Latest attack on Medicaid also sabotages Treaty Rights, Indian health programs

Agency Says Indian Health Should Not Be Exempt From Medicaid Work Rules Because They Are ‘Race-Based’

Mark Trahant / Trahant Reports

The Trump administration is supporting a major policy shift on Indian health programs which could result in a loss of millions of dollars and sabotage treaty rights.

A story in Politico Sunday raised the issue. It said “the Trump administration contends the tribes are a race rather than separate governments, and exempting them from Medicaid work rules — which have been approved in three states and are being sought by at least 10 others — would be illegal preferential treatment. ‘HHS believes that such an exemption would raise constitutional and federal civil rights law concerns,’ according to a review by administration lawyers,” Politico said.

The new policy on Medicaid work requirements “does not honor the duty of the federal government to uphold the government-to-government relationship and recognize the political status enshrined in the Constitution, treaties, federal statutes, and other federal laws, said Jacqueline Pata, executive director of the National Congress of American Indians. “Our political relationship is not based upon race.”

“The United States has a legal responsibility to provide health care to Native Americans,” Mary Smith, who was acting head of the Indian Health Service during the Obama administration and is a member of the Cherokee Nation, told Politico. “It’s the largest prepaid health system in the world — they’ve paid through land and massacres — and now you’re going to take away health care and add a work requirement?”

Medicaid has become a key funding stream for the Indian health system — especially in programs managed by tribes and non-profits. Medicaid is a state-federal partnership and public insurance. The Affordable Care Act expanded Medicaid eligibility, but the Supreme Court ruled that each state could decide whether or not to expand. Since the expansion of Medicaid some 237,000 American Indians and Alaska Natives in 19 states have become insured.

Officially Medicaid represents 13 percent of the Indian Health Service’s $6.1 billion budget (just under $800 million).

But even that number is misleading because it does not include money collected from third-party billing from tribal and non-profit organizations. In Alaska, for example, the entire Alaska Native health system is operated by tribes or tribal organizations and the state says 40 percent of its $1.8 billion Medicaid budget is spent on Alaska Native patients. That one state approaches the entire “budgeted” amount for Medicaid.

Other states report similar increases. Kaiser Family Foundation found that in Arizona, one tribally-operated health system reported that about half of visits were by patients covered by Medicaid in 2016. And, an Urban Indian Health Program, reported that its uninsured rate at one clinic fell from 85 percent before the Affordable Care Act to under 10 percent.

Those Medicaid (and all insurance) dollars are even more significant because by law they remain with local service units where the patient is treated (and the insurance is billed). In Alaska more than two-thirds of those dollars are spent on private sector doctors and hospitals through purchased care for Alaska Native patients. And, unlike IHS funds, Medicaid is an entitlement. So if a person is eligible, the money follows.

A recent report by Kaiser Health News looked at Census data and found that 52 percent of residents in New Mexico’s McKinley County have coverage through the Medicaid.  That’s the highest rate among U.S. counties with at least 65,000 people. “The heavy concentration of Medicaid in this high-altitude desert is a result of two factors: the high poverty rate and the Indian Health Service’s relentless work to enroll patients in the program,” Kaiser reported. Most of McKinley County is located on the Navajo and Zuni reservations.


Kaiser Health News said Medicaid has opened up new opportunities for Native patients to “get more timely care, especially surgery and mental health services. It has been vital in combating high rates of obesity, teen birth, suicide and diabetes, according to local health officials.”

However the growth of Medicaid is resulting in unequal care for patients in the Indian health system. The benefits in some states, including those that expanded Medicaid under the Affordable Care Act, are more generous. Other states not only refused to expand Medicaid and have been adding new restrictions such as requiring “able-bodied” adults to have their Medicaid eligibility contingent on work.

But the Indian health system — the federal Indian Health Service and tribally and nonprofit operated programs — are in a special case because there is a 100 percent federal match for most services. So states set the rules, but do not have to pay the bill. (Medicaid is often the second largest single item in a state budget behind public schools.)

Medicaid is the largest health insurance program in America, insuring one in five adults, and many with complex and long-term chronic care needs. The Trump administration and many state legislatures controlled by Republicans see Medicaid as a welfare program. While most Democrats view it simply as a public health insurance program.

Work rules are particularly challenging for Indian Country. Unlike other Medicaid programs, patients in the Indian health system will still be eligible to receive basic care. So stricter rules will mean fewer people will sign up for Medicaid and the Indian Health Service — already significantly underfunded — will have to pick up the extra costs from existing appropriations. That will result in less money, and fewer healthcare services, across the board.

A letter from the Tribal Technical Advisory Group for Medicare and Medicaid said American Indians and Alaska Natives “are among the nation’s most vulnerable populations, and rely heavily on the IHS for health care. However, the IHS is currently funded at around 60 percent of need, and average per capita spending for IHS patients is only $3,688.” The latest per person cost for health care nationally is $10,348 (totalling $3.3 trillion, nearly 20 percent of the entire economy).

The tribal advisory group said it is “critically important” that there be a blanket exemption for IHS beneficiaries from the mandatory work requirements.

A report in September by the Kaiser Family Foundation showed that the majority of American Indians and Alaska Natives on Medicaid already work, yet continue to face high rates of poverty. It said over three-quarters of American Indians and Alaska Natives are in working families, but that’s a gap of about 8 percent compared to other Americans (83 percent).

The Trump administration’s characterization of tribal health programs as “race-based” is particularly troubling to tribal leaders because it would reverse historical precedence.

A memo last month from the law firm of Hobbs, Straus, Dean & Walker said the Centers for Medicare and Medicaid Services “has ample legal authority to single out IHS beneficiaries for special treatment in administering the statutes under its jurisdiction if doing so is rationally related to its unique trust responsibility to Indians. Under familiar principles of Indian law, such actions are political in nature, and as a result do not constitute prohibited race based classifications. This principle has been recognized and repeatedly reaffirmed by the Supreme Court and every Circuit Court of Appeals that has considered it, and has been extended to the actions of Administrative Agencies like the Department of Health and Human Services even in the absence of a specific statute.”

Mark Trahant is editor of Indian Country Today. He is a Shoshone-Bannock tribal citzen. On Twitter: @TrahantReports Cross posted on Indian Country Today.

(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.)

 

#NativeVote18 Candidates are boosted by an electorate ready for change

 

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.”

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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

The road ahead for Trahant Reports and Indian Country Today #NativeJournalism

Mark-Trahant

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 ‘bothers’ to run for Congress in Oklahoma #NativeVote18

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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.

 

 

 

What experiences should an IHS director have? In my book: Medicine & Medicaid.

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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 / TrahantReports.com #IndigenousNewsWire #NativeVote18

 

Trump budget is a ‘messaging document’

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National Economic Council discusses White House infrastructure plan. (White House photo)

Mark Trahant / Trahant Reports

Budgets are statements: This is what “we” care about.  It’s money that reveals priorities. The “we” could be, and ought to be, the country. Or the “we” could be a presidential administration that’s not really equipped to govern. So there will be lots of stories this year, like last year, about the Trump’s administration’s desire to cut federal Indian programs, wipe out public broadcasting, end student loan forgiveness, wreck Medicaid and Medicare, food stamps, housing programs, and generally just about every federal program that serves poor people.

As Trump budget director Mick Mulvaney told reporters: “This is a messaging document.”

And what a message: Rich people face tough times so they deserved a huge tax cut. Poor people are poor because of their own failures. And more money is needed for a wall that’s not needed, for the largest military in the world, and the Republicans no longer believe that deficits matter.

But Mulvaney has a different version. Here is what he says are the messages.

“Number one, you don’t have to spend all of this money, Congress.  But if you do, here is how we would prefer to see you spend it,” he said. “And the other message is that we do not have to have trillion-dollar deficits forever.”

Ok. So the action is in Congress. Even Republicans on Capitol Hill know that this budget cannot be. It’s chaos as numbers.

Perhaps the best line of nonsense was written a line written by the budget director to House Speaker Paul Ryan saying domestic spending at the levels Congress has already approved would add too much to the federal deficit. That’s funny.

For this budget to become law (and overwrite the current spending bill) the House and Senate would have to agree to a budget. That’s unlikely. As I have written before there are lots of votes against any budget but not enough votes to pass any budget. A budget resolution would allow the Senate to move forward with a spending plan with only Republican votes (and even then only one to spare). But unless the rules change (which President Trump wants) the Senate needs 60 votes for regular appropriations bills. That means a lot of compromise before federal spending.

The most popular part of the president’s budget is infrastructure spending. But most of his plan would be funding from state, local, and tribal governments. That’s a problem. Congress will not be eager to follow this approach, especially in an election year. Members of Congress love announcing new roads and other projects. It means jobs back home.

It’s telling that in the White House statement on infrastructure tribes are not mentioned (something that was routinely done in the Obama White House).

Gary Cohn, the director of the National Economic Council, wrote: “Our infrastructure is broken. The average driver spends 42 hours per year sitting in traffic, missing valuable time with family and wasting 3.1 billion gallons of fuel annually. Nearly 40 percent of our bridges predate the first moon landing. And last year, 240,000 water main breaks wasted more than 2 trillion gallons of purified drinking water—enough to supply Belgium.”

So the Trump administration’s answer is to fund this with local government dollars because, as Cohn puts it, “the federal government politically allocated funds for projects, leading to waste, mismanagement, and misplaced priorities. The answer to our nation’s infrastructure needs is not more projects selected by bureaucrats in Washington, D.C Instead, the President’s plan designates half of its $200 billion for matching funds to stimulate State, local, and private investment.”

Another thing for a broken Congress to fix. If the votes are there. In theory that should be easy. This is an area where Republicans and Democrats agree (actually anyone who looks at the crumbling state of infrastructure can figure this one out). But in this Congress? We shall see.

At the State of the Indian Nations Monday, National Congress of American Indians President Jefferson Keel said: “Native peoples are also builders and managers of roads and bridges, and other essential infrastructure. These projects are often in rural areas. They connect tribal and surrounding communities with each other, and the rest of the Nation. Tribal infrastructure is American infrastructure. In 2018, NO infrastructure bill should pass, UNLESS it includes Indian Country’s priorities.”

Back to the budget as a messaging document. The Center for Budget and Policy Priorities says this budget “violates the spirit of the bipartisan agreement that congressional leaders negotiated just a few days ago.”  That’s going to make it much more difficult to come up with the next agreement in Congress (unless the law is ironclad, stripping the administration of some of its governing authority).

The budget assumes that Congress would repeal the Affordable Care Act and replace it with a block grant formula. The votes are not there for that. It’s fantasy.

The current bipartisan agreement “calls for adding $2.9 billion per year over the next two years to the discretionary Child Care and Development Block Grant, boosting this key federal program to help make child care affordable for low- and modest-income parents.  But the budget reneges on that and proposes essentially flat funding for the program. The Administration’s blatant dismissal of a major bipartisan agreement on which the ink is barely dry may make bipartisan agreements harder to reach in the future,” the budget center reports. “And then, in years after 2019, the budget calls for cuts of unprecedented depth in non-defense discretionary programs even though that’s the part of the budget that contains many federal investments in long-term economic growth.  By 2028, funding for non-defense discretionary programs would fall 42 percent below the 2017 level, after adjusting for inflation.  Indeed, by 2028, total NDD spending, measured as a share of gross domestic product, would be at its lowest level since Herbert Hoover was president.”

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Where federal money is spent. Source: Congressional Budget Office.

To me that’s the key point. Domestic spending, the programs that serve Indian Country, are already dropping and have been for a long time. All domestic discretionary programs add up to about 4.6 percent of the budget — and federal spending on Indian Country is a tiny fraction of that.

And, as the budget center points out, that means Trump budgets would actually “go below the 2019 sequestration levels, which Congress just agreed is too low to meet national needs.”

The messaging document (the budget, remember?) has another problem. It’s based on assumptions that are even more of a fantasy than repealing the Affordable Care Act. The budget assumes a 3 percent growth rate this year and 4 percent next year. So lots more people earning more and paying more income taxes (since corporations will be paying less). Not. Going. To. Happen.

Even economists think this is nonsense. The crackdown on immigration, for example, is shrinking the economy, not growing it. And the Congressional Budget Office projects a long term growth rate of just under 2 percent. Last year the economy grew at 2.6 percent, below what Trump said would happen and even below the consensus of economists.

This 2019 budget will accomplish one thing: It will serve as a mile post for the fall election. Republicans can make the case for defense spending and, I suppose, that they used to be against deficits. And Democrats will make the case for protecting health care and other domestic priorities.

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 / TrahantReports.com #IndigenousNewsWire #NativeVote18

 

 

 

 

 

 

 

#NativeVote18 — Minnesota’s first election test starts with precinct caucuses

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Rep. Peggy Flanagan speaking at a campaign event. She Tweeted: “My fave photo from our kickoff. I’m running for my little girl and all girls who deserve to be seen, heard and valued.” (Photo via Twitter)

Mark Trahant / Trahant Reports

The November election seems far off. It’s almost a year away, right? Sorry. Elections are a series of steps that lead to that moment when ballots are actually counted. 

And for the #NativeVote18 candidates some of those early steps are real tests. And in Minnesota one of those critical test is Feb. 6.

So far there are 15 Native candidates on my national list, people running for office statewide or for a seat in the U.S. House of Representatives. That’s extraordinary and compelling when you think about it. There are two candidates for state governors, two for Lt. Governors, eight running for Congress, one for the U.S. Senate, and two for attorney general and secretary of state. Seven of the candidates are Democrats, 5 Republicans, and 2 Green Party candidates and one independent. That’s a lot of diversity in thought, geography, and, of course, culture.

Back to that test. Voters in Minnesota will caucus at the precinct level. It’s a meeting that is run by a political party. Here is how it works (from the Secretary of State’s office): “We encourage Minnesotans to show support for their preferred candidates by participating in the candidate endorsement process that leads up to the state party conventions. It all begins on Tuesday, February 6, 2018 with the precinct caucuses. Going to a caucus is a great way to show support for a candidate, raise an issue that’s important to you, influence who the party will endorse for many offices, and meet people in your community.”

There are two important things that happen at these precinct-level meetings. First there will be a “preference” vote for governor. The winner of that poll could use it to help raise money and suggest a larger base of support. The second thing is the election of delegates to the state convention. This is the big deal. Because in Minnesota state party delegates will later endorse a candidate before the primary.

A precinct caucus can be won by a small group. Basically if someone decides to take a bunch of friends to a meeting — that could change everything. That’s especially true in this year’s election because both parties have so many candidates running. A small, dedicated group of friends could win an election. Literally. (Said in a Rob Lowe voice.)

On the Democratic side (the Democratic Farmer Labor Party) there are six plus candidates, a mayor, three legislators, a state auditor, and a member of Congress.

And Rep. Tim Walz is campaigning with his pick for Lt. Gov, Rep. Peggy Flanagan. Flanagan is a member of the White Earth band of Ojibwe. And she would be the first Native American woman to hold this office. This is unusual for a team to be put together so early, but it’s also an opportunity for voters to see what an administration would look like. And for the team to balance each other in terms of interest and perception.

That’s already been an issue. Rebecca Otto, the state auditor and a DFL candidate for governor, says she is running to be the most progressive candidate. In a fundraising letter she she has “strong disagreements” with Walz because he voted for Keystone XL three times in Congress, supports the Enbridge Pipeline and “says he does not oppose the DAPL pipeline.” As is often the case, the story is more complicated than that. It’s true that Walz voted for Keystone, but he also has said that if any pipeline negatively impacts Native people, violates treaty rights, or disturbs burial grounds, it should not be built. 

There are two political tactics at work here: Otto’s team is eager to weaken support for Walz-Flanagan in Native communities and discount Flanagan’s role by only focusing on Walz’ record in Congress.

But Walz and Flanagan are running together early — so voters should judge both of them. Together. Should Walz be elected, Flanagan would be there to make the case. She would be inside the room. She might win the day. She might not. But she’ll be there for four years pushing and reminding Walz about the importance of Native issues. Especially pipelines.

Tuesday’s precinct caucus is a test for Walz and Flanagan — and for voters from Native communities in Minnesota. A precinct caucus is the perfect forum for Indian Country because a small dedicated group can win.

There are also nine Republicans running in their party caucus Tuesday. Last week former Gov. Tim Pawlenty signaled that he might try one more time. That could shake up that side of the race big time.

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 / TrahantReports.com #IndigenousNewsWire #NativeVote18

The federal government shutdown is a failure by Congress to govern

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Updated Sunday.

Mark Trahant / Trahant Reports

The government is in its official shut down mode. And it’s a fight that has been brewing for a long time. It’s complicated because there are several different congressional factions, think of them as mini-political parties, that have different goals.

Remember this: The Republicans are in charge. This process could have been resolved within the caucus — if the GOP leadership had the votes. Back in September. And that’s the main problem. There are not enough votes for an affirmative solution. It’s so much easier for one faction or another to say “no.” (The House did pass their latest, short-term version with the support of the so-called Freedom Caucus. But several Senators in the Republican camp are still not on board because that solution doesn’t send enough money to the military and still other senators are not happy with another Continuing Resolution for any additional spending.)

Democrats have not had much say in the government since the election of Donald J. Trump as president. Senate leaders have used budget rules designed to pass legislation with 51 votes. But this short-term spending bill does not qualify — at least for now. More on that shortly.

There are three things on the Democrats’ “must” list. They want domestic spending protected (remember, one GOP faction wants deep cuts into government spending). Party leaders have been successful doing this with every Continuing Resolution so far because the alternative is the Budget Control Act and that would require deep cuts to the military (as well as domestic programs). Because of this threat, the faction in Congress that supports more money for the military has been willing to work with Democrats.

Democrats also want funding for the Children’s Health Insurance Program or CHIP. That is a huge program for Indian Country (along with Medicaid) pays the health care costs for more than half of all American Indian and Alaska Native children in the Indian health care system.

The CHIP program is in the House Continuing Resolution. But, as the National Indian Health Board posted last week, the House bill “does contain a 6-year reauthorization for the Children’s Health Insurance Program but does not include the Special Diabetes Program for Indians. This is a huge miss. The Special Diabetes for Program for Indians expires March 31. The ideal solution would be for the Senate to include both CHIP and the diabetes program in any deal that’s made with the White House.

The bill also does not fund Community Health Centers which could lose up to 70 percent of their budget.

The final sticking point for the Democrats is protecting the people who were brought to this country by their parents or other adults unlawfully as children. This issue is interesting because nearly everyone sees the value in finding a solution to the problem because the United States is their country in all but paperwork. Yet even the rhetoric is changing. A few days ago Republicans were talking about agreement on this point. Today the language is harsh, Republicans saying Democrats are trying to “protect illegal aliens.”

But the Senate bill that the president rejected was bipartisan. Immigration hardliners did not want the deal, even though it would have increased funding for the wall, because it was too lenient on Dreamers. The White House represents the most conservative element on immigration issues.

Of course none of these issues are new. But Congress has not had the votes to pass any plan. So the solution has been short-term spending bills. This government shutdown is about ending that stalemate, resolving the debates, and moving forward.

That said:  Don’t be surprised if another “deal” is another short-term pass. But the goal is to force Congress into a real debate. Big picture stuff. (Yeah, right. I know, but I had to write it anyway.)

Rep. Tom Cole, R-Oklahoma, told National Public Radio that he doesn’t think “anybody’s going to negotiate very seriously with a gun to their head.” He said one of the problems is the Senate and the dysfunction over the “rule of 60.” Because of that, Cole said, the Senate hasn’t passed a single appropriations bill. “They didn’t do a real budget this year. The House did.”

The rule of 60 is the power of the minority to call for a filibuster. It takes 60 votes to end debate. President Trump took to Twitter Sunday to call for an end to that Senate rule. “Great to see how hard Republicans are fighting for our Military and Safety at the Border. The Dems just want illegal immigrants to pour into our nation unchecked. If stalemate continues, Republicans should go to 51% (Nuclear Option) and vote on real, long term budget, no C.R.’s!”

Of course Indian Country (and the economy) will be hit hard if this shutdown lasts very long. Lots of families, both government employees and contractors, could lose a paycheck.

The problem is we really don’t know exactly how the Trump administration will manage this particular closure.  Some agencies, such as the Environmental Protection Administration, are using year-end funds to continue operation. The White House has posted a round up of agency plans. But we will know about the direct impact next week.

During the last government shutdown, 21-days that started on December 16, 1995, and continued to January 6, 1996, all 13,500 Department of Interior Bureau of Indian Affairs  employees were furloughed; general assistance payments for basic needs to 53,000 BIA benefit recipients were delayed; and estimated 25,000 American Indians did not receive timely payment of oil and gas royalties,” according to the Congressional Research Service. The last time around furloughed employees were eventually paid. Eventually.

All told Standard & Poor’s estimated the U.S. economy lost $24 billion last time around.

The Indian Health Service and the Department of Interior posted planning memos in September about what is expected to happen. Basically: Many BIA employees will be furloughed, except for those that work in public safety or who are managers. However the Bureau of Indian Education will mostly continue working as normal.

Former Indian Health Service Director former IHS director Dr. Michael Trujillo told Congress that the government closure “caused considerable hardship within Indian communities. One result of staff furloughs was difficulty in processing funds for direct services and to contracting and compacting tribes so the delivery of health services could continue. Those staff that continued providing health services were not paid on time. Threats to shut off utilities to our health facilities and even to stop food deliveries were endured. We reached a point where some private sector providers indicated that they might not accept patients who were referred from Indian Health facilities because of the Federal shutdown.”

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

 

 

 

 

How much does climate change cost? Try $1.5 trillion and counting has only started

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Dominica’s capital of Roseau in the days after Hurricane Maria. (Photo by Timothy Fishleigh, Caapi Cottage Retreat Center.)

Mark Trahant / Trahant Reports

The Trump administration, and its allies in Congress, are fighting a losing war. They continue to press forward for the development of oil, gas, coal, when the rest of the world understands the implication of that folly. Global warming is the most pressing issue for our time. Period.

The thing is governments really have two choices when it comes to managing the impact on its peoples from global warming: Spend money on trying to reduce the problem; or spend money on cleaning up the catastrophes.

The Trump administration is on the hook for the catastrophe. A report released Monday by The National Centers for Environmental Information pegged the total cost this year at $1.5 trillion, including estimates for Hurricanes Harvey, Irma and Maria. (And that doesn’t even begin to count the human toll, lost lives, lost jobs, lost opportunity.)

I witnessed first hand the impact of Hurricane Maria on the island of Dominica last month. We keep hearing stories about the power grid being down (similar to Puerto Rico) and you think, why? It’s been months. Why aren’t the lights on? Then you see nearly every electrical pole on the island sideways. The entire grid needs to be rebuilt (or better, rethought) and that’s decades of infrastructure. So the figure of $1.5 trillion is far short of what will be needed. Nearly every electrical line, every other house, the damage was so widespread it’s impossible to overstate. And that’s just one island. Multiple the effect across the region. The planet.

Even the United States.

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The Centers for Environmental Information says there were sixteen weather and climate disasters  with losses exceeding $1 billion each across the country last year. These events included one drought, two flooding events, one severe freeze, eight severe storms, three cyclones, and one extraordinary wildfire. These “events” as the center defines them resulted in 362 deaths.

Turns out 2017 was a record-breaking year. “In total, the U.S. was impacted by 16 separate billion-dollar disaster events tying 2011 for the record number of billion-dollar disasters for an entire calendar year,” the report said. “In fact, 2017 arguably has more events than 2011 given that our analysis traditionally counts all U.S. billion-dollar wildfires, as regional-scale, seasonal events, not as multiple isolated events.More notable than the high frequency of these events is the cumulative cost, which exceeds $300 billion in 2017 — a new U.S. annual record.”

A similar report was published by the Government Accountability Office including a recommendation that Executive Office of the President “identify significant climate risks and craft appropriate federal responses.”

But instead of trying to reduce the impact — and the costs of weather-related catastrophe — the Trump administration continues on course for new development of oil and gas. The Interior Department announced new rules that, if enacted, will open up nearly all of the United States coastal waters to more oil and gas development beginning next year.

“By proposing to open up nearly the entire OCS for potential oil and gas exploration, the United States can advance the goal of moving from aspiring for energy independence to attaining energy dominance,” said Vincent DeVito, Counselor for Energy Policy at Interior in the news release. “This decision could bring unprecedented access to America’s extensive offshore oil and gas resources and allows us to better compete with other oil-rich nations.”

Or as Interior Secretary Ryan Zinke put it: “The important thing is we strike the right balance to protect our coasts and people while still powering America and achieving American Energy Dominance.”

Dominance is such a funny word. How can any nation be dominant in the face of hurricanes that are ever more powerful and destructive? How does energy dominance work when tens of thousands of Americans will have to move because their homes are no longer there because of fire or storms? What happens if that number grows into the hundreds of thousands? Millions? How can we afford to spend trillions of dollars rebuilding what we have now?

A group of elders on the Bering Sea immediately condemned the Interior Department’s offshore drilling plan. “We told them that in person last October and again in writing, that there were 76 tribes in these regions opposed to this,” said the statement from the elders. “The draft plan implies that Bering Sea communities were ‘generally supportive of some’ oil and gas activity. This is not accurate and there is no evidence of this from Bering Sea communities. For decades, our people have opposed oil and gas activity and we continue to oppose it today. The northern Bering Sea is a very fragile ecosystem. The marine mammals that we rely on use it as their highway and they follow specific migration routes. That is how we know when and where to find them. The noise and vibration associated with drilling will interfere with their sonar and disrupt their migrations. Then we the coastal people will lose our primary food source.”

There is a connection between developing oil and gas and paying the high costs to clean up after a storm. One side of the ledger goes to a few; the oil and gas “industry.” The folks who bought and paid for this administration.

The other side of the ledger is the rest of us. The taxpayers who will foot the bill for this continued folly.

And on the Bering Sea? The folks who live there are one storm away from a tragedy. As the elders put it: “Our people and our way of life are being exposed to danger and we do not understand why.”

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

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First, do no harm. What it takes to manage the Indian health system

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Robert Weaver, Quapaw, is President Donald J. Trump’s nominee to head the Indian Health Service. Weaver’s background is insurance, not health care delivery. (Weaver Group photo)

 

Mark Trahant / Trahant Reports

What qualifications are needed to manage (and possibly reform?) the Indian health system? It’s Indian Country’s largest employer with more than 15,000 on the payroll and many, many more people who work in health care for tribes, non-profits and other related agencies. The IHS budget is $6.1 billion. Yet it’s also the least funded national health care delivery system, operating in a political atmosphere where critics ask, why can’t it do more?

The Wall Street Journal published a story last week that raised questions about Robert Weaver, the Trump Administration’s nominee to head the Indian Health Service. The Journal challenged Weaver’s history at St. John’s Regional Medical Center in Joplin, Mo., from 1997 to 2006. However it quoted Jennifer Talhelm, an HHS representative, saying “any suggestion Mr. Weaver is unqualified to run IHS is a pure act of character assassination.”

Weaver is a member of the Quapaw Tribe of Oklahoma.

A few facts: Weaver will be the least educated director of the Indian Health Service ever. If confirmed, Weaver will the tenth permanent director. All but one prior to Weaver have been physicians, most with multiple degrees in public health, science, and health administration. One former director, Robert McSwain, was not a medical doctor, but he was a longtime health manager and holds a Master of Public Administration from the University of Southern California. On his CV, Weaver lists his education at Missouri Southern State University in International Business with an emphasis in Marketing and Accounting; Minor in Spanish; Minor in Vocal Music & Piano. However the Journal reported that he was seeking a degree and did not graduate.

Weaver’s background is insurance. In a September 2016 profile in Native Oklahoma magazine, Weaver said, “We have Native Americans who are brilliant — geniuses — at gaming, but where are the Native American geniuses at insurance? It’s the second-largest cost we pay other than payroll. Yet it just goes to the wayside.” He told the magazine that his business saved the Quapaw Tribe more than $5 million a year.

“I try to be a translator for tribal leaders to understand this convoluted, difficult-to-understand, most of the time full of lies and deception industry, into ‘this is what it is. This is what your choices are.’ I get it,” he told Native Oklahoma.

Perhaps the Indian Health Service should be led by someone with an insurance background. It would surely help if the agency could come up with a better funding model, including a mix of insurance funds (third-party billing in IHS-speak.)

But there are three problems that ought to be clearly addressed through the Senate confirmation process.

First there is the problem of scale. Weaver would jump from managing a $10 million a year small business — one where he can hire and fire at will — to running a $6 billion agency where personnel decisions are made by folks higher in the chain of command at the Department of Health and Human Services or even as a favor to a United States Senator. And firing? Just one such action could take up more time than the three years left in this administration. And that’s the easy stuff. The agency’s operations are complicated by Congress, law, regulation, tribal relations, the Veterans Administration, Medicare, Medicaid, and private insurance.

To his credit, Weaver has been outspoken about the underfunding of the Indian health system. (Question: Will he say so again in his confirmation testimony?) In a paper he wrote a year ago, Weaver said: “Healthcare is a treaty right for all Native Americans. The method of delivering healthcare for Native Americans is the Indian Health Service system established through the Federal Government. The Federal Government allocates funds to the IHS system each fiscal year. This allocation has been and continues to be inadequate to meet the healthcare needs of Native Americans. Currently it is underfunded by thirty billion dollars annually.”

That figure of $30 billion would eliminate the funding disparity for Indian health. (The National Congress of American Indians has published a plan to make that so over a decade.)

The second problem is how to articulate the Indian health story. This is a problem of “duality,” two competing ideas. On one hand you have some significant health and management problems such as those identified in the Great Plains by The Wall Street Journal. On the other hand you have a system that is innovative and includes models of excellence (such as clinics in the Pacific Northwest or the Alaska Native Medical Center.) One story is told. The other less so. I am convinced that a fully-funded system will only happen when we tell both stories. The narrative of failure is not an incentive to invest more money.

The third problem is the Affordable Care Act and Medicaid. Weaver wrote that the law works for Native Americans but overall it was a failure. “We now see that it did not provide health insurance for the forty million uninsured Americans identified as the target market in 2008, it is not affordable for those who were pulled into the ACA system, and the out of pocket maximums associated with the plan effectively make access to healthcare unattainable,” he wrote. The first part of that sentence is factually incorrect. The uninsured rate dropped from 20.5 percent in 2013 to 12.2 percent in 2016, a 40 percent decline. You can argue about the cost of that insurance, but it’s complicated because the ACA required minimum standards for insurance, covering such things as women’s health. All of the Republican plans are designed to save money by getting rid of those standards.

Of course in the Trump era there’s probably not a candidate for any public office who champions the ACA.

But I also don’t see any Medicaid experience in Weaver’s background and that is an expertise area that is critical. Some of the medical, treatment, and ethical issues are extraordinarily complex. They will require a solid team to help consider all of the alternatives that have life and death consequences. (So, if confirmed, he’ll need a lot of help.) Oklahoma is not a Medicaid expansion state, so there would not be a lot of experience in squeezing every dollar from Medicaid by making more people eligible or rethinking the coding of costs. The public insurance of Medicaid (and Medicare) now total $1.05 billion of the IHS budget, but it could be a lot more.

Weaver could use his expertise to help tribes improve insurance for tribal members and employees — and that could boost funding for IHS. Private insurance is now only about $110 million of the agency’s revenue.

So what are the qualifications necessary to run the Indian health system? I have a bias. I have met some of the great physicians who ran the agency. I remember Emery Johnson’s passion and thoughtfulness about what IHS could be. I’d even argue that IHS has had remarkable leadership since its founding. So the standard, for me, at least, is quite high. There are also two Native women who have run state health agencies — an ideal background for managing the IHS. There is a lot of talent out there.

But the Trump administration likes the idea of shaking up government. And, appointing someone to run the IHS with a very different background, does just that. Perhaps Weaver brings a new way of thinking and managing. Then again we would do well to remember the latin phrase that medical doctors learn early in their training, Primum non nocere. It means: First, do no harm.

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 do so. Just credit: Mark Trahant / TrahantReports.com #IndigenousNewsWire #NativeVote18 #IndianHealth

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(Note: I use the phrase, Indian health system (lower case) unless I am specifically talking about the agency. My reason is that the narrative of a government-run health care agency, the Indian Health Service, doesn’t reflect what most of what the agency does now. The funding mechanism that supports tribes and non-profit health care agencies is the largest part of the system.)