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.)

 

#NativeVote18 Candidates are boosted by an electorate ready for change

 

Cross posted on Indian Country Today.

Mark Trahant / Trahant Reports

A special election in Pennsylvania is a good sign for Native American #NativeVote18 candidates running for office. Why? Because this cycle is already favoring out-of-power Democrats and, quite possibly, independents. It’s hard to peg any constituent group more out-of-power than those who would represent Indian Country in the Congress of the United States.

First, the news from Pennsylvania, then we will look at the map. Democrats are claiming victory in a special election for that state’s 18th Congressional District. Perhaps. Officially, the race is too close to call between Democrat Conor Lamb and Republican Rick Saccone. It’s a practical tie with Lamb holding a tiny lead. But Lamb has claimed victory and Democrats are celebrating no matter what happens next because this is a district that favors Republicans, it was won by President Donald J. Trump by 20 points. So even normally red districts are up for grabs come November.

Or as Democratic Congressional Campaign Committee Chairman Rep. Ben Ray Lujan (New Mexico) posted Tuesday night: ““These results should terrify Republicans. Despite their home field advantage and the millions of dollars … We have incredible candidates with deep records of service running deep into the map this year, and it’s clear that these Republican attacks are not going to stick.”

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Back to the map: Sharice Davids, who is running in Kansas fits that storyline precisely. She is running in a district that Republicans should win easy. Rep. Kevin Yoder won re-election in 2016 with an 11-point margin. But remember the Pennsylvania 18th favored Republicans by 20-points.

Davids is Ho-Chunk, an attorney, and she worked in the Obama administration. This is pretty much an anti-Trump-agenda resume’.

The most immediate boost from Tuesday’s vote should be more campaign donations.

Another #NativeVote18 candidate who could benefit from a re-imaging of the election landscape is Amanda Douglas in Oklahoma. After Lamb claimed victory in Pennsylvania she tweeted: “Yes! his is exactly what I’m talking about!!! I can’t wait to work with newly elected Congressman@ConorLambPA!”

Douglas, Cherokee, is running in the state’s 1st Congressional District. Two years ago Democrats did not field a candidate in that race. It’s rated as a “plus-17” Republican district — in other words, awful similar to the Pennsylvania 18th.

In another part of Oklahoma, two Cherokee Nation citizens could both potentially be on the fall ballot. Rep. Markwayne Mullin is running for his fourth term as as Republican. Democrat Jason Nichols, the mayor of Tahlequah, is running as a Democrat. Mullin won 70 percent of the vote in his last election bid.

Rep. Tom Cole is also running for re-election as a Republican in Oklahoma’s 4th congressional district. Cole, Chickasaw, also earned more than 70 percent of the vote in the last election.

One #NativeVote18 candidate who had a good week before the Pennsylvania election was running in New Mexico.

Debra Haaland, 2018 Elections

Haaland’s challenge is to win the Democratic primary in June because, unlike most Native candidates, she’s running in a district that favors Democrats.

Last weekend Haaland was the top-vote getter at the state’s party convention, winning nearly 35 percent of the vote in a crowded field. She told delegates: “Congress has never heard a voice like mine.”

Haaland, is Laguna Pueblo. Congress has never elected any Native American woman to its ranks since voting began in 1789.

Haaland, Davids, or Douglas could be the first.

The Pennsylvania race also raises questions for the #NativeVote18 candidates who are Republicans. Former Washington State Sen. Dino Rossi would be at the top of that list. Rossi, Tlingit, is hoping to succeed a moderate Republican, Rep. Dave Reichert, in Washington’s 8th congressional district. That district has been trending Democratic.

The president’s popularity is reflected by Rossi’s own words. He told The Seattle Times that he is “not running to be ‘The Apprentice.’ I am running to be the congressman from the 8th Congressional District. The way I am going to treat Donald Trump is just the same way I would have treated George W. Bush or Barack Obama. If I agree with them I agree with them, and if I don’t, I don’t.”

One #NativeVote18 candidate who is not running away from President Trump is Gavin Clarkson in New Mexico’s 2nd Congressional District. His campaign website proclaimed “the best way to help President Trump stop the swamp and protect New Mexico is to run for the Republican nomination to make sure we retain this Congressional seat in November.”

Then this Southern New Mexico district is changing too. The seat is now held by Rep. Steve Pearce is running for governor — making this an open seat. Pearce won easily, capturing 60 percent of the vote. But the district is now 54 percent Hispanic and in a wave election, it could be the ideal seat for a Democratic pickup. Trump won the district by 10 points, half of the margin in Pennsylvania.

There are also three #NativeVote18 candidates running as independents or on third-party lines. Eve Reyes Aguirre is running for the U.S. Senate in Arizona on the Green Party ticket. Aguirre is an Izkaloteka Mexican Native.

She recently tweeted that she is an “unconventional politician” and is rounding up signatures to make the ballot. Henry John Bear is running as a Green Party candidate in Maine’s 8th Congressional District. Bear is a citizen of the Houlton Band of Maliseet Indians. And, finally, in Minnesota, Ray “Skip” Sandman is running in the 8th Congressional District as an independent. Sandman is Ojibwe.

Can an independent or third party candidate win in this environment? It’s hard to say, there is no real evidence yet. But as the Pennsylvania results show, this is an election cycle where anything is possible.

Mark Trahant is editor of Indian Country Today. He is a member of the Shoshone-Bannock Tribes. Follow him on Twitter @TrahantReports

Amanda Douglas ‘bothers’ to run for Congress in Oklahoma #NativeVote18

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Amanda Douglas is running for Congress in Oklahoma’s 1st congressional district. She is a citizen of the Cherokee Nation of Oklahoma. (Campaign photo)

Mark Trahant / Trahant Reports

Across the country more women than ever are running for office, including Congress, statewide posts, and legislatures. That’s the case in Indian Country, too. So is it a record year? It sure looks to be so.

Amanda Douglas is the latest candidate. “Northeastern Oklahoma is so skewed that not a single non-Republican candidate has officially registered to run for the 1st District in the coming 2018 election,” she wrote on her campaign web site. “Most agree that this is because it is historically a heavily Republican district– it hasn’t seen non-Republican representation since 1987. The thought is that there isn’t enough support for anyone other than a Republican to even bother running.”

Douglas is bothering to run. (This gets to my favorite rule in politics: You gotta run to win.) Two years ago no Democrat bothered to run and the incumbent, Rep. Jim Bridenstine picked up 100 percent of the vote. Not bad, right? He is not running for re-election because he is President Donald J. Trump’s choice to head the National Aeronautics and Space Administration (NASA). That means the district will be an open seat.

Douglas and her family are citizens of the Cherokee Nation from Glenpool, Oklahoma, and she’s a graduate of Oklahoma State University.

“Yes, I know,” she writes. “I am not exactly drowning in political experience; however, I want you all to know that I consider that an advantage over other candidates at this point. We need fresh air in Washington. We need representation in Congress that is NOT part of the club– someone who is there for the good of the PEOPLE, not for financial gains or exploitable opportunities.”

There are now three Native American women running for the U.S. House. Deb Haaland in New Mexico, Sharice Davids in Kansas, and Douglas in Oklahoma. All are Democrats. In Arizona, Eve Reyes Aguirre is a candidate for the U.S. Senate running on the Green Party line. There are two Native American women running for state governors, Paulette Jordan in Idaho, and Andria Tupola Hawaii. And Peggy Flanagan is running for Lt. Gov. Minnesota. There are also six Native American running for Congress. 

Mark Trahant is the editor of Indian Country Today. He is a member of the Shoshone-Bannock Tribes. @TrahantReports on Twitter.

 

 

 

The money chase. #NativeVote18 federal candidates make their pitch for big bucks

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U.S. Rep. Tom Cole, a member of The Chickasaw Nation, raised more than $869,000 last year. #NativeVote18 (Campaign photo)

Mark Trahant / Trahant Reports

It’s time to look at the money. How much money are #NativeVote18 candidates raising?

Yes, I know, this is a silly metric. After all there is no relationship to governing and calling up people you don’t know and asking them for money. Yet this is the system in place. A candidate is more likely to be successful if she or he can raise a lot of money.

So it’s no surprise that the big money collectors — even in Indian Country — are the ones who already hold office or who have held office recently. And it’s probably no surprise that the big money is headed down Republican alley.

The top money raiser is Rep. Tom Cole, R-Oklahoma. The latest Federal Election Commission reports were posted at the end of January and reflect fundraising for 2017. His net: $1.7 million, cash on hand.

Several tribes donated the maximum amount to Cole’s campaign. Oklahoma tribes, such as his own, the Chickasaw, and the Cherokee Nation, backed Cole as well as tribes from across the country ranging from Penobscot to Stillaguamish.

Some of the contributors have different agendas. Tribes, for example, support Cole because of his strong stands on tribal sovereignty. Yet the American Dental Association, another contributor, has worked against that very issue by challenging the tribes right to regulate mid-level dental practices. (Previous: Tribal sovereignty and the call for better oral health.)

Washington congressional candidate Dino Rossi comes in second for fundraising last year, netting a little more than a million dollars. This is remarkable when you consider he was not even a candidate until September. Rossi is Tlingit and Italian.

As I wrote in September:  “One of his first jobs was working for Bernie Whitebear at Seattle’s United Indians of All Tribes. It’s interesting how some candidates make their tribal affiliation prominent and weigh in on issues that impact Indian Country. That would not be Rossi. But he doesn’t shy away (as many politicians do) from the conversation. It’s just not his focus.”

His campaign finance report bears that out. You won’t find a lot of tribal money.

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Debra Haaland, who is running for Congress in New Mexico, raised more than $386,000 in her bid. If elected, she would be the first Native woman ever elected to the House. (Campaign photo)

The top Democrat for fundraising this cycle is Debra Haaland running in Albuquerque. She ended the year just shy of $200,000 in cash. Haaland, of course, and I can’t write it often enough, would be the first Native American woman ever elected to Congress. She’s running in a district that favors Democrats but she must win the primary first against seven other candidates. So far Sedillo Lopez, a former associate dean at the University of New Mexico Law School, has raised some $456,000 and reports $348,000 in cash on hand. Haaland has raised a total of $386,000 in contributions.

There is a huge difference between Haaland’s fundraising and Cole’s money. Most of her contributions come in $10 and $25 chunks. Small money. But that’s important because it could reflect interest by real voters instead of tribes and Political Action Committees and business interests. She does get some money from tribes, including her own, Laguna Pueblo, but not nearly as much as is found in Cole’s treasury.

The race for Oklahoma’s second congressional district could become the first election between two tribal members, the incumbent, Rep. Markwayne Mullin, and his challenger Tahlequah Mayor Jason Nichols. Both men are Cherokee.

But so far on the money side it’s not much of a contest. Mullin raised about $725,000 last year, netting $434,333.37. Nichols raised $17,575.52 and ended with $8,287.30 cash on hand.

The trick in any campaign is to raise as much money as needed to be competitive. That doesn’t always mean first. But it does mean having the resources to compete in media advertising, including social media, hiring staff, and organizing.

Several #NativeVote18 candidates showed no fundraising in the FEC reports. It could be because there fundraising is scant, or ramping up later, or because reports have not been filed yet.

#NativeVote18 spreadsheet of federal candidates with links to FEC reports.

Next up: State candidate fundraising totals.

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

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

 

 

First, do no harm. What it takes to manage the Indian health system

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Robert Weaver, Quapaw, is President Donald J. Trump’s nominee to head the Indian Health Service. Weaver’s background is insurance, not health care delivery. (Weaver Group photo)

 

Mark Trahant / Trahant Reports

What qualifications are needed to manage (and possibly reform?) the Indian health system? It’s Indian Country’s largest employer with more than 15,000 on the payroll and many, many more people who work in health care for tribes, non-profits and other related agencies. The IHS budget is $6.1 billion. Yet it’s also the least funded national health care delivery system, operating in a political atmosphere where critics ask, why can’t it do more?

The Wall Street Journal published a story last week that raised questions about Robert Weaver, the Trump Administration’s nominee to head the Indian Health Service. The Journal challenged Weaver’s history at St. John’s Regional Medical Center in Joplin, Mo., from 1997 to 2006. However it quoted Jennifer Talhelm, an HHS representative, saying “any suggestion Mr. Weaver is unqualified to run IHS is a pure act of character assassination.”

Weaver is a member of the Quapaw Tribe of Oklahoma.

A few facts: Weaver will be the least educated director of the Indian Health Service ever. If confirmed, Weaver will the tenth permanent director. All but one prior to Weaver have been physicians, most with multiple degrees in public health, science, and health administration. One former director, Robert McSwain, was not a medical doctor, but he was a longtime health manager and holds a Master of Public Administration from the University of Southern California. On his CV, Weaver lists his education at Missouri Southern State University in International Business with an emphasis in Marketing and Accounting; Minor in Spanish; Minor in Vocal Music & Piano. However the Journal reported that he was seeking a degree and did not graduate.

Weaver’s background is insurance. In a September 2016 profile in Native Oklahoma magazine, Weaver said, “We have Native Americans who are brilliant — geniuses — at gaming, but where are the Native American geniuses at insurance? It’s the second-largest cost we pay other than payroll. Yet it just goes to the wayside.” He told the magazine that his business saved the Quapaw Tribe more than $5 million a year.

“I try to be a translator for tribal leaders to understand this convoluted, difficult-to-understand, most of the time full of lies and deception industry, into ‘this is what it is. This is what your choices are.’ I get it,” he told Native Oklahoma.

Perhaps the Indian Health Service should be led by someone with an insurance background. It would surely help if the agency could come up with a better funding model, including a mix of insurance funds (third-party billing in IHS-speak.)

But there are three problems that ought to be clearly addressed through the Senate confirmation process.

First there is the problem of scale. Weaver would jump from managing a $10 million a year small business — one where he can hire and fire at will — to running a $6 billion agency where personnel decisions are made by folks higher in the chain of command at the Department of Health and Human Services or even as a favor to a United States Senator. And firing? Just one such action could take up more time than the three years left in this administration. And that’s the easy stuff. The agency’s operations are complicated by Congress, law, regulation, tribal relations, the Veterans Administration, Medicare, Medicaid, and private insurance.

To his credit, Weaver has been outspoken about the underfunding of the Indian health system. (Question: Will he say so again in his confirmation testimony?) In a paper he wrote a year ago, Weaver said: “Healthcare is a treaty right for all Native Americans. The method of delivering healthcare for Native Americans is the Indian Health Service system established through the Federal Government. The Federal Government allocates funds to the IHS system each fiscal year. This allocation has been and continues to be inadequate to meet the healthcare needs of Native Americans. Currently it is underfunded by thirty billion dollars annually.”

That figure of $30 billion would eliminate the funding disparity for Indian health. (The National Congress of American Indians has published a plan to make that so over a decade.)

The second problem is how to articulate the Indian health story. This is a problem of “duality,” two competing ideas. On one hand you have some significant health and management problems such as those identified in the Great Plains by The Wall Street Journal. On the other hand you have a system that is innovative and includes models of excellence (such as clinics in the Pacific Northwest or the Alaska Native Medical Center.) One story is told. The other less so. I am convinced that a fully-funded system will only happen when we tell both stories. The narrative of failure is not an incentive to invest more money.

The third problem is the Affordable Care Act and Medicaid. Weaver wrote that the law works for Native Americans but overall it was a failure. “We now see that it did not provide health insurance for the forty million uninsured Americans identified as the target market in 2008, it is not affordable for those who were pulled into the ACA system, and the out of pocket maximums associated with the plan effectively make access to healthcare unattainable,” he wrote. The first part of that sentence is factually incorrect. The uninsured rate dropped from 20.5 percent in 2013 to 12.2 percent in 2016, a 40 percent decline. You can argue about the cost of that insurance, but it’s complicated because the ACA required minimum standards for insurance, covering such things as women’s health. All of the Republican plans are designed to save money by getting rid of those standards.

Of course in the Trump era there’s probably not a candidate for any public office who champions the ACA.

But I also don’t see any Medicaid experience in Weaver’s background and that is an expertise area that is critical. Some of the medical, treatment, and ethical issues are extraordinarily complex. They will require a solid team to help consider all of the alternatives that have life and death consequences. (So, if confirmed, he’ll need a lot of help.) Oklahoma is not a Medicaid expansion state, so there would not be a lot of experience in squeezing every dollar from Medicaid by making more people eligible or rethinking the coding of costs. The public insurance of Medicaid (and Medicare) now total $1.05 billion of the IHS budget, but it could be a lot more.

Weaver could use his expertise to help tribes improve insurance for tribal members and employees — and that could boost funding for IHS. Private insurance is now only about $110 million of the agency’s revenue.

So what are the qualifications necessary to run the Indian health system? I have a bias. I have met some of the great physicians who ran the agency. I remember Emery Johnson’s passion and thoughtfulness about what IHS could be. I’d even argue that IHS has had remarkable leadership since its founding. So the standard, for me, at least, is quite high. There are also two Native women who have run state health agencies — an ideal background for managing the IHS. There is a lot of talent out there.

But the Trump administration likes the idea of shaking up government. And, appointing someone to run the IHS with a very different background, does just that. Perhaps Weaver brings a new way of thinking and managing. Then again we would do well to remember the latin phrase that medical doctors learn early in their training, Primum non nocere. It means: First, do no harm.

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 #IndianHealth

Trahant Reports is on iTunes or Soundcloud. Download here. 

(Note: I use the phrase, Indian health system (lower case) unless I am specifically talking about the agency. My reason is that the narrative of a government-run health care agency, the Indian Health Service, doesn’t reflect what most of what the agency does now. The funding mechanism that supports tribes and non-profit health care agencies is the largest part of the system.)

 

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

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Mark Trahant / Trahant Reports

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

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

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

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

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

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

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

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

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Source: Georgetown University Health Policy Institute

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

On the Democrats’ side the numbers are smaller.

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

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

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

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

 

This article was corrected to fix a misidentified candidate.

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

 

SheRepresents

 

Price visits Indian Country … and is gone

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


Trahant Reports

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

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

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

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

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

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

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

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

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

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

 

 

Dino Rossi seeks House seat in Washington; Notes from #NativeVote18 #IndigenousNewsWire

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Former state Sen. Dino Rossi, a Republican, is running for Congress in Washington’s 8th district. (Official photo)
Mark Trahant / Trahant Reports

Dino Rossi has an interesting political legacy. He was for several weeks the Gov.-elect for Washington state. Then after much counting (and recounting) Democrat Christine Gregoire took the lead by 129 votes and was she sworn in as governor on January 12, 2005.

Since then Rossi has run for governor again, the U.S. Senate, and was recently appointed to a state Senate seat to fill out the remaining term of a member who had died.

Rossi is Tlingit. One of his first jobs was working for Bernie Whitebear at Seattle’s United Indians of All Tribes.

It’s interesting how some candidates make their tribal affiliation prominent and weigh in on issues that impact Indian Country. That would not be Rossi. But he doesn’t shy away (as many politicians do) from the conversation. It’s just not his focus. He has a fascinating background. From his transition team biography: “Dino’s mother, Eve, came from Alaska. She was half Irish, half Tlingit Alaskan Native. She’d married in Alaska and had five children, but the marriage became difficult. To get away from the situation, Eve took her kids to Seattle. For a time the family lived in public housing in Holly Park while Eve waitressed during the day and went to beauty school at night.” His mother met and married John Rossi and the family eventually moved to Mountlake Terrace. Back to the bio: “The Rossi kids were raised on a school-teacher’s salary. They didn’t have a lot of money, but their house was full of love.”

If you read his story, you’d think it was a classic liberal narrative. Public housing. Government works. But no. Rossi favors the bootstrap side of the story, a working family that raised itself up. He has always run as a conservative candidate. That said. In his Senate role he was willing to reach across party lines and come up with a deal.

I remember a Seattle P-I Editorial Board with then Sen. Rossi where he talked about the shortage of funds for higher education. But then, he suggested, book as much spending as possible on the capital side of the ledger. That’s where serious dollars could be found, he suggested. Creative.

Or as his bio puts it: “In the state Senate, Dino became a leader on budget issues. He eventually became Chairman of the Senate Ways & Means Committee – which writes the state budget – in 2003, when the State faced the largest dollar deficit in history. Dino was able to work across party lines and balance the budget without raising taxes and while still protecting the most vulnerable. Dino also focused on other issues: he spearheaded legislation to punish drunk drivers and child abusers; he worked to fund the Issaquah salmon hatchery; he secured funding for Hispanic/Latino health clinics, and he championed funding for the developmentally disabled community.”

Washington’s 8th District poses a lot of the same challenges that Rossi faced when he ran for governor; the demographics of the district (like the state) are more more diverse and liberal than a few years ago. But he enters this race with one advantage: He will be the only Republican while there will be a half-dozen Democrats.  Washington has a top-two primary, but the winning Democrat will have to build name ID and consolidate support, something Rossi will already have with Republicans.

The seat is now held by Rep. Dave Reichert, a Republican.

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Native American congressional candidates. Interactive map and database.

#NativeVote18 notes:

There are now seven #NativeVote18 candidates for Congress. Three Republicans, Rossi as well as Oklahoma Rep. Tom Cole and Rep. Markwayne Mullin. And four Democrats, Carol Surveyor in Utah, Debra Haaland in New Mexico, J.D. Colbert in Texas, and Tahlequah Mayor Jason Nichols (who’s challenging Mullin).  So far.

I have updated my #NativeVote18 interactive map and database, including early financial reports. (Speaking of that: I have started working on this cycle’s legislative database … if you know of candidates, please let me know.)

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Haaland endorsed by Navajo Nation Vice President

New Mexico candidate Debra Haaland picked up an endorsement by Navajo Nation Vice President Jonathan Nez. He wrote: “Let’s honor the voice and rightful place at the table by electing the first American Indian woman to Congress. Deb is a champion for all citizens of New Mexico and will represent us with dignity on Capitol Hill.”

The “first” remains a powerful argument. Here we are in 2017 and Congress has never seated a Native American woman ever. As a Haaland fundraising page puts it: “Congress has never heard a voice like mine.” She is a Democrat.

 

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Carol Surveyor, a Democrat, running for Congress in Utah. (Campaign photo)

Surveyor writes about her mother’s murder

On her Facebook page, Utah candidate Carol Surveyor  tells a powerful, personal story about violence against women. “One has only to live on a reservation or speak to members of the communities to know that rates of missing and murdered women and girls are high. Nearly every Native family has a story of a female relative who is missing, murdered, or whose murder has gone unsolved,” she writes.

“So when my mother was murdered on November 30, 2015 four days after Thanksgiving I couldn’t stop crying. I couldn’t stop thinking about what were the last words I said to her, did I tell her I loved her, did she know. A week later on a Monday December 7, 2015 18 days before Christmas we buried my mother. I saw her white coffin lowered into the ground. As my mother’s bags that she use to carry with her when she came to visit were also lowered into the ground with her I felt my heart break.”

She writes: “My mother, My mother’s teachings of resilence is what got me this far.” Read the whole post.

This is exactly why it’s so important for there to be representation for all in Congress — including Native American women. We know there is a problem. We need more data and we need solutions. And that cannot be done without more voices where decisions are made.

Surveyor is campaigning as a Democrat.

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

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

 

 

 

 

 

 

 

 

Alaska’s Walker, Mallott seek second term; plus NM, Utah and Oklahoma races

*** Updated to include new candidate, maps.

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Time flies. Alaska Gov. Bill Walker, Lt. Gov. Byron Mallott are seeking a second term for their independent partnership. (Photo via Facebook.)

Mark Trahant / Trahant Reports

I have been avoiding politics. Last year I was consumed by dozens of races across the country, building data bases, checking names, and generally being enthusiastic. Now? Well, this year, I have been absorbed by the Republican plans to rewrite the Affordable Care Act, destroy Medicaid as we know it, and, as a by-catch, sabotage the Indian Health system.

Of course policy and politics are connected. The people we elect are the ones who make the decisions about our health care, our education, how much money the government spends and collects, or whether we’re at war or at peace. Imagine being a Native American politician in the Trump era. It would be an uphill climb to represent constituents as well as being a public advocate for Native people and community.

Labor Day is always the big weekend in politics. In an election year, it’s the date when campaigns really gear up, there is a crunch of about nine weeks until votes are counted. For the 2018 cycle, that marker is still more than a year away. Yet late summer is when candidates are recruited, a few take the plunge, and those who say yes, build campaign organizations and raise money.

There is a lot to report about American Indian and Alaska Native candidates.

Starting in Alaska where Gov. Bill Walker and Lt. Gov. Byron Mallott are running for re-election. In 2014 Walker and Mallott ran a campaign that transcended party politics. Mallott, a Tlingit and former chief executive of Sealaska Corporation, had been the Democratic Party’s nominee for governor until he dropped out to join Walker. This was politics at its best. I remember being at several campaign events, including a couple panels I moderated, and was struck by the similarity of their messages (and more important, their tone) so coming together was good for the polis, a Greek word that means the ideal in a community.

Mallott told Juneau radio station KINY that the pair would again run as an independent team. “What ever we do, we’ll do together,” Mallott said. He said party labels do not come up in their governing plans because they’re more interested in solving problems. Walker and Mallott took office with the state facing an unprecedented fiscal crisis brought on by low oil prices and structural deficits. Mallott called it a slow rolling recession. “We need to put this behind us,” he said, “so Alaska can grow again.”

Walker and Mallott officially filed for re-election on August 21 as independent candidates.

This will be a tough race. Walker and Mallott have raised issues that are not exactly popular, such as reducing the state’s permanent dividend (per capita to you and me) as well as implementing new taxes to pay for government.

There are not that many independents in state governments (or the federal government, for that matter).  So it will be interesting to see if Democrats again choose to align with Walker and Mallott. (Alaska’s House is also run by a partnership of Republicans and Democrats working together, while the Senate remains under Republican leadership.)

For their part, Republicans are operating as if the Democrats will field a candidate (one name tossed about is former Sen. Mark Begich). The state’s party chair, Tuckerman Babcock told KTOO television that “from our perspective, having two Democrats running is a good thing.”

Walker and Mallott have a track record. If nothing else (and there is a lot more) they can be proud of expanding health care access in Alaska through Medicaid expansion. This program opened up health insurance to at least 35,000 additional Alaskans and improved the funding stream for the Alaska Native health system. The uninsured rate in the state dropped from 18.9 percent to 11.7 percent. A success story all around.

One measure of that success: A group of doctors is promoting a ballot initiative to codify the Medicaid program in Alaska (protecting the program no matter who is governor).

 

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Kelly Zunie (Facebook photo)

Kelly Zunie is running for the Republican nomination for New Mexico’s lieutenant governor. She is a member of the Zuni Pueblo and served as Cabinet secretary for the New Mexico Indian Affairs Department for nearly three years.

Her campaign Facebook page said:  “Zunie is committed to meeting the needs of New Mexico’s private sector business owners to improve capacity to expand and the workforce. Zunie will also focus on the safety of New Mexico’s children and families.”

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Former New Mexico Democratic Party Chair and candidate for Congress Debra Haaland. (Campaign photo)

 

On the Democratic side, Debra Haaland is running for New Mexico’s first congressional district. (Previous: Pueblo woman. Mom. Gourmet cook … candidate for Congress.) Haaland previously has been a Democratic nominee for Lt. Gov. and served as the state’s party chair. Now she’s running in a contested primary for the state’s most urban district (and only a little more than 3.5 percent Native American). She’s a member of the Laguna Pueblo.

The key to winning this race is building up enough financial resources and early ballot strength to win the primary. Haaland has already raised more than $150,000, including significant sums from Indian Country contributors. Joe Monahan’s New Mexico political blog put it this way: “Something a bit historic is happening in the early going in the Dem race for Congress. Large sums of money from Native America tribes and pueblos here and outside the state is starting to flow to Haaland, who would be the first Native American woman ever elected to the US House.”

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Carol Surveyor, candidate for Congress in Utah.  (Facebook photo)

And in Utah, Carol Surveyor is running for the House in that state’s second congressional district. Surveyor is Navajo and a political organizer, co-founder of Utah League of Native American Voters. Surveyor told Enviro News Utah that it’s about time a Native American woman served in Congress. “Women of color are often overlooked in their opinions, their views, their leadership, and so forth,” she said. “Native Americans have traditionally been overlooked and forgotten in this country, women in native communities are traditionally matriarchal. Yet, there have been many native women who have run for public office. In the past, there are native women who have run for federal office, but unsuccessfully. Again, I think this is because politics is still viewed as a men’s game. My remark about “it is time,” refers to changing the game, and what better way to change the entire game than by electing a Native woman? Doing so would be a shift in the way many people the world over see the U.S., how many people see U.S. politics in this country, and it would show how progressives in the U.S. recognize and understand the forgotten voices. I am a forgotten voice.”

The web site, Indianz.com, posted a story that said J.D. Colbert, a citizen of the Chickasaw Nation, is running for the 3rd Congressional District in Texas. “Voters there haven’t elected a Democrat there in 50 years but the banker and business leader is counting on a shift in demographics to send him to Washington, D.C. ‘America is in the crucible of seismic demographic transition. The impending death of the White majority and the rise of a more diverse New America is the fundamental cause of divided America and is the basis of the divisive cultural wars,’ said Colbert, who is also a descendant of the Muscogee (Creek) Nation.”

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Tahlequah Mayor Jason Nichols (photo: Oklahoma Municipal League)

Finally, there is an interesting twist in Oklahoma. Remember there are currently only two tribal members in the Congress, both Republicans. U.S. Representatives Tom Cole and Markwayne Mullin. Cole is Chickasaw and Mullin is Cherokee. (Previous: Rancher, businessman, and yes, absolutely, a career politician.)

Now another Cherokee Nation tribal member, Tahlequah Mayor Jason Nichols is challenging Mullin. (This would be a first if both win primary contests: Tribal members on both sides of a congressional ballot.) Nichols is running as a Democrat.

Nichols told the Tahlequah Daily Press that he’s running because of the dysfunction in Washington.  “I’m accustomed to operating in a nonpartisan environment where ideas and practical considerations are the focus of discussions,” he said. “As the mayor of a small town, you have to look your constituents in the eye every day. That’s kept me grounded and reminded me there are real people affected by every decision I make, to never lose sight of that, and to make certain I stay connected with them and never forget whom I work for. That isn’t a political party.”

Nichols is a political science instructor at Northeastern State University and has worked as an information technology officer for a tribe and a school district.

That’s it. We’re off and running. More politics ahead. Watch for the hashtag, #NativeVote18.

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

 

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Interactive map and spreadsheet of #NativeVote18 candidates.