We hate health care reform. The bill was too many pages, too complicated and didn’t fix all the problems right now, this minute. (One of America’s core democratic values is our impatience.)
But the why is fascinating. Many of us hate the reform bill because it went too far; but most of us are unhappy because health care reform didn’t go far enough. We wanted more action, a smarter health care system, even, more government to make our health care system work smarter.
Yet that voter angst — both for and against — set the stage for this November election and the Republicans’ Pledge to America. “In a self-governing society, the only bulwark against the power of the state is the consent of the governed, and regarding the policies of the current government, the governed do not consent,” the pledge says. (Except that some of us do give our consent.)
Elections are policy choices. And this GOP Pledge is a clear guide about what Republicans would do if given power. There are significant implications for Indian Country in this document (even though American Indians and Alaska Natives aren’t mentioned at all).
The Pledge says: “Because the new health care law kills jobs, raises taxes, and increases the cost of health care, we will immediately take action to repeal this law.”
But if that were to happen it would mean the repeal of the Indian Health Care Improvement Act. That law was just made permanent after nearly a decade of congressional inaction to reauthorize the 1976 act. This act was both symbolic and practical, setting the course for many improvements in the Indian health system ranging from improved funding to better training and recruitment.
Of course it won’t be easy to repeal the health care bill. The bar is set high: Republicans would have to round up enough votes to beat a presidential veto, a two-thirds majority. So the Pledge outlines a back up plan: “We will fight efforts to fund the costly new health care law.”
The Pledge promises to return federal spending to 2008 levels. The Indian Health Service budget was $3.35 billion that year; in fiscal year 2011 the president is requesting $4.4 billion. That’s nearly a 24 percent cut in existing services at IHS. (That does not include the additional money spent from the stimulus funds that would also be eliminated.)
The problem is these look like big numbers: Four point four billion dollars! But it’s not news to Indian Country to report that the Indian Health Service is already underfunded. We’re talking about an agency that spends less per patient than any other health care system in America, including federal prisons.
The Pledge to America would roll back all government spending to 2008 levels in education, at the Bureau of Indian Affairs, and that would impact tribal contracts for those same programs. As National Congress of American Indians President Jefferson Keel said in March: “In every area of the federal budget, Indian programs receive less per capita than for the rest of the nation.” That will be even more so if these cuts come to pass.
This is what the Pledge to America looks like in Indian Country: Deep spending cuts; layoffs for federal and tribal employees working through federal contracts; and, if there’s no consensus from the Democrats in Congress, the potential of another government shut down.
Perhaps Indian Country is considered a necessary sacrifice because tax cuts are the all-important measure of good government. Yet federal taxes are less than 15 percent of the country’s gross domestic product, the lowest share since 1950. But that tax cut pledge is paramount, right?
Then again the word “pledge” out to be of particular interest to Indian Country. Like it or not the United States made pledges to Indian Country, such as the one to provide health care.
But it’s a pledge that is easily dismissed by Republicans so eager to curb the power of the state. Some promises matter more than others.