Indian Country politics and public policy

Commentary by Mark Trahant

 

 

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Make or break week? Senate Majority Leader Mitch McConnell said it was important to vote on a Senate health care bill before the July 4th holiday recess. But what’s in that bill? Ah. That won’t be known until it’s time to vote. (McConnell press office photo via Twitter.)

How to destroy the economy with 50 votes

Mark Trahant / Trahant Reports

I have been wondering what I should say about the Republican health care legislation in the Senate. We do know that there is a policy split among Senators about how much and how fast to cut Medicaid. We know the bill will cut taxes. But beyond that there is more information on one of my whiteboards than what is posted in public.

Senate Majority Leader Mitch McConnell is moving this legislation in secret. And there’s a reason. As The Washington Post puts it: “ So McConnell’s theory is that if the Senate’s bill were seen, debated and discussed, opposition would grow and grow, and eventually at least three of his members would bail out (the Republicans’ 52-48 majority means they can only lose two votes). Which might well be true.”

So true in fact that I am not sure which is a worse outcome for Republicans: Failing to pass a bill (ticking off their conservative base) or passing this legislation that by all independent measures will make the U.S. health care system worse.

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It’s easy to imagine the coming 2018 election commercials: Millions lose health insurance; health care-related bankruptcies on the rise; and all done in secret so that wealthy campaign donors pay less in taxes.

Indian Country, of course, is largely missing from this debate. There is an assumption that the bill doesn’t impact the Indian Health Service. But Medicaid is growing and it could be, no, ought to be, a significant funding stream for IHS. Even the Trump administration’s budget recognizes that. It projects $914 million in third-party billing for IHS in fiscal year 2018, a slight increase. That’s mostly Medicaid. But the numbers don’t reflect what will happen if that Medicaid money is taken away because the IHS appropriations (which is essentially flat) will have to serve more patients with less resources. Remember half of all Native American children are insured by Medicaid or the Children’s Health Insurance Program.

When the House passed the American Health Care Act a number of “moderate” House members said the bill was bad, but don’t worry the Senate will fix it. Even President Donald J. Trump echoed that idea, telling Senators the House bill was mean and that the Senate should be more generous.

In fact the idea that the Senate would make the bill better was a key part of the House vote. Alaska Rep. Don Young, for example, was said to be a no vote (Alaska gets the worse deal of any state in the House legislation) but ended voting yes. Young told the Alaska Dispatch News two things: First, the bill was moving too fast. And, more important, “this bill we passed today will not become law. It’ll be changed as time goes by. But unless we move it, or move a vehicle, nothing’s going to happen, and that’s not good.”

So process mattered. Then. Now the Senate is engaged in the screwiest legislative path ever; essentially asking Senators to support a blank page. And improving the bill? Hardly. The secret Senate bill is only trying to win with 50 votes, not shape sound public policy.

Every member of the Senate Republican caucus agrees on cutting taxes. That’s the fuel that keeps this bill moving forward. But not all agree about cutting Medicaid (and funding for Planned Parenthood). In a closely divided Senate some members are going to have to take one for the team; vote against their own state interests and voters. Thirty-one states expanded Medicaid coverage under the Affordable Care Act — and twenty of those states are represented by Republicans. All but three have to agree to take away insurance from their voters.

But that’s the easy sell. If there is a long transition period probably nearly all of the 20 Senators will go along. But the conservatives (especially those that represent states that did not expand Medicaid) want a quicker timetable. That means the “moderates” will be going before voters right away and campaigning on less Medicaid for all. That’s terrible politics because the numbers are staggering: Seventy million Americans are on Medicaid. If Congress turns this into a block grant program millions will lose health insurance. Millions of voters.

There are new studies that show how devastating the American Health Care Act would be to public health and the economy. A study by the Commonwealth Fund says nearly a million Americans would lose jobs if this legislation passes. “By 2026, 924,000 jobs would be lost, gross state products would be $93 billion lower, and business output would be $148 billion less. About three-quarters of jobs lost (725,000) would be in the health care sector. States which expanded Medicaid would experience faster and deeper economic losses,” the Commonwealth Fund study found.

Indian Country would lose jobs, too. There are no numbers yet but the Indian Health Service budget would take a significant hit and there would be pressure to reduce the number of employees. Remember the Indian Health system is Indian Country’s largest employer.

The Senate only has a few working days before it’s July recess. If it’s to become law, the bill will need a “score” from the Congressional Budget Office (because of Senate rules this bill must be budget-related). But that won’t happen unless McConnell thinks he has the 50 votes needed to pass. Policy be damned.

Mark Trahant is the Charles R. Johnson Endowed Professor of Journalism at the University of North Dakota. He is an independent journalist and a member of The Shoshone-Bannock Tribes. On Twitter @TrahantReports

Reposting or reprinting this column? Please credit: Mark Trahant / TrahantReports.com

 

History

Raw data? Charts and interactive version of this graphic here and here.

 

Fair to say this budget will result in the early death of too many people

Mark Trahant / Trahant Reports

It’s easy to blame Donald J. Trump for a terrible budget. This is classic disruption; it’s designed to change the nature of government immediately. It’s also a destructive document that would result in great hardship across the nation and Indian Country. It’s not too strong to say that this plan would mean an early death for too many people.

So we ignore what’s proposed and turn to Congress for the real spending plan. The idea is that Congress will do something better. They must. Or face the consequences from voters in the 2018 elections. And it’s already clear that few Republicans are eager to reshape government (at least as dramatically as the president.)  It’s unlikely that Congress will vote to eliminate agencies ranging from the Corporation for Public Broadcast to the Denali Commission. And the minus signs inked across budget lines will be less severe than requested.

But let’s be clear: The best outcome is probably another Continuing Resolution that patches together a temporary budget for a few months or possibly the entire year. Again. That’s become business as usual in Washington.

The ‘worse’ news: A failure to govern

That’s the good news. The bad news — strike that — make it the worse news is that neither political party has enough support to enact a thoughtful spending plan. The crisis is not a financial one (well, it is sort of) but represents a systemic failure to govern.

The best example of that problem is the debt ceiling. Basically it’s a law that allows the Secretary of Treasury to finance the debt that the United States already owes. The money has already been appropriated or authorized by Congress. It’s spent. So the only question is to pay the bill or not. Yet nearly every member of Congress (from the Tea Party to Sen. Barack Obama) bluster about the debt and threaten to withhold their vote. But the party in the White House cannot operate that way. Obama changed his tune as quickly as did Trump. It’s the nature of the job.

Congress isn’t run by two political parties; there are at least three major factions. (This is not unusual: Just before the Civil War the Republican Party was deeply divided by economic conservatives and the Radical Republicans who were organized against slavery.) Today’s Congress is composed of Republicans, the more strident House Freedom Caucus, and the Democrats.

It will take votes from two of the three factions to lift the debt ceiling and pass a budget in the House. This is important because the first “test” of a coalition was the vote to repeal the Affordable Care Act and replace it with the American Health Care Act. The moderate Republicans sided with the House Freedom Caucus to pass a measure that would strip insurance coverage from 23 million Americans (according to the Congressional Budget Office). You’d think this would be nonsense politics for Republican moderates. Yet they still voted yes. The thing here is that this is the coalition to watch. So if Speaker Paul Ryan goes that route again it will mean a debt ceiling bill that results in even more spending cuts than the Trump budget. Imagine that.

The other alternative is just as unthinkable. It’s for Ryan to reach out to Democrats and build a majority coalition. This happens in state capitals all the time. But it’s considered near treason in politics and it would cost Ryan his job. Beyond that, the votes of the Democrats would come with a price, most likely a promise not to cut taxes on the wealthy.

Then whatever spending bill that emerges from the House must win 60 votes in the Senate. That’s not going to happen if the House Freedom Caucus wins the day. (Remember there are currently 52 Republicans, 46 Democrats and 2 independents in the Senate).

This is real juggling. Debt. Budget. And health care. And the Juggler-in-Chief doesn’t even like balls in the air. He tweeted last month: “Our Country needs a good ‘shutdown’ in September to fix mess!”

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A federal government that’s ‘ineffective’

Back to the budget and what it means for Indian Country.

The same division in Congress over the debt ceiling (or health care) will play out on the budget. The House Freedom Caucus essentially agrees with the president’s budget. If there’s any reluctance … it’s that the spending cuts are not deep enough. The argue that the federal budget must be balanced in a decade and it will take painful cuts to reach that goal. (So the other Republicans, such as Rep. Tom Cole, will need to find votes for their moderate course from Democrats to reach a legislative majority).

The tension over national spending priorities, historically, has impacted federal Indian policy before.

President Franklin D. Roosevelt initially sharply cut federal Indian programs as part of an austerity drive.

In the late 1920s and early 1930s spending by the Bureau of Indian Affairs doubled from 1928 to 1932 (following the publication of the Meriam Report about the failure of federal programs and declining health, education and just about social indicator for Native Americans. “Several past policies adopted by the government in dealing with the Indians have been of a type which, if long continued, would tend to pauperize any race,” the report said, calling the government’s efforts “ineffective.” But Hoover’s 1933 budget reversed that progress and cut the Bureau of Indian Affairs budget by 15 percent, dropping from $25.6 million to $22.1 million. Then a year later, in 1934, dropped another 13 percent to $18.7 million.

But it was Congress — not the president — that was stingy. But at a public hearing in 1938 tribal leaders from Wisconsin, Minnesota and Michigan complained about the “resistance of the government itself against any increased appropriations.”

However after the passage of the Indian Reorganization Act in 1934 spending did pick up and budgets increased.

After World War II the government again sharply cut spending in Indian Country. The 1948 budget declined by 9 percent, but that turned out to be a one-time hit. A year later the budget increased by more than 50 percent, to $62.1 million.

The figures were similar after President Richard Nixon announced the new policy of self-determination without termination on July 8, 1970. Nixon said, “we must begin to act on the basis of what the Indians themselves have long been telling us. The time has come to break decisively with the past and to create the conditions for a new era in which the Indian future is determined by Indian acts and Indian decisions.”

And the BIA’s budget reflected that idea. The budget increased by 18.5 percent in 1971, another 19 percent in 1972, and 23 percent in 1973.

But Nixon, like many Republicans, separates federal spending on the Bureau of Indian Affairs and the Indian Health Service from other programs that benefits Native people. President Lyndon B. Johnson’s Great Society programs such as the Office of Economic Opportunity opened up new channels for tribal innovation. For the first time tribal leaders were managing significant budgets without the Bureau of Indian Affairs. The agency’s director wrote Congress in 1974 that OEO was ineffective and an “old approach” that did not serve the poor.

This is a pattern that continues today. Many mainstream Republicans are supportive of appropriations for the Bureau of Indian Affairs or the Indian Health Service, but less so for other general programs that benefit Indian Country, such as the Comprehensive Employment and Training Act (signed into law by Nixon but ended by Ronald Reagan.)

A twist here: My first professional job as editor of The Sho-Ban News was funded by CETA in 1976. Tribes could use the money to create jobs — even at a tribal newspaper. And did so.

I had moved to Washington, D.C., before Ronald Reagan was elected in 1980 and he, like Trump, promised sharp cuts across the federal government. One plan was floated that would cut social programs by a third (shifting some of the money to states as block grants).

But Congress was on the other side of this equation and mostly ignored the president’s requests.

Yvette Joseph, Colville, who was working for the Senate Committee on Indian Affairs, compared the budget on Indian programs from 1968-1988 to similar government programs and found significant underfunding. She wrote: “Gwen Ifil did a story on my research when she worked for the Washington Post. It made it on the front page of the newspaper and was the impetus for Senator Dan Inouye seeking a billion dollar increase to the Indian Budget because we could show how significantly, the federal Indian budget had been been reduced under Ronald Reagan’s zero-sum budget policies. That year, we did not reach our goal, but were in fact able to increase the American Indian / Alaska Native budget by $750 million in FY 1989. It was amazing to be a part of this work.”

Obama is the exception to the rule

The Obama era is another exception, and on the upside. As former Assistant Secretary for Indian Affairs Kevin Washburn wrote in Indian Country Today: “In his first term, Obama increased the Indian Health Service budget by more than $800 million and steadily increased IHS funding by more than $1.2 billion, reaching $4.8 billion in total. Obama’s second term began inauspiciously with sequestration imposed by Congress in 2013, but the Indian Affairs budget at Interior for the Bureau of Indian Affairs and the Bureau of Indian Education nevertheless increased from approximately $2.3 billion to $2.8 billion before Obama left office, an increase of a half-billion dollars. These increases significantly outpaced inflation and produced real and significant gains for Indian country.”

Beyond that top-line there was another potentially significant action that’s being debated again: The Affordable Care Act. This law opened a door for the full-funding of the Indian Health Service because it recognized that health care delivery and insurance are not the same thing. So if more American Indians and Alaska Nations could bring insurance to their federal, tribal, or not-for-profit clinic, it could add significant resources to the entire system. It did this by expanding Medicaid, requiring tribal employees to have insurance, and by setting up a free insurance plan under the ACA. I think a lot more could have been done to promote this idea, but it’s all at risk now anyway. But it’s important to note that Medicaid works — especially in Indian Country. (I will be writing more about that next week as health care debate moves to the Senate). More than half of our children are now covered by that public insurance. And we still have thousands of people who are eligible but who have not yet signed up.

Medicaid is an entitlement. That is different from appropriations because Congress does not have to act for the money to be there. (Which is exactly why the Republicans want it to go away by changing the law.)  Medicaid was the most successful part of the Affordable Care Act, both in Indian Country, and among the general population. Yet the House plan would cut spending by $834 billion over ten years and shift more of the cost of public health insurance to the states (leaving huge questions about where American Indian and Alaska Natives fit in).

Ok. Stay with me here. This will be complicated. Much of the budget cuts — including those that would impact Indian Country — are taken from the smallest part of the budget, domestic discretionary.  All safety net programs (except for health and social security) total about 10 percent of the budget. The big bucks are found at Social Security (33 percent); Medicare, Medicaid, Children’s Health Insurance Program, and marketplace subsidies together total about 28 percent of the budget. Defense is 16 percent of the budget and Veterans programs at about 4 percent. And interest on the debt is 7 percent (thanks to low interest rates). But expect that category to grow as interest rates increase.

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Domestic programs are already funded at historical lows. This chart from the Center on Budget and Policy Priorities shows spending levels below that of 1962.

Domestic spending (except for health) has been declining since 2010. Depending on the final numbers in Trump’s budget, it’s likely that spending will drop to less than what was spent on 1962 on such programs. Before the Great Society. This is the part of the budget that includes Indian Country programs.

The point here is that the Congress could zero out domestic spending and there still would be a deficit.

The bigger problem is demographic. Two trends to consider. First the sheer size of the Baby Boom generation. And, second, humans are living longer than ever before. As Pew Research points out “about 10,000 Baby Boomers are retiring every single day, many of them not as well prepared financially as they’d hoped. The graying of our population will put stresses on our social safety net and present our elected leaders with a daunting challenge: how to keep faith with the old without bankrupting the young.”

Medicaid is a great example of this divide. Most of the news stories (including mine) focus on the health care aspects of this great program. Yet two-thirds of Medicaid — nearly $400 billion — is spent on the elderly and the disabled. About 60 percent of nursing home residents are supported by Medicaid and it’s the only program for seniors and for people with disabilities that pays for long-term care. Our discourse and the debate seems to ignore that.

Then our elders in Congress aren’t any better than those of us who write. Consider the illogic of the House Republican budget: It protects Social Security but it could wipe out funding for the older Americans who live in nursing homes. That same budget proposal cuts Medicaid for the poor both adults and children, but protects Medicare for those 65 years and older.

So who, exactly, are the constituents? (The only answer that is consistent: Tax cuts for the wealthy. That’s the point of the GOP health care plan.)

Also from Pew: “Today’s Millennials – well-educated, tech savvy, and underemployed – are at risk of becoming the first generation in American history to have a lower standard of living than their parents.” (It’s worth noting that young people in the United Kingdom turned out in record numbers and one of their top concerns was “austerity.”)

To be fair, Democrats haven’t come to grips with the cost side of this equation. There are just not enough taxes to pay for the growth of Medicare and Medicaid unless there is also a significant restructuring of the health care system. Still. The Affordable Care Act was just a start. A baby step at that. Get this: The Indian Health system is more in line with a health care system should cost than what is spent by the rest of the country. The gap that we so often complain about must be the country’s future. (As a reminder: According to the National Congress of American Indians, In 2014, the IHS per capita expenditures for patient health services were just $3,107, compared to $8,097 per person for health care spending nationally.)

So, yes, eventually, that means a single payer system of some kind. Sooner would be better than later. There is no other way to make the budget work.

Neither the Congress nor the White House is ready to take on these big issues. It’s much easier to cut smaller programs that matter to people, again, like those that serve Indian Country, and think the task is complete. It’s not.

So while it’s easy to blame the president for a terrible budget. The problem is much worse. And the solutions remain distant. The government is failing.

Mark Trahant is the Charles R. Johnson Endowed Professor of Journalism at the University of North Dakota. He is an independent journalist and a member of The Shoshone-Bannock Tribes. On Twitter @TrahantReports

Reposting or reprinting this column? Please credit: Mark Trahant / TrahantReports.com

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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A glacier on Mt. Anderson in the Olympic Mountain Range is gone as a result of climate change. Quinault President Fawn Sharp says that’s a clear sign that something is wrong. Four tribes said they would implement the Paris agreement even though President Donald J. Trump said he’s out. (Photo by Larry Workman of Quinault Nation.)

Protecting Mother Earth and tribal homelands

Trahant Reports

President Donald J. Trump announced last week that the United States was pulling out of the Paris agreement on climate change. That agreement includes every country in the world except Nicaragua, Syria … and now the United States.

The problems related to climate change are  enormous — so the thinking goes — and the best course is a planetary response.

But nearly every government will be involved, including tribal governments.

Shortly after the president’s announcement four Native Nations announced their plans to support the Paris agreement.

“For hundreds of years the pollution based economy has degraded our home,” states Swinomish Chairman Brian Cladoosby in a news release. “We can no longer allow a failed system to continue to destroy the planet.  The Paris Climate Change Agreement reflects the global consensus that we must act together and we must act now.”

The Standing Rock Sioux Tribe, the Quinault Indian Nation, the Swinomish Indian Tribal Community, and the Central Council of the Tlingit and Haida Indian Tribes of Alaska said they will fill the vacuum and take aggressive action to protect the places we call home. The tribes said in a news release that climate change touches all aspect of life, from those who have no voice, the salmon, buffalo, seals and polar bears, to those who are suffering the impacts of water loss, shoreline erosion, drought and loss of homelands and waters.

Across North American tribes see climate change, or global warming, as real, human-caused, and something that is changing life right now.

The Quinault Nation is already experiencing an increase in ocean storm surges that requires the Lower Village of Taholah be relocated because of flooding and a potential catastrophe if there were to be a tsunami.

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Quinault President Fawn Sharp. (Photo by Larry Workman, Quinault Nation.)

Tribal President Fawn Sharp said: “We are talking about human lives here, and regardless of who is in office the fact is the federal government is our trustee … This responsibility is constitutionally mandated, and it’s not something the President or anyone else can wriggle out of.”

“Climate change is the definite direct cause of many other challenges as well, not just for us here at Quinault but for all citizens,” she said. “When a critically important glacier that’s thousands of years old totally disappears in a matter of a few years, it’s a sure sign that something’s wrong. And that something is man-caused climate change. The same goes for the massive algal blooms and the, warm areas and acidification problem in the ocean, the increased forest fire danger, slide and erosion  problems, invasive species  and low flows in our area rivers. These are very serious problems.”

Last year the Bureau of Indian Affairs awarded $8.7 million for tribal climate change projects for 63 tribes. But more than 200 tribes applied for the program and the Trump administration says it is ending all federal spending on climate change programs.

The president said that withdrawing from the agreement will support more energy resource development, including a revival of the coal industry. And a couple of weeks ago Vice President Mike Pence toured a working coal mine on the Crow Reservation promising new jobs. But that might be an impossible dream. The job losses in the coal industry have more to do with the low price of natural gas and changing global markets.

Standing Rock Chairman Dave Archambault II says his tribe is actively moving away from fossil fuels. “Indigenous communities around the world are among those being most quickly and severely affected by climate change. Regardless of the official position of the United States administration, we will continue to stand together in agreement with the Paris Climate Change Agreement,” Archambault said. “Our tribe is actively working to move away from fossil fuels and we continue to battle those who disregard our efforts to protect our water and lands.”

People living in Alaska are also already seeing impact of a warming planet. “Alaska tribal governments are living with the early but significant effects of climate change. Our traditional knowledge learned over millennia within our aboriginal lands leaves us with no doubt that immediate action to reduce the impacts of climate change is our duty as sovereign indigenous governments,” states Central Council of Tlingit and Haida Tribes of Alaska President Richard Peterson, “such, we will seek to participate in the Paris Climate Change Agreement.”

This might be a moment for tribes to engage in global diplomacy. In the news release, Sharp said: “When we get a seat at that table people in this country who understand the climate change problem might be able to convey their concerns through us at the international level. We might also be able to sign on to the Paris Agreement. We are looking into that possibility. So it is possible that even though the US has backed out of that historic agreement, the tribal governments  from throughout the country could help fill the void,” said President Sharp.

 

 

 

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Sen. Claudia Kauffman speaking in Seattle. She is a candidate for Seattle’s Port Commission. (Photo via Facebook.)

 

Mark Trahant / Trahant Reports

It’s such a simple thing: Every citizen should have a voice at the table when decisions are made. It’s a powerful notion because no democracy can sustain itself unless all of its people, all of those who have a stake in the outcome, are included.

But that idea remains illusive. And never more important.

What does a seat at the table look like? It means more Native Americans win election to office as governors, members of Congress, U.S. Senators, mayors, county commissions, judges, members of state legislatures, and, yes, why not, even the White House. Indian Country deserves more of a voice, both in terms of fairness and as elected representation that’s based on our share of the population. Wait. That’s fairness, too. (Previous: Indian Country wins with more representation in the states.)

Then there are elected offices that we don’t think about, yet are important, and by definition, are that seat at the table.  Claudia Kauffman is running for such a job, Commissioner for the Port of Seattle. This is a $650 million a year public business that manages Seattle’s seaport, airport, and a portfolio of real estate. It has its own police and fire departments. Tribes and native people are impacted by port decisions ranging from  cleaning up rivers and salmon habitat to regulating oil drilling rigs that berth in Seattle on their way to Arctic waters.

Kauffman is Nez Perce. She is the first Native American woman who was elected to the Washington state Senate a decade ago.  (Previous: She Represents: A survey of Native American Women who have been elected to office.) She also works for the Muckleshoot Tribe as the Intergovernmental Affairs Director. One of her tasks in that role is distributing $1.3 million a year to more than 200 local schools, churches and not-for-profit organizations. She’s also been a trustee at The Evergreen State College and on the board of visitors at Antioch College.

Kauffman grew up in Seattle’s Beacon Hill as the youngest of seven children. “I come from a family with a long history of giving back to the community,” Kauffman says on her web site. “A family with strong and well grounded values and connection to our community, our environment, and our future. I will work to bring trust back into government, to provide leadership in the direction of the Port of Seattle, and bring family wage jobs.”

A couple of years ago Kauffman told the port commission that it could use her perspective as a working mother, a small business owner, and a community leader. “My record of public service includes working closely with state, federal and tribal governments, which I believe, makes my experience unique and beneficial to the Port of Seattle Commission,” she wrote. In the state Senate Kauffman said she worked on transportation, international trade and economic development. “I led the Senate in the successful passage of the MicroEnterprise Development in which we funded training for small business owners … my work with the Muckleshoot Indian Tribe provides critical connections, understanding and perspective.”

In her campaign brochure, Kauffman said she will build on her tribal contacts and strengthen ties with the 29 tribes in the state. Tribes “are large employers,” Kauffman said. “In 2010, they paid $1.3 billion in wages and purchased $2.4 billion in goods and services.”

This will be a challenging race. She’s running for Commissioner Position One, against a well-funded incumbent, John W. Creighton III. Also on the August primary ballot will be Ryan Calkins and Bea Querido-Rico. (This is a non partisan election for voters of King County, Washington.)

Creighton is the longest serving port commissioner and one of the commission’s best fundraisers.

But Kauffman is no stranger to that world. She raised nearly $300,000 in her bid for the Senate and she was one of those candidates who worked incredibly hard knocking on every door at every opportunity. She also has a political organization — a network of people who are willing to work extraordinarily hard to win an election.

This is what a seat at the table looks like.

Mark Trahant is the Charles R. Johnson Endowed Professor of Journalism at the University of North Dakota. He is an independent journalist and a member of The Shoshone-Bannock Tribes. On Twitter @TrahantReports

Reposting or reprinting this column? Please credit: Mark Trahant / TrahantReports.com

 

 

 

 

 

 

 

 

 

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Trahant Reports

One election will not erase what is Donald J. Trump. Most of his voters see him as the antidote to business as usual. He’s shaking thing up (even if there is disagreement on specific issues). Destroying health care? Yes. So what. At least something new will surface.

Montana voters, it would seem, have a lot more at stake than most. This is a state where Medicaid expansion is working well. That very idea will be repealed in the Republican plan. So this election is a big deal.

Except voting is soooo hard. Especially when it’s a special election and no one is running for president.

Some numbers: Denise Juneau lost that same congressional district in November earning 201,758 votes to Ryan Zinke’s 280,472.

On Thursday Greg Gianforte won with 50.2 percent of the vote and only 189,240. In November 74.44 percent of the electorate showed up. Thursday night it was 54.4 percent.

Glacier County is a case in point. This is where the Blackfeet Nation votes. Juneau won the county by more than two-to-one over Zinke. In November more than 5,000 people voted. Last night: About 2,400.

So Democrats may be soothed by the fact that Gianforte lost nearly 7 points from Zinke’s win in November. The idea being that Democrats are picking up strength in a pro-Trump state. Matthew Yglesias wrote as much for Vox. That geography determines so much of the Congress and that turns into a Republican advantage. But, “for prognostication purposes you don’t just want to know who wins or loses a special election — you want to know the margin,” he writes. “To win by only seven in Montana, a state that Trump won by 20 points, is a clear sign that seats Trump won by four or five points or more aren’t truly safe.”

True enough. But it really will depend on who shows up at the polls in 2018.
Yes this was a special election. Yes the rules were confusing (changed along the way) about where to vote and how.

But all of that is just is a call to do better. We need to figure out how to get more people engaged. (Again.)

To me the real loss in Montana is that in an era when so much is at stake, 321,000 voters passed.  They voted that voting is not all that important. — Mark Trahant

 

 

 

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Good morning. I am resisting the temptation to parse the Trump budget. The document does not express anything except White House contempt.

Congress is already rewriting this document. So focus the energy (and line by line reviews about spending) on Capitol Hill not the White House. — Mark Trahant

Interactive version here

#DisruptIndianCountry #FederalBudget #Infographic #Share

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The best moment for the new Trump Administration was the one where the president smiled in Saudi Arabia and said only 26 words in public. This was terrible reality TV but we all watched knowing that it was likely just a pause. Something outrageous must be coming up next. Meanwhile, beyond the distraction, Republicans work to dismantle the most successful government health insurance for the poor, Medicaid. (White House photo)

 

 

Mark Trahant / Trahant Reports

Reality TV works for one simple reason: The antics of the characters are beyond what’s believable in fiction. It’s compelling drama because normal people do not do such things. So part of watching is to find out when the story arc ends, to discover when the situation becomes “normal” again. (Even though the story does go on and on and on.)

That’s why the presidency of Donald J. Trump would make a terrible novel or screenplay: There’s no mechanism to suspend disbelief. Tell the story about a four-month term in the White House, a time marked by so much chaos, unprofessionalism, and distraction, and a reader (and especially an editor or producer) would shake their head and say, “Try again. This story is not believable.”

That’s why only the metaphor of reality TV works. America the unbelievable.

Last week the best moment of the new Trump Administration was the one where the president smiled in Saudi Arabia and said only 26 words. This was terrible reality TV but we all watched knowing that it was likely just a pause. Something outrageous must be coming up next.

The White House Reality Show is entertaining.

Meanwhile more important stories are still being written and played off-screen. That’s why our focus must return to the policy fights ahead: How this country (and our planet) deal with climate change, how we stop the rigging of elections, and, how we make certain the court system is fair. Next week the White House will formally send Congress its budget plan for the next year. We already know this plan will be nonsense. Another distraction. The real work of budgeting will occur in Congress and it will require votes from both Democrats and Republicans to make it so.

At a House hearing last week, for example, Rep. Tom Cole (R-Oklahoma) said he was disappointed in a White House recommendation to cut  $5.8 billion from next year’s funding for the National Institutes of Health. He such a draconian cut would stall so much progress from recent investments.

In other words: No sale. Across the Congress, across the government, this same notion is being repeated. Eliminate the Corporation for Public Broadcast? No sale. Down the list the message is much the same, eliminate the Denali Commission? No sale. Etcetera, etcetera, etcetera.

Paying for health care

But while Congress might rewrite the budget in some areas, there are real dangers ahead. I’m obsessed with what this bunch is doing to the funding streams for health care, especially Medicaid.

This is what the Trump Show hides: The House’s American Health Care Act does much more than roll back the Affordable Care Act (or Obamacare as they like to say.) It ends a Medicaid program that works. It’s the single most effective form of “government” insurance that secures health care options for 62.3 million Americans. To add a little perspective here: Medicare — supposedly untouchable in politics — insures 43.3 million seniors.

These are huge numbers.  Medicaid is expensive. And we all pay for this plan. As we should. It’s one of the best things this country does.

So it’s no wonder that Speaker Paul Ryan and Republicans are eager to make this go away (both because it costs so much and because it requires a lot of taxes to pay for this enterprise).

This is an issue where the philosophical divisions run deep. Every Republican wants to spend less federal money on this program. Significantly less. Once you do that, there will be fewer people who participate in this public insurance program. That’s math, not politics. The House plan (according to the Congressional Budget Office) strips $880 billion from Medicaid funding in order to reduce health care taxes on wealthy people by $883 billion. Tit for tat.

Watch this debate closely. Parse every word. The Republicans in the Senate who say they champion Medicaid often only talk about Medicaid expansion. And that’s followed by, there should be a transition to something else (namely, block grants that states cannot afford). What else? How does that work? And who pays?

At a town hall in Anchorage last week, Alaska Sen. Dan Sullivan followed this script to the letter. According to The Alaska Dispatch News the Republican senator told a contentious town hall, that he wanted to make sure the people who received health care coverage under Medicaid expansion “do not have the rug pulled out from under them.” Medicaid for now. Then something else. What else? How does that work? And who pays?

The answer is to protect the framework of Medicaid (and if we were smart, enhance and expand it). It’s the one part of Indian health funding that’s growing and already accounts for the insurance of record for more than half of all our children. (And, this is really important, third-party insurance billing, which includes Medicaid, is money that stays at a local IHS clinic or hospital. It does not go into the general budget.)

Medicaid is a partnership between the federal government and the states. So states set many of the rules, federal government then agrees or not, and pays only a portion of the bill. But patients within the Indian Health system are usually eligible for a 100 percent reimbursement.

So states set the rules for Indian Country — including limitations — yet don’t pay the cost. Already six states are already looking to tighten Medicaid rules. Arizona is keen on adding work requirements. Wisconsin wants drug testing (imagine the trap that sets for patients in opioid treatment programs). Maine wants to test assets beyond income. The goal of each new regulation is to shrink the number of people insured by Medicaid.

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Medicaid works, especially in Indian Country

I’ve heard Republicans say they like the results of Medicaid but that we as a country cannot afford it. That’s particularly troubling because Medicaid is more efficient that private insurance. (Even with its convoluted payments from the federal government to states and Indian health programs). How can that be? Julia Paradise, associate director of the Program on Medicaid and the Uninsured for the Kaiser Family Foundation, says Medicaid acts as a “high risk pool.” Because so many people are excluded (or out-priced) from private insurance Medicaid is the only option. “Among adult Medicaid enrollees who are not working, illness or disability is the main reason. By covering many of the poorest and sickest Americans, Medicaid effectively serves as a high-risk pool for the private health insurance market, taking out the highest-cost people, thereby helping to keep private insurance premiums more affordable.”

And, as Paradise notes in the recent report, “10 Things to Know about Medicaid: Setting the Facts Straight,” evidence continues to mount that Medicaid improves health outcomes. This is especially true when it comes to detecting and treating diabetes, mental health programs, and research has found that Medicaid expansions for adults were associated with significant reductions in mortality.

The Senate is now busy rewriting the House’s awful health bill. It will be a different entity, that’s for sure. But will the Senate protect (and if they are smart, enhance and expand) the best basic public health insurance program that we have now? There is no evidence to suggest that. And too many people are watching reality TV to even notice.

 

 

Mark Trahant is the Charles R. Johnson Endowed Professor of Journalism at the University of North Dakota. He is an independent journalist and a member of The Shoshone-Bannock Tribes. On Twitter @TrahantReports

Reposting or reprinting this column? Please credit: Mark Trahant / TrahantReports.com

 

 

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Trahant Reports

The flurry that is the Trump Administration continues to impact Indian Country in ways that are expected — as well as those that surprise. A nasty surprise at that.

The latest offering is a presidential signing statement that targets federal programs that serve American Indians, Alaska Natives, as well as those that fund historically black colleges. Because this statement is attached to the spending bill that just passed Congress, H.R. 244, it gives the Trump Administration legal cover to cancel grants and funding streams already in motion.

Here is the language from the White House:

My Administration shall treat provisions that allocate benefits on the basis of race, ethnicity, and gender (e.g., Division B, under the heading “Minority Business Development”; Division C, sections 8016, 8021, 8038, and 8042; Division H, under the headings “Departmental Management Salaries and Expenses,” “School Improvement Programs,” and “Historically Black College and University Capital Financing Program Account”; Division K, under the heading “Native American Housing Block Grants”; and Division K, section 213) in a manner consistent with the requirement to afford equal protection of the laws under the Due Process Clause of the Constitution’s Fifth Amendment.

In other words the Trump Administration doesn’t want to spend money on Native American housing block grants or on HBCUs. (And that makes me wonder, are tribal colleges next?) The spending bill included some $654 million for tribal housing programs.

Will the Trump Administration spend the money that’s appropriated?  That’s now a real question. The signing statement is a serious threat to appropriations for this year.

Presidential signing statements are extra-legal authority. No. That’s not right either. The American Bar Association said in 2006 that this process undermines the law. It’s an invention says a president knows more than Congress. Signing statements have been around since James Monroe. But, according to the American Presidency Project, Andrew Jackson was a fan. “In May 1830, Andrew Jackson wrote an message to the House stating his understanding of the limits of an appropriation:  “the phraseology of the section which appropriates the sum of $8,000 for the road from Detroit to Chicago may be construed to authorize the application of the appropriation for the continuance of the road beyond the limits of the Territory of Michigan, I desire to be understood as having approved this bill with the understanding that the road authorized by this section is not to be extended beyond the limits of the said Territory.”

The Trump White House is eager to destroy the federal government as it exists now. And this signing statement is a sneak attack. — Mark Trahant

 

 

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