Starting next Tuesday I am beginning an Indiegogo campaign to fund my journalism projects. My official goal is $5,000, but I am hoping to exceed that figure. The money will be used to pay my salary, travel, and to keep my technology current. (The bonus is that if I reach the larger amount, I’d like to visit the Tar Sands next month.)
I am hoping for early support and broad support; campaign will just last 30 days. 
And if you can’t help with funding — please pass along my funding pitches, my regular posts, or just keep reading. Thank you.
  

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The next phase in the epidemic: Reducing the rate of growth and other success stories

MARK TRAHANT

Indian Country has long faced the epidemic of diabetes with rates 2.3 times greater than the general population. The toll from this deadly disease was so great that a federal Special Diabetes Program for Indians was launched some thirteen years ago.

Across America diabetes rates are exploding. A recent piece in The Washington Post put it this way: “Diabetes has reached epidemic proportions in the U.S., due to sugary diets and the lack of exercise. If current disease rates continue, one in three Americans will have diabetes by 2050. Over time, the condition can lead to kidney failure, limb amputations and blindness, among other complications.”

The post linked to a blogger, The Data Dude, and a chart that shows diabetes rates increasing in all but a few counties across the nation, a total of 2,992 of counties. Only five counties had rates that stayed the same and only ten counties showed an actual decrease.

Here is the thing. Two of the ten counties showing a decrease in diabetes rates are found on Indian reservations, Fort Peck, Montana, and Rosebud, South Dakota. According to the United States Centers for Disease Control and Prevention, the rate of growth for diabetes in Roosevelt County, Montana, dropped from 13.2 percent to 12.9 percent, a three-tenths decline from 2004 to 2012. And a similar decline occurred in Mellette County, South Dakota, where the rates declined from 13 percent to 12.7 percent.

If these two reservation communities are showing a decline, what do the numbers look like across Indian Country?

Unfortunately the CDC and the Indian Health Service use different data because, of course, the county map is not ideal. The Indian Health Service reported that its data would not be comparable with the county data cited.

However — and this is important — IHS data do indicate a slowing in the rate of rise of the prevalence of diabetes in American Indian and Alaska Native people nationally. From 2001-2005, there was a relative increase in age-adjusted diabetes prevalence in American Indian and Alaska Native adults of 2.2% per year on average. Contrast that with the period between 2006 and 2013 where diabetes prevalence among the same population increased at a rate of 0.8% per year on average.

Another measurement of that trend comes from the United States Renal Data System. The data show that the incidence of end-stage renal disease due to diabetes in American Indian and Alaska Native people decreased by 43 percent between 2000 to 2011. Looking at the numbers another way, between 1995 and 2006, the incident rate of End Stage Renal Disease in American Indians and Alaska Natives with diabetes fell by 27.7 percent—a greater decline than for any other racial or ethnic group.

The IHS says: “This translates into far fewer American Indian and Alaska Native patients with diabetes starting dialysis. Also, obesity rates and diabetes prevalence in American Indian and Alaska Native youth have not increased since 2006.”

What’s working?

In Poplar, Montana, Tessie LeMere, diabetes coordinator for the Fort Peck Tribal Health Department, says a lot of the work is community focused. One important activity encouraging people to drink water instead of sugary soda. “We offer our water system. If you have your own jug, you can bring it in here and we’ll give you clean water. We do home visits. We do community screenings. The community screenings are a big thing because it’s not just for our patients, that’s for everybody just to get the awareness and prevention out there. We have wellness centers. We pay to those so our patients have access. We also have a dialysis program over at tribal health. That I think has brought the awareness more into reality.”

Perhaps that’s it. The success in Indian Country of the diabetes program is about doing everything, reaching out to both patients and those who are at risk for the disease. Again the numbers tell a story. A generation ago, before the Special Diabetes Program for Indians, only about a third of all Indian Health patients had access to diabetes clinics; today that number exceeds two-thirds. And 94 percent of patients have access to diabetes clinical teams, three times more than in 1997. And nearly 100 percent — 99 percent according to IHS — of people in the IHS system have access to diabetes education (up from 36 percent in 1997).

We hear all the time about how bad things are in Indian Country. The story of improving diabetes rates counters that narrative. It shows a lot of things: First, tribally designed programs work, government funding is important and lessons from Indian Country can help the larger nation treat its diabetes epidemic

Mark Trahant is an independent journalist and a member of The Shoshone-Bannock Tribes. For up-to-the-minute posts, download the free Trahant Reports app for your smart phone or tablet.

Fort Peck Tribal Health Department is a success story showing how a community can reduce diabetes rates. From left: Janene Padilla, Diabetes Coordinator Tessie LaMere.  Cheryl Bighorn-Savior (RN), and Laurel Cheek.

Fort Peck Tribal Health Department is a success story showing how a community can reduce diabetes rates. From left: Janene Padilla, Diabetes Coordinator Tessie LaMere. Cheryl Bighorn-Savior (RN), and Laurel Cheek.

  
Mike Williams and his granddaughter Megan at a hunting and fishing rights rally last year in Anchorage. (Williams family photo.)

New inter-tribal fish commission formed to give Alaska tribes a say



MARK TRAHANT

Alaska reminds me of Washington state. Let me qualify that. Alaska reminds me of Washington state before the mid-1970s. Back then the region was deeply divided over treaty rights, salmon, and even the definition of what it meant to be an American Indian in modern times. 

The official state government machine, ranging from biological reviews to law enforcement, was geared up to obliterate any tribal claims to salmon fishing. The clashes were not just legal; many were violent and tragic.

But then Boldt happened. Federal courts upheld the treaty rights of Native people. As author and professor Charles Wilkinson wrote: “The truest and most profound fact about the Boldt decision is that it was conceived and accomplished by Indian people. The transcendent meaning of the Boldt decision was to uphold the treaty rights of Northwest tribes, but it was also a national case about national obligations and values. The decision was a gift to all of America.”

The 1974 ruling by U.S. District Judge George Boldt did something else. It established tribes as “co-managers” of the salmon. So tribes and intertribal organizations organized and invested millions of dollars on salmon habitat recovery, management, and even law enforcement to make certain that the tribal side of the bargain was met.  Most important: Tribes gained a meaningful say about wildlife management. Salmon are still under significant threat, but river after river is also showing improvement.

Alaska’s story is a bit different — even as it evolves. The newly created state of Alaska took charge of fish and game in 1960. And a few years later the state began to close traditional fisheries claiming conservation. Instead of a treaty document that outlined a clear tribal right to hunt and fish, the 1971 Alaska Native Claims Settlement Act ended the formal protection of aboriginal rights. However in 1980 Congress enacted a subsistence title to the Alaska National Interest Lands Conservation Act. The new federal law was supposed to protect customary subsistence uses by Alaska Natives. 

But the definition of that “protection” was assumed by the state and federal governments with little meaningful role for Alaska Natives. And when Native voices did rise, the state’s reaction was mostly litigation or criminal enforcement.

On May 5, 2015, 28 tribes on the Kuskokwim River started down another path, assuming co-management of fish in the river system by creating a Kuskokwim River Inter-Tribal Fish Commission. It’s modeled on the Northwest Indian Fish Commission, an organization that was led for many years by the legendary Billy Frank Jr. (Frank is really an American hero. He went from being a “getting arrested guy” during the fish wars to a wise elder who was widely respected.) Mike Williams, Sr. of Akiak, was elected chairman of the new commission.

“The people of the Kuskokwim River are no longer satisfied with serving in an advisory role to state and fishery managers,”  says a news release from the new commission. “The message, Kuskokwim River tribes and rural residents desire a “meaningful role” in the management of fish and wildlife as it is expressed by Congress in section 801 (5) of the Alaska National Interests Lands Conservation Act, a role that until now most Western Alaskans agree has been meaningless.

I am convinced that co-management works. In Washington, Oregon and in Idaho there are salmon streams that would have gone extinct without a broader, more comprehensive management approach. Even small tribes hire people to work on habitat restoration or protecting baby salmon from predators. And it’s hard to understate the importance of creating natural resource jobs because it gives Native people a new purpose, working on the land to improve wildlife.

“My thoughts go to my ancestors that have managed our resources for over 10,000 years. They have done a great job in making sure we have food security,” said Chairman Williams. “We have traditional science and knowledge as we live right where they always fished. In recent times, the federal and state governments have begun to manage our resources. The policy is coming from far away.”

Williams said that there have been too many advisory boards that many Native people felt were wastes of time because they weren’t followed up with cooperation. 

“I sat down for many hours with my uncle, the Late Joe Lomack, Traditional Chief, on the climate and natural resource issues,” Williams said.  “We got very concerned on the reports about Chinook disappearing up north then the Yukon River and then our Kuskokwim River. Now that we have established our Fish Commissions, both in the Yukon and Kuskokwim Rivers, we have a structure in place to start to engage our involvement in a meaningful ways to help manage our resources instead of always giving advice.”

This is the moment when Alaska should embrace this approach. For too many years the state has spent significant resources litigating against a tribal say instead of listening. This is both expensive and ineffective.  On the other hand, a meaningful role for tribes on wildlife issues has proven to be successful in Washington and other Northwest states.

It’s time for Alaska to deliver this gift to America.

Mark Trahant is an independent journalist and a member of The Shoshone-Bannock Tribes. For up-to-the-minute posts go to trahantreports.com or, download the free Trahant Reports app for your smart phone or tablet.

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Budget targets $246 million below last year’s committee levels, says Democrat on House Interior Appropriations

MARK TRAHANT / TRAHANTREPORTS.COM

House and Senate negotiators have reached a deal on a budget resolution. That agreement then would go to each House for a vote. (An outcome that is not certain.) But, if it passes, it would be the first budget enacted by Congress in six years.

Let’s be clear about this plan: It would require deep spending cuts in federal Indian programs.

While the budget itself is not law, it sets limits for each of the appropriations committees to follow. According to a report from The Associated Press the draft document adds some $40 billion to military spending and calls for deep cuts to all domestic programs, including the Bureau of Indian Affairs and the Indian Health Service.

“The plan sets broad budget goals but by itself has little teeth; instead, painful follow-up legislation would be required to actually balance the budget,” the AP said. “It also permits the GOP majority to suspend the Senate’s filibuster rule and deliver a special measure known as a reconciliation bill to Obama without the threat of Democratic opposition. Republicans plan to use the special filibuster-proof bill to wage an assault on Obama’s Affordable Care Act rather than try to impose a variety of painful cuts to Medicare, Medicaid, food stamps, student loans, and other so-called mandatory programs over Obama’s opposition.”

The House budget is blunt about the next steps required to balance the budget within a decade, including another repeal of the Affordable Care Act. “None of the reforms proposed in this budget will be able to solve the underlying challenges in our health care system so long as Obamacare remains on the books. Our budget fully repeals Obamacare,” according to the budget plan.

This very notion sets up a debate. President Barack Obama would need to sign any appropriation into law — so a veto threat has merit. But the Congress still must pass a bill to appropriate money that would defy their own budget rules on programs such as the Indian Health Service (because some of that agency’s authorizing legislation is the Affordable Care Act. Remember: The Indian Health Care Improvement Act is a chapter of the ACA.)

So the actual final budget is going to be difficult to resolve.

At the same moment that the Congress is pursuing its latest “repeal” of the Affordable Care Act more states, even states controlled by Republicans, are moving forward with an expansion of Medicaid. This may be the most important part of the Affordable Care Act, especially for Indian Country because it’s adding new dollars to the underfunded health care system. Montana is the latest state to expand Medicaid.

A new report by the Kaiser Family Foundation says hospitals in states with Medicaid expansion are reporting a significant decrease in uncompensated care and a boost from Medicaid revenue. “Overall,” the report said, “hospitals in Medicaid expansion states saw increased Medicaid discharges, increased Medicaid revenue, and decreased cost of care for the poor, while hospitals in non-expansion states saw a very small increase in Medicaid discharges, a decline in Medicaid revenue, and growth in cost of care to the poor.”

In past budget years, American Indian and Alaska Native programs have been able to get support from the appropriations committees, but in this cycle there will be less flexibility because of the instructions in the budget. The ranking Democrat on the House Appropriations Committee, Rep. Nita Lowey from New York, said the “Majority’s allocations, which are based on the House budget resolution that passed on a party-line vote, are insufficient and fundamentally flawed.”

She said: “The Interior bill’s allocation paints a similar picture with an allocation that is $246 million below the FY 2015 enacted level. We will still have to cover the increased costs to combat deadly wild fires, provide contract support costs in the Indian Health Services, and prepare for Centennial anniversary of the National Park Service, all from an allocation below last year.”

This budget resolution would cut deeper than even the sequester. As Lowey said in a press release, “I think my colleagues on the other side generally agree that sequestration was a failure, and a return to those sequester-level caps threatens important defense and non-defense priorities alike.”

The Republicans have yet to identify specific spending numbers based on their budget targets.

No Democratic votes are required in either the House or the Senate to enact this budget resolution. The president does not need to sign the resolution, but he will need to sign into law any future appropriations based on the spending plan.

Mark Trahant serves as the Atwood Chair at the University of Alaska Anchorage. He is an independent journalist and a member of The Shoshone-Bannock Tribes. For up-to-the-minute posts, download the free Trahant Reports app for your smart phone or tablet.

Montanans love to talk about how special our state is. For those from some place other than Montana, you may think that we mean our beautiful mountains, the vast golden prairies, and incredible blue sky that never seems to end. And you would be right – we do mean that. But what really makes Montana special is the people.

The people of our state are kind and generous. We are the type of people who celebrate together during the good times, and look out for each other when times get tough.

Montana is particularly lucky because the people can dramatically change the direction and future of our state. Over the last few months, it was clear that the people of our state stepped up and did just that. They talked and our legislature listened. Late last week, the Montana Legislature passed the Health and Economic Livelihood Partnership (HELP) Act (SB 405). This bill is compromise legislation to extend health care coverage to low-income Montanans who need it, and the Governor has indicated that he will sign it as soon as it reaches his desk.

We are a group of organizations that have spent the past two and a half years working to expand access to affordable health care for the lowest-income Montanans. And we will forever be grateful to you, the people of Montana, for making your voices heard.

It was you who made more than 10,000 calls and emails to your legislators in support of Medicaid expansion. More than 150 of you submitted letters to the editor and opinion editorials. More than 300 of you came to the Capitol to testify. You kept the conversation going on social media. Hundreds of you came to rally on the Capitol steps or walk the halls talking to your legislators. It was you who passed Medicaid expansion.

Montana will be a better place because you made your voices heard. This legislation will help create thousands of new jobs. Montanans will be healthier and more productive because when people have health care, medical problems are more likely to be treated earlier and illnesses are less likely to affect one’s ability to work. Our rural hospitals will be able to keep their doors open because more people will have insurance to cover medical expenses. Montana tax dollars will come back to our state to boost our economy. And most importantly, tens of thousands of Montanans will be able to get the health care they need and deserve.

Never forget that when you talk – and sometimes it has to be loud and often – but if you talk loud and often enough, your elected representatives will listen.

Montana thanks you.

Sincerely,

Montana Women Vote, Montana Human Rights Network, Montana Budget and Policy Center, Montana Primary Care Association, American Cancer Society Cancer Action Network, Montana Organizing Project, Planned Parenthood Advocates of Montana, Western Native Voice, SEIU 775, MHA…An Association of Montana Health Care Providers, and AARP Montana.

MARK TRAHANT

Montana will be the next state to expand Medicaid. Gov. Steve Bullock is expected to sign the bill authorizing expansion into law on Wednesday at noon.

Remember this is a Republican-controlled legislature — so I think it demonstrates that when people really look at the numbers, the number of jobs, the number of people insured, the reduction in uncompensated care for health facilities, the case for expansion is overwhelming.

The Montana Budget and Policy Center reports that there remains work to be done. From the Center’s post: “Next, the state will have to submit a section 1115 waiver to the federal government to expand coverage and receive increased federal funds. Section 1115 waivers allow states to pursue experimental, pilot, or demonstration projects that promote the objectives of Medicaid, namely to keep low-income families healthy. (It’s called “1115 waiver” for short, because of the section in the Social Security Act where this flexibility is provided.)” That process will require approval from the Centers for Medicaid and Medicare Services (or CMS). “The 1115 waiver process is an important step, and we will be closely following it. 70,000 Montanans are depending on it.”

The Montana Budget and Policy Center also submitted an op-ed for publication. I’ll post that shortly.

Western Native Voice reports: Native Americans working for progressive change in Montana Indian communities will rally before the Medicaid expansion bill signing ceremony Wednesday, April 29th, at 11:30 AM on the stairs of the Capitol. Coming together to celebrate Medicaid expansion and all the other important legislative achievements for Montana Indians, the rally will also focus on the road ahead to building civic power in Native communities

In Alaska the outcome over Medicaid expansion is still unknown. The Alaska Legislature has not been keen on expansion despite a push from the Gov. Bill Walker.

The Republican strategy against Medicaid expansion focuses on reimbursement rates for Medicare, pitting seniors against those eligible for Medicaid (including the Alaska Native medical system). What’s interesting to me is that the job picture has not been a part of the debate when the evidence in every other state that has expanded Medicaid is that new jobs were added.

Two other Montana legislative developments: Enacting a water rights settlement and improving the funding for tribal colleges. The new law authorizes an 8% increase to the per-student funding that tribal colleges receive for non-Indian resident students, subject to appropriations, changing the distribution rate from $3,024 to $3,280 per non-Indian student. This is the first increase to the statute since 2006.

“In Montana, tribal colleges and universities benefit the state economy and provide an affordable option for quality post-secondary education,” said Laura John, State-Tribal Policy Analyst for the Montana Budget and Policy Center. “House Bill 196 takes us one step closer to reaching adequate funding levels needed to support Montana’s non-tribal students.”

The governor called the legislature back into special session. So there will be more twists and turns ahead.

I also wrote a few weeks ago about price of oil and its impact on Keystone, the tar sands, and other debates over energy policy versus the environment.

Two pieces are worth looking at. First, a Brookings report that says low oil prices are here to stay. (The reason is simple: Excess capacity, reduced consumption and lots of oil being pumped by every concern.) As the report points out: “The U.S. and its neighbor Canada have both increased oil output, and their response to the fall in oil prices has been to reduce the pace of production growth by reducing capital investment, but output and capacity continues to grow.”

Today Bloomberg posted five charts that tell the story quickly.  “Before deciding prices will race back to $100, here are five charts worth keeping in mind.”

President Barack Obama and First Lady Michelle Obama have lunch with youth from the Standing Rock Sioux Tribe at We The Pizza/Good Stuff Eatery in Washington, D.C., Nov. 20, 2014. (Official White House Photo by Pete Souza)

President Barack Obama and First Lady Michelle Obama have lunch with youth from the Standing Rock Sioux Tribe at We The Pizza/Good Stuff Eatery in Washington, D.C., Nov. 20, 2014. (Official White House Photo by Pete Souza)

Investment in Native youth equals a million lines of code

MARK TRAHANT

No child grows up hearing — or asking — for numbers. Instead the four words, “tell me a story,” are the ones deeply embedded into our human software. And that will never change. But the power of numbers, the importance of data, is growing exponentially and becoming essential to how we understand larger narratives.

Then this is not new. The use of statistics, counts, numbers, all have always been a part of how we tell stories. Buffalo hide paintings are great examples from another century. Pictographs recorded people, buffalo, soldiers, villages, and meteor storms. The data was recorded.  Then we did the same things with ledgers, books, computer tapes, and a couple of decades ago floppy discs, CDs, and thumb drives. Today we carry more data capacity in our phone than we ever had in our offices and homes. And what’s on that recording? IBM once estimated that the content of all of human history totaled some 5 exabytes (or five billion gigabytes of information). Now we produce that many videos, pictures, and words every couple of days.

We need more useful numbers — and this is one of Indian Country’s great challenges in an era of both austerity and transparency. In 1900 the Bureau of Indian Affairs budget was $8.2 million. It took nearly 80 years before that funding level topped a billion dollars. Then the first $2 billion was  in 2001. Last year $ 2.6 billion. And the Obama administration’s current request is for $2.924 billion. (I am working on a history of Indian appropriations — more on that soon.)

So I have been thinking about these numbers in the context of the recent narrative about Native youth. The stories themselves are inspiring, starting with the president’s visit with young people in North Dakota, followed by the recent meeting at the White House. As First Lady Michelle Obama put it: “So we all need to work together to invest deeply — and for the long-term — in these young people, both those who are living in their tribal communities … and those living in urban areas across this country. These kids have so much promise — and we need to ensure that they have every tool, every opportunity they need to fulfill that promise.”

This is where the numbers and the story intersect.

A commitment to invest deeply and for the long-term requires serious cash and resources. The president’s budget matches that rhetoric with a budget request of $1 billion to promote Generation Indigenous, an initiative designed for Native American youth. “In today’s global economy a high quality education is no longer just a pathway to opportunity – it is a prerequisite to success,” the Interior Department said. “President Obama set out a vision for a 21st century education system grounded in both high academic standards and tribal values and traditions. Making advanced education opportunities available for tribal members is a high priority for tribes, who see education as the path to economic development and a better quality of life for their communities through an educated and skilled tribal member workforce.”

Today’s Native youth are perfectly cast for this initiative. Even on remote reservations or Alaska villages this is the digital native generation. They have grown up collecting more data on their phones — music, Facebook posts, video and photographs — than any other generation in history. They grow up connected to other Native youth across the country making deep digital friendships with dozens, even hundreds of other Native American youth. That’s new. It’s exponential.

I also think about the digital opportunity ahead for young people who live in a remote community. You can live anywhere in the world and produce videos for YouTube. Or write computer code. In 1971 a Unix computer had a couple hundred thousand lines of code. Today the software for a modern car has more than 90 million lines of code. That’s a lot of jobs for young people who have the right skills. And why not Generation Indigenous?

Of course that means Congress will have to actually appropriate the kind of dollars to make youth a priority. Not just a story, but a future that’s bolstered by real numbers.

Mark Trahant serves as the Atwood Chair at the University of Alaska Anchorage. He is an independent journalist and a member of The Shoshone-Bannock Tribes. For up-to-the-minute posts, download the free Trahant Reports app for your smart phone or tablet.

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