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 money chase. #NativeVote18 federal candidates make their pitch for big bucks

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U.S. Rep. Tom Cole, a member of The Chickasaw Nation, raised more than $869,000 last year. #NativeVote18 (Campaign photo)

Mark Trahant / Trahant Reports

It’s time to look at the money. How much money are #NativeVote18 candidates raising?

Yes, I know, this is a silly metric. After all there is no relationship to governing and calling up people you don’t know and asking them for money. Yet this is the system in place. A candidate is more likely to be successful if she or he can raise a lot of money.

So it’s no surprise that the big money collectors — even in Indian Country — are the ones who already hold office or who have held office recently. And it’s probably no surprise that the big money is headed down Republican alley.

The top money raiser is Rep. Tom Cole, R-Oklahoma. The latest Federal Election Commission reports were posted at the end of January and reflect fundraising for 2017. His net: $1.7 million, cash on hand.

Several tribes donated the maximum amount to Cole’s campaign. Oklahoma tribes, such as his own, the Chickasaw, and the Cherokee Nation, backed Cole as well as tribes from across the country ranging from Penobscot to Stillaguamish.

Some of the contributors have different agendas. Tribes, for example, support Cole because of his strong stands on tribal sovereignty. Yet the American Dental Association, another contributor, has worked against that very issue by challenging the tribes right to regulate mid-level dental practices. (Previous: Tribal sovereignty and the call for better oral health.)

Washington congressional candidate Dino Rossi comes in second for fundraising last year, netting a little more than a million dollars. This is remarkable when you consider he was not even a candidate until September. Rossi is Tlingit and Italian.

As I wrote in September:  “One of his first jobs was working for Bernie Whitebear at Seattle’s United Indians of All Tribes. It’s interesting how some candidates make their tribal affiliation prominent and weigh in on issues that impact Indian Country. That would not be Rossi. But he doesn’t shy away (as many politicians do) from the conversation. It’s just not his focus.”

His campaign finance report bears that out. You won’t find a lot of tribal money.

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Debra Haaland, who is running for Congress in New Mexico, raised more than $386,000 in her bid. If elected, she would be the first Native woman ever elected to the House. (Campaign photo)

The top Democrat for fundraising this cycle is Debra Haaland running in Albuquerque. She ended the year just shy of $200,000 in cash. Haaland, of course, and I can’t write it often enough, would be the first Native American woman ever elected to Congress. She’s running in a district that favors Democrats but she must win the primary first against seven other candidates. So far Sedillo Lopez, a former associate dean at the University of New Mexico Law School, has raised some $456,000 and reports $348,000 in cash on hand. Haaland has raised a total of $386,000 in contributions.

There is a huge difference between Haaland’s fundraising and Cole’s money. Most of her contributions come in $10 and $25 chunks. Small money. But that’s important because it could reflect interest by real voters instead of tribes and Political Action Committees and business interests. She does get some money from tribes, including her own, Laguna Pueblo, but not nearly as much as is found in Cole’s treasury.

The race for Oklahoma’s second congressional district could become the first election between two tribal members, the incumbent, Rep. Markwayne Mullin, and his challenger Tahlequah Mayor Jason Nichols. Both men are Cherokee.

But so far on the money side it’s not much of a contest. Mullin raised about $725,000 last year, netting $434,333.37. Nichols raised $17,575.52 and ended with $8,287.30 cash on hand.

The trick in any campaign is to raise as much money as needed to be competitive. That doesn’t always mean first. But it does mean having the resources to compete in media advertising, including social media, hiring staff, and organizing.

Several #NativeVote18 candidates showed no fundraising in the FEC reports. It could be because there fundraising is scant, or ramping up later, or because reports have not been filed yet.

#NativeVote18 spreadsheet of federal candidates with links to FEC reports.

Next up: State candidate fundraising totals.

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

 

 

Tax cuts? Hell. No. Thousands of American Indian and Alaska Native children will lose health insurance

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Mark Trahant / Trahant Reports

Congress has yet to reenact the Children’s Health Insurance Program and states will soon run out of funds to prop up the program. That will mean that thousands of American Indian and Alaska Native children will lose their health insurance. And, the result is the Indian Health Service will have to stretch its already thin dollars to try and cover the budget hole.

The Children’s Health Insurance Program expired Sept. 30. This federal program insures young people and pregnant women who make just enough money not to qualify for Medicaid (but can’t afford private insurance). The idea is to make sure that every child has the resources to see a doctor when they are ill.

It’s hard to break down precise numbers because agencies lump funds from the Children’s Health Insurance Program or CHIP into Medicaid data. But we do know that the law worked really well. We also know there are more than 216,000 children that have health insurance because of Medicaid and the CHIP. Indeed, Native American children rely on Medicaid and CHIP at much higher percentages than other population groups. A study by Georgetown reported that 54 percent of American Indian and Alaska Native children were enrolled in Medicaid or CHIP as compared to 39 percent of all children. “Even though much progress has been made in extending Medicaid coverage to American Indians and Alaska Natives, the uninsured rate for American Indian and Alaska Native children and families remain unacceptably high,” the report said.

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Source: Georgetown University Health Policy Institute. Coverage Trends for American Indian and Alaska Native Children and Families.

Overall the uninsured rate among non-elderly American Indians and Alaska Natives fell by 7 percentage points from 24 percent to 17 percent, according to the Kaiser Family Foundation.

This is a big deal and here’s why: The Indian Health Service is a health care delivery operation that works best when insurance (third-party billing in government-speak) pays for the medical costs. Medicaid, CHIP, Medicare, and other third-party billing now accounts for 22 percent of the IHS’ $6.15 billion budget.

But if Children’s health is no longer funded (because Congress did not reauthorize the legislation) then the Indian Health Service will have to make up the difference. That means taking money away from other patients and programs. It will be a critical problem for clinics because by law dollars from third-party billing (or Medicaid and CHIP) remain local.

Alaska is the state most impacted by Congress’ failure to act because two-thirds of the children in the Native health system are covered by Medicaid or CHIP. Other states where there will be significant hits: Montana, North Dakota, South Dakota, Washington, New Mexico, Oklahoma, North Carolina, and California.

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Source: Georgetown University Health Policy Institute

The House of Representatives passed a CHIP reauthorization in early November. But that bill included a $6.35 billion budget cut to other health programs, including the Prevention and Public Health Fund, which provides money for vaccines, smoking cessation, and other initiatives to improve public health. The House would also ban lottery winners from being insured by Medicaid, tighten the timetable for people to sign up, and to change other rules.

It’s unlikely the Senate will agree. But the Senate is not moving quickly to pass its own legislation. The Senate is too busy working out tax cuts that will benefit large corporations and the very wealthy. (Previous post: What matters? Tax fight is about seven competing values.)

Across the country, some nine million low- and middle-income children rely on CHIP for health coverage. And, according to The Hill newspaper, States have asked the Centers for Medicare and Medicaid Services for funding to hold them over in the interim, and the agency has awarded about $607 million in redistributed funds to states and U.S. territories. Tribes will also lose hundreds of thousands of dollars in CHIP-related grants.

Last month, Utah Republican Orrin Hatch, who chairs the Senate committee responsible, called CHIP a “top priority” that had bipartisan support. The committee passed the bill October 2. But it’s up to Majority Leader Mitch McConnell, R-Kentucky, to bring the legislation to the floor for enactment. Then the House and Senate would have to iron out and agree on their differences before the bill can become law.

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

Three lessons from last week’s elections, Time to add names, ideas #NativeVote18

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Green Party candidate Eve Reyes-Aguirre is running for the U.S. Senate in Arizona. She is co-chair of the Global Indigenous Women’s Caucus. (Campaign photo)

Mark Trahant / Trahant Reports

Three lessons from  last week’s election results.

First: Gerrymandering can be defeated. The election districts in Virginia were designed to support incumbents, and especially Republicans. The Atlantic described the “well-documented” Republican operation to gain “control of the mapmaking process in 2010 (and) saw their share of legislative seats steadily grow, even as their actual vote shares decreased. In other words, these maps helped Republicans retain majorities even when they earned substantially fewer votes.”

That changed Tuesday. Voters swamped the supposedly safe districts and Democrats gained significantly. Perhaps even control of the legislature (votes are still be counted and will be recounted in a key race). So turnout beats districts drawn by one side to win. (The definition of gerrymandering.)

Second: Minority parties can win in this election cycle. It’s always tough to run as a third or fourth party candidate in the United States. The deck is stacked. The system is rigged to favor the two established parties. However some twenty-plus self-described Democratic Socialists (ala Bernie Sanders) won on Tuesday, including Denise Joy in Billings, Montana. Joy was elected to the city council.

This could be an interesting trend.

Some states, California and Washington, have top-two primaries. That means a candidate can win even without party affiliation. But in most states — unless the rules change — the biggest opportunity for socialists, independents and Green Party candidates is for offices such as school boards and city councils. Another mechanism that makes it easier for third party candidates is ranked choice voting (where you pick your favorite, second favorite, etc.) Several cities, such as St. Paul, Minnesota, now use that approach. Maine also voted to adopt ranked choice, but has not yet implemented it because of opposition from the legislature (and entrenched parties).

In Arizona, Eve Reyes-Aguirre (Calpolli)  is running for the U.S. Senate on the Green Party ticket. She is a co-chair of the Global Indigenous Women’s Caucus and a co–founding Mother of the newly formed World Indigenous Women’s Alliance. She was also a representative at the United Nations Commission on the Status of Women for the American Indian Law Alliance- 2015, 2017. Reyes-Aguirre is also running against the two-party system. Her web site says: “The two-party system has allowed wealth inequality to skyrocket to it’s highest point since the 1920’s. Eve is committed to developing an economy that promotes a equal sustainable quality of life for more families through the enactment of a living wage, limitations on corporate tax incentives, and a truly progressive tax structure. We must all be treated equal to live equal.”

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That brings to eight the number of Indigenous candidates running for the U.S. House or Senate so far in 2018 election. Three Republicans — Rep. Tom Cole (Choctaw), Oklahoma; Rep. Markwayne Mullin (Cherokee), Oklahoma, former state Sen. Dino Rossi (Tlingit), Washington — and four Democrats — former state NM state Democratic Party chair Deb Haaland (Laguna), Carol Surveyor (Navajo) in Utah, Tahlequah Mayor Jason Nichols (Cherokee), and J.D. Colbert (Choctaw) in Texas.

Lesson three. This is the “when” to jump and run in 2018 races. So much about politics is timing. Good candidates sometimes, no often, lose because their timing is off. It’s not the right cycle. There are too many headwinds. Barack Obama generated turnout that encouraged Native voters and candidates. The chaos of 2016 with Hillary Clinton and Donald J. Trump did just the opposite. Turnout was down, especially in Indian Country. But we know most Native American candidates are already outsiders. So we need a little luck. And good timing.

The 2018 election ought to be that. President Trump and his Republican Party have to defend infighting plus legislative failures from healthcare to possibly taxes. And the president’s popularity is only about a 38 percent approval rate. Awful numbers. On top of that, even popular presidents lose midterm elections. Democrats lead in the average of generic polls, 47 percent to 38 percent.

But Indian Country needs more candidates, especially in districts that can be won in this climate.

My top pick: Alaska’s at large district. Several Alaska Natives have challenged Rep. Don Young for this seat over the years, including Willie Hensley (Iñupiaq), Georgianna Lincoln (Athabascan), and Diane Benson (Tlingit). And Young seems invincible. He was first elected in 1973 and is the longest serving member of the House. But, if this is a wave election, then no member of the House is invincible. And, even better, there are some really strong potential Alaska Native candidates. 

Alaska will already have an interesting election field that includes Gov. Bill Walker and his running mate Lt. Gov. Byron Mallott (Tlingit).

And in Minnesota another high profile race will feature state Rep. Peggy Flanagan who is running for Lt. Gov. with U.S. Rep. Tim Walz.

At one point during the 2016 election cycle (which we now know was not good timing) there were more than a hundred Native American candidates. We need those kind of numbers again. Especially this time around. There are more than 62 Native Americans serving in state legislatures around the country and many of those will be running for re-election.

So that brings me back to rule 3, part A. It’s my favorite rule in politics because it’s so simple: You gotta run to win.

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

ICYMI: Podcast election special is on iTunes or Soundcloud. Download here. 

Raising money on the road from NCAI to Alaska (plus corrections) #NativeVote18

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Deb Haaland is a candidate for Congress in New Mexico. Diane Benson has run in four statewide races in Alaska, including a congressional seat.
Mark Trahant / Trahant Reports

New Mexico congressional candidate Debra Haaland is criss-crossing Indian Country determined to get her name out there — and to raise enough money to be competitive. She began in Milwaukee at the National Congress of American Indians annual convention and she ends the week in Anchorage at the Alaska Federation of Natives convention.

Politics is a tough business. Most Native American candidates cannot dip into their personal wealth to run for office (at least the Democrats). It’s raising money five bucks at a time. A good haul is when someone writes a check with more than one zero. Yet it’s hard to understate how important that money hunt is to a campaign. Haaland, unlike most Native American Democrats, is running in a district with a lot of other Democrats. That means she has an excellent shot at capturing a seat in Congress — the first Native American woman to do that — but first she must win a crowded primary. Haaland is Laguna Pueblo.

A Thursday night fundraiser in Anchorage was typical. It was much more of an introduction than a call for hard cash. That’s important. It was great to hear stories. We need that in politics. But it will take money, too. If we really want to see more Native Americans in Congress, thousands of  five-plus dollar donations will make all the difference.

At that event one of the most touching moments was when Diane Benson, who ran for Congress in Alaska against Rep. Don Young, talked about why she ran. Her son had been injured in the military and yet politicians were making war and peace decisions without an understanding of the consequences. Benson is Tlingit.

I have been collecting information about Congress and Native American representation. And, it turns out, I was wrong about the actual numbers. I checked this morning and according to the House of Representatives historian since March 4, 1789, there have been  10,273 people elected to that body. (I was using a smaller number.) There has never been a Native American woman. Ever.

This is my “I am wrong post” because I also was missing an important name, Georgianna Lincoln, from my list of Native women who have run for Congress. Lincoln, a former state Senator, is Athabaskan, and she also ran against Rep. Young in Alaska.

So here is my list, starting in 1988, Jeanne Givens, a Couer d’Alene tribal member in Idaho was the first. Then Lincoln in Alaska, Ada Deer, Menominee, in Wisconsin, Kalyn Free, Choctaw, in Oklahoma, Diane Benson, Tlingit, in Alaska, and Denise Juneau, Mandan Hidatsa Arikara, in Montana. Three Native women have run in the Democratic primary in Arizona: Mary Kim Titla, White Mountain Apache, Arizona Rep. Wenona Benally, Navajo, and Victoria Steele, Seneca. And in this election cycle, Carol Surveyor, Navajo, in Utah and Haaland.

I better stick with “at least” because I am sure more names will surface. But the point remains: It’s long past time to elect the first Native American woman to Congress. After 10,273 (add another 435 for next November) elections we need a first. And a second. And more, real representation.

Let’s do the numbers.  We have the first round of campaign finance reports out and there are seven Native American candidates for Congress, three Republicans and four Democrats.

And in the money chase, it’s the Republican candidates raising the dough. Former Washington state Sen. Dino Rossi, running in Washington’s 8th, in this quarter reports $578,822. To put that amount in perspective: That’s more than the incumbent, Rep. Markwayne Mullin, and nearly as much as Rep. Tom Cole. Mullin raised $511,017 this quarter. And Cole is at $640,649 (with $1.7 million cash on hand).

Rossi is Tlingit, Mullin is a member of the Cherokee Nation, and Cole is Chickasaw.

On the Democrats’ side the numbers are smaller.

Haaland has raised $262,098 so far in this election cycle. She’s second in the money race in her Albuquerque district. Remember this election is as much about the June primary as it is the general election because it’s a Democratic-leaning district.

Tahlequah Mayor Jason Nichols, Cherokee, is running against Rep. Mullin. He has yet to file any campaign reports. No reports are listed for Carol Surveyor in Utah and J.D. Colbert in Texas.

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

 

This article was corrected to fix a misidentified candidate.

ICYMI: My first audio election special is on iTunes or Soundcloud. Download here. 

 

SheRepresents

 

Indians don’t pay taxes? Or why the coming tax debate matters so damn much

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House Speaker Paul Ryan and Senate leaders announce their framework for Tax Reform. (Photo: Speaker.Gov)

Mark Trahant / Trahant Reports

The Senate has given up on destroying Medicaid and much of the health care system and is now focused on restructuring the federal tax system (and destroying entitlement programs in the process).

Here is what Speaker Paul Ryan said Sunday on CBS’ Face the Nation:  “We’re going to double that standard deduction. We’re going to make it so he can fill out his taxes on a postcard. We’re going to lower his taxes. That’s really important. So he has more tax-home pay. But there’s another component to this is, look at this machine shop, this business pays about a 40 percent tax rate but it competes with companies all around the world who pay an average 22 and a half percent on their taxes.”

The GOP Framework begins with this set of principles: “President Trump has laid out four principles for tax reform: First, make the tax code simple, fair and easy to understand. Second, give American workers a pay raise by allowing them to keep more of their hard-earned paychecks. Third, make America the jobs magnet of the world by leveling the playing field for American businesses and workers. Finally, bring back trillions of dollars that are currently kept off-shore to reinvest in the American economy.”

So how does Indian Country fit into that framework? Indians don’t pay taxes, remember? Actually if you Google that phrase it returns 2.17 million hits. It’s still a myth that will not fade away. But the larger issue of tax reform and its impact on Indian Country is still a complicated question, one that starts with the definition of “taxes.” Most so-called middle-income wage earners pay income taxes. Roughly one-third of all wage earners do not pay income taxes — and that would include a lot of tribal citizens, especially those living in their tribal nations. There are nearly 150 million tax returns filed every year and 36 million end up paying no tax at all. Another 16 million had taxable income but didn’t pay anything because of tax credits, deductions and other adjustments.

And, many of Indian Country’s working class especially benefit from one such credit, the Earned Income Tax Credit. This is a hugely successful policy that returns cash money to some 7 million family incomes; a paid bonus of sorts for working.

“Numerous studies show that working-family tax credits boost work effort,” according to The Center for Budget and Policy Priorities. “The EITC expansions of the 1990s contributed as much to the subsequent increases in work among single mothers and female heads of households as the welfare changes of that period, extensive research has found. Women who benefited from those EITC expansions also experienced higher wage growth in subsequent years than otherwise-similar women who didn’t benefit.  And, by boosting the employment and earnings of working-age women, the EITC boosts the size of the Social Security retirement benefits they ultimately will receive.

In addition, the research shows that by boosting the employment of single mothers, the EITC reduces the number of female-headed households receiving cash welfare assistance.”

So far, at least, there is no plan to end the Earned Income Tax Credit. However the House Budget Committee has proposed that the IRS require more proof from taxpayers and audit homes with an error. (Auditing the poor seems a long way from the Willie Horton philosophy of tax collection, or bank robbing, and that’s the idea you go where the money is.)

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It turns out there is a lot of data on tax collection by county. So I looked at the counties with significant a Native American population and there is some fascinating data from the Internal Revenue Service, based on 2015 tax returns.

In Oglala Lakota County, for example, some 2,010 taxpayers out of 3,980 collected an average of $3,020. The bulk of that was collected by families earning less than $25,000. And the average tax bill was $7,170. The county is comprised almost entirely of Native Americans and the Pine Ridge Reservation.

The Earned Income Tax Credit is also critical to many Navajo families. In Apache County, Arizona, that includes a large portion of the Navajo Nation, some 27,172 take advantage of the Earned Income Tax Credit. And, like Pine Ridge, most are in the under $25,000 category, but the amounts are significantly more, an average return of a little more than $4,000.

In the Bethel Census Area of Alaska there are similar numbers. Nearly 2,400 people claimed the Earned Income Tax Credit and most of the workers earned under $25,000 and averaged a refundable return of $2,738.

My point here is that this is the one policy that is essential to Indian Country because it benefits so many people who have jobs but who barely earn a living wage. Any changes to this tax credit should be opposed vigorously.

It’s also important to remember that most tribal citizens pay  a higher percentage of our income toward payroll taxes, instead of income taxes. A report by the Congressional Joint Committee on Taxation says that the 80 million tax filers making $40,000 or less will collectively pay no federal income tax and many will even receive cash payments from the IRS in 2015. But they will pay $121 billion in Social Security and Medicare payroll taxes (including the employer share, which most economists believe falls on workers).

So that will be another important factor to watch as the debate heats up. Rarely does the payroll taxes — Medicare, Social Security, etc. — sneak into the larger debate about taxes. But it should be about the total taxation, not just income taxes.

And one other unique characteristic of Indian Country tax data is that the amount paid to state and local governments is significantly lower than the general population. In most states tribal members living on their home tribal nation pay zero in state and local taxes. This will be important to remember when Congress debates the deduction of state and local taxes. (A big deal for people living in high tax states such as California or New York, but less so in low tax states and where the sales tax is the primary method to fund state government.)

Congress has a complicated road ahead before it can even pass a tax bill. The plan is for both houses to enact a budget resolution, setting out the priorities for tax reform. This is a document that basically sets limits on spending (so the committees will still decide how to spend money for Indian programs, but will be limited by their budget ceiling). This will not be easy. The House and Senate will need Republicans to stick together on fiscal issues ranging from the border wall to how large federal programs should be cut back.

Basically the same tension that existed during the health care debate will play out between so-called moderates and the more strident anti-government wing of the Republican party.

If a budget is passed, the Senate can start take up tax reform and need only 50-votes to pass the legislation. Remember, if.

Speaker Ryan talked about fixing the business rate. The Republican mantra is that U.S. companies pay more than their global competitors. (Funny: This same argument doesn’t come up with health care where a company like Boeing spends a lot on its employee health care while the French Airbus can rely on its national health care system to save money.) But there is one last issue to watch: Don’t just believe any number that is posted as a tax rate. There may be a tax with 40 percent tax rate, but if the deductions and credits add up, the effective tax rate could be 20 percent. So that’s the number to watch and ask about, how much is that effective tax rate?

One final point: It’s interesting that so much of the discourse is about companies wanting to pay lower taxes as an incentive to create more jobs. Yet many technology companies are moving to the higher tax land called Canada. “As America closes its borders, Canada is playing the longer, smarter game,” Richard Florida and Joshua Gans wrote in Politico this week. “Canada, more than any other place, is uniquely positioned to benefit from Trump’s anti-immigrant posture … If he keeps up his anti-immigration push, the United States’ polite neighbor to the north could soon be eating Americans’ lunch.”

It’s not always about the taxes.

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

ICYMI: My first audio election special is on iTunes or Soundcloud. Download here. 

Price visits Indian Country … and is gone

Tom Price at Pawnee
Former Secretary of Health and Human Services visits the Pawnee Indian Health Center. (Photo via Twitter.)


Trahant Reports

Tom Price, M.D., visits Indian Country. He goes to Alaska. He goes to Oklahoma. He says nice things. (He didn’t have the time to really translate that into policy or funding.) And now he’s gone after excessive use of government and chartered air craft.

Dr. Price was the Secretary of Health and Human Services from February 10 through September 29. That would be 231 days in office.

He visited with leaders of the Alaska Native Medical Center, the Cherokee Nation of Oklahoma, and the Pawnee Nation. In Anchorage he was quoted in The Alaska Dispatch News saying: “And so what I said to my team – I need to get out there and see what’s going on. And so this is part of that process to get there and see how they’re doing the kind of things they’re doing.” Then the Associated Press said the Secretary’s three-day trip was “part of the federal agency’s integral relationship with tribal governments … Price will also host a meeting of the Secretary’s Tribal Advisory Committee — the first such meeting ever held in Indian Country.”

He wrote about his visit: “What we saw there was remarkable: The Alaska Native Health Consortium has built a system that truly puts the patient at the center of everything. It meets patient’s needs holistically by integrating physical and mental healthcare, and incorporates Alaska Native traditions and spirituality. As I said on several occasions, I think there’s something the rest of America could learn from what Alaska Natives have built.”

Price promised to visit a “range” of tribal nations.

“Partnering to run tribal health systems is a solemn responsibility on the part of HHS, and it’s one that I take very seriously as Secretary and as a physician,” he said. “But if we’re being honest with ourselves, we must acknowledge the fact that, as a Government, we have not always performed as effectively as we should.”

And, there was a lot for the secretary to learn. Health care innovation that’s coming from Indian Country, the management of the Indian Health Service, dealing with opioid addiction, and of course, money.

Are we back to square one? A lot depends on the president’s next choice for HHS Secretary. The acting Secretary, Donald Wright, is a medical doctor with a background in public health. He’s worked at the agency for a decade and at one time was in charge of the Commissioned Officers Corps. He knows his way around the building and the issues.

Other potential candidates: Florida Gov. Rick Scott, former Louisiana Gov. Bobby Jindal, the administrator for the Centers for Medicare and Medicaid, Seema Verma, former Sen. Judd Gregg, R-New Hampshire, the Commissioner of the Federal Drug Administration, Scott Gottlieb, and Veterans Administration Secretary David Shulkin.

This report from Open Secrets looks at the financial interests of potential nominees.

 

 

Seriously? States complain to Senate about the burden of Native health care #IndigenousNewsWire

 

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Medicaid has worked under the Affordable Care Act, reducing the number of uninsured in Indian Country. (Kaiser Family Foundation)

Mark Trahant / Trahant Reports

First: A fantasy. Wouldn’t it be cool if once, just once, there was a debate in Congress that could only be decided by a vote that benefits Native people? I don’t know. Something like, “I won’t vote for any bill unless it fulfills the treaty obligations that the United States has promised Native people.” It could happen, right?

Well the current Senate debate on health care has a twist on this pipe dream. States are complaining about the burden, that’s right, the burden of Native American health care. So here’s the deal now: When an eligible Native American gets services through the Indian Health system, the cost is a 100 percent federal obligation. But, if that person or family is on Medicaid they could also get care from any provider. In that case the state would have to pay its share of the cost as it does for any other citizen. 

As the Kaiser Family Foundation points out: “Just as with other eligible individuals, AIANs who meet state eligibility standards are entitled to Medicaid coverage in the state in which they reside. AIANs may qualify for Medicaid regardless of whether they are a member of a federally-recognized Tribe, whether they live on or off a reservation, and whether they receive services (or are eligible to receive services) at an IHS- or Tribally-operated hospital or clinic. AIANs with Medicaid can access care through all providers who accept Medicaid for all Medicaid covered benefits. As such, they have access to a broader array of services and providers than those who rely solely on IHS services for care. Moreover, Medicaid has special eligibility rules and provides specific consumer protections to AIANs.”

The Graham-Cassidy plan would change that by making this cost a 100 percent federal obligation. States would be off the hook.

This is where it gets screwy. There are legitimate state concerns — basically it’s a complicated maze to figure out a patient’s path and how the money flows. But it’s still a benefit for states because Native people are citizens and so a full-federal match for most costs is a net gain.

South Dakota (a state that did not expand Medicaid) would gain $795 million from a block grant, but would still lose a significant share of its health care funding between 2020 and 2026, according to the Kaiser Family Foundation.

But (and I can’t believe I am writing this sentence) Sen. Mike Rounds told South Dakota Public Radio that the state would get a “large chunk of funds would cover 100 percent of the healthcare costs for Native Americans who receive Medicaid. Right now, the Affordable Care Act requires a state match.”

This is a fraction of what the state will lose — so this is a straight-faced claim that Native health care is a burden. (Remember this cost is only for tribal citizens who do not use Indian Health Service, a small slice of the population.)

South Dakota is not alone. A state legislative report in Arizona estimated that the state will lose a third of its Medicaid funding ($3.8 billion now, $4.9 billion by 2020). But according to the Capitol Media Services of the Arizona Daily Star, Gov. Doug Ducey dismisses those losses because the numbers are not from an independent review. Yet there is not enough time for the Senate to get a Congressional Budget Office assessment by the September 30 deadline. So this is all being made up on the fly.

“Christina Corieri, the governor’s health policy advisor, said one of those provisions would free the state of its financial obligations to share the cost when Native Americans get care at non-Indian Health Service facilities,” the Arizona Daily Star said. Corieri “could not say what that number would save Arizona other than ‘it’s a very large number.'”

Seriously?

There are roughly 130,000 Native Americans in Arizona on Medicaid, about 6 percent of the state’s version of Medicaid, the Arizona Health Care Cost Containment System. And of that, we’re talking about a subset, those who choose to go outside of the Indian health system. It’s just not a very large number. Period.

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 credit: Mark Trahant / TrahantReports.com

 

 

 

 

 

Senate’s ‘last’ shot at Repeal and Replace? Indian health still gets dinged

Business Meeting on 20 Agenda Items Tuesday July 28 2015 10am
Alaska Sen. Lisa Murkowski could once again be a deciding vote on the future of health care. (Senate photo)

Mark Trahant / Trahant Reports

You have to wonder why the latest Senate Republican plan to repeal and replace the Affordable Care Act did not get written with one senator in mind, Lisa Murkowski of Alaska.

Yet the bill by Senators Lindsey Graham (R-SC) and Bill Cassidy (R-LA) is more conservative than previous approaches. It has lots of wish-list boxes to tick, no money for Planned Parenthood, big tax cuts, and its spends way fewer federal dollars. The bill only needs 50 votes to pass but that must happen before the end of this month.

Medicaid would become a block grant program that states could design (and pay for). So it would likely disappear. The Center for Budget and Policy Priorities estimates that federal funding for health care would be reduced by $299 billion in 2027 alone with cuts impacting all states. And here’s a fun fact: Big states that expanded Medicaid would be hit harder. A lot harder.

Why 2027? That’s the year block grants disappear.  Graham and Cassidy argue that only a temporary block grant would be allowed under the rules of debate. So no “new” thing. Congress would have to meet “pay for” standards to replace that after 2027; meaning there would be cuts in other federal programs equal to the new spending.

And, like other Republican plans, this one would add significantly to the ranks of the uninsured. The Center for Budget and Policy Priorities estimates 32 million would lose coverage. States could also end essential benefits, coverage of pre-existing conditions, and allow companies to charge people significantly more when they’re ill. (Health insurance coverage that you cannot afford is the same as no insurance.)

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“Like the earlier version of the Cassidy-Graham plan, the revised plan would disproportionately harm certain states. The block grant would not only cut overall funding for the Medicaid expansion and marketplace subsidies but also, starting in 2021, redistribute the reduced federal funding across states, based on their share of low-income residents rather than their actual spending needs. In general, over time, the plan would punish states that have adopted the Medicaid expansion or been more successful at enrolling low- and moderate-income people in marketplace coverage under the ACA,” the CBPP reports. So by 2026, the “20 states facing the largest funding cuts in percentage terms would be Alaska, California, Connecticut, Delaware, the District of Columbia, Hawaii, Kentucky, Louisiana, Maryland, Massachusetts, Minnesota, Montana, New Hampshire, New Jersey, New York, North Dakota, Oregon, Rhode Island, Vermont, and Washington. These states’ block grant funding would be anywhere from 35 percent to nearly 60 percent below what they would receive in federal Medicaid expansion and/or marketplace subsidy funding under current law.”

A lot to like in Alaska, right? Murkowski said she is undecided until she sees the Congressional Budget Office assessment. She told CNN: “I will use the governor’s words,” Murkowski said, referring to Alaska Gov. Bill Walker. “He said, ‘I understand that a block grant gives me increased flexibility, but if I don’t have the dollars to help implement the flexibility, that doesn’t help us much.’ So, we are both trying to figure out how those dollars fall.”

Graham-Cassidy plan continues the 100 percent reimbursement to states for patients served by the Indian Health Service and it adds an increase in the federal match to 100 percent for medical assistance provided by non-Indian Health Service providers for tribal enrollees. The idea is more American Indians and Alaska Natives should take their business away from IHS facilities. Let’s be clear about this: It would drain resources away from the Indian health system.

This bill would also allow tribes to set up group plans to buy insurance for tribal members to replace the Medicaid expansion. “Creates new optional coverage group as of January 1, 2020 for members of Indian tribes up to 138% FPL in states that had expanded coverage as of December 31, 2019, who were enrolled in Medicaid as of December 31, 2019, and do not have a break in eligibility of 6 months (or a longer period specified by the state).”

So in summary this bill would not add any new resources to the Indian health system. But it would cut funding significantly (again, remember Medicaid).

The last Senate Republican plan failed by a single vote. It’s likely that Arizona Sen. John McCain will end up being a “yes” this time around (the state’s governor is giving him cover, saying it’s a good plan). However Kentucky Sen. Rand Paul says he’s now a “no.” In his mind this plan does not repeal the Affordable Care Act. Susan Collins remains a likely “no.” If those positions stay the same, then this bill’s fate could end up being decided by Senator Murkowski.

Is there anything in this legislative gem that improves health care in Alaska? No. Does it improve the Alaska Native medical system? No. The Indian Health Service? No. Then why is she even considering this vote. It should be an easy no. Again.

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 credit: Mark Trahant / TrahantReports.com