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.)

 

Trump complains. And signs the business-as-usual spending bill into law anyway

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President Donald J. Trump speaks about the $1.3 trillion Omnibus Spending Bill before signing into law. (Official White House photo by D. Myles Cullen)

Indian Health, Bureau of Indian Affairs see a budget increase

Mark Trahant / Indian Country Today

The federal government’s newly enacted budget is a massive “omnibus” act that spends $1.3 trillion and makes some members of Congress pleased and others angry. It’s a document that reflects a broken budget system. And, at the same time, it’s a business-as-usual document in a presidential administration that has promised structural change.

“There are a lot of things I’m unhappy about,” President Donald J. Trump told reporters at the White House Diplomatic Reception room. “But I say to Congress, I will never sign another bill like this again. Nobody read it, it’s only hours old.”

But the negotiations were not hours old. The back and forth between Democratic and Republican lawmakers was essentially a year late. This spending bill only funds the federal government between now and the end of September. But the process took so long because neither side had enough votes to pass the document on their own; Republicans needed votes from Democrats and to get those votes there had to be deals. Lots of deals. Business as usual.

And business as usual is good for Indian Country. Federal Indian programs, some of which had been slated for either elimination or deep cuts, continued on course.

The omnibus spending bill increases funding for the Indian Health Service by 10 percent, and the Bureau of Indian Affairs and Bureau of Indian Education by 7 percent to $3.064 billion. The IHS budget line s $5.5 billion. When the budget is compared to the president’s request, the increases are even sharper, more than 16 percent for the IHS and 23 percent for the BIA.

At the BIA, according to an analysis by Amber Ebarb at the National Congress of American Indians, “Overall, the eliminations and reductions proposed in the president’s budget were rejected.”

Other budget items:

  • The bill includes a 3 percent set aside for Indian tribes within the funds available under the Victims of Crimes Act. The cap for these funds was set at $4.4 billion, which amounts to $133 million. As Ebarb wrote: “This is an important step forward for Indian Country, which has the highest rate of criminal victimization and had up until this point been left out of this funding. This funding will address the long standing inequity and meaningfully improve the landscape of victim services in Indian Country.”
  • The bill provides $50 million for grants to Indian tribes or tribal organizations to address the epidemic, and $5 million for tribes in the Medication-Assisted Treatment for Prescription Drug and Opioid Addiction program.
  • Infrastructure spending would increase for BIA and IHS construction, BIA road maintenance, and a $100 million competitive grant program is added under Native American Housing Block Grants in addition to the $655 million provided for the NAHBG formula grants.

 

President Trump said he signed the bill into law because it increased military spending. “I looked very seriously at the veto. But because of the incredible gains that we’ve been able to make for the military, that overrode any of our thinking.”

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

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

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

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Mark Trahant / Indian Country Today

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

 

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

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

#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

Trump budget is a ‘messaging document’

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

Mark Trahant / Trahant Reports

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

 

 

 

 

 

Eleven words that should serve as a warning from the State of the Union

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(White House photo)

The state of democratic institutions

Mark Trahant / Trahant Reports

I skipped watching the State of the Union last night. That was the first time in, well, a couple of decades. There was really no reason to watch. I figured President Donald J. Trump would set out to be presidential in tone, but his words would largely be the more of the same.

It wasn’t a boycott on my part. I just didn’t care to listen. It’s so much less stressful to read the text later.

The State of the Union is a joint session of Congress. The House of Representatives is jammed with its members, the Senate, members of the Supreme Court, the cabinet, and invited guests. A fitting place for these eleven words said by the president: “Tonight, I am calling on the Congress to produce a bill …”

The topic was infrastructure. But the problem of Congress producing a bill should be the greater question.

Instead of watching the State of the Union I was reading about the Ancien Régime, the end of the monarchy in France, the time just before the revolution.

I am especially interested in the mechanics of the Estates General. This was a legislative body with no official power (the king held that). The First Estate was the clergy, the wealthiest community in France at the time, owning about ten percent of all the land and exempt from all taxes. The Second Estate was the nobility. Still rich. Just not as rich as the priests. At least on a per capita basis. (And did own about a third of all the country’s property.) The Third Estate was supposed to be everyone else, but in practice it was really the bourgeoisie, the merchants, the lawyers, the folks who had some money and some property.

At first each “estate” had an equal vote. But there were only about 10,000 members of the clergy, about 400,000 nobles, and 25 million people. So representatives that accounted for about 3 percent of the population could out vote the 97 percent.

The Estates General had one essential mission: Approve a budget. But for more than a decade that body could not find the votes.

The opening of the Estates General would have been a familiar scene to those watching the pomp of a State of the Union. “Louis XVI … as a peaceful king, he declared himself ‘the people’s greatest friend.’” Make France Great Again, right?

There are two things from that era that ought to be a concern in the United States. The absolute imbalance between representation in the legislature and the population. And the inability to come together and agree on a spending plan.

Two of the three bodies in the Estate General wanted to tax everybody else. The Third Estate, the people, knew that meant them.

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The Republican plan at least pretends to cut taxes for everybody (all the while growing the deficit beyond reason). But rich corporations (our version of the Second Estate) get permanent tax breaks while the majority does not. If you look at the data since the 1950s the Corporate Estate taxes have been shrinking dramatically. (The United States has mostly paid for these tax cuts by increasing the payroll tax, the money that comes out of our paychecks.)

Just before the Revolution, the French government was facing all sorts of fiscal problems. As French economists Thomas Sargent and François Velde wrote in the Journal of Political Economy that after wars (including the cost of the American Revolution) there was a call to cut government spending across the board. And tax revenues “grew too slowly, causing debt service to increase. By 1788, as in 1770 and during the Regency, the inexorable compounding of interest brought France to a fiscal crisis. France in the grips of some ‘unpleasant arithmetic.’”

There is unpleasant arithmetic in our future. Especially when Congress cannot reach a reasonable conclusion about spending. The richest country on the planet is budgeting over the course of a few weeks.

The other issue that ought to be a concern is the destruction of basic democracy. The Estates General was completely illogical (one-third, one-third, one third) and it eventually reformed so that the people had at least as twice as much representation as the church and nobles. But that system was still way out of whack.

That, too, is America. It’s not quite as bad. Yet.

“Americans are dreamers, too,” President Trump said when he talked about his ideas on immigration. That’s odd. Which Americans have access, politically at least, to those dreams?

There are 3.5 million citizens in Puerto Rico who cannot vote for Congress, the Senate, or president. There are less than 3.5 million citizens living in Wyoming, Vermont, North Dakota, Alaska and South Dakota. Those citizens are represented by ten United States Senators and five members of the House of Representatives. And don’t get me started about California’s place in this mess. (It’s not democratic and it’s not fair.)

It’s not the electoral college. And it’s mostly not gerrymandering. The imbalance in the U.S. system of democracy is old and structural. It’s about geography and who gets counted as voters. (A problem that is sure to grow in the next census.) And on top of that state legislatures are working to make it harder to vote, even further limiting democratic representation.

The Economist this week published its index of democracies. “America sits in 21st place in the ranking, level with Italy. It remains a “flawed democracy” for the second year in a row,” the magazine said. The index uses index 60 indicators across five broad categories—electoral process and pluralism, functioning of government, political participation, democratic political culture and civil liberties—and “concludes that less than 5 percent of the world’s population currently lives in a “full democracy.”

Seems to me that would be a good goal for any State of the Union. “So tonight I am calling on the Estates General * cough* I mean Congress to produce a bill …” 

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 

 

How much does climate change cost? Try $1.5 trillion and counting has only started

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Dominica’s capital of Roseau in the days after Hurricane Maria. (Photo by Timothy Fishleigh, Caapi Cottage Retreat Center.)

Mark Trahant / Trahant Reports

The Trump administration, and its allies in Congress, are fighting a losing war. They continue to press forward for the development of oil, gas, coal, when the rest of the world understands the implication of that folly. Global warming is the most pressing issue for our time. Period.

The thing is governments really have two choices when it comes to managing the impact on its peoples from global warming: Spend money on trying to reduce the problem; or spend money on cleaning up the catastrophes.

The Trump administration is on the hook for the catastrophe. A report released Monday by The National Centers for Environmental Information pegged the total cost this year at $1.5 trillion, including estimates for Hurricanes Harvey, Irma and Maria. (And that doesn’t even begin to count the human toll, lost lives, lost jobs, lost opportunity.)

I witnessed first hand the impact of Hurricane Maria on the island of Dominica last month. We keep hearing stories about the power grid being down (similar to Puerto Rico) and you think, why? It’s been months. Why aren’t the lights on? Then you see nearly every electrical pole on the island sideways. The entire grid needs to be rebuilt (or better, rethought) and that’s decades of infrastructure. So the figure of $1.5 trillion is far short of what will be needed. Nearly every electrical line, every other house, the damage was so widespread it’s impossible to overstate. And that’s just one island. Multiple the effect across the region. The planet.

Even the United States.

2017-billion-dollar-disaster-map

The Centers for Environmental Information says there were sixteen weather and climate disasters  with losses exceeding $1 billion each across the country last year. These events included one drought, two flooding events, one severe freeze, eight severe storms, three cyclones, and one extraordinary wildfire. These “events” as the center defines them resulted in 362 deaths.

Turns out 2017 was a record-breaking year. “In total, the U.S. was impacted by 16 separate billion-dollar disaster events tying 2011 for the record number of billion-dollar disasters for an entire calendar year,” the report said. “In fact, 2017 arguably has more events than 2011 given that our analysis traditionally counts all U.S. billion-dollar wildfires, as regional-scale, seasonal events, not as multiple isolated events.More notable than the high frequency of these events is the cumulative cost, which exceeds $300 billion in 2017 — a new U.S. annual record.”

A similar report was published by the Government Accountability Office including a recommendation that Executive Office of the President “identify significant climate risks and craft appropriate federal responses.”

But instead of trying to reduce the impact — and the costs of weather-related catastrophe — the Trump administration continues on course for new development of oil and gas. The Interior Department announced new rules that, if enacted, will open up nearly all of the United States coastal waters to more oil and gas development beginning next year.

“By proposing to open up nearly the entire OCS for potential oil and gas exploration, the United States can advance the goal of moving from aspiring for energy independence to attaining energy dominance,” said Vincent DeVito, Counselor for Energy Policy at Interior in the news release. “This decision could bring unprecedented access to America’s extensive offshore oil and gas resources and allows us to better compete with other oil-rich nations.”

Or as Interior Secretary Ryan Zinke put it: “The important thing is we strike the right balance to protect our coasts and people while still powering America and achieving American Energy Dominance.”

Dominance is such a funny word. How can any nation be dominant in the face of hurricanes that are ever more powerful and destructive? How does energy dominance work when tens of thousands of Americans will have to move because their homes are no longer there because of fire or storms? What happens if that number grows into the hundreds of thousands? Millions? How can we afford to spend trillions of dollars rebuilding what we have now?

A group of elders on the Bering Sea immediately condemned the Interior Department’s offshore drilling plan. “We told them that in person last October and again in writing, that there were 76 tribes in these regions opposed to this,” said the statement from the elders. “The draft plan implies that Bering Sea communities were ‘generally supportive of some’ oil and gas activity. This is not accurate and there is no evidence of this from Bering Sea communities. For decades, our people have opposed oil and gas activity and we continue to oppose it today. The northern Bering Sea is a very fragile ecosystem. The marine mammals that we rely on use it as their highway and they follow specific migration routes. That is how we know when and where to find them. The noise and vibration associated with drilling will interfere with their sonar and disrupt their migrations. Then we the coastal people will lose our primary food source.”

There is a connection between developing oil and gas and paying the high costs to clean up after a storm. One side of the ledger goes to a few; the oil and gas “industry.” The folks who bought and paid for this administration.

The other side of the ledger is the rest of us. The taxpayers who will foot the bill for this continued folly.

And on the Bering Sea? The folks who live there are one storm away from a tragedy. As the elders put it: “Our people and our way of life are being exposed to danger and we do not understand why.”

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

Trahant Reports is on iTunes or Soundcloud. Download here. 

 

 

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.)

 

Make 2018 the year we fight about policy (instead of tweets from Donald J. Trump)

Kids Fig 2

Correction: The chart I originally published was misleading. The CBO score for the tax bill (and most of the other measures) looks at the cost over ten years. Appropriations are made in a single year. So that made the tax bill appear more costly in visual form. I am working on a new version now, something that illustrates the downward pressure on federal spending but uses an apple-to-apple comparison. (I also added a sentence in the report below to stress that the tax cuts are measured over a decade.)

Funny thing: I was so intent on getting the area of the bubbles correct that I completely spaced the CBO’s measure of ten years as opposed to a single year for appropriations.

Damn.

Two take aways. First. I still want to illustrate, visually, the downward pressure on the budget. The balloons I used were misleading, but the point remains the same. The pressure to cut is going to grow in intensity. Second: The reconfigured bubbles (which take up too much space because of their relationship) really show the problem of entitlement spending, such as Medicaid. That’s a whole different topic … but visually, wow.

 

Elections should be fought over policy not nonsense

Mark Trahant / Trahant Reports

Elections in America are usually fought over nonsense. Trivial topics. Stuff that grabs headlines. Or issues that remind voters why they are in Political Party A or B. (And for good measure there is always contention about the personality of a So So Candidate who does (or does not) connect with voters.)

Nonsense.

This problem is particularly acute in the Trump era. The recent news cycle pits President Donald J. Trump versus Steve Bannon. The White House statement that Bannon “lost his mind” is attention grabbing. Our political minds want to know what this means for the next election and the Trump coalition (which still defies logic because it subtracts supporters, rather than reaching out and finding new ones).

But politics ought to be more about policy. What choices are being made in our name? What’s the best way to improve the lives of children, the next generation? How do we invest public resources, that means tax dollars, into making life better? These are questions that get far less attention than the latest presidential tweet.

Then the president and Congress have already set the rules for this debate when they passed tax cuts. Now, every act of Congress, every budget from the administration, will set out to justify (and pay for) that law.

This is the problem: The Congressional Budget Office predicts that the  federal deficits will increase to $1.8 trillion over the next decade. “As a result of those higher deficits, debt held by the public would increase from the 91.2 percent of gross domestic product in CBO’s June 2017 baseline to 97.5 percent,” CBO said. That means that the annual budget deficit will be nearly equal to the entire economy.

But CBO is on the conservative side of this argument. The Committee for a Responsible Federal Budget warns that after adding interest costs the tax plan would be enough to “increase debt to 111 percent of gross domestic product … That would be higher than any time in U.S. history, and no achievable amount of economic growth could finance it.”

A federal debt that’s bigger than the entire economy. And, key phrase here, “no achievable amount of economic growth could finance it.”

Already leaders of the Congress — the same bunch who did proposed this tax legislation — are now saying the country cannot afford to spend money on social programs.

Utah Sen. Orrin Hatch (who is soon to retire) said he was one the earliest sponsors of the Children’s Health Insurance Program“I invented it,” he said on the Senate floor. He says he doesn’t know anyone who doesn’t support its reauthorization. Yet. So he preaches that this country must live within its means.

Congress gave corporations a tax break worth $1.3 trillion. And another $425 billion was rewarded to small businesses that pay their taxes on individual returns (so-called pass through taxes). On top of that (for desert, perhaps) the Congress gave the very wealthiest, those few who pay estate taxes on inherited wealth, a break worth $83 billion. Even though those numbers reflect a decade of revenue, it still means that many in Congress say there is not enough money to fund the government.

That’s a rotten framework. But it’s more complicated when you add one more layer: The Budget Control Act of 2011. That law was passed to limit Congress’ power to spend freely. It sets in place budget caps for domestic and defense spending. If the caps are exceeded, then an automatic sequester (remember that?) kicks in unless Congress passes a waiver. That deal linked spending for defense and domestic programs.

Now it’s a problem because the Republicans want to spend a lot more money on the Pentagon. They want that part of the budget to go up. But because it’s linked to domestic programs — such as those that impact Indian Country — that cannot happen without an agreement with the Democrats. Wednesday the leaders of both parties in the House and Senate met to try and make that happen. House Minority Leader Nancy Pelosi described the meeting as  “positive and productive.”

Democrats, for once, have some power to bargain. More spending for defense cannot happen without their votes. (Republicans remain divided over all federal spending.) So Democrats are trying to see how much leverage they have and over what issues. It’s likely that domestic spending will be a part of any deal, and possibly the Children’s Health Insurance Program. Several Democrats, including Sen. Bernie Sanders of Vermont, have said they will not vote for any budget unless it includes a provision to protect immigrants who were brought to this country as children, the so-called Dreamers. (President Trump removed Obama-era protections for this group and it’s a moral imperative for Democrats (and many Republicans) to protect some 800,000 people from deportation. The Deferred Action for Childhood Arrivals, or DACA, began under President Obama.)

That’s a huge agenda. It’s likely that Congress will again push it forward past its deadline of Jan. 19. Even if there is a deal, say today, then the actual writing of the budget will have to go back to the Appropriations subcommittees to be put into legislative language. That will take time.

Federal spending on Indian Country ought to be in a different category, one that does not yet exist. There should be a line item for treaty obligations. Should.

So far the budget numbers are hard to know for federal Indian programs. The Trump administration’s budget was largely ignored. And the House and Senate committee numbers look lean, but fine. But the thing is until there is an actual deal, none of these numbers matter. After a deal each committee will have to go back and determine what money can actually be spent. If it’s a good deal, the numbers will stay the same or even improve. The alternative? No words.

Of course the bigger issue in Congress is about priorities. This Congress has already decided that tax cuts are the most important thing that had to be done. So every fight over the budget has to somehow go through that filter. There is not enough money because Congress is giving corporations $1.4 trillion so they can be more competitive and profitable. (Funny: thought they were both.)

As economist William G. Gale wrote for the Brookings Institute: “… tax cuts are not free; they eventually have to be financed with higher taxes or lower spending. And once those financing requirements are taken into account, most low- and middle-income households are likely to be worse off than they would have been without the tax cut in the first place.”

Worse off. Then Indian Country knew that before the tax bill ever reached the president’s desk.

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

Trahant Reports is on iTunes or Soundcloud. Download here. 

 

 

 

Happy New Fights: Battle over the budget will grow as deficit spending explodes

 

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President Donald J. Trump delivers remarks at the White House on the tax reform legislation. (Official White House photo by Stephanie Chasez)

Mark Trahant / Trahant Reports

The first year of the Trump era has been challenging: The administration and the Congress sought to repeal the Affordable Care Act and radically redesign one of the nation’s best public health insurance programs, Medicaid. That plan failed.  And I’ll come back to that point shortly.

But first: Congress did move forward with its other agenda item, to rewrite the tax code and reduce the amount of federal income taxes that most pay. And the two key words here are income tax. That’s important because most people pay more in payroll taxes than income taxes. The Joint Committee on Taxation looked at the numbers a couple of years ago and found that 80 million tax filers that earn $40,000 or less pay no federal income tax and many even get cash refunds. But we pay $121 billion in Social Security and Medicare payroll taxes. Even those families who make between $40,000 and $75,000-pay three times as much in payroll tax as in federal income tax—nearly $190 billion of the former and just $64 billion of the latter. The total income for a household has to exceed $100,000 more before income tax is a bigger cost than payroll taxes. Bottom line: Wealthy people get a tax cut.

The big winner in the tax bill, however, is business. The new law sharply drops what corporations and small business pay in federal income taxes. The Tax Policy Center calculates that savings at nearly three times as much for business owners in 2019 as for people who whose primary source of income is wages or salaries. The Tax Policy Center found that all households would get an average 2019 tax cut of about 1.6 percent of after-tax income (roughly $1,200). Those who make most of their income from wages would get a tax cut of about 1.5 percent of after-tax income, or about $1,200. But owners of pass-through businesses such as partnerships and sole proprietorships would get an average tax cut of 4.3 percent of their after-tax income (about $4,300).

It’s important to note that corporate taxes have gone up in recent years, but are not at historically high levels (as shown in this Tax Policy Center chart.) During the 1950s corporate taxes were 6 percent of the Gross Domestic Product.

 

corporate_gdp

One way Congress looks at business taxes is to account for “pass through” taxes. So if you earn money as, say, a freelancer. Then you can deduct expenses on another form. This process could be useful to a few people in Indian Country. If you do work that could be considered a “business” (and make enough to pay income taxes) make sure that you are set up as a business because you will pay less tax under this new law.

So lots of people — and especially companies — will pay less in federal taxes. And the federal treasury will have a lot less funding as a result.

“The tax bill will provide a bonanza to the most well-off Americans and profitable corporations, even as it leads millions of Americans to lose health coverage and ultimately raises taxes on many low- and middle-income Americans,” writes Robert Greenstein of the Center for Budget and Policy Priorities. “And, faced with criticism that the tax bill will swell budget deficits, President Trump and House Republican leaders have made clear that one of their top priorities for 2018 will be to use the fast-track budget “reconciliation” process — the same process they used to pass the tax bill — to cut assistance programs that aid millions of struggling families, to try again to repeal the Affordable Care Act (ACA) and cut Medicaid, or both.”

The process of reconciliation means that budget cuts next year could pass the Senate with only 50 votes — all Republicans. That’s awful. But the good news is that even might be a huge hurdle for Republican leaders. The problem is that the Republican majority is not sure what it wants. Some members want more money for the military and are willing to work with Democrats (who want money for domestic programs to make that so). Others want stark budget cuts; sequester times X. Others just want to find a deal of some kind, something that governs the country.

We already know these divisions are deep because the Republican-only majority has been unable to pass a budget for 2018 (which started October 1). The government is running on a temporary spending bill that expires Jan. 19. Right now the House is working off a funding level that would significantly increase defense spending and slight reduce domestic programs. The Senate is basically working off last year’s budget.

That’s all well and good for now but remember the pressure will increase to balance the budget as the cost of the tax legislation is calculated. As the National Congress of American Indians said: “The current tax reform legislation amounts to little more than a $1.5 trillion increase in the federal deficit over the next ten years. This deficit increase will inevitably create pressure to cut federal programs and services that are extremely important to tribal communities. Deficit-financed tax cuts that lead to austerity budget cuts would affect all Americans, but would disproportionately impact American Indians and Alaska Natives who rely on federal funding of the trust responsibility as well as social programs.”

Congress is governing at two and three week intervals because there are not enough votes to pass a real budget. And that’s not a good sign going forward because the budget only gets more complicated next year because of other issues that Congress has been avoiding.

Happy New Year.

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

Trahant Reports is on iTunes or Soundcloud. Download here.