Indian Country politics and public policy

Commentary by Mark Trahant


President Donald J. Trump speaks about the $1.3 trillion Omnibus Spending Bill before signing into law. (Official White House photo by D. Myles Cullen)

Indian Health, Bureau of Indian Affairs see a budget increase

Mark Trahant / Indian Country Today

The federal government’s newly enacted budget is a massive “omnibus” act that spends $1.3 trillion and makes some members of Congress pleased and others angry. It’s a document that reflects a broken budget system. And, at the same time, it’s a business-as-usual document in a presidential administration that has promised structural change.

“There are a lot of things I’m unhappy about,” President Donald J. Trump told reporters at the White House Diplomatic Reception room. “But I say to Congress, I will never sign another bill like this again. Nobody read it, it’s only hours old.”

But the negotiations were not hours old. The back and forth between Democratic and Republican lawmakers was essentially a year late. This spending bill only funds the federal government between now and the end of September. But the process took so long because neither side had enough votes to pass the document on their own; Republicans needed votes from Democrats and to get those votes there had to be deals. Lots of deals. Business as usual.

And business as usual is good for Indian Country. Federal Indian programs, some of which had been slated for either elimination or deep cuts, continued on course.

The omnibus spending bill increases funding for the Indian Health Service by 10 percent, and the Bureau of Indian Affairs and Bureau of Indian Education by 7 percent to $3.064 billion. The IHS budget line s $5.5 billion. When the budget is compared to the president’s request, the increases are even sharper, more than 16 percent for the IHS and 23 percent for the BIA.

At the BIA, according to an analysis by Amber Ebarb at the National Congress of American Indians, “Overall, the eliminations and reductions proposed in the president’s budget were rejected.”

Other budget items:

  • The bill includes a 3 percent set aside for Indian tribes within the funds available under the Victims of Crimes Act. The cap for these funds was set at $4.4 billion, which amounts to $133 million. As Ebarb wrote: “This is an important step forward for Indian Country, which has the highest rate of criminal victimization and had up until this point been left out of this funding. This funding will address the long standing inequity and meaningfully improve the landscape of victim services in Indian Country.”
  • The bill provides $50 million for grants to Indian tribes or tribal organizations to address the epidemic, and $5 million for tribes in the Medication-Assisted Treatment for Prescription Drug and Opioid Addiction program.
  • Infrastructure spending would increase for BIA and IHS construction, BIA road maintenance, and a $100 million competitive grant program is added under Native American Housing Block Grants in addition to the $655 million provided for the NAHBG formula grants.


President Trump said he signed the bill into law because it increased military spending. “I looked very seriously at the veto. But because of the incredible gains that we’ve been able to make for the military, that overrode any of our thinking.”

(The National Congress of American Indians is the owner of Indian Country Today and manages its business operations. The Indian Country Today editorial team operates independently as a digital journalism enterprise.)

Mark Trahant is editor of Indian Country Today. He is a member of the Shoshone-Bannock Tribes. On Twitter: @TrahantReports (Cross-posted on TrahantReports)


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Mark Trahant / Indian Country Today

Congress did its job: The federal government’s budget is done. The last step was President Donald J. Trump’s signature and so now the government marches on. At least for the rest of this year, until the end of September.
But the White House said Friday that the president may veto the budget because there is not enough funding for a border wall or a solution for the so-called Dreamers. This is after the president assured House and Senate leaders that he would sign the measure into law.


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A veto would mean the federal government would shut down at midnight and Congress would have to start a new round of budget negotiations. This will be even more complicated because many lawmakers have left Washington for a two-week recess.
There will be intense pressure from some Republicans for the president to sign this budget into law anyway.

Budgets are a guide to priorities: What programs are more important? Where is the support from Congress and from the people? Did the president get what he wanted?
That last question is the easy one. The money for the budget wall was minimal, at best.
It’s fair to say the administration’s budget was soundly rejected by a Republican Congress. Sure, Democrats contributed a great deal to this budget (and Democrat votes were required to make it so,) but even before that occurred, majority-party lawmakers were dismissing the harsh budget program changes sought by the president.
The president’s team had all kinds of ideas: Deep spending cuts, the elimination of public broadcasting, replace Medicaid with block grants, and, yes, even deeper spending cuts. Yet Congress enacted a budget that increased federal spending both for the military and domestic programs. It’s Congress, not the president, writing the checks.
How bad was the president’s budget? The National Congress of American Indians put it this way in recent testimony: “The president’s budget would cut the Bureau of Indian Affairs by about half a billion dollars, or 15 percent. BIA Social Services would be reduced by more than a third, Indian Child Welfare by more than a quarter, and critical human services programs, law enforcement and courts programs, environmental protection, housing, and education programs would face unconscionable reductions. Infrastructure programs, such as the Indian Community Development Block Grant would be eliminated, and the Indian Housing Block Grant and road maintenance would be reduced.”
Instead, Congress added dollars and protected programs that the White House sought to eliminate.
“This bill represents real progress for Indian Country, significantly increasing our investments in Native health care, infrastructure, economies, and communities. It rejects the president’s dangerous proposed budget cuts and instead provides funding increases that will lead to healthier communities and better outcomes across Indian Country,” said Sen. Tom Udall, D-New Mexico, in a news release. Udall is vice chairman of the Senate Committee on Indian Affairs and ranking member of the Appropriations Subcommittee on Interior, Environment, and Related Agencies.
The omnibus spending bill would have increased funding for the Indian Health Service by 10 percent, and the Bureau of Indian Affairs and Bureau of Indian Education by 7 percent to $3.064 billion. The IHS budget line is $5.5 billion.
Conservatives were not happy with the additional spending in the omnibus bill. “Republicans control the government, yet Congress still follows the Democrats’ playbook,” Sen. Rand Paul, R-Kentucky said. “Time and again, spending skyrockets, and conservatives are expected to fall in line to praise the party for making the big-spending status quo worse.”
However Rep. Tom Cole, R-Oklahoma, a member of the House’s leadership team praised the legislation. “Despite divisions, both sides of the aisle have the responsibility to deliver this legislation for the American people so that the federal government runs efficiently and effectively,” Cole said. “Neither side got everything it wanted, but the end product reflects a broadly supported compromise. A majority of Republicans and Democrats voted for this bill. President Trump urged its passage and has promised to sign this legislation. As we begin to consider funding for Fiscal Year 2019, it is imperative that Congress remain committed to the return to regular order in the appropriations process.”
The president will decide in the next few hours whether or not he got enough of what he wanted.
(The National Congress of American Indians is the owner of Indian Country Today and manages its business operations. The Indian Country Today editorial team operates independently as a digital journalism enterprise.)
Mark Trahant is editor of Indian Country Today. He is a member of the Shoshone-Bannock Tribes. Follow him on Twitter @TrahantReports (Crossposted on Trahant Reports.)

Mark Trahant

Cross-posted on Indian Country Today.

UPDATE: The House of Representatives passed the $1.3 trillion fiscal 2018 omnibus appropriations bill. Thursday.  The vote was 256-167. Next up: The Senate will vote on the measure.

Congressional leaders have agreed to a massive $1.3 trillion spending bill to fund the government for the remainder of this fiscal year. The House and Senate must still vote on the measure. The text of the 2,232 page bill was released Wednesday at 8 p.m.

The spending bill, which followed an overall agreement last month, increases spending for most domestic programs, including more than $3 billion for the Bureau of Indian Affairs and $5.5 billion for the Indian Health Service. Other line items include increased funding for tribes for the research and implementation of the Violence Against Women Act and renewed funding for the Special Diabetes Program for Indians.

House Speaker Paul Ryan said the legislation also “fulfills our pledge to rebuild the nation’s military. We are delivering the biggest increase in defense funding in 15 years.”

That includes a pay raise of 2.4 percent for military personnel — and an increase of 1.9 percent for most federal civilian employees.

The legislation would significantly boost funding for programs that deal with the opioid epidemic. “With nearly $4 billion, the funding bill makes the largest federal investment to date for fighting the opioid epidemic, which the president has declared a national emergency,” Ryan reported on his House web page. “It includes funding for treatment, prevention, and law enforcement programs that help save lives and stem the spread of this scourge.”

The spending bill includes  $1.57 billion for President Donald J. Trump’s border wall as well as an increase for  immigration enforcement, including additional law enforcement.

The House could vote on the measure as soon as Thursday (waiving a requirement for members to get at least three days to review the language of the legislation).

The Senate vote could come Friday, however, one senator could slow the process down because of rules that require unanimous consent. This would result in another, short government shutdown at least over the weekend. Sen. Paul Rand, R-Kentucky, did just that last month.

He has not said what action he will take on this spending bill, but he tweeted this morning: “It’s a good thing we have Republican control of Congress or the Democrats might bust the budget caps, fund planned parenthood and Obamacare, and sneak gun control without due process into an Omni…wait, what?”

Mark Trahant is editor of Indian Country Today. He is a member of the Shoshone-Bannock Tribes. On Twitter: @TrahantReports

Mark Trahant / Indian Country Today

Cross-posted on Indian Country Today.

Here we go again. Congress has three days to resolve long standing disputes over immigration, health care, taxes, abortion rights, guns, building a border wall, a New York City tunnel, and funding federal programs. Republicans control the House and the Senate, but still need votes from Democrats to enact any spending legislation.

Wait. Didn’t that all happen five weeks ago? Yes. Well, sort of. The Congress and President Donald J. Trump agreed to an overall two-year, $1.2 trillion plan for spending federal dollars. That plan gave Congress five weeks to work out a variety of details, setting a deadline of March 23 at midnight.

And, so, here we go again. It’s the details that continue to divide Congress.

House rules require 72-hour notice before a vote. The legislation has yet to be posted.Rep. Tom Cole, R-Oklahoma, told The Hillnewspaper Monday that Congress is close. “They’re scrambling, working really hard to try to get them done so they can file tonight, or tomorrow at the latest.”

Federal Indian programs are not a part of the policy disputes in Congress, but many agencies including the Bureau of Indian Affairs and the Indian Health Service would have operations suspended during a government shutdown. Indian education programs are funded in advance and would not be impacted. There have been two short government shutdowns this year.

Michael “Keawe” Anderson, executive director of the Native American Contractors Association, sent a note to members suggesting contract officers investigate the status of federal contracts, especially if there is a “soft” shutdown over the weekend. “However, given the uncertainty that has become our new norm, I would also add that you should discuss a longer term shutdown – a ‘hard shutdown’—and what their expectations would be,” wrote Anderson.

The National Congress of American Indians will testify Thursday before the Senate Select Committee on Indian Affairs about the budget and the president’s drastic cuts. “Many of the proposed deep reductions in the president’s Budget threaten to limit this protection and these benefits,” the prepared testimony said. “The proposed budget cuts to tribal governmental services, if enacted, would represent a clear retreat from the federal commitments and treaty promises made to tribes.

The President’s budget would cut the Bureau of Indian Affairs by about half a billion dollars, or 15 percent. BIA Social Services would be reduced by more than a third, Indian Child Welfare by more than a quarter, and critical human services programs, law enforcement and courts programs, environmental protection, housing, and education programs would face unconscionable reductions. Infrastructure programs, such as the Indian Community Development Block Grant would be eliminated, and the Indian Housing Block Grant and road maintenance would be reduced.”

It’s unclear how much funding would be restored to federal Indian programs under any Omnibus bill. The February deal between Congress and the president significantly increased spending for defense and domestic programs, but the details have yet to be enacted into law.

Both the House and Senate will have to act and the president would have have to sign the measure.

Before that occurs, however, there are serious policy disputes that have yet to be resolved.

Congressional Republicans continue to press for funds to construct a border wall with Mexico. Rep. John Carter R-Texas, chairman of the House Appropriations Homeland Security subcommittee, told The Wall Street Journal that he is continuing to push for $1.6 billion for the border wall. Democrats have said that spending might be possible — if the budget extended protections for the Dreamers, undocumented immigrants who came to the United States as children. But there were still differences about a sharp increase for the U.S. Border Patrol.

Another issue splitting Democrats and the president was funding for the Gateway, a project to improve rail service in the New York City region. The president said he would veto any spending bill that included that $900 million project. (Many Republicans from New York and New Jersey support Gateway.)

Another complication: Abortion rights and health care spending. Senators Susan Collins, R-Maine, and Lamar Alexander, R-Tennessee, have proposed language that would reimburse insurance companies for low-earning customers (a requirement of the Affordable Care Act.)

President Trump told the two senators he supports the measure. However there is significant opposition in both the House and Senate. One provision would also add new abortion rights restrictions to dollars spent by insurance companies, something that Democrats say they could not support. The Kaiser Family Foundation reported that the abortion language conflicts with state laws in California, New York and Oregon.

Conservatives in the House say the spending proposals lack conservative “principles” and may voter against the legislation. Members of the House that support increased funding for the military have called for an end to short-term spending bills and want this process completed. Either one of those factors could complicate a last minute deal before a vote in the House and Senate.

(The National Congress of American Indians is the owner of Indian Country Today and manages its business operations. The Indian Country Today editorial team operates independently as a digital journalism enterprise.)

Mark Trahant is editor of Indian Country Today. He is a member of the Shoshone-Bannock Tribes. Follow him on Twitter @TrahantReports


Cross posted on Indian Country Today.

Mark Trahant / Trahant Reports

A special election in Pennsylvania is a good sign for Native American #NativeVote18 candidates running for office. Why? Because this cycle is already favoring out-of-power Democrats and, quite possibly, independents. It’s hard to peg any constituent group more out-of-power than those who would represent Indian Country in the Congress of the United States.

First, the news from Pennsylvania, then we will look at the map. Democrats are claiming victory in a special election for that state’s 18th Congressional District. Perhaps. Officially, the race is too close to call between Democrat Conor Lamb and Republican Rick Saccone. It’s a practical tie with Lamb holding a tiny lead. But Lamb has claimed victory and Democrats are celebrating no matter what happens next because this is a district that favors Republicans, it was won by President Donald J. Trump by 20 points. So even normally red districts are up for grabs come November.

Or as Democratic Congressional Campaign Committee Chairman Rep. Ben Ray Lujan (New Mexico) posted Tuesday night: ““These results should terrify Republicans. Despite their home field advantage and the millions of dollars … We have incredible candidates with deep records of service running deep into the map this year, and it’s clear that these Republican attacks are not going to stick.”


Back to the map: Sharice Davids, who is running in Kansas fits that storyline precisely. She is running in a district that Republicans should win easy. Rep. Kevin Yoder won re-election in 2016 with an 11-point margin. But remember the Pennsylvania 18th favored Republicans by 20-points.

Davids is Ho-Chunk, an attorney, and she worked in the Obama administration. This is pretty much an anti-Trump-agenda resume’.

The most immediate boost from Tuesday’s vote should be more campaign donations.

Another #NativeVote18 candidate who could benefit from a re-imaging of the election landscape is Amanda Douglas in Oklahoma. After Lamb claimed victory in Pennsylvania she tweeted: “Yes! his is exactly what I’m talking about!!! I can’t wait to work with newly elected Congressman@ConorLambPA!”

Douglas, Cherokee, is running in the state’s 1st Congressional District. Two years ago Democrats did not field a candidate in that race. It’s rated as a “plus-17” Republican district — in other words, awful similar to the Pennsylvania 18th.

In another part of Oklahoma, two Cherokee Nation citizens could both potentially be on the fall ballot. Rep. Markwayne Mullin is running for his fourth term as as Republican. Democrat Jason Nichols, the mayor of Tahlequah, is running as a Democrat. Mullin won 70 percent of the vote in his last election bid.

Rep. Tom Cole is also running for re-election as a Republican in Oklahoma’s 4th congressional district. Cole, Chickasaw, also earned more than 70 percent of the vote in the last election.

One #NativeVote18 candidate who had a good week before the Pennsylvania election was running in New Mexico.

Debra Haaland, 2018 Elections

Haaland’s challenge is to win the Democratic primary in June because, unlike most Native candidates, she’s running in a district that favors Democrats.

Last weekend Haaland was the top-vote getter at the state’s party convention, winning nearly 35 percent of the vote in a crowded field. She told delegates: “Congress has never heard a voice like mine.”

Haaland, is Laguna Pueblo. Congress has never elected any Native American woman to its ranks since voting began in 1789.

Haaland, Davids, or Douglas could be the first.

The Pennsylvania race also raises questions for the #NativeVote18 candidates who are Republicans. Former Washington State Sen. Dino Rossi would be at the top of that list. Rossi, Tlingit, is hoping to succeed a moderate Republican, Rep. Dave Reichert, in Washington’s 8th congressional district. That district has been trending Democratic.

The president’s popularity is reflected by Rossi’s own words. He told The Seattle Times that he is “not running to be ‘The Apprentice.’ I am running to be the congressman from the 8th Congressional District. The way I am going to treat Donald Trump is just the same way I would have treated George W. Bush or Barack Obama. If I agree with them I agree with them, and if I don’t, I don’t.”

One #NativeVote18 candidate who is not running away from President Trump is Gavin Clarkson in New Mexico’s 2nd Congressional District. His campaign website proclaimed “the best way to help President Trump stop the swamp and protect New Mexico is to run for the Republican nomination to make sure we retain this Congressional seat in November.”

Then this Southern New Mexico district is changing too. The seat is now held by Rep. Steve Pearce is running for governor — making this an open seat. Pearce won easily, capturing 60 percent of the vote. But the district is now 54 percent Hispanic and in a wave election, it could be the ideal seat for a Democratic pickup. Trump won the district by 10 points, half of the margin in Pennsylvania.

There are also three #NativeVote18 candidates running as independents or on third-party lines. Eve Reyes Aguirre is running for the U.S. Senate in Arizona on the Green Party ticket. Aguirre is an Izkaloteka Mexican Native.

She recently tweeted that she is an “unconventional politician” and is rounding up signatures to make the ballot. Henry John Bear is running as a Green Party candidate in Maine’s 8th Congressional District. Bear is a citizen of the Houlton Band of Maliseet Indians. And, finally, in Minnesota, Ray “Skip” Sandman is running in the 8th Congressional District as an independent. Sandman is Ojibwe.

Can an independent or third party candidate win in this environment? It’s hard to say, there is no real evidence yet. But as the Pennsylvania results show, this is an election cycle where anything is possible.

Mark Trahant is editor of Indian Country Today. He is a member of the Shoshone-Bannock Tribes. Follow him on Twitter @TrahantReports


Mark Trahant / Indian Country Today

Many years ago Richard LaCourse and I would sit around and toss ideas about what the perfect Indigenous newspaper would look like. LaCourse, at the time, was trying to create a new publication in Washington, DC.

Imagination was his currency. What was possible?

LaCourse had a lot of experience answering that question. He had helped build the American Indian Press Association. He had edited or written for several tribal newspapers, including his own, The Yakama Nation Review. He launched a one-person crusade to raise the standards of Native American journalism.

I even remember the first time I heard him do that. It was on Feb. 24, 1977, at a workshop in Spokane. A workshop speaker was telling tribal editors that they worked for tribal councils and should slant the news accordingly. LaCourse stood up. Angry. Shaking his finger. “Are you aware of the 1968 law that guarantees freedom of the press in Indian Country? Indian newspapers should be professional, straight reporting operations, and your assumptions about cheerleaders for a point of view has nothing do do with the field of journalism. Why are you making this presumption?”

I am thinking of Richard LaCourse as we begin Indian Country Today’s third chapter. The goal is to build on the legacy of LaCourse—as well as from the first two chapters of Indian Country Today. The publication was founded by Tim Giago in South Dakota in 1991 and was followed by the ownership of the Oneida Nation of New York.

It’s hard to think of a better word than legacy, actually. The word is from the 14th century Latin legatus, an ambassador, envoy, a deputy sent with a commission. A century later the word had shifted and become associated with property, a gift. Both definitions fit. The gift is all of the work done before. The commission is the tasks ahead.

Indian Country Today is now owned by the National Congress of American Indians—but we will act independently. We are creating a framework to ensure that. But our primary task is the same as LaCourse’s vision: Professional, straight reporting that tells stories about Indigenous people and our nations.

I’d like to thank the National Congress of American Indians (NCAI) for engaging in this experiment. It would have been easy to say, “well, no.” Especially when the challenges of independence are factored into that equation.

The NCAI has a long history of working with the Native press (even while our missions are different.) One of the great journalists of her generation, Marie Potts, a Maidu, and editor of California’s Smoke Signals best writing in Washington while on working on a fellowship with NCAI during the late 1960s.

The best way I know how to demonstrate our independence is to produce solid, thoughtful journalism. Every day. So there is a lot of hard work ahead. (And we will need some time to make this so.)

What does this mean for Trahant Reports? For the time being I will cross post on Trahant Reports and Indian Country Today sites. I have a lot of material I am working on for the elections ahead, Indian health, and other policy issues. So more, not less.

And Indian Country Today is back in business and we are ready to serve.

Our goal is to hire a team in Washington, create (and fund) reporting fellowships around the country, and build capacity for freelance contributors. We want to be partners, not competitors, with tribal newspapers, public media, and web publishers.

I have been teaching journalism for the past seven years and I am always telling students that this is a time of great opportunity. The digital world means that we can reach our audiences instantly. We can communicate ideas. We can explain a complicated process. We can expose wrongdoing. Or write a story about pop culture that makes us smile.

We can invent a new kind of news organization, one that trades on the currency of imagination.

Mark Trahant is editor of Indian Country Today. On Twitter: @TrahantReports


Amanda Douglas is running for Congress in Oklahoma’s 1st congressional district. She is a citizen of the Cherokee Nation of Oklahoma. (Campaign photo)

Mark Trahant / Trahant Reports

Across the country more women than ever are running for office, including Congress, statewide posts, and legislatures. That’s the case in Indian Country, too. So is it a record year? It sure looks to be so.

Amanda Douglas is the latest candidate. “Northeastern Oklahoma is so skewed that not a single non-Republican candidate has officially registered to run for the 1st District in the coming 2018 election,” she wrote on her campaign web site. “Most agree that this is because it is historically a heavily Republican district– it hasn’t seen non-Republican representation since 1987. The thought is that there isn’t enough support for anyone other than a Republican to even bother running.”

Douglas is bothering to run. (This gets to my favorite rule in politics: You gotta run to win.) Two years ago no Democrat bothered to run and the incumbent, Rep. Jim Bridenstine picked up 100 percent of the vote. Not bad, right? He is not running for re-election because he is President Donald J. Trump’s choice to head the National Aeronautics and Space Administration (NASA). That means the district will be an open seat.

Douglas and her family are citizens of the Cherokee Nation from Glenpool, Oklahoma, and she’s a graduate of Oklahoma State University.

“Yes, I know,” she writes. “I am not exactly drowning in political experience; however, I want you all to know that I consider that an advantage over other candidates at this point. We need fresh air in Washington. We need representation in Congress that is NOT part of the club– someone who is there for the good of the PEOPLE, not for financial gains or exploitable opportunities.”

There are now three Native American women running for the U.S. House. Deb Haaland in New Mexico, Sharice Davids in Kansas, and Douglas in Oklahoma. All are Democrats. In Arizona, Eve Reyes Aguirre is a candidate for the U.S. Senate running on the Green Party line. There are two Native American women running for state governors, Paulette Jordan in Idaho, and Andria Tupola Hawaii. And Peggy Flanagan is running for Lt. Gov. Minnesota. There are also six Native American running for Congress. 

Mark Trahant is the editor of Indian Country Today. He is a member of the Shoshone-Bannock Tribes. @TrahantReports on Twitter.





Robert Weaver, Quapaw, was President Trump’s first choice to head the Indian Health Service. His nomination was withdrawn last week. (Weaver Group photo)

Mark Trahant / Trahant Reports

Who should run the Indian Health Service? Not “who” exactly, but what kind of leader? What kind of skills and experience would be the most useful?

This question is more important than ever. The Trump administration has withdrawn the nomination of Robert Weaver to lead the agency. Weaver, a member of the Quapaw Tribe of Oklahoma, has a background in private insurance working with tribes to set up plans to cover tribal members. But his nomination was sidetracked after The Wall Street Journal reported serious misstatements on his resume both in terms of education and work experience. So last week a representative of the Department of Health and Human Services said: “Mr. Weaver is no longer the Administration’s nominee for Director of the Indian Health Service.”

For his part, in a letter to tribal leaders, Weaver said the president has been an “ardent supporter of fixing Indian Health throughout this process.” And he said “he will fight to give voice to the change needed at IHS until the mission is complete … the delivery of timely, high healthcare for Indian Country no matter where you live.”

But Weaver went further in an op-ed for Native News Online. He said he wanted to be IHS director for the “sole purpose” of being a part of the solution.  “… many Tribes supported me from around Indian Country. Why? I think because they know that babies are being born on IHS hospital floors. They know that people are dying of heart attacks because the crash carts at their IHS hospitals don’t have the proper medications. They know that some of the places where they live don’t have running water. They knew that I was the right person to start addressing these abuses because I’ve been an unwavering advocate for our peoples’ health and wellness for the past decade and I was willing to meet and listen.”

The key word is “mission.” The mission of the Indian Health Service has become so distorted that even policy makers cannot or will not articulate the challenges ahead. The discourse about the Indian Health Service continues to be about a federal agency that delivers health care to American Indians and Alaska Natives. And, within that story, there are so many clinics and hospitals that only require more order and funding in order to carry out even basic health care. The system is failing. Babies being born on hospital floors. The usual.

Only the IHS story is much more complex. We need to think differently about the IHS. (As I have written before: I would even change the name to the Indian Health System to reflect what the agency now does.)

Most of the Indian Health system is managed by tribes or non-profits. There are 26 IHS hospitals, and 19 tribal or or non-profit hospitals. But, and this is huge, there are 526 clinics, health centers and stations run by tribes and non-profits and only 91 by IHS. 

Hospitals Health Centers Alaska Village Clinics Health Stations
IHS 26 59 N/A 32
Tribal 19 284 163 79


The federal role is changing. The Indian Health Service still does operate health care delivery. And it sets standards. But it’s also a major funding source — and even that is misleading because it is Medicaid, not the Indian Health Service, that’s often the largest source of funding for tribal and non-profit facilities.

This is a critical difference because Medicaid has been under attack by the Trump administration from day one. The administration claims it’s protecting the Indian Health Service budget … all the while proposing deeper and deeper cuts into Medicaid.

There is a disconnect. And it’s visible in the budget. The line item for “collections,” that is money from Medicaid, Medicare and private insurance, is roughly $1.2 billion. That’s a number that has not changed much despite a huge expansion of Medicaid under the Affordable Care Act. This number should have been growing dramatically. But it’s not because it does not capture the amount of dollars collected tribes and non-profits, only the money that goes into IHS direct services.

This is misleading because when you talk to tribal and non-profit administrators, as I have, there is a different story to tell. Medicaid is now more important to local budgets than the IHS itself. 

The expansion of Medicaid also explains a lot about the shortages within the Indian health system. The federal Indian Health Service will take Medicaid funds, but it’s not growing the pot. Tribes and nonprofits have done that. And so there is more money for Indian health in states that have expanded Medicaid.

This is not the Indian Health Service we grew up with. And the next director of the Indian Health Service needs to acknowledge this complexity and own the new story. If I had my way: the next IHS director would have a solid background in medicine and Medicaid.

Mark Trahant is an independent journalist and a member of The Shoshone-Bannock Tribes. On Twitter @TrahantReports

Reposting or reprinting this column? Please do so. Just credit: Mark Trahant / #IndigenousNewsWire #NativeVote18


I have been working on #NativeVote18 lists … folks running for state legislatures (55 and counting, 25 women and 30 men). I have also been working on a list of Native American women who have run for state wide offices and Congress. Fascinating stuff. (I was thinking of a trivia game I could post.) There have been four candidates for governor, three for Lt. Gov., and 12 for Congress. First statewide race that I have found, 1978. Cool stuff. #SheRepresents Will post this soon. I want to make a graphic.

Here is the #NativeVote18 state legislature list. Who’s missing?

One thing I should mention: Google has changed the way you can access pictures and it no longer is compatible with fusion tables. So I am looking for a solution or a new spreadsheet system. #Transparency

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