This is a first: Legislation would fully-fund Indian health system, raise billions

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Sen. Bernie Sanders proposed “Medicare for all” bill would fully-fund the Indian Health system for the first time in history. (Senate photo)
Mark Trahant / Trahant Reports

Bernie Sanders is expected to introduce his version of health care reform, a plan he calls “Medicare for all.” At least fifteen Democrats have signed on as co-sponsors to the single-payer plan.

“This is where the country has got to go,” Sanders told The Washington Post. “Right now, if we want to move away from a dysfunctional, wasteful, bureaucratic system into a rational health-care system that guarantees coverage to everyone in a cost-effective way, the only way to do it is Medicare for All.”

Sanders’ bill has no chance in a Republican Congress. Yet the Vermont Independent (who caucuses with the Democrats) is adding to the richness of the debate. He is showing a clear alternative to Republican plans (the latest is one by Sens. Lindsey Graham, R-South Carolina, and Bill Cassidy, R-Louisiana.)

But Indian Country should take note. Sanders bill would fully-fund the Indian health system. Let’s do the math. The current budget for the Indian Health Service is $6.091 billion dollars. And of that, roughly $1.2 will come from Medicaid, Medicare and other insurance. This serves about 2.2 million American Indians and Alaska Natives in 39 states.

But if Sanders’ proposal for universal care were enacted every one of those 2.2 million patients would have funding from insurance. The national average for Medicare beneficiary is $10,986. The total: $24.191 billion. A four-fold increase (and this does not include appropriations, just insurance dollars). So if you include both, the total is roughly $30 billion.

This sound like an awful lot of money, right? That big number reflects what other health systems already spend. So actually it’s the ideal demonstration of just how underfunded the Indian Health Service is under current law and insurance schemes. This is what a fully-funded Treaty Right looks like.

Of course some of this can be done now, even without Sanders’ bill. Many people in tribal communities are posting on Facebook exactly how to sign up for Medicaid (the government insurance program that so many in Indian Country already qualify for.) They are doing this as an act of defiance, because the Trump administration has recently quit advertising the program and is not actively promoting sign-ups.

But, again, let’s do the math. If every American Indian and Alaska Native was eligible for Medicaid that would net the Indian health system about $7.211 billion (instead of the $1.2 billion from third-party billing now). I actually think this is a more realistic number (even under a Sanders’ plan) because it does not include some of the spending by Medicare (and for that matter, Medicaid) on senior citizens. The national average for Medicaid is a modest $3,278 for an adult and for $2,577 average for children. The total for IHS would be in the neighborhood of $15 billion. More than double what is spent now.

Either Medicare or Medicaid: This is what full funding looks like. And a Treaty Right fulfilled. Finally.

Speaking of children, the Senate has reached a bipartisan deal in the Senate to reauthorize the Children’s Health Insurance Plan or CHIP. This insurance plan covers 9 million young people through Medicaid. The program is set to expire at the end of the month unless Congress acts and then President Donald J. Trump signs a new legislation into 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

Note: A correction was made to the original post.   Sen. Bernie Sanders is an independent. 

 

 

#NativeVote16 – The story is far from over: What’s next for Bernie Sanders?

Mark Trahant / TrahantReports

Vermont casts 22 votes for its senator, Bernie Sanders. A minute later, Sanders asks the rules be suspended and that Hillary Clinton be nominated by acclamation. And so the Bernie Sanders’ chapter comes to an end. The question is, “what’s next?”

Let’s explore this from a couple of different points of view.

What’s Sanders’ story going to be? What’s he going to do to advance causes that are progressive? And, more important for my readers, what will he do to improve life in Indian Country?

It’s interesting to explore what happens to senators after they run for president. Most disappear. Some fifty senators have run and lost (only Obama has won the office in recent times) so the “what’s next?” question is actually the norm.

One candidate who came up short was George McGovern from South Dakota. His landslide loss to Richard Nixon did not define his legacy because he recruited so many young people to his cause. Bill Clinton is a beneficiary of the McGovern campaign. McGovern, like Sanders, was not particularly interested in Native American issues before his presidential campaign. But in 1972 campaign McGovern called for the complete restructuring of the Bureau of Indian Affairs either as a White House program or as a cabinet-level agency.

Ted Kennedy is a another example of how someone can build a progressive legacy after his failed White House bid. “Freed at last of the expectation that he should and would seek the White House, Mr. Kennedy devoted himself fully to his day job in the Senate, where he had already led the fight for the 18-year-old vote, the abolition of the draft, deregulation of the airline and trucking industries, and the post-Watergate campaign finance legislation,” The New York Times wrote in his obituary. “In the years after his failed White House bid, Mr. Kennedy also established himself as someone who made “lawmaker” mean more than a word used in headlines to describe any member of Congress.”

Imagine what Sanders the “lawmaker” could do. He could be the architect for many new initiatives, better Indian health or education funding, or, basically taking the best of the Democratic Party Platform and making is so. This is what he told Deborah Parker on a live Facebook feed this afternoon: “We are very proud of the work that Deborah as done (writing the platform) … and we will make sure that the language is implemented.”

It’s clear that Sanders travels to Indian Country changed him. His observations and experiences are bound to stir reform. As Jane Sanders also told Parker today: “He didn’t win the presidency, but he’s a senator.” And now, perhaps, a lawmaker. A lawmaker that will be most effective if he has an ally in the White House.

There is one more thing I would like to see Sanders do: Invest his time and considerable fundraising ability in helping elect five Native American Democrats to Congress. He could especially make a difference in the next few days by raising money for Victoria Steele in Arizona and Joe Pakootas in Washington state. These two candidates have primary elections in August. Both would make great members of Congress (and allies for any Sanders’ legislative agenda).

Ideally Congress is only the start. What about a Sanders’ grassroots movement that supports Native progressive candidates for legislatures, county commissions, and city governments.

What about Sanders’ supporters? (Some of whom continue to maintain they will never support Hillary Clinton. Several are even posting how disgusted they are with Sanders for giving up too easily.) So the options are: Don’t vote in November; vote for Donald J. Trump; vote for a third party candidate; or vote for Clinton.

Staying home and voting for Trump are essentially the same option. A Trump presidency is not the same as Clinton.

Three stark differences:

* Clinton would tip the scales toward climate action; Trump would favor oil, gas and coal.
* Clinton would boost Indian health programs and Medicaid expansion; Trump promises repeal of the Affordable Care Act, including the Indian Health Care Improvement Act.
* She would build on the legacy of President Obama; Trump promises a rollback of the past eight years which he calls a failure.

On top of all that: There is a vacancy on the Supreme Court and conservatives would be eager to reshape abortion law, the Indian Child Welfare Act, and tribal jurisdiction.

What about voting for Jill Stein and the Green Party or the Gary Johnson-Bill Weld Libertarian Ticket?

Philosophically that makes a lot of sense. I’d really like to see third parties be included in the presidential debates and the national conversation. This country ought to have more than two governing parties. But how do you get there and how does it impact the prospect of a Trump presidency? The fact is only two parties are at present competitive. It’s a wild card vote. In some states, say, Montana, or Utah, it could help Clinton pull off a surprise win. But in Florida or other swing states it’s really an unknown about where the votes would come from (Trump or Clinton). Down the road this is one of those structural electoral problems we need to fix. Our vote should count if we go Green. But not in 2016.

Sanders said as much today. He’s quoted in The Washington Post saying, “If we were in Europe right now, in Germany or elsewhere, the idea of coalition politics of different parties coming together — you’ve got a left party, you’ve got a center-left party, coming together against the center-right party. That’s not unusual. That happens every day. We don’t have that. We have and have had [two parties] for a very long period of time — and I know a little bit about this, as the longest serving independent member of Congress.”

Will  the people who followed Sanders do that once again. Most will. Some won’t. (My first question to those who say, #neverhillary is where do you live? In some states you really do have a free vote. But in a swing state? No.)

So there the Democrats have a nominee — and it’s not Bernie Sanders. Yet he has chapters to add to his story.

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

 

#NativeVote16 – Alaska Native success story is an innovation for the states

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Vermont Governor Peter Shumlin last week signed S.20 into law, the fourth state in the nation to allow dental therapists to provide dental care. The Alaska Native Tribal Health Consortium began dental health therapy in 2004. (Photo from Vermont Public Interest Research Group or VPIRG.)

 

Just one example of innovation from the Native health system

Mark Trahant / TrahantReports

In the news business, this would be a man bites dog story. That’s the idea that a narrative framework is the opposite of what’s supposed to be. The usual story is that Indian health programs are a disaster and only getting worse. But in the real world if you want to find innovation, efficiency, and ideas that must be borrowed by state governments, then explore some of the many successes found in the Indian health system.

Of course that’s not what we are reading about lately. Most of the news stories about Native health focus on the serious problems in the Great Plains. That indeed is a crisis — and one worth fixing.

But at the same time there are other parts of the Indian health system that are unbelievable success stories.

Consider the data: Just before the Indian Health Care Improvement Act was signed into law in 1976 the average age at death for American Indians and Alaska Natives was 48.3 years. The age at death for White people was 72.3 years. And today? That 20-plus-year difference has been reduced to a gap of less than five years. Today the life expectancy at birth for American Indians and Alaska Natives is 72.3 years, compared to 76.9 for all races.

And that steady progress, imperfect as it is, has been made without the same resources as the general population. Doing more with less is part of the operating framework at tribal health facilities, nonprofits that operate health clinics for a Native community, and, even for the federal Indian Health Service.

The story that still needs to be told is that the U.S. medical system could learn a lot from the Indian health system. The U.S. system is the most expensive in the world, by far, while the Indian health system operates at levels comparable to what other nations spend on health care. Could Indian health use more resources? Absolutely. That’s the frustrating part of the narrative; it’s the option that Congress never seems to consider. (Previous: Paul Ryan’s call for Indian health ‘choices’ would be a disaster.)

So with that context let’s celebrate a success story with roots from the Alaska Native medical experience.

Last week Vermont Gov. Peter Shumlin signed into law a bill that licenses dental therapy in Vermont. Therapists are midlevel providers who will provide dental procedures such as fillings and simple extractions. “This is important because there’s a direct connection between oral health and overall health,” the governor said. “Having dental therapists available to work with dentists and hygienists will make it easier for Vermonters to get the care they need, closer to home and no matter what type of insurance they have.”

More than a decade ago the Alaska Native Tribal Health Consortium experimented with a program to train midlevel oral health providers. It was a community-based program to serve a need because too few dentists were practicing in remote Alaska Native villages.

Almost immediately this was an “aha!” moment as other communities saw this as a smart way to expand dental access. Dental therapy students were hired and trained right out of high school and then were put right to work.

But the innovation was followed by a fight. The American Dental Association sued trying to stop this program, saying that the midlevel providers were practicing dentistry without a license. The Alaska Native Tribal Health Consortium fought back and won, using the Indian Self-Determination Act and the Indian Health Care Improvement Act to trump the state’s licensing regulations.

The data today is clear. The program has been spectacularly successful providing routine dental care to some 40,000 patients every year. As the Pew Charitable Trusts wrote: “Evidence is growing that expanding the dental team to include midlevel providers, often called dental therapists, helps dentists build their businesses while increasing access to high-quality, cost-effective care. A 2014 report from the Minnesota Board of Dentistry and Department of Health evaluated the impact of these providers and found that they expand access to care for vulnerable populations and improve the efficiency of clinics and dental offices.”

Across the country, both in Indian Country, and now in states, the idea of a midlevel dental practice is expanding.

Last summer at the National Congress of American Indians, Brian Cladosby, Chairman of the Swinomish Indian Tribal Community, and president of NCAI, said the tribe would expand dental health therapy using its own sovereign regulatory structure. In recent months tribes in Oregon began their own pilot program to train dental therapists.

This innovation is the future. It expands dental care as well as opportunity for young people who want a career in dental health. It’s important to tell the story and its roots with the Alaska Native Tribal Health Consortium.

Supreme Court Justice Louis Brandeis once called states “the laboratories of democracy.” Tribes, and intertribal organizations, then, might be first test labs.

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