It’s an old American story: malign policies hatched in Washington leading to pain and death in Indian country. It was true in the 19th century. It is true now, at a time when Congress, heedless of its solemn treaty obligations to Indian tribes, is allowing the across-the-board budget cuts known as the sequester to threaten the health, safety and education of Indians across the nation.

Many Republicans have lately taken to dismissing the sequester as a mild headache for a country that needs to tighten its belt. They are willfully averting their eyes from Indian reservations, where the cuts are real, specific, broad and brutal. The victims are among the poorest, sickest and most isolated Americans.

The sequester in a nutshell? “More people sick; fewer people educated; fewer people getting general assistance; more domestic violence; more alcoholism,” Richard Zephier, executive director of the Oglala Sioux Tribe, recently told Annie Lowrey of The Times.

The damage is being done to agencies and programs whose budgets rely nearly entirely on federal sources, now being slashed. In signing treaties with Indian nations in return for land, the federal government promised a wide array of life-sustaining services. One of the most important is the Indian Health Service, which serves about two million people on reservations and is grossly underfinanced even in good times. It routinely runs out of money halfway through the year. Though Medicare, Medicaid and veterans’ health were exempted from sequestration cuts, the Indian Health Service was not. It stands to lose about $228 million in 2013 from automatic sequester cuts alone, out of a $4 billion budget. That will mean 3,000 fewer inpatient admissions and 800,000 fewer outpatient visits every year.