Indian Country politics and public policy

Commentary by Mark Trahant

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Trahant Reports

How much does it cost to buy the vote of a ‘moderate’ Republican? Today the going rate is $8 billion. (And that, by the way, is more than ten times amount of money the Indian health system is at risk of losing if Congress enacts the “American Health Care Act.”)
The $8 billion would fund a high-risk pool for individuals with pre-existing conditions. The idea surfaced Wednesday as an amendment from so-called moderate Reps. Fred Upton of Michigan and Billy Long of Missouri after a meeting with President Donald J. Trump. This pool of funds is supposed to make it easier to take away a requirement in the current law to cover pre-existing conditions. Upton is quoted by The Hill newspaper saying, “I think it is likely now to pass the House.”
Here’s the thing. An $8 billion pool won’t come anywhere close to meeting the need.
Just think about this: Chronic care, including diseases such as heart disease and diabetes, consume nearly nine-out-of-ten health care dollars (which totaled $2.9 trillion in 2013). Add to that cancer and other costly diseases and it’c clear that $8 billion is not even a down payment.

But as I have been reporting: “The bill would still wipe out Medicaid as we know it. Medicaid represents 13 percent of the Indian Health Service budget (or $808 million).” Indian Country’s biggest concern right now ought to be Medicaid, Medicaid and Medicaid. There are now 30 million children covered by Medicaid; more than half of all Native children.
The last version of the bill sticks with its revision of Medicaid by capping the costs.
The crazy part of this equation is “why?” The Senate is not going to pass this bill. Several Republican Senators, including Alaska’s Lisa Murkowski, have said they support Medicaid as a state decision. This bill will, however, put House Republicans on the record. Alaska’s Rep. Don Young has been listed throughout this process as an undecided or a “lean no.” No other state will lose as much in this legislation as Alaska. So the choice will be a vote for the party or one for constituents.

The revised bill is expected to move to the House floor as soon as today. This legislation is moving so fast that few will have a chance to review it. And the Congressional Budget Office will not be able to look at the bill’s impact on either the budget or on American’s access to insurance. — Mark Trahant

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