#NativeVote18 The election math behind Paulette Jordan’s campaign in Idaho

Paulette Jordan is one of seven Native American candidates running for statewide office — and one of two Native women running to a lead a state

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Paulette Jordan: The issues “that tribes push forward are good for everyone.” Jordan is running for governor of Idaho and has a May 15 primary. (Official photo)

Mark Trahant / Indian Country Today

A couple of weeks ago I was driving across the border into Idaho from Montana. I stopped the car and took a picture of the “Welcome to Idaho” sign. I thought: It would be cool if that sign read, just under the Idaho greeting, Paulette Jordan, Governor.

Jordan, Coeur d’Alene, is running as a Democrat in what is perhaps the reddest, most Republican state in the country. So it’s an impossible task, right?

No. Let’s do the math.

The first part of that equation is done: Running. So many talented people survey a political campaign and then, for whatever reason, pass. But the inviolate rule of politics is that you must run in order to win. So that is a huge step.

Jordan is one of seven Native American candidates running for statewide office and one of two Native women running to a lead a state, (something that has never been done before.) She will be the first of those candidates to face voters and she will need to win a contested Democratic primary on May 15. A date that’s coming up fast.

One of the most important reasons for Native American candidates is the aspirational aspect. It’s a way for young people to see a future, (one that is far more important than just politics.) During a recent trip to Fort Hall, and the Shoshone-Bannock Tribes, Jordan took time out to visit the students. She also met with community members where she said on KPVI 6 that the issues that “tribes push forward are good for everyone, all of humanity. So when we talk about education in tribal communities, it’s the same for Hispanic communities, it’s the same for every single district up and down this state.”

Jordan is running against A.J. Balukoff, who, unlike Jordan, can use his own wealth to fund his campaign. (Something he has already done to the tune of $175,000.) Four years ago Balukoff was the Democratic nominee for governor and lost by a wide margin.

Idaho has an odd primary. The Republicans limit their ballots to anyone except those who publicly claim party membership. But anyone who is “unaffiliated” or independent can pick up a Democratic Party ballot on election day. Because Idaho is such a conservative state, most voters sign up with the Republicans. Four years ago more than 155,000 voters did just that, while only 25,638 voted in the Democratic primary.

This is actually an advantage for a candidate like Jordan. She only needs to find a few thousand votes (my bet is there will be more interest than four years ago.) So, let’s say that means the primary winner will earn at least 25,000 votes. That’s a plausible number in a season where nontraditional candidates are getting a second and third look.

There is only one county in Idaho that regularly votes for Democrats: Blaine County. That’s Sun Valley, Ketchum, the Wood River Valley. Think lifestyles of the rich and famous. Hillary Clinton had a two-to-one margin over President Donald J. Trump in Blaine County. Jordan must do well here.

Votes from Idaho’s five reservations could help, too. The numbers are small, but if they are one-sided, say 100, 200, 300 votes to a handful, it could give her an edge. Especially in a primary.

Jordan should also poll well with younger Democratic voters and with Hispanics. These two constituent groups are growing in numbers and importance. Well, sort of. Idaho is a young state: There are more people under 18 than any other demographic group. And younger voters from 18 to 25 are a relatively small cohort at roughly 155,000 people. But in the last elections this group increased its turnout rates, so there is a potential upside. Hispanics now account for 12 percent of Idaho’s population and, according to Pew Research, are some 80,000 eligible voters (far more than what would be needed in a primary election.)

The math is there. It’s possible.

What about Jordan’s message? Is she connecting with primary voters? That’s a much tougher call. She has to reach voters in a state with two time zones and a distinct geographic divide. I often joke that Idaho is the only state with three capitals: Salt Lake City, Spokane and Boise. Each major city has its influence over regions of the state.

Recently Jordan’s team made a rookie mistake adding the word “ever” to an email about her being the only Democrat elected in North Idaho. This took away from an important message: Jordan won re-election to the Idaho House two years ago in a terrible cycle for Democrats. Her campaign convinced voters who would not normally vote for a Democrat. This should be said over and over as a reason why Idaho Democrats should vote for Jordan.

And after that? The toughest hill to climb come after the primary. Jordan would then need to make her case to Idaho’s deeply conservative Republican voters. But if there is ever a year to do just that, it’s this one.

But first the May 15 primary is coming fast. That’s a hurdle that Jordan needs to clear first.

Mark Trahant is editor of Indian Country Today. He is a member of the Shoshone-Bannock Tribes. On Twitter: @TrahantReports (Cross-posted on TrahantReports)

Trump complains. And signs the business-as-usual spending bill into law anyway

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President Donald J. Trump speaks about the $1.3 trillion Omnibus Spending Bill before signing into law. (Official White House photo by D. Myles Cullen)

Indian Health, Bureau of Indian Affairs see a budget increase

Mark Trahant / Indian Country Today

The federal government’s newly enacted budget is a massive “omnibus” act that spends $1.3 trillion and makes some members of Congress pleased and others angry. It’s a document that reflects a broken budget system. And, at the same time, it’s a business-as-usual document in a presidential administration that has promised structural change.

“There are a lot of things I’m unhappy about,” President Donald J. Trump told reporters at the White House Diplomatic Reception room. “But I say to Congress, I will never sign another bill like this again. Nobody read it, it’s only hours old.”

But the negotiations were not hours old. The back and forth between Democratic and Republican lawmakers was essentially a year late. This spending bill only funds the federal government between now and the end of September. But the process took so long because neither side had enough votes to pass the document on their own; Republicans needed votes from Democrats and to get those votes there had to be deals. Lots of deals. Business as usual.

And business as usual is good for Indian Country. Federal Indian programs, some of which had been slated for either elimination or deep cuts, continued on course.

The omnibus spending bill increases 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 s $5.5 billion. When the budget is compared to the president’s request, the increases are even sharper, more than 16 percent for the IHS and 23 percent for the BIA.

At the BIA, according to an analysis by Amber Ebarb at the National Congress of American Indians, “Overall, the eliminations and reductions proposed in the president’s budget were rejected.”

Other budget items:

  • The bill includes a 3 percent set aside for Indian tribes within the funds available under the Victims of Crimes Act. The cap for these funds was set at $4.4 billion, which amounts to $133 million. As Ebarb wrote: “This is an important step forward for Indian Country, which has the highest rate of criminal victimization and had up until this point been left out of this funding. This funding will address the long standing inequity and meaningfully improve the landscape of victim services in Indian Country.”
  • The bill provides $50 million for grants to Indian tribes or tribal organizations to address the epidemic, and $5 million for tribes in the Medication-Assisted Treatment for Prescription Drug and Opioid Addiction program.
  • Infrastructure spending would increase for BIA and IHS construction, BIA road maintenance, and a $100 million competitive grant program is added under Native American Housing Block Grants in addition to the $655 million provided for the NAHBG formula grants.

 

President Trump said he signed the bill into law because it increased military spending. “I looked very seriously at the veto. But because of the incredible gains that we’ve been able to make for the military, that overrode any of our thinking.”

(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. On Twitter: @TrahantReports (Cross-posted on TrahantReports)

ICTSpending

Data day. Working on #NativeVote18 #SheRepresents spreedsheets

I have been working on #NativeVote18 lists … folks running for state legislatures (55 and counting, 25 women and 30 men). I have also been working on a list of Native American women who have run for state wide offices and Congress. Fascinating stuff. (I was thinking of a trivia game I could post.) There have been four candidates for governor, three for Lt. Gov., and 12 for Congress. First statewide race that I have found, 1978. Cool stuff. #SheRepresents Will post this soon. I want to make a graphic.

Here is the #NativeVote18 state legislature list. Who’s missing?

One thing I should mention: Google has changed the way you can access pictures and it no longer is compatible with fusion tables. So I am looking for a solution or a new spreadsheet system. #Transparency

 

https://www.google.com/fusiontables/DataSource?docid=1i_wzJ_tneyBQ-A_htt1xnDqeo3wEhyXQ8KI9mGQt

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. 

Exploring the business of Native news; inventing a medium that does not exist

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Mark Trahant / Trahant Reports

It’s tempting to think of “news” as the business model for Indian Country Today. What are the stories? Does it represent an authentic voice (or voices) for Indian Country? Who are the great reporters? Where should they be? How much video? Text? Opinion? Is the story compelling? Does coverage match the experience of our readers? What’s on our digital front page? What stories do people want to read? What’s new?

These are great question for any editor. But they should be dismissed. For now. If Indian Country Today is to revive there are other questions that must be asked and answered. Starting with: Is there funding? Is Indian Country a viable market? If so, what does that look like? Where will the revenue come from? How much will it cost to produce? And how often? And, by the way, where is the money coming from?

There are really only two answers that need to be figured out: Where the money comes from and how that money is spent. Everything else is just detail.

When I first read that Indian Country Today lost (I’ll say invested) some $3 million in its last year, I thought, wow, that’s more than I lost running Navajo Times Today back in the day. Then I did the math. Uh oh. If you look at the value of a dollar now compared to 1987 then, well, let’s just say the total exceeds $5 million.

Problem: It costs a lot of money to produce news.

Then the media world is upside down. Today so many costs are a fraction of what they were in 1987. As a daily newspaper the Navajo Times Today, I still believe, needed about 4 years to break even and then would have been profitable. Our advertising projections were solid but what slowed us down was the costly nature of delivering the paper daily throughout the Navajo Nation. The internet has sharply reduced those costs — any organization can publish on the web for far less than what it cost us a generation ago. But, at the same time, advertising no longer works to pay the bills. (The funny thing: Had we been successful in 1987 … the paper would still be in deep trouble because so many of the elements required for a successful daily newspaper have evaporated.) 

The Navajo Times of today (owned by the tribe, but chartered and operated independently) is quite successful. It’s a weekly and it still attracts significant advertising and readership. But the strength of those ads are regional, not national.

The challenge for Indian Country Today is that it generated a large readership, at least by Indian Country’s standards, but not enough of a readership for a national advertising strategy which measures success by the millions. Most digital ads are sold using a measurement of cost per thousand or CPM. So if there are 100,000 readers and let’s say 2 percent click the ad, that could generate about $2,000. So it would take a whole lot of those kinds of ads to fund a newsroom.

I don’t think a subscription model works for Indian Country either. The problem is that a few people will pay, but not enough to cover the costs, so you end up producing a publication for the elite. I almost went down this road a couple of years ago for Trahant Reports. I was thinking of converting the report into a paid newsletter that probably would have sold to a few law firms, lobbyists, and tribes particularly interested in public policy. Hell, I might have even made money at it. But the true cost would have been high: I try to make public policy interesting for everyone. And those readers would have been gone. Fortunately a friend pointed this out to me — and I reversed course. My content remains free for readers and for other news organizations.

So what models are there that might work? How can Indian Country serve readers as an independent news organization? And, just as important, how will that enterprise get started?

I won’t explore the for-profit model here because it’s not an option. But that mechanism does work for News from Indian Country, Native News Sun, and many other regional publications. It’s also important to remember that there will be competition for resources and content. Any non-profit enterprise will compete for many of the same dollars raised by tribal radio stations, the Native Voice One network, Native Public Media, Native American Journalists Association, and on and on. The Indianz.com and Pechanga.net attract the same web readers with their content and aggregation. (See the Native Media Universe, an always unfinished database.)

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News that’s Not-for-Profit

Indian Country Today’s next chapter is likely to be some kind of not-for-profit venture. The Oneida Nation of New York, the owner of Indian Country Today Media Network, donated the assets of the venture to the National Congress of American Indians. It’s now up to NCAI to figure out what will happen next (starting with many conversations at the annual convention next week in Milwaukee).

This is a bit complicated because NCAI is an advocacy organization for tribes and its members. Just imagine the first time a journalist writes a hard-hitting story that a senator on the Appropriations Committee does not like. Or a tribal leader.

But this is a problem that can be solved.

One of the best news operations in Washington is Kaiser Health News, owned by the Kaiser Family Foundation. They are both non-profits. Kaiser Health News is in the same building as the Kaiser Family Foundation, often uses that research, or speakers, or other resources. Yet Kaiser Health News operates independently and partners with existing mainstream media such as National Public Radio or The Washington Post. Another hybrid, Think Progress, operates independently of its sponsor, the Center for American Progress. There is another model — a completely different approach — that works in Seattle, the Sightline Institute. This organization focuses on actionable research about the Pacific Northwest region and its view of a sustainable future. This could be something that the NCAI Policy Research Center could do. It’s a smaller operation that builds on existing scholarship.

But Kaiser Health News and Think Progress do something else that’s essential: They employ dozens of journalists. Indian Country Today did that too. And that ought to be at the top of the list in terms of developing a “what’s next?” plan.

Two other non-profits that have a significant presence in Indian Country’s media universe are Yes! Magazine and High Country News. Both publications treat Indian Country as an important beat and pay freelancers for coverage. High Country News also has a Native issues editor, currently Graham Lee Brewer, a member of the Cherokee Nation. Yes! invested significant resources into covering Standing Rock. Both of these non-profits have a long track record. High Country News began in Lander, Wyoming, in 1970. And Yes! started in 1997.

There is a newer model to consider, ProPublica. This is an independent, stand alone, news organization that’s funded by philanthropy. Imagine a bunch of journalists being hired with an agenda to do news. The work is done by professionals and then given away to other news organizations. There are several regional variations of ProPublica throughout the country that lay out a road map for the how to operate Indian Country Today as a non-profit enterprise.

That’s the money out. Spending it will be simple. There are a lot of talented people who would love the opportunity to keep doing what they’ve been doing, or better, to do more. The distribution of the news could be by web, a wire service, through other media, or all of the above. Technology has made distribution much easier.

A summary of the money out: The cost of a staff, buying freelance, travel, and some administrative costs. But how much money, who decides who gets the jobs, and how much will freelancers be paid?

The data is interesting. According to Pew Research, 73 percent of all non-profit news sites employ less than three people. Only 19 percent have between five and ten employees. “Small budgets tend to mean small staffs and that is the case for a large majority of the digital native news outlets,” according to a Pew Research survey of nonprofit outlets.

What about the money in? As I have already written: I don’t believe there is a national market for advertising. Indian Country’s numbers are just too small for a mass market. There could be, from time to time, some ads. But nothing comprehensive and not in amounts that would make a difference. I also think a subscription model won’t work for the reasons I’ve already said.

So what does that leave?

I’d start with the public media model. It doesn’t matter who “owns” Indian Country Today. We all do. We have a stake in an intelligent account of the day’s events in a context that gives them meaning.

So a public Indian Country Today could challenge us with semi-annual fundraisers, crowdfunding, and a call to action. Twice a year at least. And, like other public media, that means raising additional money from foundations, companies, tribes, basically, any group willing to write a check.

One recent Pew Research report estimated that roughly $150 million in philanthropy now goes to journalism annually.

And much of that comes from crowdfunding. Pew Research: “From April 28, 2009 to September 15, 2015, 658 journalism-related projects proposed on Kickstarter, one of the largest single hubs for crowdfunding journalism, received full – or more than full – funding, to the tune of nearly $6.3 million.”

Then if that sounds like a lot of money, Pew also reports, “the journalism projects produced and revenue gained from these crowdfunded ventures is still a drop in the bucket compared with the original reporting output that occurs on any given day and the roughly $20 billion in revenue generated by newspaper ads alone.”

But as a revenue stream — perhaps not the only one — crowd funding could be significant for Indian Country Today. If, the news operation is credible and compelling. If.

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There is a lesson from ProPublica that ought to apply to any model (or blend of models) that eventually surfaces, and it raises another question, what business are you in? No, really?What business?

At a recent Google Hangout with the Online News Association, ProPublica’s Vice President of Business Development and ONA Board Member Celeste LeCompte drew parallels between the news industry and other enterprises. She said she visited a go-kart factory in China and she discovered they also made trampolines. Why? Because she said the company was “not a go-kart business. It was this crazy machine-bending, metal-piping, powder-coating and spring-attaching business. And that got me thinking about the ways in which companies make their money.”

That same principle applies to information. ProPublica, for example, collects a lot of data as part of its reporting. It then sells that data to other clients for other uses.  “We are storytellers in this business,” she said. “That’s all we’re asking to do in the business side as well. When you’re creating real value for an audience, you probably have an opportunity to ask them to compensate you for that.”

What parallel market exists from information in Indian Country? And, what are the prospects and the ethics of marketing that information?

Of course the minute you have the answer, the rules change. One funder — even a good one — can keep an operation going for some time (as in the case of Indian Country Today) but what happens when priorities change? Is there a route to sustainability that includes lots of sponsors and supporters?

Answering these questions is difficult in the media world we all know. Newspapers. TV. A little web. Podcasting. The familiar. But that world is vibrant. And it’s gone. The challenge is to invent a news ecosystem for Indian Country that builds on models that do not yet exist.

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. 

Previous: When the Native press is strong, so is Indian Country

Indian Country Today had its beautiful moments

Disclosures: I have been working in Native media since 1975 — so I have a long list of disclosures for this piece. I am currently a board member for Yes! magazine. I am a former board member of Sightline and a long time ago, High Country News. I was editor and publisher of the Navajo Times Today in the mid 1980s (and was fired from that job.) I had a fellowship with the Kaiser Family Foundation. And I am a former president of the Native American Journalists Association. And, finally, my weekly radio commentary is distributed via Native Voice One. I am also an owner, stockholder in News From Indian Country. 

Alaska’s special deal in Senate health bill isn’t enough to fund successful Medicaid

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Alaska’s Health and Human Services Commissioner Valerie “Nurr’araaluk” Davidson. A report by her agency says Medicaid now covers one in four people in Alaska; nearly half of whom are children. If Medicaid caps are enacted, the “magnitude of the federal cuts are such that they may well affect Alaska’s ability to finance other state priorities such as education and infrastructure.”

Mark Trahant / Trahant Reports

It would be cool, just this once, if the Senate would say, “Indian Country you are so important. So we are adding a special provision to this health care bill that adds big bucks to the Indian Health Service.” Then Senators with significant American Indian or Alaska Native populations would shift their votes from perhaps to yes.

That might sound like a fantasy. But it’s the track that the Alaska delegation is on; senators secured a special deal in the Senate health care plan for their state. Only it’s not about Alaska Natives. And it’s not nearly the same amount of dollars that the state will lose with Medicaid cuts (or, for that matter, in high cost insurance.) But it’s a “victory” of sorts that will be claimed if Sen. Lisa Murkowski eventually votes yes on the Senate bill. (Sen. Dan Sullivan was a likely yes, anyway, although he’s claiming credit too.)

Here’s the deal. The legislation includes a complicated formula to reduce Medicaid spending — except in states with a population density of less than 15 people per square mile. That’s Alaska, Wyoming, North and South Dakota, and Montana. New Mexico just misses but then it’s a Blue state and its senators would likely vote no anyway. And, the exception might be of use to Sen. John Hoeven from North Dakota but, like Sullivan, he probably would vote with leadership anyway.

So really it’s about Alaska — and Murkowski’s vote. She’s a firm maybe. So far three senators have said no (enough to kill the bill) but we won’t know how solid those no votes are until there’s an actual vote. The self-proclaimed no votes are Sen. Susan Collins of Maine, Rand Paul of Kentucky and John McCain of Arizona. (Republicans need 50 votes from their own party.)

The rural exception to the Senate bill adds up to just under $2 billion, according to The New York Times.

But special deal or not, the big picture might be more important to Murkowski.

Alaska is a state where the evidence is strong that the Affordable Care Act and Medicaid Expansion are working. Nearly a quarter of the state’s population is enrolled in Medicaid and the state’s 2015 expansion added more than 34,739 people. Half of the state’s children are insured by Medicaid.

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And, of course, Medicaid is an essential revenue source for the Alaska Native medical system — a system that Murkowski praised just this week at a hearing on the Indian Health Service.

A study done for Alaska’s Department of Health and Human Services — run by Commissioner Valerie “Nurr’araaluk” Davidson — is blunt. It says: To stay under a per capita cap Alaska would be required to cut its Medicaid program spending by $929 million in federal and State dollars between FY 2020 and 2026, with a federal funds loss of $473 million … The magnitude of the federal cuts are such that they may well affect Alaska’s ability to finance other State priorities such as education and infrastructure.”

The report says the cap will not include patients in the Indian Health system, but that Alaska will have to cut back on eligibility to reduce Medicaid spending.

Analysis of the House plan (remember at some point the House and Senate bills would have to be merged and passed again) would cost Alaska $2.8 billion in Medicaid funds between 2020 and 2026.

What’s even more problematic: “Alaska will have to establish its Medicaid budget almost two years before it knows the amount of federal Medicaid funding available for that budget year.” That could result in a “claw back” effect where money has to be returned to the federal treasury after its already spent. The impact of the Senate bill would be quick. The state’s report estimates that within three years a quarter of all Medicaid funding would be eliminated. And, more important, by 2022 95% of expansion enrollees will have lost coverage due to Alaska’s highly seasonal workforce.”

So will the rural exception be enough to buy votes? It’s certainly not enough funding to maintain Alaska’s successful Medicaid Expansion.

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

 

Lies we’re told: Strip millions (billions) from health care & call it better

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At a Senate appropriations subcommittee hearing Wednesday there was a testy exchange between Sen. Jon Tester, D-Montana, and the acting director of the Indian Health Service Rear Admiral Michael Weahkee (Zuni). Tester asked how money can be taken from the budget without hurting the quality of care or staffing at IHS. The Senate video is here.

Mark Trahant / Trahant Reports

A Senate hearing Wednesday on Indian health illustrates the larger problem exactly: How can you strip millions of dollars from a health care system and get better results?

The answer is you cannot.

But that’s not what the Trump administration testified. And it’s not what the Senate leadership is saying about its health care bill. Or the House for that matter.

So they lie. And it’s a lie that is so bold, so outrageous, that it should not told with a straight face. There is no defense. That’s why doctors, governors, hospitals, patients, economists, policy-makers, anyone willing to tell the truth about the destructive nature of these so-called health plans are in the opposition. A recent USA TODAY/Suffolk University poll shows the support for the Senate plan by only 12 percent making it one of the most unpopular bills ever.

And yet the Senate bill is still on the table. A new bill is out today and a vote could come as soon as next week. President Donald J. Trump told a Christian television show that he would be “very angry” if this bill fails.  “I am sitting in the Oval Office with a pen in hand, waiting for our senators to give it to me,” the president said. “It has to get passed. They have to do it. They have to get together and get it done.”

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I have been writing a lot about the GOP plans in the House and Senate. Three recent pieces: The impact on jobs in Indian Country; Trump tells tribal leaders Medicaid cuts will be good; and health care policy is a debate worth having (but this is not that.) And I still find I have something to say because the Senate and House bills are so harmful to Indian Country.

Let’s start with the hearing on Capitol Hill Wednesday. Rear Admiral Michael Weahkee, the acting director of the Indian Health Service, testified about the agency’s budget to the Senate Appropriations Subcommittee on Interior, Environment and Related Agencies, chaired by Alaska’s Sen. Lisa Murkowski. “I am pleased to provide testimony on the President’s Fiscal Year (FY) 2018 Budget Request for the IHS, which will allow us to maintain and address our agency mission to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives (AI/ANs) to the highest level,” began his written statement. It gets better: “The Budget reflects the Administration’s high priority commitment to Indian Country, protecting direct health care investments and reducing IHS’s overall program level by only 0.9 percent when compared to the Annualized Continuing Resolution, in the context of an 18 percent reduction within the overall HHS discretionary budget.”

In other words we’re cutting the hell out of all budgets — so be happy with your cuts Indian Country.

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So what if the words “maintain” and “raise” don’t fit with the highest level of health care. It’s no secret that Indian Health is already underfunded.

The measure of that shortage that makes the most sense is to compare spending by IHS to what’s spent by the federal government on federal employees. According to the National Congress of American Indians that measure shows IHS funding at about 60 percent of need.

(Of course you could argue that the U.S. health care system is too expensive. But that’s a different conversation. Reform is not even on the table right now. This whole fight is just about money; money for health care or tax cuts.)

The problem with the Senate hearing and a recent Wall Street Journal article on the failure of the Indian Health Service in the Great Plains is that the Indian Health Service is not what it was. It’s no longer just a government health care agency. In fact most of the agency is a funding mechanism for tribal and non-profit health care facilities.  The congressional oversight needs to be re-imagined to fit both of these missions.

The Journal stories highlighted operational issues in South Dakota and Nebraska that demonstrate a tragic failure. (This is the IHS story most of us already know.) And after years of warning the agency has not come up with a strategy to effectively fix its own management.

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“Because this is our IHS. These are our facilities that are supposed to care for our first people,” Sen. Murkowski said. “And the stories that were detailed were shocking.”

But Sen. Murkowski correctly identified the division within IHS. She told Alaska Public Media that Alaska’s Native health facilities are run by tribes, under contract to the IHS, so their problems aren’t the same. True. But that’s more than half of the system. That’s the story that the Journal did not tell (and do the reporting about why tribes and non-profits are able to deliver better care than the agency itself.)

The answer, in part, take us back to the larger Senate debate. The Alaska Native Medical Center has balanced funding: Money from IHS, aggressive third-party billing from private insurance and especially Medicaid as well as foundation grants. This kind of balance ought to be the future (unless Congress says, “well, let’s fund Indian health at 100 percent of need”) for others across Indian Country.

That’s why the narrative of failure is problematic. It’s true that there is a systemic crisis — especially in the Dakotas. So much so that Montana Sen. Steve Daines has even suggested changing the name of IHS to “Indian Health Suffering.” Old story.

But that’s why there should also be a narrative of success. I, too, would change the name of IHS, but to the Indian Health System. Because parts of that system are excellent and ought to be a model for health care, period.

And that’s where Medicaid comes into the picture. At the Senate hearing there was frustration because IHS did not provide enough data.

The IHS budget calls for $1.2 billion in third-party billing. Most of that is Medicaid. That will work for next year. But it’s important to remember the House and Senate plans will cap and reduce what is spent on Medicaid. Right now: If a person is eligible, the money  is there. Under the GOP alternative there will be a set amount of some kind. The money will run out.

But IHS officials did not talk about Medicaid much. And Montana Sen. Jon Tester pointed out:  “I think it’s absolutely unbelievable that you can’t separate how much Medicaid has helped your with third-party billing.” This is is what we need to know.

The Indian Health Service operates in both Medicaid and Medicaid expansion states. Remember not every state expanded Medicaid under the Affordable Care Act (To date: Thirty one states and Washington, D.C. are on board). For example: South Dakota did not and North Dakota did. So we ought to have data about how much Medicaid money goes into the system, for what kind of patents, and how it’s used (hint: by law it’s supposed to remain at the local service unit.) We should have similar data for tribal or non-profit facilities. Life-saving data.

The Center for Budget and Policy Priorities released a report earlier this week that highlighted the connection between Medicaid and Indian Health. “The Medicaid expansion has improved access to care for thousands of American Indians and Alaska Natives especially in states with large AI/AN populations including Alaska, Arizona, and New Mexico. It has also provided much-needed revenue to Indian Health Service (IHS) and Tribally operated facilities, allowing them to expand services and hire and retain more staff. Ending Medicaid expansion would jeopardize coverage for these newly insured low-income AI/AN adults, and reduce revenue for IHS and Tribally operated facilities, forcing them to revert to pre-ACA service levels.”

In Montana, a state that recently expanded Medicaid, more than 11,000 American Indians have signed up for the insurance. “At a time when Montana is working in a bipartisan basis to address the suicide epidemic and improving health outcomes for American Indians, D.C. politicians are threatening to take away health insurance for thousands of Americans Indians in Montana,” said Heather Cahoon, State Tribal Policy Analyst for the Montana Budget and Policy Center. “More than 11,000 American Indians in Montana now have access to health insurance through our bi-partisan Medicaid expansion plan, and we can’t afford to go back.”

But going back is on the Senate agenda today. The Republican caucus is counting votes to see if a compromise is possible within their own ranks. The bill will be released, scored by the Congressional Budget Office, and, if Sen. Mitch McConnell gets his way, there will be a vote early next week.

But the facts are this: The Senate bill still strips $700 billion from Medicaid. And that number will grow over time. And the Trump administration is cutting from the already underfunded Indian Health Service budget by 6 percent. Now. That, too, will get worse down the road.

And so there will be many lies flying fast. It’s a health care bill. Or this legislation won’t take away your insurance. Medicaid will be better off. So will the patients. Whatever. The Congressional Budget Office is wrong. Then there’s that forever lie: That United States is meeting its solemn treaty promises to American Indians and Alaska Natives.

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

 

 

 

 

 

 

 

 

 

 

 

Health care debate should also focus on the thousands of jobs in Indian Country

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Mark Trahant / Trahant Reports

I am not sure of the exact year. It probably happened around 1996. That’s when the Indian Health Service became the single largest employer in Indian Country.

This makes sense when you think about it: Indian health was once a small (unappreciated) division of the Bureau of Indian Affairs. But by 1996 the agency’s budget was larger than the BIA’s — and there were likely more workers. The administration estimates that next year the BIA will have some 6,770 full-time employees (a decrease of 241) while the Indian Health Service will have more than 15,119 employees (including 1,928 uniformed Public Health Service officers).

Big numbers, right? But that reflects what is happening with health care generally. Google “region’s top employers” and it’s common to see clinics, hospital systems, and university medical centers as any region’s largest employer.

“Employment of healthcare occupations is projected to grow 19 percent from 2014 to 2024, much faster than the average for all occupations, adding about 2.3 million new jobs,” reports the Bureau of Labor Statistics. “Healthcare occupations will add more jobs than any other group of occupations. This growth is expected due to an aging population and because federal health insurance reform should increase the number of individuals who have access to health insurance.”

But here’s the thing: Many of these health care jobs are dismissed as “low wage.” The BLS calls these health care support jobs and the median income (or half pay more and half pay less) as $27,910 which is lower than the median annual wage for all occupations in the economy. The list of support jobs would include Community Health Representatives (long a staple in Indian Country), medical record keeping and coding jobs, as well as different kinds of medical technicians. But what’s considered low wage in the general population, and in cities, can be a good gig in a rural, tribal community.

Alaska is a prime example. More than half of Medicaid spending serves rural constituents, three times more than the national average. Medicaid covers two-thirds of all American Indian and Alaska Native children and more than one in four, or 28%, of American Indian and Alaska Native adults. The Urban Institute estimates that the kind of block grants found in the Senate’s Better Care Reconciliation Act would cost the state $590 million in federal funding — a number that would decline even sharper after 2025. The job losses would be substantial.

This is another reason why the House and Senate plans to roll back the Affordable Care Act (and the destruction of Medicaid as part of the deal) are so important to the Indian health system. The Senate plan especially reverses decades of Medicaid growth. That’s no good for patients (as I have reported before here and here) but it also will cost Indian Country jobs.

Medicaid directly accounts for 24 percent of IHS’ workforce, but even that is short of the kinds of jobs that serve tribal communities. It does not include school-based programs. Or those private companies that bill Medicaid for transportation of patients or other patient services. Same story for jobs that stem from medical coding, accounting and third-party billing services.

Across the country, Medicaid is a major job creator for women, supporting at least 3 million direct jobs.  According to a report by the National Women’s Law Center: “When Medicaid pays for a health service—a visit with a health professional, a laboratory test, a hospital stay, a home health visit—this payment supports the facility, agency, or medical practice that delivers the service, and the individuals who provide this care receive compensation as well. Women’s high participation in the health care industry, which employs more than 22.8% of all women in the workforce, means that Medicaid disproportionately creates jobs for women.”

I don’t have a breakdown for these jobs in Indian Country, but from personal experience I would bet the numbers are similar if not higher.

Senate debate begins again next week

The Senate, of course, still does not have consensus about a bill to replace the Affordable Care Act. Majority Leader Mitch McConnell suggested this week that Republicans might need to try another direction because “no action is not an alternative.” The Associated Press quoted the senator saying: “If my side is unable to agree on an adequate replacement, then some kind of action with regard to private health insurance markets must occur.” That plan would require votes from Democrats and would likely include a compromise.

Other senators, including Paul Rand, have proposed repealing all of the Affordable Care Act without a replacement, basically putting that off for another day. That would be particularly troubling for Indian Country because a full repeal would likely include the Indian Health Care Improvement Act. But that, too, is complicated by Senate rules. A full repeal would need 60 votes unless that legislation was framed narrowly around budget issues.

But Republican leaders have not given up. The new story they are telling is that 22 million people would “choose” to not carry health insurance. It’s a freedom thing. But that does not square with the destruction of Medicaid. And the jobs that public insurance program has created.

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

 

Fundraising: Counter fake news by supporting Trahant Reports on the radio

Sponsors

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This will be a short pitch. (Then back to regular programming.) I am looking for a few financial supporters of Trahant Reports. Well, at least, for the radio version of my commentary. Trahant Reports is a combination of my blog and a weekly commentary carried on Native Voice One. 

My goal is to write about serious policy issues that impact Indian Country. In the era of President Donald J. Trump that mission is more important than ever (and my readership numbers reflect that.)

Traffic for the blog continues to grow. A piece last week on Medicaid, for example, had some 20,000 views on Facebook, hundreds of shares, and my regular reach on Twitter now exceeds 210,000 accounts.  Apple News is another growing vehicle for Trahant Reports: People subscribe on their iPhones and see my latest work immediately.  And, most important, on top of all that, most of my readership is through other media that carry Trahant Reports as part of their report. My idea is to keep the content free (although I should mention that a couple of news organizations send a check anyway. And I am grateful for that.) A shout out to all those who share my work on social media. You have no idea how important that simple act is to spreading the word. Two interesting elements here: First, the more serious the story — such as a deep-dive on Medicaid — the bigger my readership numbers. Second, readers are fond of my early idea white boards. As soon as they are posted, folks send me follow-up ideas or suggestions.  This is cool because it’s really interactive.

So that’s the blog report.

Trahant Reports on Native Voice One is in its third year. We started as an audio web post,  then last year made the programming available to stations directly. Every Monday a new three-minute commentary is made available for tribal and community radio stations. It’s also found on iTunes and Soundcloud. I also produce special reports that are 30-minutes in length. (There is a special coming up soon on Native women running for elective offices).

This is where sponsors come in. I am looking for underwriters to help pay for this programming. Major sponsors will get a credit at the end of a show (as well as many thanks on social media).

July is my fundraising month. So I’ll make this pitch. Sponsor Trahant Reports on the radio. Thank you. Ok, now it’s back to work. I have too many stories in my head to spend much time on the financial end of this operation. I’d much rather be writing and reporting. But I figure if I don’t ask … then the answer is already no. So there, done. Pitch complete. Drop me a line if you’re interested in being an underwriter. Email: mntrahant@mac.com

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