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Posts published in “Trahant”

Impacts of the cut

trahant MARK
TRAHANT

 
Austerity

Indian Country has already been hit hard by the sequester.

Lacey Horn, treasurer of the Cherokee Nation, recently told National Public Radio that the tribe had been planning for the impact for some time with cost-cutting measures, a hiring freeze for all non-essential positions, and canceled training and travel. “We’re delaying or foregoing any capital acquisitions, both large and small. And we're looking at our encumbrances to see if there's any changes in scope or quantity that we can make and strictly enforce the employee overtime.”

Horn’s goal is to try and absorb the sequester “to the greatest extent possible before we start making reductions in jobs and services.”

This is exactly what a tribal government should be doing. Looking for ways to “absorb” the cuts with as little impact as possible on direct services or jobs.

But can tribes do that over and over for the next decade? The Budget Control Act, the law that governs the sequester, is a ten-year austerity effort. As the Bipartisan Policy Center describes the law: “Sequestration’s effect will be akin to that of a slow motion train wreck ... the ramifications will steadily worsen as time passes.”

The Congressional Budget Office reported that the president’s budget would “lower the caps for 2017 through 2021 on discretionary spending that were originally set by the Budget Control Act and extend those caps through 2023. However, much of that lower spending would be offset by eliminating the automatic spending reductions that have occurred or are scheduled to occur under current law from 2013 through 2021. In total, those changes would lead to discretionary outlays that are 6 percent lower in 2016 than they were in 2012 but that would grow later in the decade; as a percentage of GDP, such outlays would fall from 8.3 percent in 2012 to 5.0 percent in 2023, 0.5 percentage points lower than the amount in CBO’s baseline and the lowest level in at least the past 50 years.”

Think about the last part of that sentence. The president’s budget would lift some of the hard spending caps under the Budget Control Act, but even then federal spending for domestic programs would be at the lowest level since President Kennedy’s time. And, as I have written before, the president’s budget represents a decent outcome. The president’s budget, according to CBO, would trim federal deficits by $1.1 trillion over the coming decade. Not a bad outcome. But the president’s budget would require a “yes” vote from both the House and the Senate. That’s not going to happen. (more…)

Repeal it again?

trahant MARK
TRAHANT

 
Austerity

The U.S. House of Representatives has scheduled a vote Thursday to repeal the Affordable Care Act (including the permanent authorization of the Indian Health Care Improvement Act). House Majority Leader Eric Cantor, R-Virginia, tweeted: “It just keeps getting worse. I am scheduling a vote for next week on the full repeal of #Obamacare.”

Since the law was enacted more than three years ago, House Republicans have voted more than thirty times to repeal part or all of the law. And, perhaps, more important, Republicans in Congress have tried to pull every lever they can think of to make sure the current law is neither executed nor fully-funded. The goal of Republicans in Congress is to make the Affordable Care Act “worse.”

But the problem for Republicans (and in a different way for supporters of the law) is that Americans are confused. Polling last month by the Kaiser Family Foundation showed that four in ten Americans, or 42 percent, are unaware that the Affordable Care Act is the law. Some 12 percent think it was repealed. Another 7 percent say the Supreme Court overturned the law. And 23 percent have no idea whether the act is still law. Nearly half of those surveyed say they “do not have enough information about the health reform law to understand how it will impact their own family, a share that rises among the uninsured and low-income households.”

Then again, it’s no wonder most people are confused by the law. From the moment it passed there has been a misinformation campaign from opponents designed to confuse and stir up distrust.

President Barack Obama said last week that “misinformation” will continue at least through the next election cycle. He talked about the Affordable Care Act last week using Mother’s Day as the reason, saying, “the law is here to stay.” So many people are already better off because of the law, seniors, women, low-income Americans, sick people and families with children. “You're benefiting from it,” he said. “You just may not know it.” (more…)

Jobs evaporating in Indian country

trahant MARK
TRAHANT

 
Austerity

Wall Street celebrated last week’s jobs report. The Bureau of Labor Statistics reported that unemployment fell to 7.5 percent and that 165,000 new jobs were added in April. The report also revised its numbers from the past couple of months, saying that the job creation was stronger than first glance.

But the same numbers are lousy in Indian Country. If you read the full report there’s a number (and a trend) that is concerning: Government sector employment continues to drop. In the technical language of the BLS, “Employment in ... government, showed little change over the month.” Little change was a minus 11,000 jobs. But if you pull back and look at the longer trend government employment continues to shrink.

A report by The Hamilton Project last year detailed this larger trend.

“Total government (i.e., the sum of state, local, and federal) employment has decreased by over 580,000 jobs since the end of the recession, the largest decrease in any sector since the recovery began in July 2009. State and local governments, faced with tough choices imposed by the confluence of balanced-budget requirements, falling tax revenues, and greater demand for public services, have been forced to lay off teachers, police officers, and other workers,” the report by Michael Greenstone and Adam Looney reported last August. This is the lowest public-sector employment in 30 years.

But go back even further and the trend is even more stark. Between 1950 and 1975 government jobs accounted for 1 in every 4 jobs created “contributing to widespread public belief that government, especially the Federal government, is too large,” said a 1981 BLS report.

There is no national data on the growth of tribal governments just after this time frame, but there should be.

The post-1975 growth of tribal government services is stunning, drive around any reservation and the visible evidence is overwhelming. Tribes created programs, took over the management of Bureau of Indian Affairs and Indian Health Service, built schools and colleges.

The California Indian Gaming Association reported in 2003, for example, that “tribal government economies have for three years lead the state in job growth, with employment more than doubling since January 2000, when there were 17,200 workers on tribal payrolls.” (more…)

Fixing the wrong problem

trahant MARK
TRAHANT

 
Austerity

Last week was a perfect illustration of the broken structure that is the United States government. Congress cannot pass a budget. It can barely pass a law to pay bills already incurred and owed. And its best “deficit” cutting attempt is the decade-long sequester, across-the-board cuts that hit the wrong programs, at the wrong times, and in the most harmful process.

Yet inconvenience air travelers and the entire Congress (and President Barack Obama) moves faster than Usain Bolt. So a bill is proposed and enacted to lift the sequester giving the Federal Aviation Administration more flexibility in its spending ending the furlough for air traffic controllers. Problem solved.

But for most of the country the sequester continues for another decade.

Cuts that make less sense than air traffic delays, such as laying off teachers in more than three-quarters of all school districts, will continue as planned.

Or the sequester cuts to programs that serve American Indians and Alaska natives. In testimony last week to the House, the National Congress of American Indians reported: “For many tribes, a majority of tribal governmental services is financed by federal sources. Tribes
lack the tax base and lack parity in tax authority to raise revenue to deliver services. If federal funding is reduced sharply for state and local governments, they may choose between increasing their own taxes and spending for basic services or allowing their services and programs to take the financial hit. On the other hand, many tribes have limited ability to raise substantial new revenue, especially not rapidly enough to cover the reduction in services from the across the board reductions of the FY 2013 sequestration.”

NCAI says the sequester process undermines “Indian treaty rights and obligations.” (more…)

Austerity and termination

trahant MARK
TRAHANT

 
Austerity

If you look at the failed history of termination - the idea of ending the federal-treaty relationship with tribal governments - there were two distinct motives. Some believed it was the next logical step for Indian progress, an economic integration. While others hated government and used termination as a method to shrink and attack government.

National Congress of American Indians President Joseph Garry, a member of Idaho’s Coeur d’Alene Tribe, said at the 1958 convention, that Congress adopted the termination resolution in good faith ... “believing it would be good for Indian people” even though it was clearly dangerous and a disaster. That’s why nearly everyone, friends and foe alike, were at least partial supporters of termination policy.

Utah’s Republican Senator Arthur Watkins was from the shrink-and-attack government camp. He was zealous about termination, badgering tribal witnesses when they came to Capitol Hill, refusing to even consider alternatives. He dismissed treaty obligations outright. Indians, he said, “want all the benefits of the things we have – highways, schools, hospitals, everything that civilization furnished – but they don’t want to help pay their share of it.”

This story should have a familiar ring to it. The same forces are at play when it comes to austerity. One camp sees the problem -- the country’s demographic imbalance -- and opts for austerity as a solution or at least a partial solution. While the other camp hates government and sees austerity as a tool to shrink and attack. Arthur Watkins would be at home in a Tea Party crowd.

The practical problem with austerity, however, is that it does not lead to growth, especially over a short period of time. But from those that hate government, there was an evidence that too much debt also made it harder for an economy to grow. A pair of economists, Carmen Reinhart and Kenneth Rogoff, published a paper in 2010, that found that public debt slows growth when it reaches or exceeds 90 percent of a country’s Gross Domestic Product. This work became the intellectual rallying cry for austerity. As House Budget Committee Chairman Paul Ryan put it: “Economists who have studied sovereign debt tell us that letting total debt rise above 90 percent of GDP creates a drag on economic growth and intensifies the risk of a debt-fueled economic crisis.”

But last week another paper found Excel errors in that Reinhart and Rogoff paper (based on the work of a graduate student) and reached a conclusion that “contrary” to Reinhart and Rogoff, namely that the “average GDP growth at public debt/GDP ratios over 90 percent is not dramatically different than when debt/GDP ratios are lower.” (more…)

A tale of two budgets

trahant MARK
TRAHANT

 
Austerity

President Barack Obama’s budget request for 2014 does not roll back austerity. But it would significantly shift resources, adding money to important programs, and protecting much of Indian Country from government contraction.

The Bureau of Indian Affairs budget request is $2.6 billion, an increase of $31.3 million over what Congress enacted in 2012.

“The president’s budget request for Indian Affairs reflects his firm commitment to keeping our focus on strengthening and supporting tribal nations, and protecting Indian Country,” Kevin K. Washburn, assistant secretary for Indian Affairs reported last week. “While realizing the benefits from improvements to Indian Affairs program management, the request supports our mission to federally recognized tribes, particularly in the areas of trust lands and natural resource protection. The request also promotes economic development, improves education, and strengthens law enforcement and justice administration.”

There’s a lot to like in this year’s budget request. There would be additional money for law enforcement, police, courts, and expanded domestic violence services. There would more money for trust management and real estate. And, most important, there would be additional investments in the Bureau of Indian Education (such as a $3 million scholarship fund for post-graduate education in sciences).

To my way of thinking this budget does not represent what kind of education funding is needed. Indian Country represents a young population that I think should be an essential part of balancing the country’s demographics (basically the retirement of the baby boom generation plus a longer life expectancy). But that’s a bigger issue than this budget request. (A good detailed example of this is in The Washington Post’s wonkblog where Ezra Klein writes that the federal government spends $7 on the elderly for every $1 spend on kids.)

The funding picture is similar at the Indian Health Service, basically, a request for more, even if not enough. The president’s budget calls for $4.430 billion in direct spending, and a total increase of $243.6 million over what Congress enacted in 2012. “The request includes funds to support activities identified by the tribes as budget priorities including increasing resources for pay costs, funding medical inflationary costs for the Purchased/Referred Care program (formerly known as Contract Health Services); funding contract support costs shortfall; and staffing for new/replacement facilities,” according to the budget request to Congress.

It wasn’t all that many years ago that the president’s budget request for IHS was just the beginning of the process. The appropriations committees in the House and Senate would look at the numbers, match it to the need, and in many cases find more money to spend. If it were up to the subcommittee chairs that would still happen. The legislators who are nearest the actually programs and what they do understand the challenge and look for improvements. (more…)

More stories than spread sheets

trahant MARK
TRAHANT

 
Austerity

Modern budgets in the federal government are more stories than spread sheets.

Consider the three competing budgets for 2014. The House budget is stark. There are no new taxes and spending drop below even the sequester levels. The Senate sets out a very different course. That budget plan increases taxes, mostly on the White House, and restores spending to many parts of the budget.

Today’s White House plan melds the House and Senate into a compromise plan. That is, if compromise is even possible in today’s political environment. Remember that no single plan, not the House, not the Senate, and certainly not the president’s, will be enacted into law without lots of changes, debates, and compromises. This is only the beginning of the process where every line is written in pencil. (The Washington Post has a great graphic that shows how rare it is for a president’s budget to actually get enacted.)

But this is a smart budget. It’s might even work because it’s neither the House nor the Senate approach.

“The budget also incorporates the president’s compromise offer to House Speaker Boehner to achieve another $1.8 trillion in deficit reduction in a balanced way,” the White House says. “When combined with the deficit reduction already achieved, this will allow us to exceed the goal of $4 trillion in deficit reduction, while growing the economy and strengthening the middle class. By including this compromise proposal in the budget, the president is demonstrating his willingness to make tough choices and his seriousness about finding common ground to further reduce the deficit.”

There is a lot to like in the president’s budget because it invests in the areas of government that require more money, mainly education. If you pull back and look at the big picture, the federal government’s primary challenge is demographic -- an aging workforce that’s ready to retire -- so the best answer is to invest heavily in education, so that young people have the skills to earn as much income as possible. (Instead of what we’re doing now: Loading up this generation with student debt.)

The budget: “Improves college affordability and value with a continued commitment to Pell Grants; budget-neutral student loan reforms that will make interest rates more market-based; a $1 billion Race-to-the-Top fund to support competitive grants to States that drive higher education reform, while doing more to contain tuition; a $260 million First in the World fund to spur cutting-edge innovations that decrease college costs and boost graduation rates; and reforms to Federal campus-based aid to reward colleges that set responsible tuition policy, provide a high-quality education and better serve students with financial need.” (more…)

How to stop the sequester

trahant MARK
TRAHANT

 
Austerity

A couple of weeks ago I was on Capitol Hill. In between meetings, I sat in the sun and watched tourists come and go. I also saw the First Amendment in action -- the right of the people to petition the government for a redress of grievances (or lobbying as it’s known these days) -- as tribal leaders, community representatives and lobbyists rushed past the visitors on their way to their next appointment.

This is the tried-and-true formula for reversing such things as the sequester. Someone from the home district flies to Washington and then makes the case to their member of Congress for a different course. It’s how the process is supposed to work.

It’s even possible that this route will work again. Sometime this summer when Congress enacts a new debt ceiling or next year’s budget there might be enough support to fix the worst problems of the sequester.

Then again it’s important to remember that the sequester is just one element in the broader austerity push. Austerity is a trend in governance, federal, state, and even tribal, and resources will continue to shrink. The only way to slow, let alone reverse, this trend is to substitute the players on Capitol Hill. In other words: Win the next election.

What if Democrats ran the House of Representatives and the Senate during Obama’s last two years in office? The budgets would be far superior for Indian Country (to be fair: there is support from Republicans for Indian Health Service and Bureau of Indian Affairs money, the difference would be that Democrats support that revenue stream plus money from other federal program sources.) (more…)

Changes ahead on Indian health

trahant MARK
TRAHANT

 
Austerity

Three years ago, on March 23, 2010, President Barack Obama signed into law the Affordable Care Act. The bill also included the permanent authorization of the Indian Health Care Improvement Act.

As I wrote at the time: “When Medicare and Medicaid passed Congress in 1965 and were signed into law there was no consideration – none – of how those bills impacted Indian Country. It was as if the Indian Health Service, then all federal employees, was off the books, a forgotten instrument. In fact there wasn’t even a plan that allowed IHS to tap into Medicare or Medicaid dollars. That had to wait for the Indian Health Care Improvement Act of 1976.

That is not the case with President Obama’s health care reform. Indian Country is included throughout the document in large and small measures designed to improve the health of Native people.”

Indeed, three years later, only a year before many of the most important provisions of the law begin, it’s hard to understate what this law means to the Indian health system.

Consider the money. The Indian Health Service is funded largely by appropriations. In recent years this has worked well with bipartisan support for increased funding. Since 2008 there has been a 29 percent increase in IHS funding.

But that is unlikely to continue. The appropriations process itself is, well, I’ll use the technical term here, a total wreck. So getting a logical appropriation will be less and less likely.

But the Affordable Care Act opens up revenue streams that are not appropriations, money that is, essentially, automatic. If a patient qualifies, then the money is there. This happens two ways. First, many more people will be eligible for Medicaid funding and second there will be new insurance exchanges with plans that could be purchased by both individuals and tribes, mostly, as employers. (more…)

More money, better health?

trahant MARK
TRAHANT

 
Austerity

Idaho’s Rep. Mike Simpson, a Republican, asked a critical question Tuesday. It’s one rarely asked, let alone, answered. The question: Does more government money work?

Specifically, Simpson, the chairman of the House Interior Appropriations Subcommittee on Interior, Environment, and Related Agencies, was asking if recent increased funding for the Indian Health Service has made a difference.

Dr. Yvette Roubideaux, director of the IHS, went through the numbers at an oversight hearing. IHS appropriations have increased 29 percent since 2008 which, she said, is “making a substantial difference in the quantity and quality of healthcare we were able to provide to American Indians and Alaska Natives.”

For example: Contract Health Service dollars, money spent to purchase medical services outside of the Indian health system, has been increased by 46 percent since 2008. “Four years ago, most programs were funding only Medical Priority 1, or ‘life or limb’ referrals. Now, Dr. Roubideaux reported, “the increased CHS funding means that almost half (29 out of 66) of Federal CHS programs are now funding referrals beyond Medical Priority 1.”

That means that there is now money, at least some money, for preventative services such as mammograms and colonoscopies. “The increased CHS money also means that the IHS Catastrophic Health Emergency Fund, which used to run out of funding for high cost cases in June, now is able to fund cases through August,” Dr. Roubideaux said.

Simpson said: “You can get sick now up to August?” To which Dr. Roubideaux replied, that the phrase, “Don’t get sick after June,” has been incredibly effective describing the problem of what it means for a health care delivery system to run out of money.

Clearly more money in the contract health care (soon to be labeled in the next budget as “purchased and preferred care”) program is making a difference and most likely saving lives. But what about in other program areas? There the data is convincing as well. The Improving Patient Care program, a team based approach to care, has increased the number of sites to a total of 127 (adding 89). This has resulted in both quantity (empanelling 261,180 active patients in a primary care team up from 85,079) and quality (IPC sites show patient satisfaction increasing from 55 percent in April 2011 to 72 percent currently.)

IHS has provided more women mammograms, up from the low to mid-40 percent range to more than 50 percent.

No one thinks that there is enough money in the Indian health system. But in this one subcommittee there is bipartisan agreement that more government spending does indeed work and that the Indian Health Service could use more. This is dangerous talk in DC, the very words that strike fear, government spending is effective. (more…)