Congress votes to repeal Affordable Care Act; kinda, sorta replacement is next

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Mark Trahant / Trahant Reports

Congress has voted to repeal the Affordable Care Act. Kinda, sorta. Because it’s actually way more complicated than a straight repeal of the law.

The House and Senate passed budget resolutions that instruct four committees in Congress to strip funding from the budget. This is important because it means that the actual language of the repeal will only require 50 votes to pass in the Senate (instead of the 60 votes that most bills require). Thus no help is needed from Democrats to make the repeal so.

Yet the  details of that repeal — including what it actually means for the Indian Health Care Improvement Act, a chapter of the law — remain unclear. The language of repeal must focus on budget issues. The final language will be sorted out by the House Energy and Commerce, House Ways and Means, Senate Finance and the Senate Health, Education, Labor and Pensions committees.

And to make matters even more complicated President-elect Donald Trump told The Washington Post Sunday that he wants to replace the Affordable Care Act with insurance for all. What ever that means. Hard to imagine that Republicans in the House will go along. Trump told the Post that Medicaid cuts are not a part of his plan.

So far the actually legislative proposals go the opposite direction and target tens of billions of dollars that states now get for Medicaid expansion. It’s likely that any replacement will be some kind of block grant program that sends a set amount to states instead of funding every eligible person. The Indian health system is budgeted to receive $807,605,000 in fiscal year 2017 from Medicaid (and another 248 million from Medicare). (Previous: The billion dollar dilemma, funding Indian health in the Trump era.)

Under the rules of the Senate the fiscal repeal process is open to amendment. The Senate still must vote on a proposal by New Mexico Democrat Tom Udall to protect Native Americans on Medicaid. “Any reduction in federal payments to the Indian health system would jeopardize the lives and well-being of American Indians and Alaska Natives, as most health care facilities that serve Native Americans are already woefully underfunded,” Sen. Udall said.

The repeal will also likely end federal subsidies for people who buy private insurance on the open market. American Indians and Alaska Natives are eligible for a basic plan at no cost under the current law.

There is a long way to go before the repeal becomes law (and an even longer path ahead for any replacement). More about that later.

But first: There is something Indian Country can do now. There is still time to sign up for Medicaid, Medicaid expansion, the Children’s Health Insurance Program, and insurance found on the exchanges. This is money that will benefit the Indian health system for at least a year and as long as four years. This act of defiance will not only bring money to a local clinic or hospital, but it will pressure state lawmakers to find a solution for the people who already have Medicaid.

The Affordable Care Act in Indian Country has been a steady success. The law did not result in immediate full funding for Indian health. (In fact: I think the Indian Health Service could have done a lot more to sell the insurance programs to individuals.) Nonetheless Medicaid collections in the Indian Health Service budget have increased by more than 50 percent since the law was enacted. There are still far too many patients in the Indian health system who are uninsured. (Yes, I know, a treaty right, but one that’s not fully-funded.) The fact is patients who carry health insurance, including Medicaid, have more options in terms of care, especially when patients need treatment or specialists outside of the Indian health system. Unlike Medicaid, the Indian Health System is funded by appropriations. Healthcare services are limited by that funding.

American Indians and Alaska Natives still are uninsured at higher rates than the rest of the country. A report by Kaiser Family Foundation said too many Native Americans “have limited access to employer-sponsored coverage because they have a lower employment rate and those working tend to be employed in low-wage jobs and industries that typically do not offer health coverage.” Kaiser said Medicaid and other public coverage “help fill this gap, covering one in three nonelderly American Indians and Alaska Natives. However, even with this coverage, nonelderly American Indians and Alaska Natives are significantly more likely to be uninsured than the national average (21 percent vs. 13 percent).”  And when it comes to children, “Medicaid plays a more expansive role … covering more than half of American Indian and Alaska Native children.” Yet the uninsured rate remains nearly twice as high as the national rate for children at 11 percent.

This Sunday was another deadline for people to sign up for insurance through the exchanges. But American Indians and Alaska Natives are exempt from that deadline. As healthcare.gov puts it: “Members of federally recognized tribes and ANCSA shareholders can enroll in Marketplace coverage any time of year. There’s no limited enrollment period for these individuals, and they can change plans up to once a month.” This is a zero cost plan. And signing up now is an act of defiance.

Remember there will be a transition once Congress comes up with a replacement plan. Adding more people to the rolls of Medicaid, Medicare, Children’s Health Insurance, and market exchanges is one way to demand that Congress come up with an alternative and not just destroy what’s in place.

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Link: Interactive version of graphic.

So what will a replacement bill look like? That is impossible to know. There are at least four Republican alternatives that are little more than concept papers at this point.

On Sunday, Sen. Rand Paul, an ophthalmologist, R-Kentucky, who voted against repeal (because there was no replacement plan) said he would offer his own. A previous plan by Paul would have cut the Indian Health Service budget by more than 20 percent. He told radio host Laura Ingraham that Native Americans “don’t do very well because of their lack of assimilation.”

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Tom Price is the nominee to head the Department of Health and Human Services and a critic of the Affordable Care Act. He has proposed his own plan to replace the law that relies on tax credits and other “market-based” solutions. (GreatAgain.Gov photo)

Tom Price is a surgeon, a member of Congress, and President-elect Donald Trump’s pick to run the Department of Health and Human Services. He has proposed his own replacement for the Affordable Care Act, the Empowering Patients First Act. His basic premise is to lure people away from insurance subsidies by offering tax credits, health savings accounts, and market-based incentives. But his plan was dismissed by a lot of Republicans because the tradeoff of a market-based health care system is that millions of working Americans will lose access to any insurance. The Fiscal Times says Price’s plan “Price would foster an insurance market very welcoming to young, healthy and financially self-sufficient people but hostile to sicker and older people.” Price’s plan (like Ryan’s A Better way) allows individual Native Americans to contribute to a Health Savings Account “regardless of utilization of IHS or tribal medical services.”

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House Speaker Paul Ryan starts his reform proposal with “A better way.” The main idea is that insurance should be more competitive, creating more options for consumers.  “Patients with pre-existing conditions, loved ones struggling with complex medical needs, and other vulnerable Americans should have access to high-quality and affordable coverage options. Obamacare’s solution was to force millions of people onto Medicaid, a broken insurance program that has historically failed lower-income families,” according to the policy paper. The plan says that American Indians and Alaska Native should be able to purchase care outside of the Indian health system with health savings accounts. “This gives American Indians more choice in where they receive care.”

Rep. Tom Cole, R-Oklahoma, and a member of the Chickasaw Tribe, has said that a replacement bill must include provisions for the Indian health system. He has not advocated for a particular plan but wrote in a column last week that “opponents of Obamacare have yet to settle on one specific replacement alternative, but there is a broad consensus about the core foundation upon which a replacement plan will be developed. Simply put, Americans should have access to more choices in health care plans, have a range of prices that make health care affordable to everyone, and a revised set of current rules and regulations to give Americans greater flexibility in purchasing and keeping their plans that aren’t dependent on where you live, who you work for, or what pre-existing condition they may have.”

Sen. Lamar Alexander is chairman of the Senate Health, Education, Labor and Pensions Committee. The Tennessee Republican has said he only wants to see the Affordable Care Act repealed once there are concrete, practicable reforms in place. He said his first focus will be on making sure that the insurance system is stable and fixing the exchanges where 11 million people have signed up for policies.

Alexander also wants states to have more flexibility with Medicaid, determine the rules about how that money could be spent.

One way that could occur is to cap the spending that each state gets for Medicaid, shifting to a set amount per person. According to the Kaiser Family Foundation: “Proponents of per capita cap proposals argue that this structure could reduce federal spending and promote flexibility for states.  However, such policies may be difficult to implement and may result in cost shifts to states if pre-determined growth rates are lower than expected program spending.”

It’s unclear how the federal match for American Indians and Alaska Natives would work under this scenario. Nor is there a guarantee that Native American recipients of Medicaid (or whatever plan follows) would not be required to come up with a co-pay for medical care. That idea would crush the notion that Indian health care is a pre-paid federal obligation.

I would not bank on any of these plans becoming law. There is no easy or fast way to enact a new health care law. As Ezra Klein wrote in Vox: “Donald Trump likes to say he’s going to repeal Obamacare and replace it with ‘something terrific.’ Sadly for everyone, that’s probably not possible. What is possible is repealing Obamacare and replacing it with something that makes a different set of equally painful trade-offs.” The replacement of the Affordable Care Act will need 218 votes in the House and 60 votes in the Senate. The problem is that the very ideas that will improve prospects in the Senate, will likely weaken the case in the House.

So here are the three most important things to remember. First: Repeal can happen quickly. Second: Signing up for an insurance program now is an act of defiance. And, third, Congress is going to have a hell of a time agreeing on a replacement. It’s more likely that we will see chaos before we see consensus about the “what’s next?”

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

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

Draft. Native Legislators spread sheet

Good morning. Writing. So I started last year thinking that 2016 would be a record year in terms of Native Americans winning office at state and congressional level. Did not happen. But here is a twist: Seven states now have Native American legislators in their leadership.

Spreadsheet of elected Native leaders shows 57 elected in 15 states.

Who am I missing?

https://docs.google.com/spreadsheets/d/1f6__GVaWJjpKSTFvCBZDef5vL5gIzdAsn15UyXTB1M8/edit?usp=sharing

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Denise Juneau’s eight years of promise

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Denise Juneau at a congressional debate last August. The event was at Frazer High School, one of the community participants in the state’s Schools of Promise. (Trahant photo)

Mark Trahant / Trahant Reports

HELENA, Montana — It’s easy to think about politics as being about elections. We concentrate so much of our attention, our money, and our energy on campaigns. But then what? Most politicians run because they want to change things. They want government to be effective, to use the machinery of state for We, the People.

Pull back the lens and look at the past eight years and Denise Juneau’s term as Montana’s Superintendent of Public Instruction. Yes, it was a big deal for her to get elected. She is the first, and only, American Indian woman to hold a state constitutional office (such as governor or attorney general). She is a member of the Mandan Hidatsa and Arikara Nation and Blackfeet.

So then what?

“I have had a great time being Superintendent of Public Instruction. Eight years of working with communities across this state on Graduation Matters Montana, on Schools of Promise, on Farm to School, we could run down a whole litany of different topics,” Juneau said last week at the Montana Budget and Policy Center’s Legislative Summit. “There is really a lot to be proud of.”

In what Juneau said was her last public speech as Montana’s school superintendent she credited the work of Montana Budget and Policy Center and other community groups that worked together to bring about change. Take Graduation Matters Montana.

“When I first stepped into office, drop out rates were too high, way too many students were dropping out of school, and we used data, and we talked about information, we talked about reasons,” Juneau said. “The information you can then use to advocate for change. That change has actually resulted in 58 communities across this state pulling people together at a community level to get things done.”

The result: Raising Montana’s graduation rates to historic highs for two years in a row. And, at the same time, raising academic standards in English, math, science, arts, and health, so that that a high school diploma is more valuable.

Another successful effort was the Schools of Promise program in Montana’s tribal communities. That program, which began shortly after Juneau took office in 2009, were grants targeted to reservation communities and “struggling schools.” That program invested state resources, including an unprecedented 22 employees, so that the schools could get grants to improve everything from teaching to school leadership.

“I have learned from this position that being an advocate is so important, being able to use the position that you have, to talk to people about the important things that need to happen,” Juneau said. “I have just had a blast being the top advocate for public education for the last eight years and I could not be more proud of the work that happened.”

The superintendent’s term ends January 2.

Juneau also talked about her recent bid for Congress. She joins a remarkable group of Native American women who have run for that office, including: Jeanne Givens in Idaho, Diane Benson in Alaska, Ada Deer in Wisconsin, Kalyn Free in Oklahoma, and in Arizona, Wenona Benally, Mary Kim Titla and Victoria Steele. I reject the word, “unsuccessful.” It’s true that none of these candidates were elected. Yet. And every campaign, every challenge, only pushes the door open a bit wider. So: One day, soon.

“I am sad that I lost, but I do not feel bad about our campaign because we ran a damn good campaign,” Juneau said. “We raised more money than any Democrat that’s ever been in this race, we had good ads, we had great advocates out in the community, we had organizations helping us, we did everything we were supposed to do. We just lost. Those are bitter pills to swallow, but sometimes that’s what happens.” (Previous: Juneau for president?)

She said it doesn’t mean you get out of the game. “You stay in there and find other avenues to fight in and you make sure you are always, continually pushing what is in your heart and what is in your mind that you know is right,” she said. “Because if we don’t, nobody else will.”

And who knows what door will open next? “I am looking forward to doors opening, figuring out if I want to take advantage of that and bringing people with me,” Juneau said. “That’s what this game is about.”

 

 

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

Interior secretary pick has a record of listening to tribes

Rep. Ryan Zinke in Frazer, Montana, last summer. (Trahant photo)

Mark Trahant / Trahant Reports

HELENA, Montana — Just about a week ago it was clear that Cathy McMorris Rodger was headed to the Interior Department. Nope. It was a headfake. President-elect Donald Trump has instead picked Montana Rep. Ryan Zinke for the post.

This is a  much better appointment for Indian Country. Zinke is no less conservative than Rodgers, but since his days in the Montana legislature he has had an open door. He has reached out to tribes in a number of ways. He introduced and championed the Blackfeet water compact and he has supported federal recognition for the Little Shell Band of Chippewa Cree.

“The truth is Ryan does know the value of public lands, he does know, to an extent, I don’t know how deep, the issues of Indian Country,” said Sen. Jon Tester at the Montana Budget and Policy Center’s Legislative Summit Wednesday. He said the Senate confirmation hearing process will be useful in getting Rep. Zinke on record explaining his views on such things as the government’s Trust Responsibility to tribal nations.

Sen. Jon Tester, D-Montana, speaking at the Montana Budget and Policy Center Legislative Summit in Helena. (Trahant photo)

 “It’s a big deal for the state of Montana,” Tester said. “He has a chance to do some really good stuff. Compare him to some of the people nominated before, AKA Sarah Palin, we will take him in a heartbeat.”

At a congressional debate in Frazer, on the Assiniboine Sioux Tribal Nation, Zinke said he had been adopted as an Assiniboine. He said he supports tribes and sovereignty. “I don’t think anyone has worked harder trying to get Blackfeet Water Compact done … I have been out here not because I am your congressman, but because I care.” He said he has been to people’s homes, met with tribal councils, and visited powwows.

Harry Barnes, chairman of the Blackfeet Nation, told The Helena Independent, that the appointment is “a great day for Montana” and that “Montana tribes will have an ear in the Department of the Interior, which oversees the Bureau of Indian Affairs.”

Montana Republicans, many Western Republicans, are eager for an Interior Secretary who will open up more federal lands to oil and gas development. And on this score, Zinke will not disappoint. “I’m excited that the Trump administration plans to unleash the economic power of the resources of the nation,” Jeff Eisman, chair of the Montana Republican Party, told Montana Public Radio. “The federal government does control a lot of resources, especially in our end of the country.”

And it’s not likely tribes will often agree with Zinke. This is a Trump administration and Zinke was one of his early supporters. And Zinke has voted against tribes on other issues, such as the Violence Against Women Act,  a law that expanded tribal authority on domestic violence. 

If Zinke is confirmed by the Senate there would be a special election for his House seat.  (Previous: Juneau for President?)

And Denise Juneau?  She said Wednesday night: “I am looking forward to doors opening, figuring out if I want to take advantage of that, and bringing people with me.” That’s a far better answer than a yes or no. 

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

Sometimes the stars do align: Peggy Flanagan and a run for Congress

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Rep. Peggy Flanagan’s Twitter profile picture. She represents Minnesota’s District 46A and could soon be a candidate for Congress.

Mark Trahant / Trahant Reports

Sometimes the stars do align. The short version: Minnesota Rep. Keith Ellison is campaigning to chair the Democratic National Committee. If he wins, that opens up a congressional seat in a special election. And, state Rep. Peggy Flanagan is thinking about running.

Now, the details.  Ellison represents Minneapolis and some of the suburbs, including St. Louis Park and, as he puts it in his biography, is “one of the most vibrant and ethnically diverse districts in Minnesota.” He’s often a leader of the  Congressional Progressive Caucus for the 113th Congress and is often a voice for justice on issues ranging from financial services to Standing Rock.

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Rep. Keith Ellison, D-Minnesota.

Ellison wrote last week on Facebook:

“After months of protests, I’m inspired by this victory by thousands of indigenous activists and Water Protectors, and millions of Americans who support them. This is a victory for all people who fight for social justice. And it is a victory won by the power of peaceful protest – a reminder of what people can do when they stand up and organize.

We use environmental impact statements to understand how key projects will impact our environment and communities. I hope that Energy Transfer Partners, and most importantly, the next Administration, recognize the concerns raised by the Standing Rock Tribe.

I also want to acknowledge that the responsibility for this project falls on the Energy Transfer board room, not the workers who are simply trying to do their jobs. Working Americans need our support as well. That’s why I support a broad infrastructure package that creates good jobs for millions of American workers.

We have a responsibility to respect the sovereignty of the Standing Rock Tribe, and to ensure their voices are heard. And we must ensure that the millions of people who depend on the Missouri and Cannonball rivers have access to clean water. As the Water Protectors at Standing Rock remind us every day: Water Is Life.”

This is not exactly the message we have been hearing from the Democratic National Committee. Instead, since the summer, when the presidential campaign was at its height, we heard statements about protecting peaceful protest and workers (without a definition of what was meant).  The Democratic Party has been trying to represent corporate patrons (including those who build and fund pipelines) as well as some of its core constituent groups. That no longer works. If it ever did. In this age of social media and transparency, the people are demanding more accountability and a clear sense of direction about social justice.

And that’s the basis of Ellison’s campaign, building a party that champions grass roots efforts. He said last week: “The Democratic Party must be the party that delivers for working people. We can do that by meeting folks where they are, looking them in the eye, treating them with respect, and working to solve their problems. For me, that means a chair with only one full time commitment.”

So that means Ellison (unlike former DNC Chair Debbie Wasserman Shultz) would give up his congressinal seat. “I have decided to resign as a member of Congress if I win the election for DNC chair. Whoever wins the DNC chair race faces a lot of work, travel, planning and resource raising. I will be ‘all-in’ to meet the challenge.”

Ellison was a strong candidate before his announcement last week. But since then he is earning more endorsements from elected Democrats. According to Politico, supporters now include: Reps. John Lewis, Raul Grijalva, Luis Gutierrez and Tulsi Gabbard, a former DNC vice chair, as well as Sens. Martin Heinrich, Bernie Sanders, Chuck Schumer, Elizabeth Warren, and on Thursday, the AFL-CIO also announced its endorsement.

The election of the DNC chair will happen at the party’s winter meeting, sometime before March 2017. There are at least two other candidates:  Raymond Buckley, a NH party leader, and Jaime Harrison, chairman of the South Carolina Democratic Party. There are other potential candidates as well, including Labor Secretary Thomas Perez.

And that’s the stage setting a Peggy Flanagan run for Congress.

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Flanagan’s entry into the race would be historic. She’s a member of the White Earth Band of Ojibwe and she would be the first American Indian woman ever elected to Congress. That sentence is in itself remarkable when you think about this country’s history and the contributions from so many Native women. Montana and Arizona could, should, have broken that barrier in 2016 by electing Denise Juneau and Victoria Steele. But the geography and the timing weren’t there. Sometimes elections require a bit more, well, luck.

And Minnesota’s fifth congressional district could be the spot. As Ellison’s biography says, it’s one of the most vibrant and ethnically diverse districts in Minnesota. This is a place where voters would appreciate, even celebrate, the historical significance of this first. After all this is a state that just elected four Native women to its Legislature. Another record.

Flanagan also has the ideal background for this job. She’s been an organizer working on social justice issues for more than a decade. More than that: She teaches other people how to win campaigns and elections for Wellstone Action and The Management Center (an organization working for social change). She was executive director of the Children’s Defense Fund-Minnesota.

And, if that’s not enough, she knows how to win a special election. She was elected to the Minnesota House in 2015 when Rep. Ryan Winkler moved out of the country. She jumped into the race early, ran unopposed, and earned 96.4 percent of the vote.

It’s not likely that Flanagan will run unopposed for a congressional seat. But she is already getting early support on social media. (Hashtag: #RunPeggyRun.)

Former Minneapolis Mayor R.T. Rybak Jr. posted this on Twitter: “Wow! It would be great to have one of the best young leaders in the country be my rep in Congress.” He’s not alone. Others have expressed their fondness for Ellison and then say Flanagan is the right candidate to build on that legacy.

In politics timing is everything. Sometimes the stars do align.

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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If, then, this. The shift from campaign promises to Indian Country policies

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President Barack Obama meets with President-elect Donald Trump in the Oval Office, Nov. 10, 2016. (Official White House Photo by Pete Souza)

Mark Trahant / Trahant Reports

If, then, this. A series of three words explaining what happens in any new White House. If Donald Trump wins the presidency, then many (not all) of the promises made during the campaign become policy. And it happens starting next month when the Congress races to try and make this so.

But “if, then, this,” is also about people. Who staffs the new campaign, especially those who represent Indian Country? And who represents the opposition?

So let’s start with what we know.

It’s likely that President-elect Donald J. Trump will nominate Cathy McMorris Rodgers as the next Interior Secretary and Tom Price as the Secretary of Health and Human Services. Who joins them? Who has their ear? How will their broad views on public policy impact Indian Country?  (Previous: Trump’s choice for Interior could risk salmon recovery, treaty rights.)

As The Atlantic said about Price. He will be running a massive federal healthcare agency, one that “administers the largest health-research centers in the world, most of the country’s public-health apparatus, the Indian Health Service, the Food and Drug Administration, and a collection of welfare and child-care services. While Price has a less-established policy record on many of these issues, his general philosophy of rolling back government spending and intervention suggests he may scale back HHS’s current efforts.” A less established policy record opens up a lot of questions.

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Another appointment, yet to be announced, would be in the next president’s executive office. Arizona State Sen. Carlyle Begay posted on Instagram: “It’s official … I’ll be working in the White House.” (Begay’s account is private, but it was reposted by Navajo Republicans on Facebook.) He doesn’t elaborate on the job title, but the most likely that post would be as a special assistant to the president on the Domestic Policy staff, a post now held by Karen Diver. Begay is Navajo.

One of the issues that the White House and Congress will have to flesh out is a proposal by Rep. Markwayne Mullin to reform the regulatory structure for tribal lands. A story in Reuters last week compared that plan to the termination, something that Mullin (who is a member of the Cherokee Nation) and former Interior Assistant Secretary Ross Swimmer say is not the case. Swimmer, who is also former principal chief for the Cherokee Nation, told Reuters: “It has to be done with an eye toward protecting sovereignty.”

Mullin said the press misunderstood him. He posted on Facebook: “This is a very personal and important issue for me and I want to clarify my actual comments that were distorted by the media. It is still and will always be my belief that the land entrusted to tribes belongs to the Native American people, and it ought to be up to them alone to decide how to best use and distribute the resources on their own land.”

Economist Terry Anderson has been making this case for years first from a think tank in Montana, The Property and Environment Research Center, and rom the Hoover Institution at Stanford University. He wrote just last month: “President-elect Trump is well positioned to grant more freedom to Native Americans.” (Note to Republicans: If you are serious about making this a policy, I would avoid the ‘free the Indians’ narrative. This was Arthur Watkins’ pitch during termination. The phrase has a definite and failed context.)

As will often be the case in a Trump White House, Anderson’s argument focuses on energy. “Considering the fact that tribes have an estimated $1.5 trillion in energy resources, President Trump should start by promoting more tribal authority over those resources,” Anderson wrote. “Such legislation is helping tribes like the coal-rich Crow. In 2013 it signed an option with Cloud Peak Energy, LLC to lease 1.4 billion tons of reservation coal. For the option, Cloud Peak paid the tribe $3.75 million and payments could increase to $10 million by 2018 if they start mining. These kinds of deals give Indians some reason for hope.”

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If, then, this. Except. I would question at least one variable in this argument. If tribes have more say about resource extraction, then will tribes also have more say about environmental concerns? Does this logic give tribes a veto over resource extraction? Would that include approval or rejection of the Missouri River crossing of the Dakota Access Pipeline?

And specifically on coal, if there is a smaller global market for coal, then what’s the point? The International Energy Agency last year reduced its prediction for coal demand (after a decade of growing sales) in part because China’s consumption is dropping sharply. “The coal industry is facing huge pressures, and the main reason is China, but it is not the only reason,” said the agency’s executive director Fatih Birol. “The economic transformation in China and environmental policies worldwide – including the recent climate agreement in Paris – will likely continue to constrain global coal demand.”

That study predicts coal from India and Australia are growing and that the pipeline is already exceeding the capacity. “Probable” new export mining capacities amount to approximately 95 million tonnes per annum. But the current market environment strongly discourages investments as a substantial rebound of coal prices before 2020 is unlikely. Consequently, further postponements or cancellations of projects are expected.” So it’s not a great time to unleash coal as a market force (unless even lower prices are the goal).

If the world is moving past fossil fuel expansion, then the markets will not be there. This will not change in a pro-coal administration.

If there is to be a Secretary McMorris Rodgers, then who would develop and implement policy for Indian Country as the Assistant Secretary for Indian Affairs? There are a lot of talented Republicans who will be making their case in the next few days and weeks. You would hope that people who have served in previous administrations, such as Swimmer, will have a say in what qualities should be sought to match the requirements of the office. Same goes for elected leaders such as Mullin, Rep. Tom Cole, and even those in state governments, such as New Mexico Rep. Sharon Clahchischilliage, a member of the Navajo Nation.

The idea of “if, then, this,” is also important to the opposition party, the Democrats.

McMorris Rodgers must give up her congressional seat. And already there are three candidates. But former Colville Chairman Joe Pakootas said he will not run in a special election. He’s now chief executive of Spokane Tribal Enterprises.

But there are other ballot possibilities. Minnesota Rep. Keith Ellison is a candidate to chair the Democratic National Committee. If he were to win that job, then he has said he would give up his seat in Congress. Already on Twitter there is speculation that the best candidate for the House seat would be Minnesota Rep. Peggy Flanagan, White Earth Band of Ojibwe.

If, then, this.

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

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

Trump’s choice for Interior could risk salmon recovery, treaty rights

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Rep. Cathy McMorris Rodgers, R-Washington, will head to the Interior Department in the new Trump administration. (Photo by Gage Skidmore, Wikipedia Creative Commons)

Mark Trahant / Trahant Reports

Washington Rep. Cathy McMorris Rodgers is President-elect Donald J. Trump’s choice to head the Department of the Interior. If confirmed by the Senate, she would managed federal lands, including those that produce energy, as well as national parks. She would be oversee the Bureau of Indian Affairs.

McMorris Rodgers has all the necessary qualifications: Pro oil and gas development? Check. Climate change skeptic? Check. Skeptical about federal land ownership in the West? Check.

And, if you need one more check mark, her record in the House does not reflect her being a particularly close ally of tribes from the Republican side.

The Violence Against Women Act is one example. In 2013, McMorris Rogers met with Deborah Parker, then vice chairman of the Tulalip Tribes,  where they explored language that would get Republican support and open tribal jurisdiction on domestic violence. But when Rep. Tom Cole’s alternative bill surfaced that did just that, McMorris Rodgers voted no. Slate magazine said he dismissed tribal concerns as “a side issue” and voted the party line against the Violence Against Women Act.

The most problematic issue for Northwest tribes might be salmon.

She describes herself as “a champion of our dams and the power they produce.” She recently told Washington Ag Network:  “There are some who believe the Snake River dams are not allowing for adequate salmon recovery. However, thanks to collaboration between states, tribes, federal agencies, and private property owners, our salmon are returning at record levels. Since 2014, more than 2.5 million adult salmon and steelhead passed Bonneville Dam, the highest returns since they began counting in 1938. The Sockeye, Fall Chinook, and Coho were also among record and near-record runs as well.”

But will salmon recovery continue without removing dams on the Snake River? A federal judge in May rejected the government’s recovery plan and said the government had to calculate at least the potential of removing dams.

An irrigation group responded by calling for the government to give up on salmon and declare the species extinct (using an odd provision in the Endangered Species Act that assembles a committee, “the God squad,” to make a determination that nothing more can be done to save salmon). Darryll Olsen, representing The Columbia-Snake River Irrigators Association,  said in the Tri-City Herald, that “the association is hoping for a fair and equitable ruling that would end a cycle of repeated litigation, and escalating and more expensive plans for what is already the most extensive fish protection and enhancement program in the world.” The debate pits salmon recovery against the four Snake River dams that make it possible to barge agricultural products from Lewiston, Idaho, to Oregon ports. And the dams generate inexpensive electricity for some 800,000 Northwest homes.

As a Tri-City Herald headline put it: “People passionate about saving Snake River dams.” But then the newspaper didn’t talk to tribes who are just as passionate about saving salmon.

And, even if the God Squad is assembled, and even if the Snake River salmon are declared extinct, there will be more litigation ahead, including the assertion of tribal treaty rights.

But the Snake River dams will have the best advocate, the Secretary of Interior.

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

 

 

 

 

 

 

 

 

 

 

Standing Rock Tribe defied history; what happens next is anything but inevitable

 

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Amazing day at the Oceti Sakowin Camp as the U.S. Army Corps of Engineers denies an easement for the Dakota Access Pipeline. It’s a huge victory for the Water Protectors. (Photo by Dale Kakkak, News From Indian Country.)

Mark Trahant / Trahant Reports

The Standing Rock Sioux Tribe has defied history.

Nearly two years ago the Dakota Access Pipeline and the U.S. Army Corps of Engineers told the tribe about an inevitable pipeline that would cross near their reservation and within treaty lands. The tribe objected. But it was inevitable. A done deal.

And in April the Camp of the Sacred Stones was set up as a center by LaDonna Brave Bull Allard as a center for spiritual resistance. Crazy, right? A few people standing together cannot do anything against the absolute power of the state of North Dakota and the oil company billionaires who want this done. Inevitable. A done deal.

Then in August Standing Rock Sioux Tribal Chairman Dave Archambault II defied state authorities and was arrested in the pipeline’s path. He told Indian Country Today Media Network:  “The Standing Rock Sioux Tribe is doing everything it can legally, through advocacy and by speaking directly to the powers that be who could have helped us before construction began.” So what? The $3.8 billion pipeline was inevitable. A done deal.

Then in September the tribe and its allies won a battle when the Obama administration said it would review the matter. “Construction of the pipeline on Army Corps land bordering or under Lake Oahe will not go forward at this time,” said the joint statement from the Department of Justice, the Department of the Interior, and the U.S. Army. “We request that the pipeline company voluntarily pause all construction activity within 20 miles east or west of Lake Oahe.”

But the Dakota Access Pipeline’s owners ignored that request. Why should they stop? This entire pipeline route was designed to avoid federal interference. So what if the federal government was reviewing the record. This project was inevitable. A done deal.

In fact a few days later, in an extraordinary exchange before the U.S. Court of Appeals, the company admitted that the process was incomplete.  Judge Thomas B. Griffith asked: “Why not wait until you see whether you’re going to get the easement?” asked the judge. “To a neutral outside observer, it looks like you’re forcing their hand … So it’s a gamble. You’re gambling you’re going to win.”

And why not gamble? The easement was inevitable. A done deal.

But inevitable blew up Sunday night. On the same weekend when thousands of veterans showed up to support Standing Rock, the U.S. Army Corps of Engineers said it will not grant the easement under Lake Oahe. And the corps will now require an Environmental Impact Statement.

So what now? That invincible force known as the oil industry is still out there, saying the project is inevitable.

U.S. Rep. Kevin Cramer said: “Today’s unfortunate decision sends a very chilling signal to others who want to build infrastructure in this country. Roads, bridges, transmission lines, pipelines, wind farms and water lines will be very difficult, if not impossible, to build when criminal behavior is rewarded this way.”

(Remember the company was proceeding without an easement.)

And from Washington, the president of the National Association of Manufacturers Jay Timmons said the decision “defies logic, science and sound policy-decision making, and the consequences can be measured in lost work for manufacturers and those in the manufacturing supply chain. If a project that has involved all relevant stakeholders and followed both the letter and spirit of the law at every step of this approval process can be derailed, what signal does that send to others considering building new energy infrastructure in this country? We can only hope that President-elect Trump will stand by his promises to invest aggressively in new infrastructure in America and start by overturning this misguided decision and allow the completion of the pipeline.”

There we go again. Inevitable. A done deal. If only the Standing Rock Sioux Tribe, the Cheyenne River Tribe, hundreds of other tribes, and people from across the planet would not have got in the way.

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Exactly so. (Photo by Dale Kakkak, News From Indian Country)

 

But there are three critical things to think about in that chronology and the idea of the inevitable.

First, no energy company can roll over a community that’s united. And that’s all of the communities involved, not just the people of Standing Rock. As Chairman Archambault said today in a news release, “throughout this effort I have stressed the importance of acting at all times in a peaceful and prayerful manner.” 

Second, President-elect Donald J. Trump can revisit this issue. He probably will. But it will not be easily undone. I have been writing for months that President Obama would likely take this action but it had to be done in concert with the federal agencies involved. A president’s power is not absolute. (I am really interested in the structure of the Army Corps’ decision to see just how complex it will be for a Trump administration to unwind.)

Third, and most important, this is a moment when North Dakota can tell the world what it really wants to be. The timing is ideal for a new beginning.

Is this a state where the sheer power of police, looking like military, will roll over the legitimate interests of a community? Is this how you tell the world, come to North Dakota, invest, we’re open? Or, does the state now take advantage of this unique opportunity to show what can be done in a spirit of reconciliation. This is the time for the state to get serious about an environmental impact statement, a smarter route, to work with the tribes, end prosecutions, and pardon those who are in the criminal justice system now. Even better: Take one more step and build bridges by investing in the Standing Rock neighborhood.

This whole pipeline encounter was a fiasco that was a better story for the 19th century instead of the 21st. It represented the total breakdown in communications between the tribes and the State of North Dakota. However there’s now a path toward the healing that needs to occur. And that is what should be inevitable. A done deal. #HealNorthDakota

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

 

 

The billion dollar dilemma: Funding Indian health in the Trump Era

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Senate Indian Affairs Committee Chairman John Barrasso, R-Wyoming, says a patient-centered culture at Indian Health Service is long overdue. Barrasso is a physician. What happens to Indian health after the repeal of the Affordable Care Act, especially Medicaid as a funding source. (Senate photo)

 

Mark Trahant / Trahant Reports

A few years ago I had a chance to ask President George Bush what he thought about tribal sovereignty in the 21st century. His answer went viral: “Tribal sovereignty means that. It’s sovereign. You’re a … you’re a … you’ve been given sovereignty and you’re viewed as a sovereign entity.”

Think about that question today; we would be lucky to get a similar answer. Bush (except for the “given” part) was correct: tribal sovereign means that, you’re sovereign.

This idea is relevant now because during the campaign Donald Trump was dismissive of any sovereignty except his perception of what America’s sovereignty is all about.

So a treaty with Mexico and Canada? Junk it, day one. A United States pledge to reduce global warming? Out. Perhaps even historic military alliances will disappear into lost budgets.

And when it comes to the federal relationship with American Indian and Alaska Native governments as sovereigns we will likely see ideas pop up that were long ago discarded as impractical, expensive, or out-and-out wrong.

At the top of that list: Shifting power from the federal government to state capitals. That was Ronald Reagan’s plan when he came to Washington. In 1981 he proposed rolling dozens of federal programs into block grants for states. Then the budget was cut by 25 percent, the argument being states could deliver the services more efficiently. But a Republican Senate didn’t buy the whole plan. In the end most of the programs were managed by states, but under federal oversight. According to Congressional Quarterly, Sen. Orrin Hatch, R-Utah, then chairman of the Senate Labor Committee said at the time, it was the best deal possible. “We’ve come 70 to 80 percent of the way to block grants,” Hatch said. “The administration is committed to pure block grants, and so am I. But there was no way we could do that.”

Expect Hatch, and House Speaker Paul Ryan, to take another shot at substantial block grants to states, representing a fundamental shift for programs that serve American Indians and Alaska Natives.

Ryan’s agenda, “A Better Way,” proposes to do this with Medicaid. It says: “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.”

This is a significant issue 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 funding, and, according to Kaiser Family Foundation, at least 65,000 Native Americans don’t get coverage because they live in states that did not expand Medicaid.

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The Affordable Care Act, which is priority one for repeal and replacement, used third-party billing as a funding source for Indian health programs because it could grow without congressional appropriations. The idea is that when a person is eligible, the money is there. The Indian Health Service budget in fy 2017 includes $1.19 billion in third-party billing, $807 million from Medicaid programs. This funding source is especially important because by law third-party billing remains at the local clinic or other unit. And, most important, when the Indian Health Service runs short of appropriated dollars it rations health care. That’s not the case with Medicaid funding.

One problem with the Affordable Care Act (after a Supreme Court decision) is that not every state participates in Medicaid expansion. So an IHS clinic in South Dakota would have less local resources than in North Dakota or Montana. This especially important for health care that is purchased outside of the Indian health system.

The most important gain from the Affordable Care Act has been insuring Native children. According to the Kaiser Family Foundation: “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 (51%), but their uninsured rate is still nearly twice as high as the national rate for children (11% vs. 6%).”

Ryan’s House plan would convert Medicaid spending to a per capita entitlement or a block grant depending on the state’s choice. There is no indication yet how the Indian health system would get funded through such a mechanism.

During the campaign Trump promised to repeal the Affordable Care Act, including Medicaid expansion, but said there would be a replacement insurance program of some kind.

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Earlier this year Sen. John Barrasso, R-Wyoming, chairman of the Senate Indian Affairs Committee, and Sen. John Thune, R-South Dakota, introduced legislation to “improve accountability and transparency at the IHS.”

Barrasso is a physician.“A patient-centered culture change at the Indian Health Service is long-overdue,” he said. “This bill is an important first step toward ensuring that tribal members receive proper healthcare and that there is transparency and accountability from Washington. We have heard appalling testimonies of the failures at IHS that are unacceptable and will not be tolerated. We must reform IHS to guarantee that all of Indian Country is receiving high quality medical care.”

What will reform look like after the Affordable Care Act goes away?

Last week Rep. Tom Cole, R-Oklahoma, said on CSPAN that the Indian Health Care Improvement Act was one of the good features of the Affordable Care Act and ought to be kept. But nothing has been said by Republican leaders about how to replace the Indian health funding stream from Medicaid, potentially stripping $800 million from the Indian health system that is by all measures underfunded.

Perhaps the most important idea in government, one that had been expanding, is the idea of including the phrase “… and tribes” in legislation and funding. That means tribes get money directly from Washington rather than the round about from DC to state capital to tribal nations. And clearly in this era that’s a hard sell. Just last week the state of North Dakota opted to punish (or so it thinks) tribes by canceling a joint appearance before the legislature because the state is not happy with the Dakota Access Pipeline protests. At a moment where there should be more talk, not less, the state walks away.

That, of course, begs the question, is this how government will work over the next four years?

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