Speaker Paul Ryan said House Republicans are close to a deal that would allow them to pass the American Health Care Act. He says this is because of “improvements” suggested by President Donald J. Trump.
Let’s be clear about these so-called improvements: The bill would still wipe out Medicaid as we know it. Medicaid represents 13 percent of the Indian Health Service budget (or $808 million). Now. It could produce even more revenue as more states opt into the plan and more American Indians and Alaska Natives sign up for that public insurance program. This is how the Indian health system reaches full-funding one day.
Ryan tweeted that the idea behind the new bill is “to give the states the ability to kind of customize the reforms to maximize the ability to lower premiums.” And the method for that is to allow states to walk away from requiring essential services. The result would be people who have insurance policies that do not cover what would be covered under the Affordable Care Act. This weakens the idea of protecting people from insurance companies that use pre-existing conditions to limit or exclude coverage.
That’s the debate that is taking center state right now. But for Indian Country the bigger concern ought to be Medicaid, Medicaid and Medicaid.
There are now 30 million children covered by Medicaid; more than half of all Native children,
I wrote last month that two states show the impact: Alaska and Montana. Both are new to Medicaid expansion. Montana currently does not have representation in Congress — so there is no voice in this “reform.” Alaska’s Rep. Don Young, a Republican, is so far listed as an undecided for this new House proposal. I also wrote that the previous House bill was particularly bad for Alaska. That’s still true but now those voting for the measure have a way to spin it: They can say it will lower premiums. Sure. And that will be fine as long as you never need the policy to actually pay for expensive medical treatment.
A House vote could come as soon as Friday. — Mark Trahant