Federal Indian programs have been added to the “high-risk” category by the Government Accountability Office. That designation could not come at a worse time because there are already so many pressures to cut the budget. And that’s exactly the wrong way to serve Indian Country.
This is Trahant Reports.
The GAO zeroes in on federal programs that it says are vulnerable to fraud, waste, abuse, mismanagement, and, the need for transformation to address economy, efficiency, or effectiveness challenges. The Bureau of Indian Education, the Bureau of Indian Affairs and the Indian Health Service made that list for the first time.
GAO says the BIA is slow to approve energy projects. Congress can’t wait to make the approval process faster than filling your car with a tank of gas. But that will have unintended consequences for the very notion of trust land, tribal control of energy projects, and the challenges of global warming.
Next the GAO says the Bureau of Indian Education needs to better manage. Only problem: Hiring for BIE schools is easier said than done. There is another problem at play: Conservative think-tanks have these as “failing schools” and would replace them with a whacky scheme to create Education Savings Accounts.
The third high-risk agency identified by the GAO is the Indian Health Service. It says to help ensure that Indian people receive quality health care the IHS should improve quality and make better hires. Absolutely. Of course the IHS is trying to improve quality and make better hires. The problem is mostly funding.
Another GAO recommendation about IHS might be the most tone deaf. It says, “we recommend that IHS realign current resources and personnel to increase capacity to deal with enrollment in Medicaid and the exchanges and prepare for increased billing to these payers.”
Congress is going in exactly the opposite direction. The serious questions, the one that Congress ought to be answering, are how much will it cost IHS when Medicaid is turned into a block grant? And, if there are to be block grants, will states even fund a federal health care delivery system?
The GAO report makes a big deal about IHS developing a fair method for how it spends money on purchased and referral care.
What the report should have said is that Congress is to blame. The problem is not the architecture; it’s the funding. No federal agency. No state agency. No private medical system spends less than the Indian health system on a patient. The real problem is that it’s impossible to defy gravity.