the relationship between specific health outcomes and funding.” But it lists the $4.3 billion was appropriated for Indian health.

Oh yeah. The report never mentions the funding shortfall for Indian health, a fact that’s clearly in the public record. The Ryan report doesn’t bother to show that per person spending for Indian health is far below the average cost of care for other citizens. By framing Indian health as a “war on poverty program” it’s easy to dismiss a constitutional promise as just another government program.

The context for this new Ryan approach is the recent budget proposals from his committee. Ryan’s budgets would slash $637 million from the Indian Health Service budget. (The good news is that Ryan most likely will not propose a budget this year; there are not 215 votes to be found in the House for any single Republican spending plan.) And the Ryan-Murray deal was a two-year bridge. The idea, from both Republicans and Democrats, is to move the debate past the election because both sides hope for more votes.

The Ryan approach to Indian Country is quite clear. End Medicaid and give the money to states (that’s worth a column by itself). Then drastically curtail funding for the Indian Health system. And, finally, pretend treaty promises never existed.

Paul Ryan is just wrong.

*Mark Trahant is the 20th Atwood Chair at the University of Alaska Anchorage. He is a journalist, speaker and Twitter poet and is a member of The Shoshone-Bannock Tribes. Comment on Facebook at: https://www.facebook.com/TrahantReports.