Paul Ryan’s legacy includes ‘big ideas’ such as a voucher for Indian health

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House Speaker Paul Ryan said he will not run for re-election. His legacy includes a massive spending while calling for smaller government. (Photo by Vince Schilling / Indian Country Today)

 

Mark Trahant / Indian Country Today

Paul Ryan came to Washington to blow up Washington. He was first elected to represent his Wisconsin district at 28 years old. He campaigned over his career for a federal government that should shrink dramatically, spend far less, that taxes should be low, and the Republicans should be the party of big ideas.

Ryan announced Wednesday he will not run for re-election. He says he will complete his term as Speaker, but that’s not certain. He likely will face pressure to step down early, so another Republican can lead the party’s team into the November election. (More than forty Republicans have already announced their retirement contributing to the story about a coming Democratic wave.)

The Speaker leaves behind a different kind of legacy. He did get his tax cuts and substantial changes in the regulatory framework. But he also delivered more federal spending than ever. The deficit will hit $804 billion this year (a jump of 21 percent in a single year) and exceed $1 trillion by 2020. And, a new report by the Congressional Budget Office, says that a decade from now the total debt will be larger than the entire economy. “That amount is far greater than the debt in any year since just after World War II,” the CBO said Monday.

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The problem for Ryan, like Speaker John Boehner before him, is that the Republican majority is nearly ungovernable. The only way for Congress to function, to actually pass a budget, is to build a coalition that includes most Republicans, some Democrats, and work with a similar coalition in the Senate. That often means spending more money. That’s not the Congress — and the party of big ideas — that Ryan once had imagined.

And President Donald J. Trump has made that process worse. He caters to the bloc in Congress that cares little about actually governing. Chaos is fine. Big ideas, not so much.

Ryan proposed a major reform of government in 2010 long before he was elected Speaker of the House. It had his big ideas: Replace Medicare with direct payments to seniors who then could buy their own health insurance; turn Medicaid into a block grant to states; end employer-based health insurance; and dramatically cut government and taxes. There was no support for that plan.

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Then two years ago, as a new speaker, Ryan unveiled another plan for reshaping government. “A Better Way” included a reform of the Indian Health Service by “giving choices to American Indians.” His big idea was to have the government issue vouchers for Indian health, outside the system. “Not only will this give American Indians more choice in where they receive care,” the Ryan plan promised. “It will challenge Indian health facilities to provide the best care possible to American Indians.”

And of course that voucher system would have cost less. The Ryan plan also included a provision for a Native American Health Savings Account so individual tribal members could buy their own health care services  (Never mind a treaty sanctioned right.)

The basic premise of Ryan’s plan was that poverty is a problem because of government programs, thus, shrink the government, and poverty will go away. He told National Public Radio: “Let’s break up the welfare monopoly, instead of having just the welfare agency at the county level give people their benefits, which they basically rubber-stamp. … They don’t actually treat the person. Let other providers also provide these full-scale wraparound benefits. Let the Catholic Church do it. Let Lutheran social services. Let America Works, a for-profit agency that’s good at this.”

This is not a new idea; it was the same logic in the 1940s when Republican complained then that the Bureau of Indian Affairs was responsible for poverty, horrible living conditions, and general mismanagement. The solution over the next decade was the idea of “freeing the Indians” by terminating the federal responsibility, Termination. And a hundred and nine tribes were terminated, representing some 12,500 tribal members, and the end result was poverty conditions that were far worse.

That’s likely what would have happened again had Ryan’s “choice” approach to Indian health became law.

Ryan’s, “A Better Way,” once again called for turning Medicaid over to the states. “Instead of shackling states with more mandates, our plan empowers states to design Medicaid programs that best meet their needs, which will help reduce costs and improve care for our most vulnerable citizens.”

Medicaid has become a significant revenue source for the Indian health system. Under current law, Medicaid is a partnership between the federal and state governments. But states get a 100 percent federal match for patients within the Indian health system. Four-in-ten Native Americans are eligible for Medicaid insurance.

Rep. Tom Cole, a Republican from Oklahoma and a Chickasaw Nation citizen, said Ryan will be missed in Congress. “Paul Ryan is a visionary leader, a committed conservative and a master of the legislative process. His tenure as been marked by exceptional accomplishments – the largest tax cut and reform in a generation; the most regulatory reform for any Congress in the modern age; the most substantial defense buildup in 15 years; the end of the individual mandate in Obamacare – and a host of other important legislative accomplishments,” Cole said.

“He is not only the best Speaker I’ve had the opportunity to serve with, he’s also the finest person. Even Paul’s political opponents readily concede that he’s a person of absolute integrity, deep sincerity and of profound decency.”

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

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)

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Congress passes a budget. President warns of a veto (and more chaos)

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Mark Trahant / Indian Country Today

Congress did its job: The federal government’s budget is done. The last step was President Donald J. Trump’s signature and so now the government marches on. At least for the rest of this year, until the end of September.
But the White House said Friday that the president may veto the budget because there is not enough funding for a border wall or a solution for the so-called Dreamers. This is after the president assured House and Senate leaders that he would sign the measure into law.

 

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A veto would mean the federal government would shut down at midnight and Congress would have to start a new round of budget negotiations. This will be even more complicated because many lawmakers have left Washington for a two-week recess.
There will be intense pressure from some Republicans for the president to sign this budget into law anyway.

Budgets are a guide to priorities: What programs are more important? Where is the support from Congress and from the people? Did the president get what he wanted?
That last question is the easy one. The money for the budget wall was minimal, at best.
It’s fair to say the administration’s budget was soundly rejected by a Republican Congress. Sure, Democrats contributed a great deal to this budget (and Democrat votes were required to make it so,) but even before that occurred, majority-party lawmakers were dismissing the harsh budget program changes sought by the president.
The president’s team had all kinds of ideas: Deep spending cuts, the elimination of public broadcasting, replace Medicaid with block grants, and, yes, even deeper spending cuts. Yet Congress enacted a budget that increased federal spending both for the military and domestic programs. It’s Congress, not the president, writing the checks.
How bad was the president’s budget? The National Congress of American Indians put it this way in recent testimony: “The president’s budget would cut the Bureau of Indian Affairs by about half a billion dollars, or 15 percent. BIA Social Services would be reduced by more than a third, Indian Child Welfare by more than a quarter, and critical human services programs, law enforcement and courts programs, environmental protection, housing, and education programs would face unconscionable reductions. Infrastructure programs, such as the Indian Community Development Block Grant would be eliminated, and the Indian Housing Block Grant and road maintenance would be reduced.”
Instead, Congress added dollars and protected programs that the White House sought to eliminate.
“This bill represents real progress for Indian Country, significantly increasing our investments in Native health care, infrastructure, economies, and communities. It rejects the president’s dangerous proposed budget cuts and instead provides funding increases that will lead to healthier communities and better outcomes across Indian Country,” said Sen. Tom Udall, D-New Mexico, in a news release. Udall is vice chairman of the Senate Committee on Indian Affairs and ranking member of the Appropriations Subcommittee on Interior, Environment, and Related Agencies.
The omnibus spending bill would have increased funding for the Indian Health Service by 10 percent, and the Bureau of Indian Affairs and Bureau of Indian Education by 7 percent to $3.064 billion. The IHS budget line is $5.5 billion.
Conservatives were not happy with the additional spending in the omnibus bill. “Republicans control the government, yet Congress still follows the Democrats’ playbook,” Sen. Rand Paul, R-Kentucky said. “Time and again, spending skyrockets, and conservatives are expected to fall in line to praise the party for making the big-spending status quo worse.”
However Rep. Tom Cole, R-Oklahoma, a member of the House’s leadership team praised the legislation. “Despite divisions, both sides of the aisle have the responsibility to deliver this legislation for the American people so that the federal government runs efficiently and effectively,” Cole said. “Neither side got everything it wanted, but the end product reflects a broadly supported compromise. A majority of Republicans and Democrats voted for this bill. President Trump urged its passage and has promised to sign this legislation. As we begin to consider funding for Fiscal Year 2019, it is imperative that Congress remain committed to the return to regular order in the appropriations process.”
The president will decide in the next few hours whether or not he got enough of what he wanted.
(The National Congress of American Indians is the owner of Indian Country Today and manages its business operations. The Indian Country Today editorial team operates independently as a digital journalism enterprise.)
Mark Trahant is editor of Indian Country Today. He is a member of the Shoshone-Bannock Tribes. Follow him on Twitter @TrahantReports (Crossposted on Trahant Reports.)

Trump budget is a ‘messaging document’

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

Mark Trahant / Trahant Reports

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

 

 

 

 

 

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

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

Mark Trahant / Trahant Reports

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Mark Trahant / Trahant Reports

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

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

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

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

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

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

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

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

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Source: Georgetown University Health Policy Institute

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

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

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

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

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

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

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

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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. 

Children’s health insurance should be an easy vote, but not so in this Congress

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More than half of all American Indian and Alaska Native children are insured by Medicaid and the Children’s Health Insurance Program (IHS.gov photo)

Mark Trahant /Trahant Reports

Here we go again: Congress is finding new ways to complicate health care.

It really boils down to the philosophy that government-funded health care is just another word for welfare. So it’s a good thing to cut it back and limit it. The other side of that is that funding health care is a right and smart because a healthy population is more productive and better for everyone. There is a third element, of course, for Indian Country, and that’s the notion that health care delivery represents a solemn promise made through treaties; thus a pre-paid obligation.

Over the past few months I’ve written a lot about the role of Medicaid in the Indian Health system, a revenue stream that raises about $880 billion. Medicaid is a federal-state partnership, so even though the federal government ultimately pays the bill for American Indians and Alaska Natives, the rules and regulations go through the states. And if that’s not complicated enough, there’s an “and” added to Medicaid … the Children’s Health Insurance Program or CHIP. On budget lines these two programs are lumped together, Medicaid and CHIP. Mostly because the funds are administered by state Medicaid programs.

The idea of CHIP is simple. The richest country in the world ought to make sure that children have health insurance and are able to see doctors (it was added to a budget resolution in 1997). “In general, CHIP reaches children whose families have incomes too high to qualify for Medicaid but too low to afford private health insurance,” the government says.

The key here is that American Indian and Alaska Children rely on Medicaid and CHIP at higher levels than the general population. In 2015 54 percent of Native children were enrolled in Medicaid or CHIP compared to 39 percent of children nationally (which is still a big number).

Congress works on two tracks. One track is language to authorize spending and an additional track is when Congress appropriates the money. The problem here comes from track one: The authorization for CHIP expired October 1 and it must be renewed before new funding.

This was supposed to be easy. A letter to Congress from the National Governors Association was clear:  “CHIP is widely supported by governors, who recognize that access to health insurance is critical to ensuring a healthy start for our nation’s children. Since CHIP was enacted, the uninsured rate for children age 18 or younger has fallen from 14.9% to 4.8% … Governors urge you to protect children’s coverage and give states certainty by providing an extension of funding for the program.”

Not only do governors from both parties agree that CHIP worked but so do a vast majority of Americans, one Kaiser Family Foundation polls pegged support at 75 percent.

In the Senate leaders have been saying, repeatedly, not to worry. CHIP renewal will happen. A bipartisan bill was in the works and put on hold while the Senate debated its larger Graham-Cassidy healthcare measure. (There were all sorts of provisions in that bill to muck up CHIP.)

But we are past that, right? Now Congress should just pass a clean extension of CHIP and, for good measure, make a few fixes to the Affordable Care Act, and then argue about other things. That was the Senate proposal.

However in the House: “Unlike the Senate KIDS Act, the House HEALTHY KIDS Act also includes offset policies designed to appropriately reduce federal spending so the extension of CHIP funding does not increase the deficit.”

In other words: The House wants to cut other programs first.

The House bill will add money to the Puerto Rico Medicaid program. But, as the Center for Budget and Policy Priorities point out it’s not enough. “The HEALTHY KIDS Act includes up to $1 billion in additional funding for Puerto Rico’s Medicaid program to help the Commonwealth recover from the devastation of Hurricane Maria.  While this is a welcome move, it falls well short of what Puerto Rico needs, and the bill provides no assistance to the U.S. Virgin Islands, badly damaged by Hurricanes Irma and Maria.” Then the House bill cuts public health funding by $5 billion and shortens the grace period for people trying to pay Affordable Care Act premiums. Two kick-the-rich provisions: Allowing states to disenroll lottery winners (because we all could win, right?) and charging higher Medicare premiums to wealthy seniors.

The House committee is urging its members to vote fast. “States are currently using unspent FY2017 CHIP allotments and redistributed funds from the Centers for Medicare and Medicaid Services (CMS) to cover current spending needs for their CHIP programs,” the committee told its members. “Without Congressional action, states could start to exhaust these funds as early as November.”

Ten states could run out of money by next month, including Arizona, Utah and especially, Minnesota. According to Kaiser Health News, “Minnesota was among those most imperiled because it had spent all its funds … Emily Piper, commissioner of the Minnesota Department of Human Services, reported in a newspaper commentary last month that her state’s funds would be exhausted last Sunday.”

If a state does not reimburse the Indian health system for these costs, IHS, as the payer of last resort, could be on the hook for these additional costs.

 

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Source: Kaiser Family Foundation

The numbers are significant. A study by Georgetown University Health Policy Institute said the uninsured rate for AI/AN children declined from 25% to 15% between 2008 to 2015. All of the states with very high proportions of their AI/AN children on Medicaid saw very large double-digit declines. The two states with the largest declines in their uninsured rate for kids were New Mexico (38% to 11%) and Alaska (32% to 17%).

“At a time when Congress is considering extremely large cuts to Medicaid and a dangerous restructuring of the program, AI/AN families are especially at risk,” the study concluded.

The politics ahead are difficult. The House bill adds budget cuts as a way to reach 218 votes. This works by making it more conservative. But it also removes the bipartisan approach, something that’s worked so well since CHIP was created. And even the House’s conservative tilt might not generate enough support for the measure to pass.

This is all nonsense. We know CHIP works. It’s government at its best. (If we do anything … we should expand it and add more children.) So the law’s renewal should be a quick “yes” vote. Then, what’s next? But Congress has to complicate — make that muck up — a program that works.

 

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

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

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

 

Price visits Indian Country … and is gone

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


Trahant Reports

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

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

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

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

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

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

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

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

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

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

 

 

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

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

Mark Trahant / Trahant Reports

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

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

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

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

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

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

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

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

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

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

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

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

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

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