Congress did its job: The federal government’s budget is done. The last step was President Donald J. Trump’s signature and so now the government marches on. At least for the rest of this year, until the end of September.
But the White House said Friday that the president may veto the budget because there is not enough funding for a border wall or a solution for the so-called Dreamers. This is after the president assured House and Senate leaders that he would sign the measure into law.
A veto would mean the federal government would shut down at midnight and Congress would have to start a new round of budget negotiations. This will be even more complicated because many lawmakers have left Washington for a two-week recess.
There will be intense pressure from some Republicans for the president to sign this budget into law anyway.
Budgets are a guide to priorities: What programs are more important? Where is the support from Congress and from the people? Did the president get what he wanted?
That last question is the easy one. The money for the budget wall was minimal, at best.
It’s fair to say the administration’s budget was soundly rejected by a Republican Congress. Sure, Democrats contributed a great deal to this budget (and Democrat votes were required to make it so,) but even before that occurred, majority-party lawmakers were dismissing the harsh budget program changes sought by the president.
The president’s team had all kinds of ideas: Deep spending cuts, the elimination of public broadcasting, replace Medicaid with block grants, and, yes, even deeper spending cuts. Yet Congress enacted a budget that increased federal spending both for the military and domestic programs. It’s Congress, not the president, writing the checks.
How bad was the president’s budget? The National Congress of American Indians put it this way in recent testimony: “The president’s budget would cut the Bureau of Indian Affairs by about half a billion dollars, or 15 percent. BIA Social Services would be reduced by more than a third, Indian Child Welfare by more than a quarter, and critical human services programs, law enforcement and courts programs, environmental protection, housing, and education programs would face unconscionable reductions. Infrastructure programs, such as the Indian Community Development Block Grant would be eliminated, and the Indian Housing Block Grant and road maintenance would be reduced.”
Instead, Congress added dollars and protected programs that the White House sought to eliminate.
“This bill represents real progress for Indian Country, significantly increasing our investments in Native health care, infrastructure, economies, and communities. It rejects the president’s dangerous proposed budget cuts and instead provides funding increases that will lead to healthier communities and better outcomes across Indian Country,” said Sen. Tom Udall, D-New Mexico, in a news release. Udall is vice chairman of the Senate Committee on Indian Affairs and ranking member of the Appropriations Subcommittee on Interior, Environment, and Related Agencies.
The omnibus spending bill would have increased funding for the Indian Health Service by 10 percent, and the Bureau of Indian Affairs and Bureau of Indian Education by 7 percent to $3.064 billion. The IHS budget line is $5.5 billion.
Conservatives were not happy with the additional spending in the omnibus bill. “Republicans control the government, yet Congress still follows the Democrats’ playbook,” Sen. Rand Paul, R-Kentucky said. “Time and again, spending skyrockets, and conservatives are expected to fall in line to praise the party for making the big-spending status quo worse.”
However Rep. Tom Cole, R-Oklahoma, a member of the House’s leadership team praised the legislation. “Despite divisions, both sides of the aisle have the responsibility to deliver this legislation for the American people so that the federal government runs efficiently and effectively,” Cole said. “Neither side got everything it wanted, but the end product reflects a broadly supported compromise. A majority of Republicans and Democrats voted for this bill. President Trump urged its passage and has promised to sign this legislation. As we begin to consider funding for Fiscal Year 2019, it is imperative that Congress remain committed to the return to regular order in the appropriations process.”
The president will decide in the next few hours whether or not he got enough of what he wanted.
(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.) Mark Trahant is editor of Indian Country Today. He is a member of the Shoshone-Bannock Tribes. Follow him on Twitter @TrahantReports (Crossposted on 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.”
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.
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
First, Congress tried to repeal and replace the Affordable Care Act by rolling back that law plus the decades long public health insurance known as Medicaid. That effort failed in the Senate. Twice. And Congress hasn’t given up. There are all sorts of proposals floating that would try yet again through the budget or another mechanism.
Meanwhile the Trump administration is trying to unravel the Affordable Care Act using administrative authority. And, in the process, guaranteeing a network of insurance chaos. The President signed an executive order that eliminates payments to insurance companies to subsidize the cost of health insurance for families that cannot afford the full cost. Insurance companies will likely increase health insurance premiums — and by a lot — or get out of the individual health insurance market all together.
This policy change impacts American Indians and Alaska Natives who get their health insurance through the exchanges. Under the Affordable Care Act, many tribal members and Alaska Native shareholders quality for a “bronze plan” from exchanges at no cost. A silver plan could also have been purchased, depending on income, using subsidized rates.
The Kaiser Family Foundation figures that insurers will need to raise silver premiums between 15 and 21 percent on average to compensate for the loss of the subsidy payments.
It’s interesting: Ending the subsidy will cost consumers more in states that have not expanded Medicaid (such as Oklahoma) since there are a large number of marketplace enrollees in those states with incomes at 100-138 percent of poverty who qualify for the largest cost-sharing reductions.
The Congressional Budget Office (CBO) estimated that the total payments were $7 billion in fiscal year 2017 and would rise to $10 billion in 2018 and $16 billion by 2027. The House of Representatives sued the Obama Administration to try and stop these insurance subsidies arguing that Congress never appropriated the money.
The CBO also said that ending the insurance subsidies will increase federal deficits by $6 billion in 2018, $21 billion in 2020, and $26 billion in 2026.
A second administrative order will change the way insurance companies write policies. The Affordable Care Act set out standards so that basic health care issues, including women’s reproductive health, would be covered. But the new rules will make it easier for people to buy limited policies that cost less, but cover fewer medical issues.
“Congressional Democrats broke the American healthcare system by forcing the Obamacare nightmare onto the American people. And it has been a nightmare,” the president said. “You look at what’s happening with the premiums and the increases of 100 percent and 120 percent, and even in one case, Alaska, over 200 percent. And now, every congressional Democrat has blocked the effort to save Americans from Obamacare, along with a very small, frankly, handful of Republicans — three. And we’re going to take care of that also because I believe we have the votes to do block grants at a little bit later time, and we’ll be able to do that.”
But the actions by the administration will only lower the cost of health insurance for one group of Americans, young, healthy ones. Insurance costs for nearly every other plan will sharply increase because of these actions. And especially at risk: Patients who are facing expensive medical treatments such as cancer.
Earlier in the week, the administration also rolled back Affordable Care Act coverage requirements for access to birth control. According to the Kaiser Family Foundation: “These new policies, effective immediately, also apply to private institutions of higher education that issue student health plans. The immediate impact of these regulations on the number of women who are eligible for contraceptive coverage is unknown, but the new regulations open the door for many more employers to withhold contraceptive coverage from their plans.”
The actions of the Trump administration mean two things: There will be chaos in the insurance markets as companies and individuals rebalance the value of those policies; and there will be litigation ahead because every one of these policy shifts will be challenged in court.
Senate Republicans campaigned against “Obamacare” for seven years. Yet there was never an alternative that had support from a majority of their own party.
The problem is simple: Many (not all) Republicans see health care programs that help people — the Affordable Care Act, Medicaid, etc. — as welfare. Others look at the evidence and see these programs that are effective: Insuring people, creating jobs, supporting a rural economy, and actually resulting in better health outcomes. Evidence-based success stories.
Of course Indian Country is squarely in the middle of this debate. Congress has never even considered, let alone acted, to fully fund Indian health programs. But the Affordable Care Act basically defined the Indian Health Service (and tribal, nonprofit, and urban operations) as health care delivery vehicles. And one way to pay for that delivery was by providing health insurance through an expanded Medicaid, no-cost insurance that tribal members could get through exchanges and employers. The ACA with all its faults sets out a plan to fully fund the Indian Health Service.
That’s the challenge now. Making sure that every American Indian and Alaska Native has insurance of some kind. Because of what happened (or, more accurately, what did not happen) in the Senate this week the money remains on autopilot. If you are eligible, the funding is there.
Yet the uninsured rate for American Indians and Alaska Natives remains high, as a Kaiser Family Foundation report noted a couple of months ago. “The Affordable Care Act’s Medicaid expansion provides an opportunity to enhance this role by increasing coverage among American Indians and Alaska Natives and providing additional revenue to IHS- and Tribally-operated facilities,” The Kaiser report said. “In states that do not expand Medicaid, American Indians and Alaska Natives will continue to face gaps in coverage and growing inequities.”
This is a problem that will grow because of congressional inaction. Nineteen states including Oklahoma, South Dakota, Wisconsin, Wyoming, Idaho, Kansas, Nebraska, Florida, and Maine, have rejected Medicaid expansion. So a tribal citizen in those states gets fewer dollars for healthcare than some Indian health patients in North Dakota, Montana, Alaska, Arizona, New Mexico, or any other state that took advantage of the expansion.
As Kaiser notes: “American Indians and Alaska Natives will continue to face gaps in coverage and growing inequities in states that do not expand Medicaid. In states that do not expand Medicaid, many poor adults remain without an affordable coverage option and will likely remain uninsured. Similarly, IHS providers in these states will not realize gains in Medicaid revenue.”
This is the what’s next? How does the country manage this divide, especially in Indian Country. (And, just as important, we also need to see the gap measured. What are the differences in treatment and outcome between Montana and Idaho or North Dakota and South Dakota? Data, please.) This is critical because under current law, third-party billing (including Medicaid) remains at the local service unit. There is now a funding inequity that needs to be addressed by state legislatures. Recently Rep. Tom Cole, R-Oklahoma, said he knows these states and they won’t expand Medicaid. (Back to the welfare, thinking.) I hope not.
The Trump administration recently made it easier for states to get a 100 percent reimbursement for Indian health patients (enticing South Dakota to reconsider joining the ranks of expansion states.)
So it’s possible, and a challenge, to make sure that the law is implemented, and that innovation continues. The ACA gives much power to an administration to a state to change the rules. You will see a lot of that now. Indian Country needs to keep a sharp eye on that process and raise objections if the result is unsatisfactory.
So why did the Senate bill fail? Sure, full credit should go to the heroic stands by Sen. Susan Collins, R-Maine, and Sen. Lisa Murkowski, R-Alaska. From the very beginning of the debate they were the party advocates for a Medicaid system that does produce better healthcare outcomes. And Alaska is a great example of that because nearly a quarter of the state’s population is served. This is how it should be across Indian Country and the nation.
And, of course, there was Sen. John McCain’s dramatic late night thumb’s down. The Arizona Republican was a no vote when it counted.
But that’s not why the bill failed. Fact is it’s remarkable that such nonsense got so far. It’s inconceivable that a plan was written at lunch the day before the vote. The bill failed because the Republicans, as a group, do not know where they want to lead the country on health care. They know they don’t want Obamacare (even though it’s based on conservative, market-based ideas). They sure as hell know they don’t want universal health insurance, either Single Payer such as Medicare for All or a government health service like Great Britain’s.
Yet when I listened to the debate yesterday so many of the complaints about insurance and costs could be solved by such a path. The problem here is that the United States made a huge mistake with employer-based insurance and that left out people who work for themselves or small businesses. The only way to fix that is a large pool of people spreading the costs, so that healthy people pay for sick people. The ACA tried to do that with mandates. Most countries accomplish that goal with universal insurance.
Another factor in the Republican plans — and another reason for the bill’s failure — is their absolute certainty in a market-based solution. Healthcare delivery and free markets do not play well together. The proof of that is simple: How much is an empty hospital bed worth to a business? Yet that should be the goal. And how much is it worth to a hospital-as-a-business to help a patient not need surgery? What market incentives are there for people to eat better?
Seven years ago, when I started writing a lot about health care, I did so because I saw the Indian Health Service as a fascinating example of government-run and managed healthcare. As we began this debate, I thought, let’s figure out what works and what needs work.
But I was way wrong. IHS is no longer only a government-run system. Much of the agency is now a funding mechanism for tribal, nonprofit, and urban operations). And that’s where so much of the innovation and excellence in Indian health exists. We need to more more about what’s working and why. Yet Congress (and the public narrative) continue to think of an IHS that no longer exists. At least entirely.
This might be a moment to focus on the latter part of what the agency does, improving the flow of funds, and adding more of our people to insurance rolls. Here’s the thing: We cannot do anything about universal health care. At least not yet. But we can have universal health care for Indian Country. It’s a huge task, but the ACA remains the law and it’s only a matter of execution (not a policy debate).
Third-party collections now account for about $1.8 billion out of the IHS’ budget. The dollars Congress appropriates is $4.8 billion. The third-party portion can grow through more insurance coverage. The appropriations side will require hard fights in Congress and the outcome is uncertain.
Back to the Senate. Texas Sen. John Cornyn, a member of the Republican leadership, joked that perhaps it’s time for a new way of doing business. “I guess we ought to go back to Schoolhouse Rock,” he said. That’s been a clear message from both Republicans and Democrats throughout this messy project. Get a bill. Hold hearings. Let a committee debate alternatives. Then let the bill come to the floor. Regular order. Schoolhouse rock.
Senate bill ‘mostly dead,’ but will it revive after break?
Mark Trahant / Trahant Reports
The Senate’s health care bill is “mostly dead.” But that’s not the same as all dead. And this holiday weekend will decide either the legislation has a second life or if there is a better way to proceed.
Republican Senate Majority Leader Mitch McConnell is planning another shot at health care reform (excuse me, a plan to cut taxes and roll back Medicaid) this week producing yet another draft of the health care bill. Meanwhile Senators (as well as members of the House) will break and return to their home districts. This is where the people have a chance to weigh in with a “hell, no!” The Senate bill may be the most unpopular piece of legislation ever, currently earning support of between 12 and 17 percent depending on which poll you read. To borrow the TSA phrase, if you see someone (as in a member of Congress) say something.
Consider this: Medicaid is popular across the board. A poll by Kaiser Health News illustrates this point. It shows that some three-fourths of Americans view Medicaid favorably. (But the poll also points out that most Americans don’t know that both GOP bills would cut deeply into the popular program.) Even Republicans think Medicaid works.
For the past few weeks I have been writing post after post about how bad this approach to health care — I mean, tax cuts — is as a policy. The problem is basic. Many Republicans do not believe health care is a right. So it’s their mission to roll back government. But not every Republican believes that. Some see the effectiveness of programs such as Medicaid and see it’s rollback as unconscionable. (Previous: Health care deserves policy debate.)
At a meeting with tribal leaders at The White House, President Donald J. Trump was asked about cutting Medicaid. His answer: “It’s going to great. This will be great for everybody.”
Read “great” as “clueless.” But the president did say it was going to be difficult to get the votes, “it’s very tough … I think we’re going to get at least very close, and I think we’re going to get it over the line. ”
We shall see. Mostly dead or all dead? And an all dead GOP health care bill could deliver a miracle.
This is the moment where McConnell will pull out his checkbook. He will be trying to win *cough* buy * cough* support from senators with sweet deals for the folks back home. If that doesn’t work, McConnell said he might be forced to work with Democrats on legislation. Imagine that! A Congress that works with both parties.
This is what really ought to happen. The Affordable Care Act has problems that need to be fixed. But it’s in specific areas, such as the individual insurance market, and a bipartisan approach would actually yield the best results.
But more important the only way that Congress governs again is for leadership to recognize that they cannot govern with Republican votes alone because they don’t have enough votes. There is a split within the Republican Party on the very question of health care as a right, let alone specifics about how much to cut and where. And that same division plays out on just about every major public policy issue.
But a few Republicans working with Democrats do constitute a majority in both Houses. A lot could get done. The Congress could pass a budget. Raise the debt limit (averting another crisis) and do the jobs that we the people hired them to do. That would take a miracle right? But we can always hope and the first step is an all dead Republican health care bill.
How long will it take for this process to unfold? This will only happen when congressional leaders run out of options and see working with Democrats as the only path forward. This will take time because as Miracle Max said in The Princess Bride: “You rush a miracle man, you get rotten miracles.”
Reality TV works for one simple reason: The antics of the characters are beyond what’s believable in fiction. It’s compelling drama because normal people do not do such things. So part of watching is to find out when the story arc ends, to discover when the situation becomes “normal” again. (Even though the story does go on and on and on.)
That’s why the presidency of Donald J. Trump would make a terrible novel or screenplay: There’s no mechanism to suspend disbelief. Tell the story about a four-month term in the White House, a time marked by so much chaos, unprofessionalism, and distraction, and a reader (and especially an editor or producer) would shake their head and say, “Try again. This story is not believable.”
That’s why only the metaphor of reality TV works. America the unbelievable.
Last week the best moment of the new Trump Administration was the one where the president smiled in Saudi Arabia and said only 26 words. This was terrible reality TV but we all watched knowing that it was likely just a pause. Something outrageous must be coming up next.
The White House Reality Show is entertaining.
Meanwhile more important stories are still being written and played off-screen. That’s why our focus must return to the policy fights ahead: How this country (and our planet) deal with climate change, how we stop the rigging of elections, and, how we make certain the court system is fair. Next week the White House will formally send Congress its budget plan for the next year. We already know this plan will be nonsense. Another distraction. The real work of budgeting will occur in Congress and it will require votes from both Democrats and Republicans to make it so.
At a House hearing last week, for example, Rep. Tom Cole (R-Oklahoma) said he was disappointed in a White House recommendation to cut $5.8 billion from next year’s funding for the National Institutes of Health. He such a draconian cut would stall so much progress from recent investments.
In other words: No sale. Across the Congress, across the government, this same notion is being repeated. Eliminate the Corporation for Public Broadcast? No sale. Down the list the message is much the same, eliminate the Denali Commission? No sale. Etcetera, etcetera, etcetera.
Paying for health care
But while Congress might rewrite the budget in some areas, there are real dangers ahead. I’m obsessed with what this bunch is doing to the funding streams for health care, especially Medicaid.
This is what the Trump Show hides: The House’s American Health Care Act does much more than roll back the Affordable Care Act (or Obamacare as they like to say.) It ends a Medicaid program that works. It’s the single most effective form of “government” insurance that secures health care options for 62.3 million Americans. To add a little perspective here: Medicare — supposedly untouchable in politics — insures 43.3 million seniors.
These are huge numbers. Medicaid is expensive. And we all pay for this plan. As we should. It’s one of the best things this country does.
So it’s no wonder that Speaker Paul Ryan and Republicans are eager to make this go away (both because it costs so much and because it requires a lot of taxes to pay for this enterprise).
This is an issue where the philosophical divisions run deep. Every Republican wants to spend less federal money on this program. Significantly less. Once you do that, there will be fewer people who participate in this public insurance program. That’s math, not politics. The House plan (according to the Congressional Budget Office) strips $880 billion from Medicaid funding in order to reduce health care taxes on wealthy people by $883 billion. Tit for tat.
Watch this debate closely. Parse every word. The Republicans in the Senate who say they champion Medicaid often only talk about Medicaid expansion. And that’s followed by, there should be a transition to something else (namely, block grants that states cannot afford). What else? How does that work? And who pays?
At a town hall in Anchorage last week, Alaska Sen. Dan Sullivan followed this script to the letter. According to The Alaska Dispatch News the Republican senator told a contentious town hall, that he wanted to make sure the people who received health care coverage under Medicaid expansion “do not have the rug pulled out from under them.” Medicaid for now. Then something else. What else? How does that work? And who pays?
The answer is to protect the framework of Medicaid (and if we were smart, enhance and expand it). It’s the one part of Indian health funding that’s growing and already accounts for the insurance of record for more than half of all our children. (And, this is really important, third-party insurance billing, which includes Medicaid, is money that stays at a local IHS clinic or hospital. It does not go into the general budget.)
Medicaid is a partnership between the federal government and the states. So states set many of the rules, federal government then agrees or not, and pays only a portion of the bill. But patients within the Indian Health system are usually eligible for a 100 percent reimbursement.
So states set the rules for Indian Country — including limitations — yet don’t pay the cost. Already six states are already looking to tighten Medicaid rules. Arizona is keen on adding work requirements. Wisconsin wants drug testing (imagine the trap that sets for patients in opioid treatment programs). Maine wants to test assets beyond income. The goal of each new regulation is to shrink the number of people insured by Medicaid.
Medicaid works, especially in Indian Country
I’ve heard Republicans say they like the results of Medicaid but that we as a country cannot afford it. That’s particularly troubling because Medicaid is more efficient that private insurance. (Even with its convoluted payments from the federal government to states and Indian health programs). How can that be? Julia Paradise, associate director of the Program on Medicaid and the Uninsured for the Kaiser Family Foundation, says Medicaid acts as a “high risk pool.” Because so many people are excluded (or out-priced) from private insurance Medicaid is the only option. “Among adult Medicaid enrollees who are not working, illness or disability is the main reason. By covering many of the poorest and sickest Americans, Medicaid effectively serves as a high-risk pool for the private health insurance market, taking out the highest-cost people, thereby helping to keep private insurance premiums more affordable.”
The Senate is now busy rewriting the House’s awful health bill. It will be a different entity, that’s for sure. But will the Senate protect (and if they are smart, enhance and expand) the best basic public health insurance program that we have now? There is no evidence to suggest that. And too many people are watching reality TV to even notice.
Remember this: There is always another election. And the 2018 congressional elections already promise to be extraordinary.
Let’s look at the landscape so far. Last week voters in Kansas surprised Republicans by barely winning a district that’s supposed to be safe. President Donald J. Trump tweeted: “Great win in Kansas last night for Ron Estes, easily winning the Congressional race against the Dems, who spent heavily & predicted victory!” And, indeed, there was a late surge that had many Democrats thinking victory. But Kansas is a deep red state. The district was represented by Mike Pompeo, who’s now the director of the Central Intelligence Agency, who won by a margin of 30 points. Trump’s margin in the same district was 27 points. And Tuesday? Estes won the district by less than seven percentage points.
The Washington Post points out that special elections are complicated. There are a lot of factors at work beyond voters view of the White House. “But a sharp shift to the left in even deep-red parts of the country has obvious implications for the GOP that this experiment simply lays bare: the potential for an electoral disaster,” the Post said.
The shift from a House managed by Paul Ryan to one led by Nancy Pelosi would have huge implications for the Trump administration — and certainly for federal-tribal relations and programs.
Was Kansas the beginning of something bigger? Look for more answers to emerge in Georgia this week and Montana in May.
Tuesday voters in suburban Atlanta will weigh in. That special election to replace Tom Price (the Health and Human Services Secretary) is a “blanket primary” meaning that all candidates run on the same ballot regardless of party. Then the top two positions — unless one wins 50 percent vote — will face each other again. A number of Republicans are splitting the conservative vote. The Democrat in the race is Jon Ossoff and he has been leading in polls from the low- to mid-40s. Enough to win this round, but not enough to win the seat. Yet. Or maybe.
At this point you can boil this race down to one question: Who will show up? If more Democrats than normal show up (by about nine points) they could win this seat on Tuesday. That’s still possible in June but more difficult in a one-on-one race.
Indian Country’s first judgement of the Trump administration comes in Montana on May 25. Montana voters will pick a replacement for Interior Secretary Ryan Zinke. Zinke defeated Denise Juneau to win re-election. Now the race is between a singing cowboy, Rob Quist, and a wealthy entrepreneur, Greg Gianforte, who lost the November race for governor.
But that’s only the headline race. What makes the Montana special election more interesting is that the Libertarian Party is also on the ballot, Mark Wicks, a rancher and writer from Inverness. At the same time: Other party candidates, including the Green Party and independents, did not get signatures to make the ballot.
So this will be a three-way race. Libertarians are more popular in Montana than any other state. (Indeed: I think one of the challenges for Juneau’s historic bid for Congress was that the Libertarians did not engage in a serious campaign. In the 2012 Senate race, Libertarian Mike Cox picked up nearly 7 percent of the vote in the race between Democrat Jon Tester and Republican Denny Rehberg.)
One important issue for Indian Country has yet to be resolved: The election process itself. Many county clerks and voting advocates have argued the special election is the ideal test for a vote-by-mail election (saving the state hundreds of thousands of dollars). However many in the Legislature argued that would give Democrats an advantage. The bill was killed. But Democratic Gov. Steve Bullock used an “amendatory veto” to revive the legislation. The Montana Legislature has not yet taken up that legislation even as county clerks move forward without a plan for a general mail ballot. I would love to see a major experiment with mail balloting for tribal communities. There is good data from Washington and Oregon that shows how effective mail ballots can be as a way to increase voter participation.
Back to the big picture. How would the Trump administration change in a world where Democrats control Congress? We actually might see a hint of that soon. The federal government must pass a new spending bill by the end of this month and it will likely be a coalition of Democrats working with Republicans to pass the measure. That means there will be funding for the Affordable Care Act, Planned Parenthood, and other programs supported by Democrats. The Republican Congress has the same problem on a spending bill as it did in the health care debate; there are not enough votes to pass a conservative alternative.
And in the House Democrats are well-positioned by history. Remember the president’s party nearly always loses seats in the first election after winning the White House. In 2010 after Barack Obama’s historic election, his party lost 63 seats in the House and 6 seats in the Senate. And according to Gallup polling, since 1946, when presidents are above 50 percent approval, their party loses an average of 14 House seats compared with an average loss of 36 seats when presidents are below that mark. And President Trump remains far below that mark.
It would be interesting to see a strong Alaska Native candidate surface in Alaska against Rep. Don Young. Young was lucky that the health care bill failed when it did because he did not need to take a vote. He would have had to choose between his party and his state (Medicaid expansion works in Alaska and the House bill would have cost Alaskans more per person than any other state). He still may have to make that choice.
Ideally I would like to see younger candidates from Indian Country. Young people who could build innovative, digital campaigns instead of relying on what’s been done in the past in terms of fundraising and advertising.
This is why the special elections right are so important. Because win or lose in Kansas, Georgia, and Montana, it shows that the House is not cemented to Republican leadership. The 2018 election cycle will be very different than the one that moved Trump into the White House. And all it takes is for a few potential candidates to see the possible … and to think, “I can do that.”
A quick update. So a reader points out that I really ought to include Debora Juarez in this list (and in the broader review of Native women in office). And it’s a spot on suggestion.
So I have added Juarez and a couple of county commissioners I know about … but there should be more. Please let me know about women serving on city councils, as mayors, county commissions, etc. Montana? South Dakota? Alaska?
Do you know of any Native women who are elected as city and county officials that should be included? Thank you.
I am working on a piece about Native American women who were elected to office at the state (or, I wish, at the federal) level.
I have identified 62 American Indian or Alaska Natives in state legislatures — 25 women (40 percent) and 37 men (60 percent). As a comparison, nationally, women make up just under a quarter of all elected legislative seats. (1,363 members or 24.4 percent). And that means Native American women are 1.834 percent of the women who serve in office.
Also eight Native American women have run for Congress and two have run for the vice presidency.
I am planning a story and an interactive graphic for the weekend. (It’s taking me longer than I planned. I keep getting distracted by the frenetic pace of the Trump administration.
Remember the sequester? Ah, the good old days. The new Trump Administration budget is short on details, but clear on direction. And we do know two things. First: If enacted, this budget would shrink the federal government to a much smaller size. Except for the military and the Veterans Administration. And, second, this budget guarantees chaos ahead.
Thursday morning the White House officially released the “skinny budget.” That’s an overall statement about the president’s financial goals for the year. It lists priorities, but provides few details. And this document does even less of that than previous skinny budgets. But the agenda, the direction ahead, would create a very different federal government. There is money available to approve (and pretend to regulate) energy projects, but nothing, really nothing, for public broadcasting, the arts, and the humanities. All told some 19 federal agencies would be eliminated.
This is where I should add: Hold on! Every one of these agencies has a constituency in Congress. You’ll see 535 budget revisions coming soon with members working to restore funding, and in some cases, even increasing the total amount of appropriation. But the overall direction is less. This is the eighth year of a slowing (and perhaps shrinking) federal government.
This is also where chaos kicks in. The political tension that surfaced in Congress over the repeal and replacement of the Affordable Care Act will only magnify in this budget debate. And to pass this budget, Republican leaders will need votes from Democrats. And if there is no agreement, then there could a shutdown of the government that could last much longer than previous episodes. The best case scenario is a continuing resolution that results in cuts, but not as dramatic as those proposed by the White House.
First throughout the document there is only one reference that include the phrase, “and Tribes.” The Obama administration often added that language to routine grants and programs for states and local governments to make it clear that tribes were eligible partners. No more.
The budget does not directly put a number on the Indian Health Service. It only lists IHS as part of the overall budget for the Department of Health and Human Services. That agency “requests $69.0 billion for HHS, a $15.1 billion or 17.9 percent decrease” from the Continuing Resolution level. The first mention in that request includes IHS (that must be good, right?) “The President’s 2018 Budget: Supports direct health care services, such as those delivered by community health centers, Ryan White HIV/AIDS providers, and the Indian Health Service. These safety net providers deliver critical health care services to low-income and vulnerable populations.”
The way this budget will work is that each department will figure out how to make the 18 percent cut (as I said, if it comes to that).
Many have compared this Trump budget to the Reagan-era budgets. I remember how that worked for IHS. The president would drop a number — and Congress would ignore it. Every time. That could happen again.
One interesting increase in the HHS budget is a request for $70 million to prosecute health care fraud. It claims a $5 return for every dollar spent tracking down “fraudulent or improper payments.”
The Department of Interior budget does not provide much information about the Bureau of Indian Affairs. It only says the budget: “Supports tribal sovereignty and self-determination across Indian Country by focusing on core funding and services to support ongoing tribal government operations. The Budget reduces funding for more recent demonstration projects and initiatives that only serve a few Tribes.” The budget says it will “sustain” funding for programs that bring in revenue from natural resources, including those programs that serve Indian mineral owners.
Many of these agencies will show a number in the budget because that reflects the cost to close the agency. Or as OMB put it “the amount of money that’s necessary for us to unwind our involvement …”
In addition Agriculture would eliminate the Water and Waste Disposal Loan and Grant Program, Commerce would eliminate the Minority Business Development Agency and NOAA grants supporting coastal and marine management. At Energy the budget would eliminate the weatherization program. At HHS, the budget proposes to end Community Services Block Grants as well as the Low Income Home Energy Assistance Program. Homeland Security would sharply curtail or eliminate grants to states and local governments (tribes, I assume). Even Meals on Wheels programs for seniors would be eliminated.
Another program that is slated for elimination is the Transportation Department’s Essential Air Service for rural airports — including those that serve remote reservation and 60 Alaska Native communities.
The only mention of “and Tribes” in the budget proposal is at the Environmental Protection Agency where the budget will avoid duplication by “concentrating EPA’s enforcement of environmental protection violations on programs that are not delegated to States, while providing oversight to maintain consistency and assistance across State, local, and tribal programs.”
The actual numbers of this budget mean little. They will go up and down. Some of the headlines, such as the elimination of public broadcasting, will survive because of support found in Congress. But it’s important to remember that this is the president’s agenda. This administration is hostile to every program that’s identified. So even if those programs are funded, the agencies will have a difficult task going forward.
Some of this agenda is nonsense. There are two ways to spend money on global warming: Learning about the science and trying to change behavior to lower carbon dioxide emissions. Or money for higher sea walls and community mitigation. This budget cuts the latter. That won’t work for long. When a community is severely impacted by fires or other climate catastrophe, the money will have to follow. Period.
But for now the debate is all about the president’s plan.
As OMB Director Mick Mulvaney said at the White House briefing room on Wednesday: “This is the “America First” budget. In fact, we wrote it using the President’s own words. We went through his speeches, we went through articles that have been written about his policies, we talked to him, and we wanted to know what his policies were, and we turned those policies into numbers. So you have an “America First” candidate, you have an “America First” budget.”
Only that’s a budget that means significantly less for the First Americans.
Not all the elected Native American Republicans make tribal issues any sort of priority. Minnesota Rep. Steve Green, for example, does not include tribal membership in his biography or in his campaign literature. Yet his district includes the White Earth Nation.
However most of the Native American Republicans who are elected to office also engage in Native policy issues before state legislatures, including support for enhancing tribal languages, teaching Native history, expanding or limiting tribal jurisdiction, voting rights, and, soon, state measures to shape the next version of health care reform.
One shared trait of the Native Americans who are elected as Republicans is support for fossil fuel energy development. “As a local elected official, I am outraged that Indian Country is prevented from harnessing our own energy resources by ever-increasing regulations,” New Mexico State Representative Sharon Clachischillage said in a Native Americans for Trump promotion. “The Trump Administration will ease restrictions on American energy reserves worth trillions of dollars. Together we will block the bureaucrats holding Native American businesses back and bring new jobs into our communities.”
But even the idea of energy development gets more complicated in Indian Country.As Sen. Hoffman reports on his biography page: “Every Alaskan deserves affordable energy. As a resource rich state (oil, gas, wind, and tidal), our state should and could, harness all of this energy to benefit all of its citizens. I pledge to continue to work towards reducing the high cost of energy in rural Alaska.” Anyone who’s purchased gas in a village — topping $6 a gallon in Hoffman’s home in Bethel — gets that.
But many of these same communities, especially in rural Alaska, are at the global warming frontline and more money will soon be required to build sea walls, fight more fires, or even relocate entire villages. In his biography, Hoffman only cites the opportunity. “Our backyard is changing opening new ventures, with the thawing of the tundra and the melting of the Arctic ice,” he writes. “It is my intent and my responsibility as your state Senator, to ensure our region participates …”
Then not every Republican even goes that far. Montana Sen. Jason Small, Northern Cheyenne, ran for office against Sharon Stewart-Peregoy, a Crow, to spur reinvestment in coal. Small recently wrote in The Billings Gazette: “Thirty million dollars a year in lost royalties, hundreds of direct jobs lost, thousands of families out of work and out of options, entire towns destroyed, statewide economic ripples, and over $1 trillion dollars in stranded assets, not necessarily because of market forces, but directly attributable to a political agenda. That is what we face in the current and unprecedented assault on reason and Montana’s economy in what has been dubbed ‘the War on Coal.’”
Then market forces will be a test of this notion. Can pro-coal Republicans legislate the revival of the coal industry? Small argued in the piece that “carbon capture and combined cycle technology can solve the global climate challenge posed in part by the world’s more than 7,000 coal-fired power plants.” Coal prices did surge after Trump’s election, at one point topping $110 per metric ton, but have since declined to about $83.50 per ton. Since the election at least one major power plant, the Navajo Generating Station near Page, has been marked for closure in two years. The Arizona utilities that own the generating station say that the low cost of natural gas is their primary reason for closing the plant. That in two words, market forces.
Waiting for Congress
Most state legislatures are waiting for Congress before taking action before another round of healthcare reform at the state level. And that’s a debate that is still hot. There are three distinct points of view about repealing and replacing the Affordable Care Act (or Obamacare). The plan by the House leadership (which has not been released yet) is supposed to be designed around tax credits instead of the insurance subsidies that are in the current law. Several of the most conservative members of the House and Senate see that as a new entitlement and have signaled their opposition. A third group of Republican moderates have been working with state governors to preserve Medicaid expansion because that insures some 22 million people (including more than $800 million for the Indian health system).
Rep. Cole is a likely supporter of the plan that emerges from House leadership. That includes a repeal of the Affordable Care Act as well as the Medicaid expansion. He recently told Native America Calling that Oklahoma did not choose to expand Medicaid and that made the system unequal.
However Cole said what ever plan emerges he said the Indian Health Care Improvement Act is a “bedrock” legal authority that must remain. “This legislation was included … purely as ‘vote bait’ to secure Democratic votes and has nothing to do with” the Affordable Care Act,” Cole said. “It is vital and ensures that Native Americans have quality health care available to them and their families. There is no controversy here – it sets the national policy for many programs and services provided by the Indian Health Service.”
A few weeks ago the repeal of the Affordable Care Act seemed like a sure thing. And now? The next week or two could answer that question. And the course that’s picked will have a huge impact on the Indian health system.
And, over that same time frame, Native American Republicans will be asked to take a stand about deep budget cuts across federal agencies. Several news agencies have reported that the Office of Management and Budget is calling for a $1.3 billion cut at the Interior Department. Interior Secretary Ryan Zinke employees that he did look at the budget and is not happy about it, according to Energy & Environment News. “We’re going to fight about it,” Zinke said, “and I think I’m going to win at the end of the day.” E & E News reported that Zinke would engage in a major reorganization of the department, one that focuses the agency on the next one hundred years (including the promotion of tribal sovereignty).
It’s easy to find the issues where Native American Democrats and Republicans disagree. Indeed it would be simple for me to shape every column as doom and gloom, the logic of “Oh, what is that Trump going to do next?” But that won’t help the policy debates that are so important to Indian Country. But that idea discounts how much agreement there is out there — even in this hyper-partisan climate. It was Rep. Cole who helped champion the reauthorization of the Violence Against Women Act in 2013, including the provisions for tribal jurisdiction over non-Indians. Tribes still have a lot of work to do to implement that law. Deborah Parker, former vice chair of the Tulalip Tribes, and a key supporter of the act, said tribes should get their law and order codes ready now to comply with the law. Too few tribes have taken that step and VAWA will again require reauthorization in 2018 so Indian Country has to present its strongest case for this Congress.
One example of a Native American issue that cuts across party lines is unfolding in Wyoming. The Indian Education for All, House Bill 76, would require the state’s schools to educate all children about the history and economic contributions by the Eastern Shoshone and Northern Arapaho Tribes.
Sen. Affie Ellis was just elected in November and is a co-sponsor of the legislation. She’s a Navajo who grew up in Wyoming and she told the Casper Star-Tribune that Native American students sometimes are threatened by verbal abuse during sports trips across the state. “It’s a really important first step to understanding each other a little bit better,” she told The Star-Tribune. “It’s a brief idea, and I think it’s a fitting one.”
At the recent Conservative Political Action Conference, or CPAC, Ellis spoke at a panel titled, “Rising Stars in the Conservative Movement.” Back in Wyoming her appearance generated both praise and criticism. The newspaper Planet Jackson Hole asked the question if Ellis was a “sane Republican alternative” to Trumpism? The paper quoted Ellis saying: “I think our country needs so desperately some thought and some well researched responses … There’s so many times when it’s easy to name call and have these cute hashtags that stick but we have to have strong facts and start communicating those facts in a very effective way. I think the hard part is the devil in the details of policy you’re working on doesn’t fit into small hashtags. Maybe we just need long hashtags.”
I don’t know about longer hashtags. The one I use, #NativePolicy, is short. But we certainly need more thoughtful, complex policy debates.