President Reagan's recent veto of an Indian health bill has raised concern among Indian lobbying groups that the administration may have plans to further limit funding for the Indian Health Service.
Reagan vetoed reauthorization of the Indian Health Care Act last month, saying the legislation was "seriously deficient." He said delivery of health care to Indians would not be affected because the fiscal 1985 budget for the IHS had been approved in the continuing budget resolution.
Among other things, Reagan cited an experimental program in Montana when he vetoed the bill. Although the Indian lobbyists also object to the program, they view Reagan's rationale as a "smoke screen" and argue that it was not worth vetoing the whole bill to block the pilot program.
Suzan Shown Harjo, a spokesman for the National Congress of American Indians (NCAI), called the veto "a shameful action that strikes a blow against the basic survival needs of Indian people."
"Without this legislation, the health care of Indian people will be set back 10 to 15 years," added Jake Whitecrow, director of the National Indian Health Board, which advises IHS on behalf of Indian tribes.
"The veto is part of a broader pattern," said Dr. Emery A. Johnson, who directed IHS from 1969 to 1981 and now is a consultant to Indian groups. "I'm afraid this administration wants to turn back the clock 30 years to the days when the only service that the federal government provided was a hospital that Indians had to crawl to."
Harjo and Joe DeLaCruz, president of NCAI, said they had been told that the Office of Management and Budget is moving to freeze funds at IHS for programs it has opposed but that were in the reauthorization bill.
"We have been told that OMB has drawn up a list of Indian health-care programs that it wants to freeze," said Harjo, who declined to name her source. "These programs eventually will be reauthorized by Congress, probably next March, but the administration can cause real damage by freezing the funds now and disrupting the programs on the grounds that they might not be re-funded."
OMB spokesman Edwin Dale Jr. declined to comment on whether the White House intends to impound IHS funds. Richard McCooskey, an IHS spokesman, said he had heard rumors outside the agency about some fiscal 1985 funds being withheld. But he said the White House would have to obtain permission from Congress to rescind program funds. "No one in this office has discussed such a move," he said.
Reagan said he vetoed the reauthorization bill, in part, because it created a four-year demonstration project in Montana that was "totally unacceptable." Under the experiment, IHS would have been required to reimburse state and local governments in Montana for health care provided to indigent Indians.
Indians can qualify for state and local health benefits, as well as assistance from IHS facilities. But some groups in Montana have complained that Indians are getting a free ride because those who live on reservations do not have to pay property taxes. They contend that the IHS, rather than the local programs, should be the primary provider of health care to indigent Indians.
Reagan said the project "would set a precedent for potentially changing the fundamental relationship of the IHS to state and local entities, as well as depriving eligible Indians of benefits that should be due them by virtue of their citizenship in the state."
But DeLaCruz contended that the only precedent the program would set "would be a conclusion that no such programs would take place in the future."
"It was a bad idea," DeLaCruz said, "but not the sort of thing that causes a veto . . . . " Indian groups and the House had opposed the test, but it was added as a compromise with the Senate.
Reagan also said the bill would have elevated the IHS to "agency status" through an "unconstitutional" method.
The IHS falls under the Bureau of Health Resources and Services Administration in the Public Health Service division of the Health and Human Services Department. The reauthorization bill would have put the program directly under the PHS. The change would have taken place within 410 days unless a congressional commission disapproved.
Reagan said it would be illegal for Congress to delegate authority to a commission to decide when legislation would take effect. But House and Senate conferees, who drafted the bill, contended that the procedure is legal and was added to appease administration officials opposed to the move, including HHS Secretary Margaret M. Heckler.
Since taking office, Reagan has called for major cuts in the IHS budget, but the OMB contends that it has sought to cut only wasteful or duplicative programs.
For instance, the administration has opposed funding health-care programs for Indians who do not live on reservations because, it argues, they could receive medical care from programs available to the general public.
Congress disagrees. "The administration has failed to produce any evidence documenting such alternative resources, despite the repeated requests of congressional committees," the House-Senate conference report on the reauthorization bill said. Instead, it said, community health centers and state and local health-care providers have testified that "most providers of their kind have neither the resources nor the capacity to provide health care to the urban Indian population."
The administration also has objected to the IHS efforts to build water and sewer lines on Indian land, saying that work should be handled by the Housing and Urban Development Department.
But Congress included $20 million in the reauthorization bill for such projects in fiscal 1986 to 1989. "The adequacy or inadequacy of sanitation facilities in Indian communities is directly related to increases or reductions in . . . diseases which plague Indian communities," the conferees said. "The alternative methods offered by OMB are clearly inadequate to effectively meet the critical needs of Indian communities."
The administration wants Indians to have "the minimum," said former IHS director Johnson. "For Reagan to say, as he did in his veto message, that he is committed to improved health service for Indians is just not the truth."