Naked and afraid? Sixteen Republican candidates compete to survive

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Presidential Debate season begins on August 6

MARK TRAHANT

What do you do with sixteen candidates? It’s a thorny problem for Republicans. Why’s that? Because right now one of those candidates, Donald Trump, is loud enough to drown out all the other “major” candidates.

Wouldn’t it be fun if the nomination contest was more like a basketball tournament? Then top-seeded Donald Trump would battle 16th seed Ohio Gov. John Kasich a battle of ideas. Or how about dropping the bunch in the jungle Naked and Afraid. We could even start voting and eliminate a candidate every week, until it’s just the Republican versus a Democrat.

Enough. Back to the chaos. And Donald Trump.

As The Washington Post put it on Sunday: “For yet another week, Trump talk dominated the Sunday morning political shows, with several devoting roundtable discussions to his disruption of the GOP presidential primary and at least two of his GOP rivals using their clashes with him in recent days as a means of securing interviews on the shows — during which they continued to clash with him.”

On August 6 in Cleveland the first debate is set, an opportunity to raise serious issues. As if. It’s more likely that it will be Trump versus the other nine candidates tossing one liners back and forth.

Of course American Indian and Alaska Native issues don’t get attention this early anyway. Usually that happens late in the campaigns, during the general election, when a position paper is released that outlines the candidate’s official policy. That’s too bad. It would be good to press candidates from both parties about how they see treaties, the federal-Indian relationship, and the management of federal programs that serve Native Americans.

Then again it’s pretty clear where most stand. The Tea Party wing of the Republicans — Trump, Marco Rubio, Scott Walker, Ben Carson, Ted Cruz, and Rand Paul — would dramatically cut federal spending. Paul has even called for the elimination of the Bureau of Indian Affairs and drastic cuts at the Indian Health Service. If any of this happened, the Sequester would be the Good Old Days.

Even a self-described serious candidate, former Florida Gov. Jeb Bush, suggests its time to reshape government. A few days ago in Tallahassee, he said that as governor he used a hiring freeze to shrink state government. He suggested the same approach would work in Washington where only one employee could be hired for every three who retire or leave government service. Bush also said it ought to be easier to fire federal employees. “There are a lot of exemplary employees in the federal government, but they’re treated no better than the bad ones,” he said. “The bad ones are almost impossible to effectively discipline or remove.”

Candidate Kasich was chairman of the House Budget Committee when President Bill Clinton declared the “era of big government is over.” That suited Kasich then. And now. One proposal at the time was to “reinvent” the Bureau of Indian Affairs with a block grant program. “The reinvented Bureau of Indian Affairs would provide block grants, rather than engaging in the direct provision of services or the direct supervision of tribal activities,” the House proposal said. This “would reduce the central office operations of the BIA by 50 percent and eliminate funding for the Navajo and western Oklahoma area offices. It would eliminate technical assistance of Indian enterprises, through which technical assistance for economic enterprises is provided by contracts with the private sector or with other Federal agencies.” Congress would have ended direct loans and reduce loan guarantees.

The Republicans running for president all share contempt for the Affordable Care Act (and most don’t know that would include the provisions of the Indian Health Care Improvement Act.) All are also supportive of more development, such as the Keystone XL pipeline, and generally dismissive of any action to limit climate change.

I don’t know. I’m still partial to a Naked and Afraid competition.

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.

Alaska says yes, boosts Indian health system by expanding Medicaid

Governor Bill Walker and Health and Social Services Commissioner Valerie Davidson announcing the expansion of Medicaid in Alaska. (Picture from video feed.)
Governor Bill Walker and Health and Social Services Commissioner Valerie Davidson announcing the expansion of Medicaid in Alaska. (Picture from video feed.)

One more state adds “new money” to the Indian health system via Medicaid

MARK TRAHANT

These days “new” money is hard to find. That’s the kind of money that’s added to a budget, money that allows programs to expand, try out new ideas, and look for ways to make life better. Most government budgets are doing the opposite: Shrinking. Calling on program managers and clients alike to do more with less.

That’s why the news from Alaska last week is so exciting: Alaska’s new governor announced the expansion of Medicaid and this will significantly boost money for the Alaska Native medical system. Indeed, the significance of this announcement to the Indian health system was clear when Alaska’s Gov. Bill Walker and Department of Health and Social Services Commissioner Valerie Davidson made the announcement at the Alaska Native Medical Center on July 16. The governor took this action using executive authority because the Alaska legislature had failed to even vote on legislation to accept Medicaid.

The governor says Medicaid expansion would reduce state spending by $6.6 million in the first year, and save over $100 million in state general funds in the first six years. “Every day that we fail to act, Alaska loses out on $400,000,” the governor said. “With a nearly $3 billion budget deficit, it would be foolish for us to pass up that kind of boost to Alaska’s economy.”

“We know Gov. Walker has worked tirelessly to expand Medicaid since he came into office on December first,” Davidson said at the news conference. It was one of the campaign promises made by the independent governor. “He included it in the budget. He introduced a bill both in the House and in the Senate side. It was a subject of both special sessions. And, it’s the right thing do do for Alaska.”

The expansion of Medicaid is one of key components of the Affordable Care Act. It’s critical a tool for the Indian health system because it opens up a revenue channel for clinics and hospitals to bill Medicaid, a third-party insurance, for services and that boosts budgets at the local level. (In a climate where Congress is unlike to spend more money on Indian health.) How big a number? More than a million American Indians and Alaska Natives are now insured by Medicaid. The Kaiser Family Foundation estimated in 2013 that Indian health facilities collected $943 million in third-party payments.  “By far the largest third-party payer is Medicaid, which accounts for $683 million or 70% of total third party revenues, and 13% of total IHS program funding for FY2013,” Kaiser reported. Nearly 150,000 Alaska Natives and American Indians receive health services across the state from tribal and non-profit health organizations funded by the Indian Health Service. By law the IHS-funded clinics must seek third party billing from patients, such as Medicaid, the Veterans Administration or private, employer-based health insurance.

Medicaid is an odd program for Indian Country. Most of us understand the Indian Health Service to be the government’s fulfillment of its treaty obligations. However the IHS has never been fully funded. Medicaid, however, is an unlimited check. If a person is eligible, then the money is there. Yet states, not tribes nor the federal government, determine the rules for Medicaid. And many Republican states have been determined to fight the Affordable Care Act, or Obamacare, at every turn, and that means refusing to accept Medicaid expansion (the Supreme Court ruled in 2012 that states could turn it down).

Alaska’s decision means that the number of states rejecting Medicaid is continuing to shrink. Most recently Montana agreed to expand Medicaid in April. The states with large American Indian and Alaska Native populations that have not expanded Medicaid include Oklahoma, South Dakota, Wisconsin, North Carolina, Maine, Wyoming, and Idaho. Utah is the next state considering an expansion.

The Affordable Care Act continues to evolve — and improve. But more important, steps that states are taking to expand Medicaid are adding real dollars to the Indian health system.

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.

The spending fight in Congress breaks down over the Confederate Battle Flag

Rep. John Lewis, D-Georgia, reminds Congress about the use of the Confederate Flag against African Americans who were standing up for their civil rights. (C-SPAN photo)
Rep. John Lewis, D-Georgia, reminds Congress about the use of the Confederate Flag against African Americans who were standing up for their civil rights. (C-SPAN photo)
MARK TRAHANT

The federal appropriations process may at its most convoluted point ever. A case in point: The Interior Appropriations bill was pulled from consideration by the leadership of Congress on July 9. That’s the spending bill that includes funding for the Bureau of Indian Affairs and the Indian Health Service.

Why? The debate wasn’t about money — even though that is an issue — but because some Southern Representatives are keen on protecting the Confederate Battle Flag from being banned on federal land.

Really.

At the same moment when South Carolina was debating, and then lowering the battle flag from state grounds, Democrats successfully included language to remove the flag from federal facilities including National Parks. Republican leaders (no doubt seeing their fellow legislators at work) quickly agreed and the measure passed on a voice vote.

That should have been the end of the story. There isn’t a lot of support anywhere for the Confederate Flag these days.

Except in Congress.

Roll Call reported that  “a number” of Southern Republicans demanded that leadership reverse that flag measure and were more than willing to cast no votes against Interior Appropriations — and possibly all 12 spending bills.

Who would ever have thought the Confederate Flag could be the controversy that stops spending on federal Indian programs? What’s next, a resolution on the Washington NFL team interrupting agricultural programs? Seriously this is messed up but it’s a good example of how dysfunctional the Congress is right now.

The U.S. Congress works best in a framework of two parties: Federalists challenging the Anti-federalists; Whigs against the Democrat-Republicans; and, mostly, Democrats versus Republicans. But now Congress is really three distinct parties: Democrats, Republicans and the Tea Party. This has happened before with the rise of the Radical Republicans around the Civil War. It was chaos then — and now.

A three-way split in the House means that Speaker John Boehner has  essentially two choices. He can accept the Tea Party ideas as mainstream ones or he can produce legislation (and especially a budget) that’s centrist enough to win Democratic votes. The speaker’s goal is 218 votes — an impossible number when Republicans are divided.

That’s why Tea Party support for the Confederate Flag is not easy to dismiss because the rest of the budget is so radical that it cannot pass without that faction’s support.

As Norman Ornstein, a congressional scholar at the conservative American Enterprise Institute, told Talking Points Memo: “What it means is he has to accommodate people he would really rather not accommodate. And what happened in this case of course he didn’t have the votes and several southern Republicans basically said, ‘You want our votes? You’re going to have to do something on the Confederate flag.’”

Then the prospect for this year’s Appropriations bills was already risky before last week’s blow up. The Obama Administration has been pressing Congress for a broader spending package that would lift the strict spending caps that are in place because of the four-year-old Budget Control Act. And Congress has pushed back by loading up the now stalled appropriations bills with poison pills, such as prohibitions that limit federal agencies from doing their jobs. (Read this: the U.S. Environmental Protection Agency.)

But federal spending will have to wait until the flag issue is resolved on Capitol Hill. As Rep. John Lewis, D-Georgia, said last week, “When I was marching a across that bridge in Selma in 1965, I saw some of the law officers, sheriff’s deputies, waring on their helmet the Confederate flag. I don’t want to go back, and as a country, we cannot go back.”

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.

Opening comments for Friday session on Native youth at National Native Media Conference.

Mark Trahant

 

Good morning. I want to congratulate all of those who made the banquet last night — especially when A Tribe Called Red was performing across town at the same time. This is the year of Native Youth. On Twitter we’ve seen #DearNativeYouth and #InvestInNativeYouth trending as well as the deep and personal interest from the President of the United States. And, yesterday, of course, was the historic White House Tribal Youth Gathering where the First Lady of the United States, Michelle Obama, called Native Youth precious and sacred members of society. “We have your back,” she told them.

But the challenge now is to move beyond the rhetoric. We all know Indian Country is a young population and the velocity of reform, of investment, needs to speed up just to stay even. 

This is the true Digital Native generation; young people connected tribe to tribe, person to person, in ways that our would amaze our ancestors. Just yesterday social media linked thousands; creating many life long friendships that will continue digitally on Facebook, Instagram and the even more honest back and forth of SnapChat. Think about this for a second: these Digital Natives have collected more media, more pictures, more music, more video, more life stories, than any generation in history. 

Technology — and the connections made via social media — are opening up new opportunities for young people. I mentioned A Tribe Called Red — musicians who might be the ideal metaphor for blending technology and tradition, fusing music into something new and fresh. Yesterday they released a new mix with Buffy St. Marie (who’s been performing for five decades). New and old is new.

Today someone living in a remote village in Alaska can make and market traditional baskets on Etsy; or produce videos on YouTube; or write computer code. In 1971 the Unix computer, the biggest, baddest machine there was, had a couple hundred thousand lines of code. Today an automobile has 90 million lines of code. And we are only at the beginning of this digital future. One that we must be prepared to shape.

And so our conversation begins today. We will start with Secretary Jewel and her impressions from the historic White House Tribal Youth Gathering.

QUESTION: We know that Indian Country’s population is young. We say that a lot — and the idea itself carries a lot of promise. But it also requires us to step up the pace because there is a greater percentage of young people. So we must increase the velocity of success — just to stay even. And that of course is not good enough. How do we do better? How do we create more opportunity while we’re in a demographic wave?

Tribal sovereignty and the call for better oral health

  
NCAI President Brian Cladoosby announcing a new dental health initiative for his community, the Swinomish Tribe.

MARK TRAHANT
ST. PAUL, MINNESOTA — The idea of “tribal sovereignty” is not static. It’s always a test, a back and forth contest between those who believe in indigenous self-government versus those who like the idea of Someone Official dictating rules.

Usually that Someone Official works for a government, a state, a county, or the federal government. These are well-intentioned people who passionately believe they are doing the right thing. But Someone Official doesn’t always have to be a government; the same disregard for tribal sovereignty is found in business, nonprofits, and in professional associations.

And so it is with the story about dental health care in Indian Country. 

Alaska, like much of Indian Country, was facing an oral health epidemic with tooth decay (and pain) being the norm for nearly every child. A number of studies reached the same conclusion: “Lack of access to professional dental care is a significant contributor to the disparities in Indian health that exist in the American Indian / Alaska Native population.”

So more than a decade ago the Alaska Native Tribal Health Consortium experimented with mid-level oral health providers, dental health therapists. The design of the program was to train and hire community-based providers right out of high school who would serve patients at the village level. The dental health therapists carry out basic dental services such as fillings and simple extractions. Their primary role is preventative and educational.

However the American Dental Association sued to stop this program, saying that the mid-level providers were practicing dentistry without a license. The Alaska Native Tribal Health Consortium fought back, using the Indian Self-Determination Act and the Indian Health Care Improvement Act to trump the state’s licensing regulations. Now more than a decade later, the program has been spectacularly successful providing routine dental care to some 40,000 patients every year.

You’d think that kind of success would bring a smile to the members of the American Dental Association.  Nope. Instead the dentists’ trade group is lobbying to make sure that the dental health therapists program is limited to Alaska (and now Minnesota).

This is where the dentists took on the role of Someone Official. The ADA decided that tribes in the lower 48 should not even have the opportunity to experiment with mid-level providers unless authorized by a state authority. The ADA did this by inserting language into the Indian Health Care Improvement Act (which is rolled into the Affordable Care Act) that says the Indian Health Service must have state approval before exanding dental health therapists.

This is where the next chapter in this story starts. At the National Congress of American Indians mid-year conference last week, President Brian Cladoosby, Chairman of the Swinomish Tribe in Washington state, announced that his tribe will enroll a student in a two-year training program to become a dental health therapist.

“We as Indians have long faced an oral health crisis, and the crisis is only growing,” Cladoosby said. “There just aren’t enough dentists in Indian Country to address this crisis. The Swinosmish dental clinic sees more than twice the number of patients per provider as the national average. That’s why we are expanding the Swinomish dental team through the proven solution of training and employing dental health aide therapists.”

This is tribal sovereingty in action. Current law might prevent the Indian Health Service from investing in better oral health care delivery; but it does not say anything about a tribal health program. This is one of those historical pushes against the status quo that write the rules for what can be done. 

The extraordinary thing about this whole story is that it should be a non-issue. Dentists and their trade group should be cheering the success of reaching so many Native people with path forward for better oral health. Nearly every clinic in Indian Country is understaffed — and I only use “nearly” because there might be one outlier out there. Fact is that there are not enough dentists in this country to serve the general population, let alone underserved communities such as Indian Country. (And in the decade following the success of the Alaska dental health therapists progam, it’s signficiant that the dentists’ trade group has proposed another solution to improve access to dental health in Indian Country.) 

A couple of years ago I had the chance to visit Bethel, Alaska, with dentists in a trip sponsored by the W.K. Kellogg Foundation.  At one point, the dentists asked one of the dental health therapists about his practice in a series of rapid fire questions. One by one he answered correctly. And the dentists walked away impressed because the people were being served. 

One more test, one answered by sovereignty in action.

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.