Indian Country and the Affordable Care Act — twists and turns

February 5, 2015

The House of Representatives voted to repeal the Affordable Care Act on February 3. Then, this is not new. The House has voted nearly sixty times to either revoke the law or to make huge changes. But this time the House and the Senate are in Republican hands. So that means what was a symbolic act now has the potential of becoming law.

Well, maybe.

The Affordable Care Act is like a national soap opera that should rivet any audience. Will the law survive? What sort of challenges does it face legally and politically? And, most important, what does this daytime drama mean to Indian Country?

Here is the story so far.

Turn back to to 1974. President Gerald Ford signed the Indian Health Care Improvement Act into law, a measure that modernized the federal delivery of health care in Indian Country. But that law had an expiration date; it needed another act of Congress to renew it. And that did not happen. Congress let the bill lapse despite repeated attempts. That’s where the story takes a turn. The whole health care reform debate was heating up and folks in Congress decided to roll the Indian Health Care Improvement Act into the Patient Protection and Affordable Care Act. This language was shortened to the Affordable Care Act or “Obamacare” — and it’s now the law of the land. The Indian health provisions were made permanent so future Congresses would not have to renew them.

The Affordable Care Act had other benefits to Indian Country. The law improved funding channels for Indian health facilities, a source of money that’s growing during lean budget years. Next year’s Indian Health Service budget estimates more than $1.1 billion collected from Medicaid, Medicare, Veterans Health Administration and private insurance.

But Republicans have been adamantly against the Affordable Care Act. Four years ago a Republican House was elected and that body started voting over and over to repeal the law.  But nothing ever happened because the Democratic controlled Senate ignored the actions in the House.

But like any good soap opera there are new characters joining the story. The Supreme Court could strike down part of the law, causing a lot of confusion. And the Senate is now run by Republicans who will definitely consider the House legislation to repeal the law. This will not be easy. The Senate usually needs 60 votes in order to pass legislation (stopping the threat of a filibuster). And there are not 60 votes to repeal the Affordable Care Act.

That’s another twist. Democrats were short 60 votes back in 2010 — so they turned to an arcane process called budget reconciliation that allowed the legislation to pass with a simple majority, or 51 votes. Now many Republicans are asking their party leaders to do the same thing and use the budget reconciliation to repeal the Affordable Care Act. That idea would probably work if there was a Republican in the White House. But you can bet that President Barack Obama will veto any attempt to roll back his signature health care legislation. So that means Congress would need a two-thirds majority to override a presidential veto. There are not nearly enough votes in either the House or the Senate to do that.

But many Republicans see repeal (enacted or not) as an important statement that will define the 2016 election campaigns.

If Republicans find a way to repeal the Affordable Care Act that would raise new questions and chaos. For example what happens to those people who’ve purchased insurance now or who signed up for the expanded Medicaid programs? Would people lose coverage and get nothing in return?

The questions for Indian Country are troubling, too. What happens to the Indian Health Care Improvement Act? Or how will the Indian health system replace money from Medicaid and other sources opened up through the Affordable Care Act?

A few Republican Senators have started a “framework” about what kinds of alternative law they would pass to replace the Affordable Care Act. Utah’s Sen. Orrin Hatch, chairman of the Finance Committee, said in a Senate floor speech:  “Our plan rests on four simple principles. First: Repeal Obamacare – with all its costly mandates, taxes, and regulations – in its entirety. Second: Reduce costs by taking the government out of the equation, and, instead, empowering consumers to make choices about their own health care. Third: Provide common-sense consumer protections to protect individuals with pre-existing conditions. And, finally: Reform our broken Medicaid system by giving states more flexibility to provide the best coverage for their citizens.”

There are key issues here for Indian Country. First, the Indian health system is not part of the debate. It must be. Any repeal of the Affordable Care Act is also a repeal of the Indian Health Care Improvement Act. Second, there is no easy way to eliminate “government” from the Indian health system. And, finally, a reform of Medicaid, especially one that grants more power to states, will reduce health care funding for Indian health facilities. Already nearly half the Indian health system is shortchanged by the states that refuse to expand Medicaid. This is a real problem.

Cue the organ music. This daytime drama has many twists and turns ahead. But the story’s ending should be simple: the United States promised American Indians and Alaska Natives healthcare. The only question should be, “how will that promise be delivered?” Stay tuned.

Mark Trahant holds the Atwood Chair at the University of Alaska Anchorage. He is an independent journalist and a member of The Shoshone-Bannock Tribes. For up-to-the-minute posts, download the free Trahant Reports app for your smart phone or tablet.

Obama’s Arctic decisions may be the Climate’s turning point

January 27, 2015

This is the Climate Moment. A possible turning point.

Consider the massive storm that resulted in a state of emergency throughout much of New England with temperatures in the teens, gusty winds, and snow measured by the foot not the inch. We know from the science that climate change will make storms more severe and more common.

It’s also the moment when the Obama administration stepped up to preserve the environment  — as well as protect Alaska Native communities — by limiting future oil and gas development in Alaska’s Arctic National Wildlife Refuge and along the Coastal Plain.

A White House blog put it this way: “This far northern region is known as “The Sacred Place Where Life Begins” to Alaska Native communities. The Refuge sustains the most diverse array of wildlife in the entire Arctic — home not only to the Porcupine caribou, but to polar bears, gray wolves, and muskoxen. Bird species from the Coastal Plain migrate to all 50 states of the country — meaning that no matter where you live, the Arctic National Wildlife Refuge is part of your landscape.”

But pretty much all of official Alaska saw this issue differently. On Capitol Hill, Alaska Republican Senator Lisa Murkowski  said the administration has “effectively declared war on Alaska. That’s my view of it.”

“It’s a one-two-three kick to the gut of Alaska’s economy,” she said, adding that the governor told the Secretary of Interior that Alaska has a budget hole of about $3.5 billion — a problem that will be made worse without more oil production.

And this is an odd time for Alaska. The state budgeted for oil to be selling at more than a hundred dollars a barrel — and now the price is less than half that. This is a state that an oil and gas trade group brags that 92 percent of the state’s revenues come from that single industry.

So Alaska has had a grand old time with its oil money. Instead of a personal income tax, Alaskans receive their version of a tribal per capita every year. In fact Alaska ranks second lowest in the country in overall taxes (Wyoming is first) but that figure is skewed because nearly all of the money comes from corporate taxes. There is no income tax or sales tax.

Perhaps this serious budget shortage might actually force Alaska citizens to contribute to their state and pay taxes the way, oh, 49 other states and the District of Columbia do.

But let’s talk climate. Neither the White House nor the Interior Department cited climate change as their reason for limiting development in Alaska.

Then again, a new analysis published in Nature in January said that more fossil fuels will have to be left in the ground in order to prevent further damage from climate change. The piece said that known reserves of coal, oil and gas, including the Canadian tar sands, all Arctic oil and gas, cannot be developed and still keep temperatures under current limits. The authors wrote: “Our results suggest that, globally, a third of oil reserves,half of gas reserves and over 80 per cent of current coal reserves should remain unused from 2010 to 2050 in order to meet the target.”

That means no new Arctic oil and gas developments. No more tar sands. And, by extension, no Keystone XL pipeline.

What’s interesting about the research is how specific it is about developing Arctic resources.

The authors, Christophe McGlade and Paul Ekins from University College in London, estimate “100 billion barrels of oil (including natural gas liquids) and 5 trillion cubic meters of gas in fields within the Arctic Circle that are not being produced as of 2010.”

That production alone could tip the globe and warm more than is considered safe. “The results indicate to us that all Arctic resources should be classified as unburnable. To conclude, these results demonstrate that a stark transformation in our understanding of fossil fuel availability is necessary. Although there have previously been fears over the scarcity of fossil fuels in a climate-constrained world this is no longer a relevant concern: large portions of the reserve base and an even greater proportion of the resource base should not be produced if the temperature rise is to remain below 2 degrees” above pre-industrial levels.

The president’s action is not final. Congress would have to do that. But this action means the Interior Department can manage the lands as if Congress had acted. (Congress could reverse Interior, but remember in the Senate that means finding 60 votes. That’s not likely to happen.)

Is this the Climate Moment? The turning point? There is a lot of work ahead, but the Obama administration is acting as if the answers are a “yes.”

Mark Trahant holds the Atwood Chair at the University of Alaska Anchorage. He is an independent journalist and a member of The Shoshone-Bannock Tribes. For up-to-the-minute posts, download the free Trahant Reports app for your smart phone or tablet.

State of Indian Nations: Unlocking digital tools in Indian Country to build a new economy

January 26, 2015

It’s time for State of the Unions. President Barack Obama, of course, on Tuesday. Then, a variety of state reports across the country. And, on Thursday, Indian Country’s national version, the State of Indian Nations. National Congress of American Indians President Brian Cladoosby spent about an hour talking about some of the challenges facing the more than five hundred tribal governments.

“Today, I bring a simple message from the tribes of the 21st Century: We must tear down barriers to growth, simplify regulations that are limiting opportunities, and acknowledge that tribes have the capability as governments to oversee our own affairs,” Cladoosby said. “Congress and the administration need to find ways to help bring federal agencies out of the 19th Century and into the 21st Century.  We need them to be partners for growth and not barriers to growth.”

President Cladoosby’s talk covered much ground — a lot of material critical to tribal governments, such as rethinking the federal-trust relationship, an invitation for leaders of Congress to visit Indian Country, and for Washington’s NFL franchise to finally, finally, change its name.

I’d like to expand on two themes from the State of the Indian Nations speech — youth and technology.

The most common age in America today is 22 years old. This year, 2015, the Millennial Generation will pass the Baby Boomers as the largest-age group in the country. Indian Country is even younger than the rest of the nation. The American Indian Alaska Native population from birth through age 24 makes up 42 percent of the total Native American population (compared to about a third for country as a whole.)

We are at a moment in history where we really ought to be investing more resources in young people. Yet, instead, as President Obama said in his State of the Union, we’re loading up this generation with student debt — a total that now exceeds a trillion dollars. This is the logic behind the president’s call to make community college free. A proposal that will benefit Indian Country, including tribal colleges and universities.

But this is also about technology. We need a structure to prepare people for jobs that don’t yet exist.

This is what President Cladoosby said: “The last technology census of tribal nations took place before Google, Twitter, or smart phones even existed.  The best data we do have indicates an ongoing digital divide. While 73 percent of Americans have access to broadband, in Indian Country, it’s only 10 percent …

“We need a comprehensive and updated study of our technology needs to advance more common sense initiatives like this one to increase our participation in the Digital Age.”

We do need more information. The Digital Age doesn’t look like it did even ten years ago. Back then “The Facebook” was a new startup — and certainly not much of a presence in Indian Country. Today Facebook is in most homes, on our phones, and a presence linking Native America in ways that television networks never did. On social networks like Facebook, Twitter, Instagram, Native Americans are creating, telling stories, and building communities. This is just the beginning of this digital age.

It’s not just social media either. It’s a whole of commerce, activity, and potential.

So what does it mean? Well, once we figure out how to unlock these digital tools we will never again be faced with watching our children leave a community just to get a job. We can create our own jobs. Anywhere. In a village in Alaska, a reservation in Montana, or, yes, in a city. But the choice will be ours.

But for that to happen we need to prepare young people better. They need to have a bundle of tools, ranging from computer science to video production.

Some of this preparation starts with schools. Helping young people get basic skills in math, science and writing. But much of this Digital Age starts with imagination.

The beauty is that we now live in a world where storytelling is a value. And that’s a value that Indian Country already understands and has for thousand of years.

Mark Trahant holds the Atwood Chair at the University of Alaska Anchorage. He is an independent journalist and a member of The Shoshone-Bannock Tribes. For up-to-the-minute posts, download the free Trahant Reports app for your smart phone or tablet.