United States Capitol Building - Washington, DC.

Congress Should Insulate the Indian Health Service from the Next Government Shutdown

By Matthew B. Lawrence

Contributors to Bill of Health’s symposium on Recommendations for a Biden/Harris Health Policy Agenda have made a number of excellent suggestions. I have one more policy suggestion to add and endorse: Congress should adopt the Biden Administration’s recent proposal to insulate the Indian Health Service from future government shutdowns.

A service population of 2.5 million American Indians and Alaska Natives rely on the federally-funded Indian Health Service (IHS). The IHS is one of several trust obligations that the U.S. government owes Native peoples as a result “of Native Americans ceding over 400 million acres of tribal land to the United States pursuant to promises and agreements that included providing health care services,” as the U.S. Commission on Civil Rights put it.

Yet the IHS is dependent entirely on annual one-year appropriations from Congress. That means that the House and the Senate must come together, on time, every single year on an appropriations package, for the IHS to continue all its operations.

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To Our Friends and Colleagues in the Federal Service

By Scott Burris

Take-no-prisoners politics has been succeeded by hostage-taking politics. The metaphor could go a few ways, but in the most concrete sense the hostages are you, our friends and colleagues who work for the public’s health as federal civil servants.  You, who often accept smaller salaries and more spartan working conditions than you could enjoy in the private sector or academia; you, who devote your passions and considerable abilities to the cause of public good; you, who have already had to endure arbitrary furloughs and budget cuts that make it harder for you to do your jobs — you are the ones who are now being left on your own with the injury of no paycheck and the  insult of a lot of politicians and pundits saying that you aren’t really needed anyway.

I won’t apologize, because this is not the work, or the desire, of the citizenry. This is the work of a small faction of the far political right. I will say how sorry I am, how ashamed I am as the citizen of a once-serious country, that you are being treated this way, and how much I appreciate the dedication that is keeping you in your vital work.

P.S. As to the people who have taken us past the brink, the best I have to offer is a little political economy from our classic public health law case, Jacobson v. Mass.  You have every right to oppose the Affordable Care Act, and to use all democratic means to roll it back,

But the liberty secured by the Constitution of the United States to every person within its jurisdiction does not import an absolute right in each person to be, at all times and in all circumstances, wholly freed from restraint. There are manifold restraints to which every person is necessarily subject for the common good. On any other basis organized society could not exist with safety to its members. Society based on the rule that each one is a law unto himself would soon be confronted with disorder and anarchy. Real liberty for all could not exist under the operation of a principle which recognizes the right of each individual person to use his own, whether in respect of his person or his property, regardless of the injury that may be done to others.