Remember when President Obama lectured Republicans about paying the government's bills on time? When Obama told Congress, "Now is the time to deliver on health care"? When he called his administration the "most transparent in history"?
Today, the Washngton Post reports that the federal government has failed to pay hundreds of American Indian tribes for contracted healthcare support services. Despite two Supreme Court rulings telling the federal government to pay up, the administration secretly prepared a proposal to renege on obligations that now total $2 billion.
From the Washington Post article:
At issue are contract support costs that are spelled out in the agreements, under which the government pays tribes to run education, public safety and health programs on reservations. The support costs — which include items like travel expenses, legal and accounting fees, insurance costs and worker’s compensation fees — typically account for 20 percent of the value of the contract, according to Lloyd Miller, a lawyer who represented the tribes at the Supreme Court.
The Friends Committee on National Legislation points out that the problem is an old one, dating to at least 1987, but it "arises with new poignancy every time the federal government undergoes a budget crunch."
Under the 1975 Indian Self Determination Act, the federal government contracts with qualifying tribal governments to carry out certain functions that the federal government would otherwise have to perform. The functions might involve anything from health care delivery to road building in Indian Country. Tribal governments that have the capacity to handle some of these functions themselves apply for the program and agree to receive the amount that the federal government would have had to spend administering the programs – called “contract support costs.”- Friends Committee
The federal government's failure to reimburse these costs has caused dangerous deterioration of medical services for Native Americans, especially those living in remote areas.
The Shoshone-Paiute tribes downgraded their hospital in 2007 to a health clinic, open only on weekdays and only until 5 p.m. It became either a three-hour drive north to Boise, Idaho, or a two-hour drive south to Elko, Nev., to the nearest hospital for tribal members and the cowboys who work on their ranches.
Pregnant women were sent off by ambulance, at times giving birth along the side of the road. Elders died before they even reached the hospital. Accidents in the evening and early morning — once handled by emergency-room doctors and nurses — started to fall to a team of emergency medical technicians. - Washington Post
Rather than push Congress to authorize more funding, the Obama administration has put forth a budget proposal that would allow the Indian Health Service and the Bureau of Indian Affairs to
limit payments to tribes.
Tribal leaders who have reviewed the plan say it amounts to a tribe-by-tribe federal cap on CSC funding that would wipe out tribal legal claims and put tribes in the difficult position of being required to spend money to administer contract support programs without providing them the funding to do so. - Indian Country Today
Health and Human Services, in its
Budget in Brief for 2014, recognized the necessity of consulting with tribes in formulating policies. Nevertheless, Indian Country Today writes, the administration developed its budget proposal "in secret,
without any consultation with the tribes and without any consultation with the authorizing committees.”The National Indian Health Board sent an
October 14, 2013, letter to President Obama, asking him to withdraw its proposal to cap contract support costs.
[I]n Salazar v. Ramah Navajo Chapter, the Supreme Court ruled favorably on the issue of Contract Support Costs for Tribes, holding that the United States is required to pay CSC in full. Following this decision, this Administration has continued to request insufficient funding for CSC. It is inappropriate for the Administration to attempt to set a cap in appropriations in an effort to limit federal agencies’ liability to fully fund tribal CSC entitlements. Additionally, the proposal to cap CSC funding on a contractor-by-contractor basis will prevent Tribes from filing Contract Dispute Act claims or otherwise recovering the full amount of CSC owed. No other government contractor is treated in this manner.- National Indian Health Board
[Lawyer Lloyd Miller said] the administration’s policy is a continuation of a “head-in-the-sand” attitude by the federal government regarding its contract obligations to tribes. “They have acted as if these contracts were just another program to be balanced against other programs or activities the agencies felt were important to prioritize, including protecting and growing their internal bureaucracies. They have treated these self-determination contracts as second-class contracts, and the Indian tribes as second-class contractors.- Tulalip News
Certainly, it has not been easy for Democrats to convince Republicans to approve increases in funding. But, when the administration itself proposes cutting payments to tribes, the odds of getting a funding increase fall to zero. Crafting the proposal in secret adds insult to the injury.
The administration is telling tribes they must go to the end of the line to wait for payment. If there is any money left after the government has paid all its other debts, the tribes might get paid…something. What business can operate on a contract like that? And, when lives hang in the balance, shouldn't payment of these bills get priority?
The federal government's handling of this matter is immoral and unacceptable. But, the issue has received little media attention compared to other budget issues like food stamps and unemployment benefits. Social media can give needed attention to this topic and urge voters to pressure their lawmakers to approve the funds necessary to pay tribal contracts in full.
Below, Sen. Lisa Murkowski (Alaska) addresses the issue at a Senate hearing.