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

IMG_0129

Mark Trahant / Trahant Reports

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

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

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

Screen Shot 2017-11-26 at 7.22.35 PM.png
Source: Georgetown University Health Policy Institute. Coverage Trends for American Indian and Alaska Native Children and Families.

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

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

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

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

Screen Shot 2017-11-26 at 7.48.43 PM.png
Source: Georgetown University Health Policy Institute

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

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

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

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

Mark Trahant is the Charles R. Johnson Endowed Professor of Journalism at the University of North Dakota. He is an independent journalist and a member of The Shoshone-Bannock Tribes. On Twitter @TrahantReports

Reposting or reprinting this column? Please do so. Just credit: Mark Trahant / TrahantReports.com #IndigenousNewsWire #NativeVote18

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

7RVNtr5C
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.”

Screen Shot 2017-11-12 at 7.57.33 AM.png

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. 

#NativeVote18 — A night of election firsts and a rejection of all things Trump

18156145_10210696665747045_6164772447020063461_o
Roxanne Murphy beat hate at the ballot box by winning nearly 80 percent of the vote in a race for Bellingham City Council. (Facebook photo)

Mark Trahant / Trahant Reports

A year ago ballots from across the country were being examined by citizens, journalists, and politicians, who were all wondering, “What the hell just happened?” The nation woke up to a President-elect Donald J. Trump.

And this morning? The Trump brand is like an overpriced hotel where you would never, ever stay a second time.

Voters from Maine to Washington and all points in between rejected Trumpism. They voted for Democrats, flipping legislatures in Washington and possibly Virginia. They voted for Medicaid. Medicaid! They voted for higher wages. And there is a clear message to Congress (if members pay attention) that governing still matters.

It was a good night for Native American candidates, too.

In Washington, Roxanne Murphy, Nooksack, won a second term on the Bellingham City Council with nearly 80 percent of the vote. What’s striking is that she ran against the ugly words of an opponent who called on hate instead of discourse. Murphy wrote on Facebook: “Got through so much racism and misogyny during this run for office. But that was all worth it for me to defend our Bellingham community, the work of our current Bellingham City Council, to mutilate a deplorable person at the polls, get more people to vote the whole ballot, and it proved that love can win over hate. Thank you for RoxingTheVote!”

Several other Native candidates won office in Washington. Chris Roberts , City of Shoreline, Zachary DeWolf, Seattle School District,  and Candice Wilson, to the Ferndale School Board.

Washington voters also flipped the legislature from red to blue. The entire West Coast is now governed by Democrats.

Renee Van Nett, Leech Lake Ojibwe, won a seat on the Duluth, Minnesota, city council. She will be the first Native American woman on that body. She told the Duluth News Tribune that her victory was a credit to “traditional issues that people are worried about … they want someone who’s accessible, someone they can call and talk to, someone who will address their needs. They want economic development. They want to be heard.”

Across the country “diversity” was a theme from election night. The “first” is a phrase that seems odd in 21st century America. Yet the first African American Lt. Governor in New Jersey. Another in Virginia. (Hint: The first Native American woman to serve in that capacity should be be next up, Peggy Flanagan in Minnesota.)

The first Sikh mayor in Hoboken (who had to run against overt hate). The first immigrant from Liberia in Montana. The first openly lesbian mayor in Seattle. (Huffington Post has a list of many of the firsts.) The main take away: This was a rejection of the narrow world view of the Trump. The diversity that is the future of America, won. Bigly.

On the policy debate ahead, perhaps the most important vote came from Maine where voters overwhelmingly voted in favor of expanding Medicaid. Maine is one of 19 states whose Republican governors or legislatures have refused to expand Medicaid under Obamacare. This is an initiative — and a process — that could move to other states. “This will send a clear signal to where the rest of the country is on health care,” Jonathan Schleifer, executive director of the Fairness Project, told The Washington Post. This vote is important because it could tip the scales in states where the legislature says one thing and the people another. Alaska. Cough. Alaska. Put Medicaid expansion on the ballot: And it will win.

Elections, of course, are always snap shots. It’s dangerous to think this rout means more of the same a year from now. But the groundwork is there. And this election night will further divide many Republicans from Trump — as well as those who fund elections. There is now real evidence from the best poll of all that voters are not happy with the direction of Congress or the White House.

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. 

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

img_3298
Deb Haaland is a candidate for Congress in New Mexico. Diane Benson has run in four statewide races in Alaska, including a congressional seat.
Mark Trahant / Trahant Reports

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

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

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

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

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

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

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

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

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

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

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

On the Democrats’ side the numbers are smaller.

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

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

Mark Trahant is the Charles R. Johnson Endowed Professor of Journalism at the University of North Dakota. He is an independent journalist and a member of The Shoshone-Bannock Tribes. On Twitter @TrahantReports

Reposting or reprinting this column? Please do so. Just credit: Mark Trahant / TrahantReports.com #IndigenousNewsWire #NativeVote18

 

This article was corrected to fix a misidentified candidate.

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

 

SheRepresents

 

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

 

8840-03-figure-6.png
Medicaid has worked under the Affordable Care Act, reducing the number of uninsured in Indian Country. (Kaiser Family Foundation)

Mark Trahant / Trahant Reports

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

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

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

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

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

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

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

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

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

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

Seriously?

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

Mark Trahant is the Charles R. Johnson Endowed Professor of Journalism at the University of North Dakota. He is an independent journalist and a member of The Shoshone-Bannock Tribes. On Twitter @TrahantReports

Reposting or reprinting this column? Please credit: Mark Trahant / TrahantReports.com

 

 

 

 

 

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

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

Mark Trahant / Trahant Reports

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

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

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

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

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

Screenshot 2017-09-19 06.04.36

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

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

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

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

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

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

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

Mark Trahant is the Charles R. Johnson Endowed Professor of Journalism at the University of North Dakota. He is an independent journalist and a member of The Shoshone-Bannock Tribes. On Twitter @TrahantReports

Reposting or reprinting this column? Please credit: Mark Trahant / TrahantReports.com

 

 

 

 

 

Trump’s deal with Democrats shows that governing is not out of the question

 

Screen Shot 2017-09-07 at 9.06.38 AM
President Donald J. Trump in North Dakota on Wednesday talking about his tax reform plans. (WhiteHouse.Gov)

Mark Trahant / Trahant Reports

Big news: The rest of the year will have less drama than the ups and downs we’ve been experiencing since January. The federal government will more or less operate on schedule, the federal debt limit fight has been pushed back to the end of the year, and President Donald J. Trump has successfully reached out to Democrats.

What a week. When it began, I wrote: “Congress is back today and one of two things will happen: It will either do its work or all hell will break loose.” But I was off. It wasn’t exactly Congress doing its job, it was the president. He bypassed his own Republican party leaders (catching them off-guard by all accounts) and struck a deal with Democrats in the House and Senate to fund government for the rest of the year and push the debt limit fight back until December.

This is exactly what the president should have been doing all along. This is governing. It means, for now, at least, that he’s reaching out to the majority in Congress (moderate Republicans plus the Democrats) instead of catering to the far right wing of the party. It’s smart politics. But it’s also dangerous because his action undermined both House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell. If it’s a one-time event, Ryan and McConnell will get over the snub. But if this is the new way of doing business, well, then, there will be a different kind of drama ahead.

There is also movement this week on the Republican plans to repeal and replace the Affordable Care Act. According to The Hill newspaper, John McCain now favors legislation proposed by Senators Lindsey Graham, R-South Carolina, and Bill Cassidy, R-Louisiana. This plan would push more of the decision making about health care to the states through block grants. It would even let states keep many aspects of the Affordable Care Act such as Medicaid expansion, as long as they’re willing to pay for the extra costs. That’s a deal breaker.

The problem for the Indian health system in such a scheme is that states neither understand nor want to invest the resources required. The ideal scenario would be for Indian Country to be a 51st state and get funding directly. But that’s not a part of the legislative proposal.

This bill would have to be considered fast under Senate rules. The current set-up is to vote on a replacement plan using the budget reconciliation process. That only requires 50 votes instead of the more common 60 vote standard (to interrupt a filibuster). The Senate parliamentarian has ruled that reconciliation goes away on Sept. 30 unless there is a new budget in place. That’s unlikely.

Another health care issue that impacts Indian Country is the reauthorization of the Children’s Health Insurance Plan or CHIP. The current law expires Sept. 30. It pays for the insurance of 8.9 million children through Medicaid. The Kaiser Family Foundation reports that “Medicaid plays a more expansive role for American Indian and Alaska Native children than adults, covering more than half of American Indian and Alaska Native children (54%) versus 23% of nonelderly adults.” CHIP would be included in that number.

CHIP also pays for school programs and other health care outreach efforts. The federal Centers for Medicaid and Medicare said: “In 2014, CMS awarded $3.9 million in CHIPRA grants to engage schools and tribal agencies in Medicaid and CHIP outreach and enrollment activities. Grantees included Indian Health Service organizations, tribal health providers, and urban Indian health providers across 7 states.”

Important stuff. We need another presidential deal with Democrats. Quickly.

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

 

 

Clues from history: Why Donald J. Trump’s presidency is over

Screenshot 2017-08-16 07.30.55.png
Lt. Col. Ely Parker and General U.S. Grant’s staff. (Library of Congress)

Mark Trahant / Trahant Reports

The Trump presidency ended yesterday.

“… Not all of those people were neo-Nazis, believe me. Not all of those people were white supremacists, by any stretch. Those people were also there because they wanted to protest the taking down of a statue, Robert E. Lee,” Donald J. Trump said.  “I’m not talking about the neo-Nazis and the white nationalists, because they should be condemned, totally. But you had many people in that group other than neo-Nazis and white nationalists, OK? And the press has treated them absolutely unfairly.”

The press is unfair to people who march at a neo-Nazi, white supremacists event?

Republicans, Democrats, corporate leaders, religious leaders, world leaders, Democrats, you name it, a broad coalition of humanity said the same thing. Hell. No.

“No, not the same,” tweeted Mitt Romney. “One side is racist, bigoted, Nazi. The other opposes racism and bigotry. Morally different universes.”

Trump lost what was left of his ability to govern. An example of that was the topic that the New York City press conference was supposed to be about, infrastructure spending. This is an idea that ought to have broad support. Not any more. Few words about the plan were reported and anything that has a Trump label is now politically toxic.

The question now is how fast will the Trump administration crumble? When will people resign in good conscience? How quickly will Congress act to limit or remove some executive powers?

There are clues. And the record is mixed. Many state governments over the years have reached that point of chaos.

One of the most controversial examples is Maine’s Gov. Paul LePage, R for Racist as well as Republican. He has continued his term in office despite calling people of color and of Hispanic origin as “the enemy.” And the tribes in Maine have often been targets of the governor. The Bangor Daily News asked: “What has gone so wrong?”

“Given colonial-era history between Maine’s Native Americans and European settlers, it would be reckless to say that relations between the tribes and the state are at an all-time low but there’s no question that problems of historic proportions exist,” wrote Christopher Cousins. “In May 2015, two of Maine’s four tribes withdrew their representatives from the Legislature after a years of clashes, culminating with Gov. Paul LePage’s cancellation of his own four-year-old executive order in April 2015 that said the tribes would be consulted on state decisions that affect them … ‘We have gotten on our knees for the last time,’ Kirk Francis, chief of the Penobscot Nation, said on that historic day. ‘From here on out, we are a self-governing organization focused on a self-determining path.'”

In Arizona, Evan Mecham who ran for governor four times before hitting the winning combination, lasted a little more than a year before being impeached. He said working women are responsible for divorce, there was nothing wrong with calling black children, “pickaninnies,” and said Martin Luther King Jr. “didn’t deserve” a holiday. And his critics were a few dissident Democrats and a band of homosexuals. Mecham sort of ran up the score: Six felony indictments by a grand jury and impeachment proceedings, a recall, impeachment by the state House followed by a conviction in the Senate in April 1988.

Screenshot 2017-08-16 07.00.59.png
John Calloway Walton

Another governor who was tossed out over racial divisions was Oklahoma’s John Calloway Walton. A 1956 book called Walton’s election “a revolution.” He was a socialist and his primary target was the Ku Klux Klan.

“Within a few months, the State House in such an imbroglio that the word “revolution” is indeed an excellent choice,”according to The Chronicles of Oklahoma. “The capitol building became an armed fortress; and in fact, it had the outward semblance of a military strong point. The test of power between the Chief Executive and the Legislative Branch that ensued would seem incredible if it were not within the memory of many of us.”

Walton kept the legislature from meeting, declaring martial law, but that did not work. “Knowing he was in dire straits, the governor called a special session to create an anti-Klan bill, but the legislature claimed they would consider that after investigating the governor,” the Oklahoma Historical Society said. “Walton offered to resign in exchange for strong laws against the invisible empire, but again the legislators rebuffed him.”

There is an interesting connection between Walton and yesterday’s election in Alabama. Oklahoma legislators wanted to prevent a candidate from winning a crowded primary (as Walton had done) and so required a majority. That’s why there will be another primary between former state Supreme Court justice Roy Moore and Sen. Luther Strange. Ten states have such a system.

Another fall out from Trump’s press conference is that the removal of civil war memorials will move to the top of the debate.

Members of the American Indian Caucus in the Montana Legislature called for the removal of a Confederate memorial in Helena. “Today, we must recognize the fact that the Confederacy and its symbolism has stood for segregation, secession, and slavery,” said a letter from state lawmakers Rep. Shane Morigeau, D-Missoula; Rep. Jonathan Windy Boy, D-Rocky Boy; Rep. Bridget Smith, D-Wolf Point; Rep. George Kipp III, D-Heart Butte; Rep. Susan Webber, D-Browning; Rep. Sharon Stewart-Peregoy, D-Crow Agency; Rep. Rae Peppers, D-Lame Deer, and Sen. Jason Small, R-Busby. “The Confederate flag was even used by the Dixiecrats, a segregationist political party of the 1940s. The flag continues to serve as an emblem for racism and racial inequality for domestic terrorist groups such as the Ku Klux Klan, neo-Nazis, and other white nationalist organizations.”

The Southern Law Poverty Center reports there are at least 1,503 symbols of the Confederacy in public spaces, and at least 109 public schools named for prominent Confederates. “There is nothing remotely comparable in the North to honor the winning side of the Civil War,” the Southern Law Poverty Center said. One proof of that: How many schools (or monuments) are standing for Ely Parker?

Parker, a Seneca, drafted the documents that spelled out the surrender to be signed by General Robert E. Lee on April 9, 1865. “I am glad to see one real American here,” Lee said while shaking his hand. Lt. Col. Parker responded: “We are all Americans.”

Parker had another concern at the time, compassion. He wrote: “Generals Grant and Lee talked over the surrender then Lee rose and said, “General Grant I want to ask you something. If our positions were reversed I would grant it to you. My men are starving and I would ask if you would give them rations.” Grant asked, “How many men have you got?” “About twenty thousand,” said General Lee. General Grant came over to me then and told me to make out an order for rations for thirty thousand. He knew – he did not propose to have anyone suffer.”

Then Parker represents the complexity of the Native American experience in America. He became an officer because he could not practice law because only white men were admitted to the bar. So he became an engineer, later a military officer and a general, and still later, the first American Indian to represent the United States as head the Bureau of Indian Affairs. In that post he took on corruption. And, basically lost. Congress held hearings, blamed him for every problem at the BIA, and took away much of his authority making him a figurehead. As historian James Ring Adams wrote in American Indian Magazine: “He was an architect of Grant’s ‘Peace Policy,’ which ended Red Cloud’s War by accepting all of the Oglala Lakota’s terms. But Parker ran afoul of philanthropists who wanted to control Indian policy through their domination of the Board of Indian Commissioners. His enemies provoked a wearing Congressional hearing into his work. Even though he was exonerated of any criminality, Parker resigned in 1871. In later years, he expressed hurt that Grant had not supported him.”

Of course the BIA is an agency that Donald Trump still hasn’t picked anyone to lead. Then, why should anyone take that job now? This presidency is over.

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

 

 

 

 

 

 

 

 

Did you hear the one about the Senator raising concerns about Indian health?

Screenshot 2017-07-26 06.41.18.png
Sen. John McCain votes yes on the Senate’s Motion to Proceed, then attacks the process, only to vote yes on the first bill that failed his test of regular order. Quite a day. (Photo via Senate video)

Mark Trahant / Trahant Reports

The Senate is now going through 20 hours of debate on a House Resolution 1628 to repeal and replace the Affordable Care Act. But the House bill was stripped of every word except the title. Now the idea is to come up with the right language to reach 50 votes (so when like the Motion to Proceed, Vice President Mike Pence can break the tie and vote yes).

The first proposal, Senate Amendment 267, had all sorts of problems on the floor. The Senate’s Parliamentarian ruled that parts of the bill did not get a score from the Congressional Budget Office and other parts violated budget rules. So 60 votes, not 50 were needed for this version to pass. But the Republican leadership wasn’t even close to 50 votes — Nine Republicans voted against it.

Including Arizona Sen. John McCain who just a few hours before said he wasn’t happy with any of the legislative proposals. Think about this. He interrupted his cancer treatment (taxpayer funded health care) then gave a stirring speech about the break down of civility in the Senate. He said he would vote against the bills as presented, and then, votes yes anyway. Quite a day.  And so much for his words. I’ll admit: I thought McCain meant what he said.

Then at least McCain earned respect and praise from President Donald J. Trump. He tweeted: Thank you for coming to D.C. for such a vital vote. Congrats to all Rep. We can now deliver grt healthcare to all Americans!”

Screenshot 2017-07-26 06.34.31.png

Screenshot 2017-07-26 06.50.10.png

Now that’s something — as is the process itself.

This week’s Senate debate on TV will be exciting. Seriously. There will be many hours ahead of members speaking to an empty chamber about why the Affordable Care Act works — or why it should be repealed. (And lots of images of staff shuffling papers on camera.) Great theater, right? Then every once in a while (about the time paint dries) there will be a call for a vote and the dramatic calling of each senator’s name for a vote.

There are two main versions that will surface soon. The first is a repeal — or at least as much of a repeal as possible with 50 votes — that’s been proposed by Sen. Rand Paul, R-Kentucky. That proposal has little chance.

Then later in the week, Senate Majority Leader Mitch McConnell, R-Kentucky, will propose an amendment that they’re calling a “Skinny Repeal.” It would eliminate some taxes, a few more regulations, but leaves Medicaid alone. It’s supposed to be something for both moderates who want to leave Medicaid alone and for conservatives who want a repeal. Ha! And remember: If this version passes the Senate the bill will move to a conference committee with the House. That’s where the Medicaid cuts will come back. This is a phony negotiating plank.

As the debate unfolds, the Senate is in a way making the case for why we need Native Americans in the legislative process. There will be all kinds of talk about what the law does to Americans, to the poor, to taxpayers, to just about every constituent group in America. What’s really needed though is for one Republican senator to explain about the Indian Health system and what havoc all of these proposals would wreak. (Last week several Democrats did just that.) One majority party senator could say the Indian Health Service has never been fully funded, despite treaty promises, so why strip millions of dollars away? Or ask about Indian children when more than half are covered by Medicaid. Or show why Indian Country needs the jobs that have been created (and will be lost) by these proposals. Better yet: One Native Senator could use data to prove that Medicaid works.

Indian Country deserves to be in this debate. Alaska Sen. Lisa Murkowski has been a key opponent of the Republican leadership’s health care legislation. It’s mostly about Medicaid. I am sure that it’s also due to her support of the Alaska Native medical system. She gets it.

But Murkowski will pay a political price for her votes, at least in a primary election. But then she’s gone through that before. And won.  Not long after the Senate vote on the Motion to Proceed, the Alaska Republican Party said Murkowski abandoned them. Party chairman Tuckerman Babcock said the “repeal of Obamacare is non-negotiable.” (Funny: I feel the same way about the Senate alternatives.)

And so the party talks about possible consequences for Murkowski. Babcock said her vote put at risk new oil drilling in the Arctic National Wildlife Refuge (would that be true) and said her Energy Committee “chairmanship could be at risk.”

And President Donald J. Trump tweeted Wednesday morning: “Senator of the Great State of Alaska really let the Republicans, and our country, down yesterday. Too bad!”

So will there be punishment? I would not be so sure. Remember the Republican majority is thin. As I reported last week: Three senators switch sides and it’s a new Senate.  Two are already really, unhappy. So the way to make it three is for Republicans to continue to attack their own members.

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

 

 

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

ValDavidson-1.jpg
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.

July2017MedicaidDashboard.jpg

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