True Believers would destroy the Indian health system


Congress always works on two tracks. The first rail is legislation that gives the government authority to spend money. The second rail is one that actually appropriates the funds. It’s that second law that dictates how the government can spend dollars for the Indian Health Service (or any other program) under parameters set by law.

This two-track idea is important to remember when you think about the chaos in Washington concerning the budget and debt ceiling.  Some Republicans, True Believers, are bent on using the budget process to rewrite the Affordable Care Act and that proposal would be catastrophic for the Indian health system.
Remember track one? Every appropriation from Congress has to link back to the legislation that set the rules for spending. In the case of the Indian Health Service, the legislative authority comes from the Indian Self-Determination Act, the Indian Health Care Improvement Act, and the Public Health Service Act. The Indian Health Care Improvement is part of the Affordable Care Act (or, as the Republicans like to call it, “ObamaCare.”)

The proposal to defund the Affordable Care Act would wipe out most of the Indian Health Service budget. This scenario is beyond absurd: Imagine every Indian Health Service, tribal, nonprofit, or urban clinic unable to open its doors after October 1 and remain closed for a full year.

That’s exactly what House Joint Resolution 62 would do. The resolution, promoted by Georgia Republican Tom Graves, would fund the government at sequester levels, while eliminating any money that implements the Affordable Care Act.

Normally this proposal wouldn’t be worth mentioning. It has some sixty supporters in the House and a few members in the Senate, so it’s not a majority view. But this also shows how Congress is drifting toward a more conservative stance. The Heritage Foundation, for example, is providing “research” on the viability of defunding the Affordable Care Act. Heritage said: “It is beyond dispute that Congress can use its power of the purse to defund ObamaCare—both its mandatory and discretionary spending—in appropriations legislation this fall. The lone remaining question is whether Congress can summon the political will to do so.”

Republicans who support this defunding approach appear unwilling to compromise. There is no middle ground for True Believers.

Idaho Republican Raúl Labrador is a good example of the True Believer Thinking. He says he will not vote for a bill that doesn’t strike down ObamaCare. “House Leadership should bring it to the floor for a vote,” he said in a news release. “If the House passes it and the Senate rejects it, it will be the Senate that’s responsible for shutting down the government.  Let’s hope it doesn’t come to that, but House Republicans must seize this opportunity to keep our promises to the American people on ObamaCare.”

The thinking from the True Believers such as Labrador is that the public would blame the president for “shutting down” government because everyone understands that neither the Senate nor President Obama would agree to such a destructive approach. (And, at some point, as I wrote last week, Republican leaders might just have to work with Democrats in the House to head off a government shutdown or a debt default.)

But the True Believers don’t care. They are willing to sink their own Republican leaders and the country in order to kill the Affordable Care Act. But do they have the votes? Even in the House? And what happens after that? Hard questions. And we need the answers soon.

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. Join the discussion about austerity. Comment on Facebook here.

Essays in the Range blog are not written by High Country News. The authors are solely responsible for the content.

Linda VanFossan
Linda VanFossan
Sep 28, 2013 08:54 AM
Well, Mark, as of today, we see what the "True Believers" are willing to do--in spite of their own Republican leaders. It is inconceivable to me that our political system is so designed that this can happen---so few can decide what causes terrible results for so many--simply out of spite! They (the Tea Partyers) are acting like spoiled children and in the process are harming so many people!! How can this be legal????
Phil Briggs
Phil Briggs
Oct 09, 2013 07:35 PM
So, I presume the Indian Health Service existed before the ACA even existed? If so, would it cease to exist if ACA ceased to exist?

I'd have to wonder who's brilliant idea it was to incorporate the Indian Health system into the ACA? Assume that the health care for Indians was 'free' before... will Indian's now have to start paying for their health care, like the rest of America? What if they cannot afford the premium? will they be taxed for this? What will they do, if they live in states where medicaid will not be expanded, so there are no subsidies?

I find it hard to believe that destitute Native American's were going to have to start paying for their own healthcare... If they're like me, they'll not be able to afford it, and will wait for the IRS to inform them how much they owe in tax (from what I understand, the tax will be withheld from tax refunds... no refund, no tax... at least not now)
Rita Gibbs
Rita Gibbs
Dec 31, 2013 10:46 PM
There are idiots, and there are mean idiots.
Linda VanFossan
Linda VanFossan
Jan 01, 2014 07:59 AM
Yes, Rita, and we are finding out just how mean some of those idiots in Washington really are!!