Latest attack on Medicaid also sabotages Treaty Rights, Indian health programs

Agency Says Indian Health Should Not Be Exempt From Medicaid Work Rules Because They Are ‘Race-Based’

Mark Trahant / Trahant Reports

The Trump administration is supporting a major policy shift on Indian health programs which could result in a loss of millions of dollars and sabotage treaty rights.

A story in Politico Sunday raised the issue. It said “the Trump administration contends the tribes are a race rather than separate governments, and exempting them from Medicaid work rules — which have been approved in three states and are being sought by at least 10 others — would be illegal preferential treatment. ‘HHS believes that such an exemption would raise constitutional and federal civil rights law concerns,’ according to a review by administration lawyers,” Politico said.

The new policy on Medicaid work requirements “does not honor the duty of the federal government to uphold the government-to-government relationship and recognize the political status enshrined in the Constitution, treaties, federal statutes, and other federal laws, said Jacqueline Pata, executive director of the National Congress of American Indians. “Our political relationship is not based upon race.”

“The United States has a legal responsibility to provide health care to Native Americans,” Mary Smith, who was acting head of the Indian Health Service during the Obama administration and is a member of the Cherokee Nation, told Politico. “It’s the largest prepaid health system in the world — they’ve paid through land and massacres — and now you’re going to take away health care and add a work requirement?”

Medicaid has become a key funding stream for the Indian health system — especially in programs managed by tribes and non-profits. Medicaid is a state-federal partnership and public insurance. The Affordable Care Act expanded Medicaid eligibility, but the Supreme Court ruled that each state could decide whether or not to expand. Since the expansion of Medicaid some 237,000 American Indians and Alaska Natives in 19 states have become insured.

Officially Medicaid represents 13 percent of the Indian Health Service’s $6.1 billion budget (just under $800 million).

But even that number is misleading because it does not include money collected from third-party billing from tribal and non-profit organizations. In Alaska, for example, the entire Alaska Native health system is operated by tribes or tribal organizations and the state says 40 percent of its $1.8 billion Medicaid budget is spent on Alaska Native patients. That one state approaches the entire “budgeted” amount for Medicaid.

Other states report similar increases. Kaiser Family Foundation found that in Arizona, one tribally-operated health system reported that about half of visits were by patients covered by Medicaid in 2016. And, an Urban Indian Health Program, reported that its uninsured rate at one clinic fell from 85 percent before the Affordable Care Act to under 10 percent.

Those Medicaid (and all insurance) dollars are even more significant because by law they remain with local service units where the patient is treated (and the insurance is billed). In Alaska more than two-thirds of those dollars are spent on private sector doctors and hospitals through purchased care for Alaska Native patients. And, unlike IHS funds, Medicaid is an entitlement. So if a person is eligible, the money follows.

A recent report by Kaiser Health News looked at Census data and found that 52 percent of residents in New Mexico’s McKinley County have coverage through the Medicaid.  That’s the highest rate among U.S. counties with at least 65,000 people. “The heavy concentration of Medicaid in this high-altitude desert is a result of two factors: the high poverty rate and the Indian Health Service’s relentless work to enroll patients in the program,” Kaiser reported. Most of McKinley County is located on the Navajo and Zuni reservations.


Kaiser Health News said Medicaid has opened up new opportunities for Native patients to “get more timely care, especially surgery and mental health services. It has been vital in combating high rates of obesity, teen birth, suicide and diabetes, according to local health officials.”

However the growth of Medicaid is resulting in unequal care for patients in the Indian health system. The benefits in some states, including those that expanded Medicaid under the Affordable Care Act, are more generous. Other states not only refused to expand Medicaid and have been adding new restrictions such as requiring “able-bodied” adults to have their Medicaid eligibility contingent on work.

But the Indian health system — the federal Indian Health Service and tribally and nonprofit operated programs — are in a special case because there is a 100 percent federal match for most services. So states set the rules, but do not have to pay the bill. (Medicaid is often the second largest single item in a state budget behind public schools.)

Medicaid is the largest health insurance program in America, insuring one in five adults, and many with complex and long-term chronic care needs. The Trump administration and many state legislatures controlled by Republicans see Medicaid as a welfare program. While most Democrats view it simply as a public health insurance program.

Work rules are particularly challenging for Indian Country. Unlike other Medicaid programs, patients in the Indian health system will still be eligible to receive basic care. So stricter rules will mean fewer people will sign up for Medicaid and the Indian Health Service — already significantly underfunded — will have to pick up the extra costs from existing appropriations. That will result in less money, and fewer healthcare services, across the board.

A letter from the Tribal Technical Advisory Group for Medicare and Medicaid said American Indians and Alaska Natives “are among the nation’s most vulnerable populations, and rely heavily on the IHS for health care. However, the IHS is currently funded at around 60 percent of need, and average per capita spending for IHS patients is only $3,688.” The latest per person cost for health care nationally is $10,348 (totalling $3.3 trillion, nearly 20 percent of the entire economy).

The tribal advisory group said it is “critically important” that there be a blanket exemption for IHS beneficiaries from the mandatory work requirements.

A report in September by the Kaiser Family Foundation showed that the majority of American Indians and Alaska Natives on Medicaid already work, yet continue to face high rates of poverty. It said over three-quarters of American Indians and Alaska Natives are in working families, but that’s a gap of about 8 percent compared to other Americans (83 percent).

The Trump administration’s characterization of tribal health programs as “race-based” is particularly troubling to tribal leaders because it would reverse historical precedence.

A memo last month from the law firm of Hobbs, Straus, Dean & Walker said the Centers for Medicare and Medicaid Services “has ample legal authority to single out IHS beneficiaries for special treatment in administering the statutes under its jurisdiction if doing so is rationally related to its unique trust responsibility to Indians. Under familiar principles of Indian law, such actions are political in nature, and as a result do not constitute prohibited race based classifications. This principle has been recognized and repeatedly reaffirmed by the Supreme Court and every Circuit Court of Appeals that has considered it, and has been extended to the actions of Administrative Agencies like the Department of Health and Human Services even in the absence of a specific statute.”

Mark Trahant is editor of Indian Country Today. He is a Shoshone-Bannock tribal citzen. On Twitter: @TrahantReports Cross posted on Indian Country Today.

(The National Congress of American Indians is the owner of Indian Country Today and manages its business operations. The Indian Country Today editorial team operates independently as a digital journalism enterprise.)

 

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

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

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

Mark Trahant / Trahant Reports

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

It’s not always about the taxes.

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

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

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The story is not over: When the Native press is strong … so is Indian Country

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Mark Trahant / Trahant Reports

Indian Country Today, a national voice for Indian Country, went dark while its owners look for a new buyer or a new business model. The “press,” even a “digital press” is the story.

It’s true that most tribal leaders have been annoyed by media, including tribal media, from time to time. It’s the nature of our roles. When we in journalism are at our best, we’re independent. And tribal leaders have a different charge; to govern. That sometimes puts us into conflict — at least a little bit.

But in the long arc of history both roles are crucial. In fact: Some of the best days in Indian Country occurred during periods of a vigorous and independent press. And, at the same time, some of our darkest days took place when there were few national voices.

To be blunt: An independent press is a pain in the ass. Especially for tribal leaders. But the alternative, darkness, is far, far worse.

One such period was the Indian Removal Era.

The Cherokee Nation was one of many tribes that had an independent press in the 1830s as it was facing the challenge of President Andrew Jackson and ultimately the removal from tribal homelands.

The editor of The Cherokee Phoenix was often at odds with tribal leaders. In 1832 he resigned as editor because  he believed he could not do his job properly. His duty, as he saw it, was to “reflect upon the dangers with which we are surrounded; to view the darkness which seems to lie before our people – our prospects, and the evils with which we are threatened; to talk over all these matters, and, if possible, come to some definite and satisfactory conclusion.”

This is a simple definition of the role of the tribal press, an instigator of discourse. The power of the tribal press, then, should follow once the people have reached a definite and satisfactory conclusion.

The evils faced by the Cherokees during Boudinot’s time were among the darkest, but they were not the only dangers before us.

I am interested in the pattern suggested by Boudinot: the warning of dark clouds, followed by community discourse, and, if possible, a community-based satisfactory conclusion.

The issue Boudinot wanted debated – the federal government’s desire to relocate the Cherokee Nation – was about as dire as can be imagined, but other schemes have, to varying degrees, also threatened the very prospect of Indian survival.

Consider how some fifty years ago many tribes were faced with removal in a political context – termination. There were a few voices of dissent from tribal media, including a newspaper published at Menominee. But the voices were primarily local.

In 1952 there was no national Indian newspaper or medium of any kind.

So it wasn’t huge news when Congress enacted House Resolution 108 calling for the termination of tribes that were “ready.”

And to get ready, various provisions were inserted into routine legislation that required tribal governments to prepare a plan to accept termination. Imagine that. As part of your government’s regular funding stream, the tribe would need to prepare documents planning termination.

This would have been a great story; had there been a national Native press.

One of the tribes ordered to prepare a termination plan was the Confederated Tribes of the Colville Reservation in Washington state. A termination plan was required in order as part of legislation that included title to tribal lands lands. Most tribal members probably didn’t think much about termination – at least at first – but in the decade that followed pro-termination supporters gained support of the tribal business council, telling tribal members that termination would mean a sale of all the reservation’s assets and a distribution of those assets to tribal members. In other words: folks were promised they would be rich.

Beginning in the early 1960s, U.S. Senator Henry Jackson, a Democrat from Washington, introduced Colville termination bills only to be blocked by the House of Representatives. And, at the same time, a pro-termination tribal business council built up a solid majority.

In October 1966, the tribe asked its members this question:

“Do you favor termination and liquidation of the tribal owned reservation assets at a fair value with the proceeds distributed equally to the members of the tribes?”

The result was one-sided: More than two-thirds of the membership approved of termination.

The Colville people, then, had gone on record for termination.

Chairman Narcisse Nicolson, Jr. said it was time for the Colville people to end their relationship with Washington, to stop taking money from the BIA, and to terminate the reservation.

He said the case was clear because “with only a relatively few exceptions, the tribal families of today are self-supporting.” He added, “Lack of employment, to the degree that it exists, is largely due to character faults which cannot be cured by paternalism.”

In Washington, D.C., BIA Commissioner Robert L. Bennett, even though he was personally opposed to termination, said he would “honor and carry out any decisions that are made by the people of the tribe, whether or not this may be in agreement or disagreement with what may happen to be particular policy of the Bureau.”

The stars seemed aligned. Think of the players on board:  Tribal members, its governing body, and the Bureau of Indian Affairs. Even the Congress was set. Senator Henry Jackson could be counted on to introduce the Colville termination bill again; this time, some thought, it followed by House enactment.

We can only imagine what it must have been like: Every major political force, the state, a powerful senator, the tribal council, and, perhaps, even a majority of tribal members, all wanted termination.

Only someone forgot to explain to Lucy Covington and her allies that it was a done deal.

In 1966 when that membership poll was taken, Covington was a minority member of the tribal council along with Frank George, Paschal Sherman, and a few others.

There were many voices challenging the wisdom of termination.

One of the tools that she used in this fight: A tribal newspaper. She started “Our Heritage,” a newspaper with the mission of informing tribal members about the issues. She would lead a quiet campaign to quiet what she called “the present fever and fervor for termination.”

And like Standing Rock, there was national call put out for writers, cartoonists, and journalists to come (at their own expense) to chronicle this important moment.

Chuck Trimble once wrote why he went. Covington “enlisted me after I gave a brief talk on the birthing plans of the American Indian Press Association at the 1970 NCAI convention in Anchorage, Alaska. She asked if I would come to Colville and help put together a newspaper. She made no offers of compensation for travel and expenses. The Press Association was not yet established and there were no funds for travel or anything else; so I went at my own expense. And when I arrived in Spokane where she met me, she sat me down in a room at the Indian Center there and told me what she expected of me. She wanted a newspaper that would tell what a tribe means to its people, and its true worth to them in terms of land, natural resources, and most of all their cultural heritage. She wanted the newspaper to be called Our Heritage, and she even described the logo she wanted for the masthead. It would be a pair of hands holding together the shape of the Colville Reservation. The logo would signify that the future of their reservation, indeed their nation, was in the hands of the people, not in the U.S. Government or the State of Washington, or anyone else.

“I was not familiar with what termination of a tribe entailed, and how it was carried out. I thought the U.S. Congress unilaterally determined that a tribe’s unique trust relationship with the Federal government would be severed, and the Bureau of Indian Affairs would execute the congressional order. When I learned that the tribe, through its elected leaders, had to approve the dissolution of their own nation, and that a majority on the existing Colville Council was forcefully behind the measure, I felt disheartened. Gaining an anti-termination majority on the Council meant internecine warfare, and Indian against Indian was always mean and messy.”

But Trimble wrote — and he drew cartoons. And Our Heritage was published.

Our Heritage profiled candidates opposed to termination and reported on the legislative battles in Washington about the advancing termination bills.

The anti-termination side won on May 8, 1971. Nicholson was defeated in his district, Omak. He was replaced by a council member who was opposed to termination, joined by a new majority of like-minded representatives.

Mel Tonasket, then-thirty years old, was the elected by the business council as the chairman. The new business council called for more federal support, closed a reservation lake to outsiders and voted to take back law enforcement powers that had been ceded to the state of Washington.

The new council also went further, claiming the inherent power of a government through an affirmation of tribal sovereignty.

And even a longtime supporters of termination reversed course. Sen. Jackson, a Democrat from Washington, in 1972 introduced a repeal of the termination resolution and recast himself as a champion of tribal governments and Indian people.

The dark clouds of termination almost ended the Colville reservation and that tribe’s unique relationship with the federal government (something that did occur in dozens of other tribal communities).

But the danger of termination was identified by both the tribe’s political leadership and the press. This fit Boudinot’s model: A description of the dangers, followed by community discourse, until a satisfactory conclusion was reached.

I recall a tribal politician speaking at the National Congress of American Indians. I am not sure who he was nor where the meeting was but I remember him identifying the tribal news media as “war correspondents.” This image stuck with me because it is so telling: Tribal political leaders identified us as soldiers in the defense of Indian country. Our work is important when we serve that war effort, helping to defeat the enemy. But that metaphor suggests that when journalism moves closer to home, when we do stories that aid the enemy, then not so much.

“Our Heritage” fit this notion perfectly. The newspaper had one purpose: stopping termination. And, at the beginning of the termination era there was no national Native press. But at the end, when tribes won, the press was actively helping tribal citizens reach a satisfactory conclusion.

Perhaps one of the reasons why I remember that NCAI speech about “war correspondents” was because of when it was given in the late 1970s. This was a time when most tribal governments truly felt under siege, it was the era the “backlash” era.

And it was a story that most of us working for tribal newspapers tried to fully cover.

“So strong is this threat and so pervasive is its national presence that Indians are referring to it as ‘the new Indian war.’ Its sources, most observers of the national Indian scene agree, are the results of that very progress; in particular, the long and significant train of court victories in the 1970s upholding tribal rights,” wrote Hopi journalist Rose Robinson from Washington, D.C. “Whatever its sources, white backlash is, by every measure, the major concern of people today.”

The backlash was promoted by organizations with names that suggested a noble calling: South Dakotans for Civil Liberties; Montanans Opposed to Discrimination and the Interstate Congress for Equal Rights and Responsibilities. These groups defined American Indians as “special citizens” who, because of treaty rights, were getting a better deal than the rest of the nation. A book, “Indian Treaties: America’s Nightmare,” was sent by the group to members of Congress, the secretary of Interior and other Washington officials. “The liberal treatment of minorities has reached unheard of proportions in denying equal rights to all citizens of our so-called democracy,” a brochure for the book said.

“Sportsmens (sic) – organizations – fishermen – hunters – land owners – commercial fishermen and just plain tax paying citizens who have just about had it with Indian take-overs make up the membership of ICERR.”

The backlash was a nationwide movement that discounted two centuries of federal-Indian policy. “That the Indians’ claims are being given any legitimacy at all is nonsensical,” wrote a columnist in the Boston Herald American about the land claims in Maine. “Whatever happened 200 years ago, the culprits were not the current land owners, so there is no justification for punishing them.”

“After so many quiet years, what has got into the Indians?” asked a two-page essay in Time. “Probably no other country would take quite so seriously land claims that propose, in effect, the impossible rolling back of history. The inherent absurdity of such a proposition might be clearer, say, in a suggestion that Australia be handed back to the aborigines. …Congress should be able to be fair without suffering the delusion that the country can really be given back to the Indians. The time for that passed forever with the vanishing of the pioneers who took it from them.”

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The movement had one goal: abrogate treaties. These efforts were on two legislative tracks: The first was led by a U.S. Rep. Jack Cunningham, R-Washington, who introduced bills directly calling for treaty abrogation; and, the second track was more moderate legislation that was introduced by a U.S. Rep. Lloyd Meeds.  Meeds, a Democrat, was also from Washington state and his role was interesting because he had once been a supporter of tribes – even honored by the National Congress of American Indians for his work on the Hill.

The Interstate Congress dismissed Indians as “treaty Americans” or “first-class citizens” and it said it had no objection to “being treaty Americans or full-fledged American citizens, but we do object to them claiming both. “Until they decide what they want to be, treaty Americans or first-class citizens, but not both, they will feel the bite of the backlash, and it will get stronger until a more equitable solution is found.”

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The Indian Country Today of that era was Wassaja, a San Francisco-based, national newspaper. Wassaja covered the annual convention of the anti-treaty group because it represented, “the first step toward abrogation.”

Wassaja – and most tribal newspapers – devoted lots of space and attention to the backlash movement. Tribal leaders saw the threat and worked to build coalitions to defeat the ideas behind the backlash, as well as their representatives in Congress.

Again, though, the dark clouds were identified and community discourse was disseminated through the native press. Indeed, the leaders of that era agreed with the label of “new Indian wars,” and even promised a literal battle if things proceeded.

Navajo Chairman Peter MacDonald Sr., for example, called for an emergency summit of all tribal leaders to develop a strategy. He said that if the backlash reached its logical conclusion, taking Indian people backwards, then Indians might return to waging war. “I don’t think anyone wants to go back to that situation.”

MacDonald’s rhetoric was harsh, but his position was not unique. He was joined on the effort in groups ranging from the conservative National Tribal Chairman’s Association to the American Indian Movement.

Discourse prevailed. Tribal leaders developed a successful strategy and their voices reached tribal and U.S. citizens. The national Native press was taking notes.

The termination era as well as the backlash era shared a language. Termination supporters wanted to “free the Indians.” The Interstate Congress proclaimed the goal of “equal rights.”

Of course in a large part what drove both of these efforts was competition over scarce natural resources. All of the tribes that were terminated had a resource that someone wanted  — often timber. And the so-called equal rights effort of the Interstate Congress were led by hunters and fishers who objected to the “preferential” rights of treaty hunting and fishing.

In both of these examples, too, there were characters willing to advance the ideas. Utah Sen. Arthur Watkins was the champion of termination. And the backlash had Jack Cunningham and Howard Grey (once identified in Wassaja as the “der Fuhrer of ICERR).

That leads me to the next threat: Slade Gorton.

Slade Gorton – who was again from Washington state – took the ideas of an early generation and led them to new, sophisticated heights.

Some context. It doesn’t take a lot of calculating to see that so much of this backlash and termination support came from Washington state. Why Washington? One reason was the intense battle for salmon fishing rights – and the favorable ruling by the federal courts.

Columnist John Mohawk wrote in another national publication, Native Americas magazine, that Gorton was “an anti-Indian activist all his political life. He fought against Indian treaty rights when he was attorney general for his home state, and he leads perennial attacks against Indian rights in the Senate.”

But unlike Cunningham, or even Meeds, Gorton developed a more sophisticated attack against tribal interests. He used his power as a Senator – and later as an appropriations committee leader – to limit how federal dollars might be used to support tribal rights.

He occasionally proposed radical rewriting of federal Indian law, advancing his idea that tribes were social clubs and not legitimate governments.

“Over time, Gorton settled into the style of the Senate, where tone trumps content most days of the week,” wrote Indian Country Today columnist Suzan Harjo. “He began using the scalpel more than the machete, but was ever-focused on his task: undercutting federal Indian law.  He was gaining surgical precision, along with seniority and clout on key committees for energy and natural resources, budget and commerce, science and transportation.

“After the 1996 election, Sen. John McCain, R-Ariz., announced that he would step down as chair of the Senate’s select committee on Indian affairs. Gorton was next in line for the job. The sound of alarm from Indian country was loud and effective. Majority Leader Trent Lott, R-Miss., interceded and Gorton withdrew in favor of Sen. Ben Nighthorse Campbell, Republican from Colorado, who became the first Native American to head the Indian panel.”

But Gorton continued his political attacks whenever and when ever he could be effective.

Here is where another difference emerges between Gorton and his predecessors, such as Jack Cunningham or Arthur Watkins. Instead of being a character in a larger drama, Gorton became the lead in the play.

An intertribal coalition built was launched to “Dump Slade.” And when someone said those two very words, nearly everyone in Indian Country knew exactly what was meant. Gorton was a modern-day Custer – and his defeat was essential for Indian Country’s survival. Gorton became the issue.

I remember a conversation I had with Joe Delacruz at an Affiliated Tribes of Northwest Indians’ meeting. He promised that Slade would be defeated. We’re raising money, we’re building a coalition, he told me, and we’re going to win.

Delacruz was right. The Dump Slade effort worked; Maria Cantwell was elected in his place.

And because Slade was the actor, the issue went away as far as tribal discourse was concerned.

But did Slade really go away? Well, if you think about him as a central character in a drama, then, yes, perhaps.

But what of his ideas? We face many of those same notions today. Even his idea that tribes are more like social organizations than governments was effectively advanced by the Supreme Court in decision after decision. Starting with the late Chief Justice William Rehnquist the Supreme Court quietly transformed Indian law. And not in a good way.

Another story I’d like to tell is from Alaska. The community of Point Hope had a huge problem in 1962. The United States government had this wacky idea of testing nuclear devices in their homeland. There was a removal plan. The government had decided that Project Chariot made sense and should go forward.

The Arctic Slope Native Association turned to a young Inupiat artist by the name of Howard Rock and asked him to start a newspaper. The Tundra Times was born in October 1962.

“He was the most soft-spoken man,” said reporter Tom Richards, who worked at the Tundra Times from 1968 to 1974. “But he had tremendous impact with just a few words.”

The Tundra Times followed Boudinot’s model perfectly. The paper warned about the dangers, the community came together and talked over these matters, and then reached a satisfactory conclusion. The Atomic Energy Commission’s Project Chariot was no more.

But Rock did not stop telling the story. He thought Alaska Natives ought to be a stronger, inter-tribal community. The newspaper’s masthead reinforced its vision of Native harmony that eventually led to the creation of the Alaska Federation of Natives. As AFN said: Rock, through his newspaper, unified Alaska Natives by “knowing the hearts and minds of the people.”

“Perhaps more than anyone else, he (Rock) helped weld together the frontier state’s 55,000 Natives for their successful years-long fight to win the largest aboriginal land claims settlement in American history,” wrote Stan Patty of the Seattle Times. He added that Rock was their voice; at times about the only calm voice when crescendos of dissent threatened to tear Alaska apart.

And that led — along with the discovery of oil at Prudhoe Bay — and to a modern treaty, the Alaska Native Claims Settlement Act.

Rock’s Tundra Times had a national voice. Its correspondent in Washington, Tom Richards, worked alongside other native journalists at the key moment in history. The Tundra Times was no cheerleader. It talked about the good of ANCSA and warned readers about some of the consequences.

“Let’s turn it around and look at the real situation,” Richards wrote. “The natives are being forced to give up their land under the traditional American principle of manifest destiny and all they’re asking is a fair shake.”

We lost the Tundra Times in on December 16, 1991. Its announcement said the board voted to “suspend publication” until a March meeting.

Suspensions, rarely result in a re-start. But the financial problems of Tundra Times were well known. The paper had been writing about its own challenges for some two decades. Its readers were familiar with the challenges.

That’s not the case with Indian Country Today. It’s darkness was a surprise, one that left little time to explore options from a broader civic community. This is a fail.

But that also brings me to Standing Rock.

As we all know, Standing Rock was a social media story. News was instant. Shared, reshared, and liked on Facebook.

It’s interesting some of the same elements from Standing Rock were present at Alcatraz or Daybreak Star or Frank’s Landing … but what was different was social media and a viral connection across Indian Country. Technology even played a role: A few months before Standing Rock Idle No More generated the same kinds of stories scattered first across Canada and then worldwide. But one explosive difference in Standing Rock and Idle No More was Facebook live. Someone could turn a camera on and generate an audience of thousands or even hundreds of thousands. We are all related, we are all connected.

Social media — well, Facebook — can even take credit for informing the President of the United States. A year ago tomorrow — imagine that — a year ago President Obama was asked about  the Dakota Access Pipeline and the #NoDAPL movement at Young Southeast Asian Leaders Initiative  town hall. This social media story popped the presidential bubble. It alerted him to an issue that he could no longer ignore.

A social media story to be sure. And important because we all remember the many, many stories asking, where were the mainstream reporters? Why was Standing Rock not the front page, network TV news story that was required? When a few armed protesters take center stage in Oregon and Nevada and it’s a big story; but when thousands of people come to stand with Standing Rock …  it’s only occasional news.

So it was a social media story.

But here’s the thing. If you go back and look at the many social media stories the ones that were the most shared, the most liked, and most respected, were stories generated by the press, and often that was Indian Country Today.

The reason is clear and easy: No one had to explain to editors at Indian Country Today why it was a story. As one editor told me: “We knew we had to blow out our budget for this one.”

Early on Valerie Taliman was on site working with reporters and letting them know that Indian Country Today was going to extraordinary lengths. I have counted more than a dozen bylines on this story, including my own. Jenni Monet was compelled to leave a teaching post and write full time from here. And to this day she faces criminal, legal peril for her reporting — something that should never be allowed in a country with First Amendment protection. “Congress shall make no law … “ yet a prosecutor in Morton County is doing just that, making up a law.

This was a story of a generation — and Indian Country Today answered. 

But it’s also a story without an ending. The newspaper helped tribal citizens across the country consider the darkness before us and the evils with which we are threatened. It helped us talk over these matters. But we still have a lot of work to do before we come to some definite and satisfactory conclusion.

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

(This is a speech Mark Trahant gave to the Tribal Leaders Summit September 6, 2017, in Bismarck, North Dakota.)

 

 

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

 

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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

 

 

September will be a mess in Congress; budget, spending and debt fights ahead

One-party government? Get real.

Mark Trahant / Trahant Reports

September is going to be a mess. Congress must sort out some really complicated fiscal issues. There is the budget, an increase in the debt limit, how much to spend on federal programs and services, and, if there’s time, tax reform.

This should be easy in a one-party government. Republicans come up with a budget plan. Then the House acts, the Senate does its thing, and President Donald J. Trump signs the idea into law. Easy. Except there is no Republican majority in Congress (other than the R listed by members’ names.)

The House is made up of at least three factions, or parties, and no majority. (The three groups are: Republicans, Democrats, and the more conservative House Freedom Caucus.) So in order to gather enough votes to pass a budget, or any other of the challenges, at least two of the three factions have to agree on a plan.

The Senate has its own divisions within the Republican Party. (The very reason why a Republican replacement for the Affordable Care Act has not yet become law.)

And the White House is not on the same page either. The president proposed a stingy budget that’s been pretty much rejected by members of the House and the Senate (except the more conservative elements such as the House Freedom Caucus.)

For example the Trump administration proposed budget calls for $4.7 billion for the Indian Health Service, a cut of some $300 million or 6 percent of the agency’s budget. But a House spending plan calls for an increase of $97 million over last year’s levels. Indeed, the Appropriations Committee that funds IHS and the Bureau of Indian Affairs plans to spend a total of $4.3 billion more than the president requested on programs under its jurisdiction. (In general: The president’s budget reflects significant budget cuts across Indian Country, according to analysis by the National Congress of American Indians.)

The Senate will come up with its own spending plan. Then, in theory, the two houses will resolve their differences and agree on how much the federal government should spend next year (and the president can go along or veto the legislation and start all over).

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But no. That’s not how Congress is actually legislating these days. More often Congress agrees to a temporary spending plan based on last year’s budget, the Continuing Resolution. That’s an easier sell to members because it represents a last minute, throw up your hands, and do something, approach. The other alternative is a government shutdown. President Trump tweeted in May that “our country needs a good ‘shutdown’ in September to fix mess!”

Yes, the budget is a mess. Period. Even take the word, “budget.” That’s a proposal from the president. But in Congress a “budget” is a spending limit that Congress imposes on itself. It sets a ceiling that each of the 12 Appropriations subcommittees have to live with. And, more important right now, the budget sets the rules for debate so the Senate can pass some legislation (such as the health care bill) with only 50 votes. (Most bills need 60 votes to stop a filibuster from stopping the process.)

Back to the congressional budget. Last month the Budget Committee approved a plan that would cut domestic spending by $2.9 trillion over the next decade. The full House will vote on this plan when it returns. It’s a bleak document that would end up slashing many of the programs that serve American Indians and Alaska Natives. Remember the appropriations committees would still spend the money; but the budget would act as an overall cap.

This budget plan starts off with historically low federal spending followed by even more severe budget cuts between now and 2027. To show how out of touch this budget is, it includes program cuts for Medicaid that were a part of the failed health care legislation. (What’s changed? Nothing.) This bill tips toward the conservatives who want more spending cuts to be sooner, as in right now.

That makes the problem political. There are probably not enough votes to make this budget so. A few Republicans don’t see this harsh approach as good government. And even if the votes are found in the House, the Senate is another story. Think health care.

And if this budget cannot pass, it’s not likely there is another one that would. Democrats in the House say: “Congress cannot continue to underfund these crucial investments … (and) without relief from these spending caps, vital government programs are facing significant cuts for fiscal year 2018 that would have significant effects on American families all across the country.”

And the budget is only one fiscal crisis. Another issue that is immediate and serious involves the debt limit. That’s the amount of money the federal government can borrow is currently set at $19.85 trillion (federal debt exceeds that level now, but the Secretary of Treasury can basically shuffle money from different accounts). Conservatives want spending cuts as part of any deal to increase the debt limit. As Rep. Tom Cole, R-Oklahoma, and a member of the Chickasaw Tribe, told MSNBC. A debt limit increase without spending cuts is “like having a credit card and saying, ‘I’ve reached my limit, I’m just going to change the limit higher without changing any of my spending habits.’”

But, like on the budget, the votes are not there. (Especially in the Senate where 60 votes will be needed.)

This is tricky because the Republican administration understands what failure could do to the country. Budget director, Mick Mulvaney, is now supporting a debt limit increase. But when he served in Congress, Mulvaney said he was willing to risk a default to force a discussion on spending.

In both the House and the Senate votes from Democrats will be needed to pass the debt limit. But will there be enough Republicans.

If Congress does not pass the debt limit, the United States would be “catastrophic.” And, almost immediately, this failure would impact federal budgets because interest rates would spike upward. Interest rates are already the fastest growing part of the federal budget and a sharp increase in rates would add significantly to the total federal debt. In other words: By voting against a debt limit increase, Congress would make the debt problem worse. Far worse.

But Republicans have campaigned against a debt limit increase for a long time. It’s going to be one tough vote.

In case you’re keeping score:

  • Republican leaders plus Democrats will be needed to increase the debt limit.
  • Most Republicans including the House Freedom Caucus will need to vote for the budget and appropriations bills.
  • Or, those budget and spending bills will have to include more Democratic priorities to win that party’s support.

So yes, September is going to be a mess. And after the budget, spending bills, and debt limit is complete, there’s still tax reform on the agenda. Yet another mess.

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

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

 

 

 

 

Health care delivery is worth a policy debate; but Senate bill is not that

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Mark Trahant / Trahant Reports

The Congressional Budget Office report on the Senate majority’s health care bill — the ironically titled “Better Care Reconciliation Act of 2017” — ought to be enough to put to rest any idea that Republicans want to improve health care in this country.

There are legitimate conservative ideas about how to reform health care. You know, the stuff they have been saying for years about market-based reforms where people can shop for their doctors and clinics online across state lines. Think Amazon. Modern, high tech, affordable care.

But that’s not on the table. Instead the House and the Senate are trying to legislate a huge tax cut, make a small dent in the long-term federal spending, trim spending on insurance subsidies, and the destroy Medicaid (and, as a bonus, shift responsibility from Washington, D.C., to state governments.)

 

Here are the numbers to back up that paragraph: CBO says the tax cut is worth $541 billion. The long term deficit reduction totals $321 billion. Getting rid of insurance subsidies under the Affordable Care Act saves $408 billion. And recasting Medicaid as a block grant (as well as phasing out the expansion) is worth $772 billion.

 

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Neither the Senate nor the House bill accomplish any health care goal. Neither bill will help people get insured. CBO says “in 2018, 15 million more people would be uninsured under this legislation than under current law—primarily because the penalty for not having insurance would be eliminated. The increase in the number of uninsured people relative to the number projected under current law would reach 19 million in 2020 and 22 million in 2026.”

And down the road when Medicaid reflects “lower spending” that too would “lead to increases in the number of people without health insurance. By 2026, among people under age 65, enrollment in Medicaid would fall by about 16 percent and an estimated 49 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.”

CBO says that even employer-based health care would shrink.

The crazy thing is that older people would be impacted the most by both the Senate and House approach.  As the Center for Budget and Policy Priorities reports: “For people age 60 or older with income at or below the poverty line, individual-market premiums would consume at least 45 percent of their income.  The share would be even higher in higher-cost states and for people at lower incomes.”

And that’s where geography impacts Indian Country. Alaska, for example, would have the highest cost in the nation. In fact: If you are 60 and trying to buy insurance … it’s basically unaffordable. Insurance costs will far exceed affordability in North Carolina, Oklahoma, Arizona, and Wyoming.

This is what’s so important to the Indian health system. Instead of getting funding from third-party billing — mostly Medicaid — the Indian Health Service would have to rely almost entirely on appropriations. The bottom line: There will not be enough money.

Remember both the House and the Senate want to convert Medicaid to a block grant. This is not just rolling back Obamacare, it’s returning health care to before Lyndon B. Johnson’s Great Society programs.

As the CBO puts it that will lower Medicaid participation by 9 million in 2020 and by more than 14 million by 2026. That’s a lot of people.

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Most of the discourse about Medicaid centers on health care. But the program also provides long-term care to elders and disabled in assisted care or in-home care. The way this program works: You give up your assets (except Trust-based assets) and then the government promised to pay for your care. The Centers for Medicare and Medicaid say American Indian and Alaska Natives are a fast growing population that already rely on these services. “Between 2000 and 2010, the number of AI/AN adults 65 years or older increased by 40.5%, a growth rate that is 2.7 times greater than that of the overall population of older adults (all races) over the same 10-year period. The AI/AN elder population is projected to reach 1,395,000 by the year 2050; that’s a 3.5-fold increase from 2010 to 2050. In addition to studies that reflect the growing population of older AI/AN adults, other studies have revealed that AI/ANs suffer a disproportionately higher rate of disabilities including (lower body) functional disabilities that increase this population’s risk for falls, demonstrating a clear need for LTSS within this population.”

So if the Senate or House bill becomes law future services — as the need grows — will be sharply curtailed. And I can’t answer what will happen to people living in nursing homes now. If a state cuts the payment to a private facility, they could, in theory at least, ask people to leave. Let that sink in. People who have given up everything to live in an extended care facility could end up with no place to go. It will all depend on state legislatures or tribal budgets.

I am used to looking at both sides of any issue. I’m interested in views different than my own and exploring whether they have merit. As I wrote above: There is a conservative approach to health care that’s worthy of debate (I’d likely still come down on the side of single-payer.) But the House and Senate bills are not it. The only ideology at work is a tax cut; a painful tax cut at that.

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

 

 

 

About that ‘budget’

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Good morning. I am resisting the temptation to parse the Trump budget. The document does not express anything except White House contempt.

Congress is already rewriting this document. So focus the energy (and line by line reviews about spending) on Capitol Hill not the White House. — Mark Trahant

Interactive version here

#DisruptIndianCountry #FederalBudget #Infographic #Share

Congress has a spending plan for this year, saving budget fights for another day

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The White House priorities such as the border wall or the defunding of arts and public broadcasting are missing from this year’s spending plan. (Trahant file photo)

Trahant Reports

Congress has a spending plan. And it rejects most (but not all) of President Donald J. Trump’s priorities. It also includes more money for most federal Indian programs.

But remember: This is a short budget. It’s only enough money to fund government operations through the end of September.

House Appropriations Chairman Rodney Frelinghuysen (R-NJ) said: “This package of the remaining Appropriations bills is the result of over a year’s worth of careful and dedicated efforts to closely examine federal programs to make the best possible use of every tax dollar. This legislation will fund critical federal government activities, including our national defense, and enact responsible funding decisions to target U.S. investments where they are needed the most. It also maintains and enhances policies that bolster economic growth and support the core values that our nation is built upon.”

About a week ago I wrote that the best option for Congress was for “the White House to work with Democrats and spend money on their priorities. It’s the basic formula that has led to enactments of budgets for the past 8 years. The bargain would mean continued spending for domestic programs as well as add money to the military. The wall? No. Cutting support for Planned Parenthood? Get serious. And health care funding? That’s why it’s called the art of the deal.”

That’s essentially what happened. But it wasn’t the White House. It was Republican leaders in Congress that did the deal.  The military budget increased $25 billion over current levels. There was also an additional $1.5 billion for border security.

Both the Bureau of Indian Affairs and the Indian Health Service will get a slight boost from this budget.

From the House Appropriations Committee:

American Indian and Alaska Native Programs – The Bureaus of Indian Affairs and Education are funded at $2.9 billion – an increase of $69 million above fiscal year 2016. This includes necessary increases for schools, law enforcement, road maintenance, and economic development.

The Indian Health Service is funded at $5.0 billion – an increase of $232 million above the fiscal year 2016 enacted level. This includes operating costs for staffing at new facilities, and increases for rising contract support costs, medical inflation, and a growing and aging population.

But the Environmental Protection Agency takes a hit. “The bill funds the EPA at $8.06 billion, a reduction of $81.4 million below the fiscal year 2016 enacted level and $209 million below President Obama’s budget request,” the Committee said. “Within this total, the EPA’s research and regulatory programs are reduced by $52 million below the current level and over $300 million below the previous administration’s request.”

However the bill will add $75 million to speed up Superfund cleanup projects.

The fight over the National Endowments for the Arts and Humanities is saved for another day too, the bill includes $150 million for each of the endowments, $2 million above the fiscal year 2016 level. A similar story for the Corporation for Public Broadcast. The bill includes an advance appropriation of $445 million for CPB for fiscal year 2019, which is the same level of advance funding provided in the fiscal year 2016 enacted level and the previous Administration’s budget request.

Another White House budget item for next year — cutting funding for the Violence Against Women Act — is also a no go in this budget. The House committee says “funds are increased within the highest-priority grant programs, including $481.5 million for the Violence Against Women programs and $403 million for Byrne Justice Assistance Grants.”

Congress must still vote on the spending bill. But the prospects are strong because Democrats are on board so it only takes a handful of Republicans to make it law.

More on the budget here. — Mark Trahant

 

History to be made as Native legislators take on leadership roles across country

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Speaker Bryce Edgmon is the first Alaska Native in that post. (360North.Org photo)

Mark Trahant / Trahant Reports

Last year I expected a record number of Native Americans to get elected to offices across the country. There were just so many really superb candidates running for Congress, state legislatures, and statewide offices. At one point my list topped a hundred candidates. Of course it didn’t turn out that way. Too many of those exceptional #NativeVote16 candidates lost. But my tally to date: Sixty-six elected representatives and senators.  So the 2016 election cycle turned out to be more of a rebuilding year instead of one that broke records.

Yet it turns out there is still history to be made.

State legislatures are convening around the country this month and there is an interesting twist: Native Americans are in key leadership positions in at least seven states. That’s impressive — and critical right now because of the types of conversations that will be going back and forth between Washington, D.C., and state capitals about Medicaid, health care and energy policy.

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Interactive version of this graphic here.

Alaska is a great bipartisan example.

Two years ago former Sealaska chairman Byron Mallott, Tlingit, was elected the state’s Lt. Gov. (He was the Democratic Party’s nominee for governor, but joined an independent fusion ticket along with Gov. Bill Walker.) The Walker-Mallott administration elevated Native issues to an unprecedented level of influence. One of the governor’s first appointments was Valerie Nurr’araaluk Davidson, an Orutsararmiut Native Council tribal member, and a long time health advocate, as the state’s commissioner for the the state’s Department of Health and Social Services. She will be the one negotiating with the Trump administration about what Medicaid will look like if Congress acts to repeal the Affordable Care Act.

Then the state legislature and the Walker-Mallott administration have been at odds over state spending and resources. Alaska has a multibillion dollar budget deficit largely because of the state’s reliance on taxes from oil and gas. As The Fairbanks Daily Miner put it: “Fortunately for the state, previous years when oil revenues were high allowed legislators to sock away billions of dollars in savings accounts. Unfortunately for the state, it was easier for legislators to spend from these savings accounts than make the hard decisions that would put Alaska on a path to a balanced budget.” Further complicating that budget challenge, Alaska citizens are paid a per capita distribution instead of paying income or other general taxes.

So after this election a new alliance was formed in the legislature to try and come up solutions, three Republicans and two independents joined the Democrats to form a majority caucus. The Speaker of the House in this coalition is Bryce Edgmon, Yup’ik. He said his native background is how he views the world. He told the Bristol Bay Times: “I know it’s not only my children and maybe their children’s future, but it’s also the future of our way of life out here in rural Alaska and a lot of our Native villages.”

There are now eight Alaska Natives in the legislature representing both parties. Rep. Sam Kito III, Tlingit, is chair of the Labor & Commerce Committee as well as the Legislative Council (a joint committee with the Senate). Neal Foster is co-chair of the Finance Committee.  And Dean Westlake, Inupiaq, is chair of the Economic Development Committee and Arctic Policy. In the Senate, Lyman Hoffman, a Democrat who caucuses with Republicans, is co-chair of the Senate Finance Committee. The House Minority Leader is Charisse Millett, Inupiaq. In a previous legislature, Millett was instrumental in legislating Alaska Native languages as official state languages.

Actually I wrote “bipartisan.” That’s probably the wrong word for what’s occurring in Alaska because a few elected representatives run for election identifying with one party, only to caucus with the other after the election. (Perhaps a model for Congress?)

Oklahoma and Montana are the two states with the most Native legislators, nine. A larger group of Native legislators makes it easier to form a caucus so members can work together on issues important in Native communities. And both states have an active Native caucus.

Oklahoma legislators are leaders in both parties. In the House, Rep. Mark McBride, Potawatomi, is the Assistant Majority Floor Leader. Rep. Chuck Hoskin, Cherokee, is the Minority Whip. And in the Senate, Anastasia Pittman, Seminole, is the Assistant Democratic Leader.

Montana’s newly elected Rep. Shane Morigeau, Confederated Salish and Kootenai Tribes, will serve in leadership this session as Minority Whip. It’s a rare honor for a freshman.

Montana’s American Indian caucus was an important voice in the last legislature on issues ranging from tribal college funding to water compacts. “We’ve been literally and figuratively the minority’s minority,” Rep. Susan Webber, Blackfeet, told the Billings Gazette. “I know it looks like we have a lot of people in the Indian caucus, a lot of people were elected, but in reality it should be more. But just us getting in there, from my perspective, is a real positive.”

A critical challenge for the American Indian Caucus this session will be Medicaid. Montana came late to Medicaid expansion under the Affordable Care Act but its impact has been swift. The state’s uninsured rate dropped from 20 percent in 2012 to 7.4 percent last year. A report by The Montana Budget and Policy Center says a repeal of the Affordable Care Act “could have disastrous impacts on Montana, putting at risk the health care coverage of over 142,000 Montanans who have benefited from ACA measures. At the greatest risk are the over 61,000 Montanans who gained access to affordable health care coverage through Montana’s Medicaid expansion plan.” Worse: the report found that “repeal could cause a greater number of uninsured Montanans than before the ACA was enacted.”

Montana Budget and Policy says 8,000 American Indians are enrolled in insurance through the Medicaid expansion program. Third-party insurance, such as Medicaid, has added nearly a billion dollars to the Indian Health Service budget. “Nationwide, reimbursements at IHS facilities, tribal operated facilities, and urban Indian clinics have increased 21% since the expansion of Medicaid,” the report said. “In 2014, nearly 40% of American Indians did not have health insurance, but Medicaid expansion represented one of the most significant opportunities to expand coverage for American Indians.”

This is important because if Congress repeals the Affordable Care Act, it will be up to state governments to pick up the pieces (as well as the cost) or strip millions of Americans from health insurance coverage. Repeal without new resources could devastate the Indian health system.

Other states where Native American legislators are included in the leadership structure: Hawaii, where Andria Tupola is Minority Floor Leader; and in Colorado, Rep. Joseph Salazar is a committee vice chair.

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Sen. John McCoy is the chair of the Washington Senate Democratic Caucus and will help foster the party’s vision and values during the session. (Legislature photo)

In Washington Sen. John McCoy, Tulalip, has been a long-time champion of issues that are important in Native communities.

McCoy sponsored legislation to close coal burning power plants and “dramatically reduce the amount of coal burned to generate energy for Washington residents, reducing greenhouse gas emissions in Colstrip by 5 million tons — the equivalent of a million cars — a year.”

The senator says Washington Republicans and dental lobbyists are blocking the creation of a mid-level dental practice along the lines of what’s been done in several states. “Indian country may not have the loudest voice in Olympia, but it still has basic needs,” McCoy wrote in The Seattle Times.

“The idea is pretty simple — allow native communities to train and recruit dental therapists to help clear the backlog of an ongoing oral-health crisis. The research is alarming — one-quarter of Native Americans aged 35 to 44 years have fewer than 20 of their natural teeth,” he wrote. “The dentists also ignore the groundbreaking success of similar programs in other states. It’s been working for 11 years for indigenous communities in Alaska, where 45,000 people are seeing reliable providers for the first time in their lives.”

This issue is not going to go away. A new national survey reports that 45 percent of U.S. voters say they go without dental care because of cost or lack of insurance. But 8 of 10 favor adding midlevel providers as a solution. “Good oral health is critical to overall health, yet policies to expand access to dental care do not reflect this,” said Tera Bianchi, project director of the Dental Access Project at Community Catalyst. “Dental therapists offer better access to care for the most underserved populations in a cost-effective way to the system. They are a smart, effective bipartisan way to improve access to care.”

And this session McCoy will be the he face of the Democratic Party, chairing the caucus where he says he will help “foster the vision and values of Senate Democrats as they navigate the 2017 session.”

In other words: Sen. McCoy has a seat at the head of the table.

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