The Bush administration's push to eliminate the urban Indian
health program comes with a much heavier price tag than
reduced services and shuttered clinics.
As part of its long-standing objections to the Indian Health
Care Improvement Act, the Department of Justice is questioning
whether urban Indians, lineal descendants and certain Alaska Natives
can receive federal services at all.
The stance threatens health care for the majority of
Native Americans who live away from reservations.
Although federal law, treaties and the trust responsibility
have provided the legal basis for Indian health care, the
Bush administration now argues such services must be tied to membership
in a recognized tribe.
Otherwise, the programs could be struck down by the courts
as unconstitutional because they are based on race,
according to DOJ.
"Under the Supreme Court's decisions, there is a substantial likelihood
that legislation providing special benefits to individuals of Indian or
Alaska Native descent based on something other than membership or equivalent
affiliation with a federally recognized tribe would be regarded by the
courts as a racial classification,"
Frederick Breckner III, a deputy assistant general, told
the Senate Indian Affairs Committee last Thursday.
To tribal leaders, such a view ignores the federal
government's obligation to provide health care to Native
Americans. They also note that it is legally unsound.
"The definition of Indian in the reauthorization is the same
definition that has been in law for 30 years
and has never been challenged on constitutional grounds,"
Rachel A. Joseph, the co-chair of the national steering
committee to reauthorize the IHCIA.
Joseph pointed out that a similar definition of Indian is found in the No Child Left Behind Act, which the Bush administration pushed through Congress six years ago. That law is also up for reauthorization.
Supporting the tribal viewpoint at the hearing was Edward P. Lazarus, a lawyer and constitutional scholar. Even if Congress were to expand health care to Native Americans
and Alaska Natives who may not be enrolled in a recognized tribe, he said health statistics support the need to address high rates of suicide, alcoholism, diabetes, suicide and other ailments,
"It seems to me that a very, very compelling case could be made -- given the conditions
of Indian health, both in the cities and on the reservations -- that
this is legislation that meets all those [constitutional] criteria,"
Breckner said the Bush administration is willing to work with the committee to address
its objections to health care for urban Indians, lineal descendants
and Alaska Natives.
But the effort to reauthorize the IHCIA has been tainted by the
release of a "white paper" by DOJ last fall, on the eve of
consideration in the Senate.
The paper cited constitutional questions about urban Indian and
Alaska Native health care, prompting Senate Republicans to put
a hold on the bill.
Those same Republicans blocked a Native Hawaiian measure on the
same grounds and, with the support of conservative groups,
have been questioning a wide range of programs as "race based."
Government lawyers have been quietly backing up these objections since
the start of the Bush administration.
The department's former solicitor general, Ted Olson,
represented a white rancher in a U.S. Supreme Court case
that denied Native Hawaiians a similar trust status as American
Indians and Alaska Natives.
With that victory on the books, the administration and its Republican
supporters appear to have turned their sights on urban Indians, lineal descendants, terminated
Indians and Alaska Natives.
"Since 2001, one arm of the Bush administration -- the Health and Human
Services Department -- has engaged tribal leaders and authorizing
committees in various bill-drafting exercises. But another executive
arm -- the Office of Legal Counsel, in the Justice Department -- has
secretly crafted reasons to oppose the drafts," Suzan Harjo, a columnist
for Indian Country Today
, wrote last month.
The cut to the $33 million urban Indian program, however, was presented
on non-legal grounds. The White House Office of Management and Budget
argues that urban Indians can find care at community health centers.
Members of Congress of both parties reversed the cut in the 2007 budget
and are poised to do the same for the 2008 budget.
"The 2000 Census indicated that as much at 66 percent of
the American Indian and Alaska Native population live in urban
areas," the Senate Indian Affairs Committee wrote in
a views and estimates letter on March 2.
"The 34 urban Indian organizations serve 430,000 eligible Indian users
at 41 sites throughout the U.S., and provide health services such
as dental, pharmaceutical, vision, alcohol or mental health treatment,
suicide prevention and family wellness," the committee of eight
Democrats and seven Republicans wrote.
on the Indian Health Care Improvement Act
(March 8, 2007)
to President Bush
to Alberto Gonzales
Indian Health Service - http://www.ihs.gov
Indian Health Board - http://www.nihb.org