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Can't Touch This: Medicaid and Children's Health Insurance Are Protected from Current Budget Threats

Mark Trahant
1/26/11

Journalists like me have played the role of Chicken Little for many years. We have written dozens of stories about the consequences of an election, predicting what will happen after Republicans win and fulfill their promises to drastically cut government.

Only very little happened. Sure, there were significant budget cuts and restructuring of programs under President Ronald Reagan, but by and large no president or Congress has yet changed the nature of the federal government.

The fact is we still don't know if this election cycle (or the next one) will depart from that storyline. We still don't know what kind of votes the Republicans can round up to make the really difficult decisions about which government programs are effective and which ones should be scuttled.

Unfortunately the budget cutting game, so far, isn't being thought through with much precision. The Republican Study Committee, for example, is suggesting eventually rolling back the federal budget to FY 2006 levels. That represents as much as $2.5 trillion over the next five years. Their plan cuts $100 billion from spending this year, an idea that's already being dismissed by House Budget boss Paul Ryan (R-Wisconsin).

The conservative plan revives old themes that have huge significance to Indian Country beyond the budget implications. For example, it calls for Medicaid to become a block grant program. "One reason that we are facing this fiscal train wreck is that the federal government has taken over many responsibilities more appropriately left to the states," according to the study group's budget outline. "Rather than having taxpayers send money to Washington for some federal program, then having the money returned to the states after a deduction for administrative expenses and one-size fits all mandates, it is often better to simply cut the federal government out of the loop altogether. Let the laboratories of democracy work on solutions to problems where Washington has failed."

Too bad those laboratories don't include tribal governments.

While Republicans fight among themselves about how much budget to cut, there are two stars shining brightly: Medicaid and the Children's Health Insurance Program. Here is what the Republican Study Group says about that spending: "Under current law, the federal government does not have control of the Medicaid budget because it simply pays a pre-set share of whatever is spent by the state program."

Those few words ought to be the essence of a strategy to defend the Indian health system. "The federal government does not have control ..." In other words: If a person is eligible for Medicaid (or Children's Health Insurance Program), then the money is there. It's automatic.

Indeed this is the one line item in the Indian Health system budget that could be significantly increased next year and the year after and beyond. The budget for IHS now calls for a modest increase in Medicaid collections: $562,674,000 up from $550,222,000. (The actual amount from Medicaid is difficult to pin down because of the way IHS collects data.) But the point is the same: These are dollars that Congress doesn't have to appropriate. And, for the same reason that figure cannot be cut during the appropriations process. It's automatic spending.

Last spring the U.S. Department of Health and Human Services announced $10 million in grants for tribes, and tribal and urban organizations, to enroll more eligible American Indians and Alaska Natives. "There are thousands of uninsured American Indian and Alaska Native children across the country who are eligible for health coverage under Medicaid or CHIP, but not enrolled," said Secretary Kathleen Sebelius.

The Affordable Care Act does much more in this regard, including expanded eligibility, but most of those provisions do not start for a few more years. But in the meantime there's an opportunity for Indian Country to increase the number of American Indians and Alaska Natives enrolled in Medicaid and Children's Health Insurance now.

Remember: This is money that Congress cannot cut without changing the entire Medicaid system. The budget may be bleak in the years ahead -- but the sky doesn't have to fall. Chicken Little here, signing off.

Mark Trahant is a writer, speaker and Twitter poet. He is a member of the Shoshone-Bannock Tribes and lives in Fort Hall, Idaho. Trahant's recent book, "The Last Great Battle of the Indian Wars," is the story of Sen. Henry Jackson and Forrest Gerard.

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