May 16, 2017 – 5:20 p.m.
Republican Appropriator Suggests New Mandatory Health Funding
By Kellie Mejdrich, CQ Roll Call
A top Republican House appropriator suggested Tuesday that a federally funded Native American health program should be reprogrammed from discretionary to mandatory funding.
In addition, he said, lawmakers might consider moving it from the Interior-Environment Appropriations bill to the Labor-HHS-Education bill.
Oklahoma Rep. Tom Cole, the chairman of the Labor-HHS-Education panel, made the remark at a hearing where tribes raised alarm about proposals to cut fiscal 2018 funding vital to their communities.
Cole’s suggestion about mandatory funding is potentially significant because it demonstrates that Republicans consider switching discretionary programs to the mandatory side of the ledger appropriate in certain cases, despite criticism of President Barack Obama’s proposals to do so in the past. Mandatory funding is not subject to yearly appropriations.
Cole’s remark also shows the intense budget pressure on appropriators as discretionary spending limits under a 2011 deficit reduction law (PL 112-25) return, absent a broader budget deal.
“Chairman Cole and I will be working on that together with his committee and I hope we can come to some kind of solution to that problem,” House Appropriations Interior-Environment Chairman Ken Calvert, R-Calif., said regarding Cole’s suggestion about mandatory funding.
A major concern voiced by multiple tribal leaders including Darrell Seki, chairman of the Red Lake Band of Chippewa Indians, was the 12 percent cut proposed by President Donald Trump in his fiscal 2018 budget blueprint for the Department of Interior, which funds the Indian Health Service, the Bureau of Indian Affairs and other programs related to tribal communities.
Trump’s “skinny budget” provided few details about where tribal programs will be cut, but the entire Interior Department would receive $11.6 billion in discretionary funding, $1.5 billion less than the fiscal 2017 annualized level.
The budget document said funding “supports tribal sovereignty and self-determination across Indian Country by focusing on core funding and services to support ongoing tribal government operations” but officials also noted reductions in “funding for more recent demonstration projects and initiatives that only serve a few Tribes.”
Tribal leaders raised questions about cuts to other programs, including the National Institutes of Health, the Great Lakes Restoration Initiative, and Medicaid. Cuts outlined in the House’s reconciliation legislation (HR 1628) to partly repeal and replace the 2010 health care law (PL 111-148, PL 111-152) could harm health in communities where tribal governments are struggling to contain opioid, heroin and methamphetamine abuse, leaders told appropriators.
Vinton Hawley, chairman of the National Indian Health Board, told the panel recent increases to the IHS budget “mainly keep up with inflation and population growth.” He said a tribal working group has recommended a $30.8 billion one-time allocation for the IHS but conceded such an expenditure was unlikely in the current budget environment.
“We recommend that Congress phase this in over 12 years. For 2018 then, we recommend $7.1 billion to IHS,” Hawley said. He noted five top priorities: money for purchasing care outside the system; hospitals and clinics; mental health services; alcohol and substance abuse services; and dental services.
He said per capita expenditures for IHS patient health services were below $3,000 per person per year.
“America needs to keep its promises to American Indians and Alaska natives and fully fund the IHS,” Hawley said, urging the committee to resist Medicaid cuts proposed in the House health care bill.
The question of mandatory funding then came up.
“There are other pots of money out there,” Cole said, noting the disparity between the Interior-Environment Subcommittee’s fiscal 2017 discretionary allocation — just over $32 billion — while the Labor-HHS-Education Appropriations bill allocation was $163 billion.
“On the health programs, we’re never going to catch up as long as this is all discretionary spending, that’s just a huge problem for us,” Cole said. He added he believed the discretionary label was “rooted in the fact the Indian Health Service predates Medicare and Medicaid by many decades . . . we need to see if there’s some way legislatively that we can do something.”
“Maybe it’s a combination,” Cole suggested, of moving some of the tribal programs to another appropriations bill and finding “some way to transfer some of these responsibilities into the mandatory programs so that there is a larger, again, pool of money.”
“Because I really worry this year, particularly, none of us know what kind of allocations we’re going to get,” Cole added.
Cole told the panel he and Calvert visited Health and Human Services Secretary Tom Price earlier in the year to discuss the funding disparity between spending on Native American health and the national average, which Cole said HHS records show was about $10,000 per Medicare patient in 2015.
“I think he was genuinely shocked,” Cole said, by the difference.
Rep. Betty McCollum, D-Minn., the top Democrat on the subcommittee, also indicated support for Cole’s effort to get more funding for tribal health programs.
McCollum asked that tribal officials produce more information about education program needs as well as the number of grants from the National Institutes of Health that she said tribes relied on to supplement their programs.
“Mr. Cole is fighting for every penny he can get, so any arrows I can put in his quiver, I’m ready to do,” McCollum said.
After the meeting, Cole told CQ the switchover from discretionary to mandatory funding he proposed during the hearing was different from those proposed by Obama. House GOP appropriators directed particular ire at the Obama administration for its proposal to reprogram funds in such a way in the fiscal 2017 transportation budget.
“Because all other health programs are under mandatory funding, so this is different. And again, this is a matter of getting adequate resources there,” Cole said.
He said if the funding was not made mandatory, then the IHS could be transferred to Labor-HHS-Education.
“You could make a big difference in Indian health just by having a bigger pot of money to draw from,” Cole said.