Senate’s ‘last’ shot at Repeal and Replace? Indian health still gets dinged

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Alaska Sen. Lisa Murkowski could once again be a deciding vote on the future of health care. (Senate photo)

Mark Trahant / Trahant Reports

You have to wonder why the latest Senate Republican plan to repeal and replace the Affordable Care Act did not get written with one senator in mind, Lisa Murkowski of Alaska.

Yet the bill by Senators Lindsey Graham (R-SC) and Bill Cassidy (R-LA) is more conservative than previous approaches. It has lots of wish-list boxes to tick, no money for Planned Parenthood, big tax cuts, and its spends way fewer federal dollars. The bill only needs 50 votes to pass but that must happen before the end of this month.

Medicaid would become a block grant program that states could design (and pay for). So it would likely disappear. The Center for Budget and Policy Priorities estimates that federal funding for health care would be reduced by $299 billion in 2027 alone with cuts impacting all states. And here’s a fun fact: Big states that expanded Medicaid would be hit harder. A lot harder.

Why 2027? That’s the year block grants disappear.  Graham and Cassidy argue that only a temporary block grant would be allowed under the rules of debate. So no “new” thing. Congress would have to meet “pay for” standards to replace that after 2027; meaning there would be cuts in other federal programs equal to the new spending.

And, like other Republican plans, this one would add significantly to the ranks of the uninsured. The Center for Budget and Policy Priorities estimates 32 million would lose coverage. States could also end essential benefits, coverage of pre-existing conditions, and allow companies to charge people significantly more when they’re ill. (Health insurance coverage that you cannot afford is the same as no insurance.)

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“Like the earlier version of the Cassidy-Graham plan, the revised plan would disproportionately harm certain states. The block grant would not only cut overall funding for the Medicaid expansion and marketplace subsidies but also, starting in 2021, redistribute the reduced federal funding across states, based on their share of low-income residents rather than their actual spending needs. In general, over time, the plan would punish states that have adopted the Medicaid expansion or been more successful at enrolling low- and moderate-income people in marketplace coverage under the ACA,” the CBPP reports. So by 2026, the “20 states facing the largest funding cuts in percentage terms would be Alaska, California, Connecticut, Delaware, the District of Columbia, Hawaii, Kentucky, Louisiana, Maryland, Massachusetts, Minnesota, Montana, New Hampshire, New Jersey, New York, North Dakota, Oregon, Rhode Island, Vermont, and Washington. These states’ block grant funding would be anywhere from 35 percent to nearly 60 percent below what they would receive in federal Medicaid expansion and/or marketplace subsidy funding under current law.”

A lot to like in Alaska, right? Murkowski said she is undecided until she sees the Congressional Budget Office assessment. She told CNN: “I will use the governor’s words,” Murkowski said, referring to Alaska Gov. Bill Walker. “He said, ‘I understand that a block grant gives me increased flexibility, but if I don’t have the dollars to help implement the flexibility, that doesn’t help us much.’ So, we are both trying to figure out how those dollars fall.”

Graham-Cassidy plan continues the 100 percent reimbursement to states for patients served by the Indian Health Service and it adds an increase in the federal match to 100 percent for medical assistance provided by non-Indian Health Service providers for tribal enrollees. The idea is more American Indians and Alaska Natives should take their business away from IHS facilities. Let’s be clear about this: It would drain resources away from the Indian health system.

This bill would also allow tribes to set up group plans to buy insurance for tribal members to replace the Medicaid expansion. “Creates new optional coverage group as of January 1, 2020 for members of Indian tribes up to 138% FPL in states that had expanded coverage as of December 31, 2019, who were enrolled in Medicaid as of December 31, 2019, and do not have a break in eligibility of 6 months (or a longer period specified by the state).”

So in summary this bill would not add any new resources to the Indian health system. But it would cut funding significantly (again, remember Medicaid).

The last Senate Republican plan failed by a single vote. It’s likely that Arizona Sen. John McCain will end up being a “yes” this time around (the state’s governor is giving him cover, saying it’s a good plan). However Kentucky Sen. Rand Paul says he’s now a “no.” In his mind this plan does not repeal the Affordable Care Act. Susan Collins remains a likely “no.” If those positions stay the same, then this bill’s fate could end up being decided by Senator Murkowski.

Is there anything in this legislative gem that improves health care in Alaska? No. Does it improve the Alaska Native medical system? No. The Indian Health Service? No. Then why is she even considering this vote. It should be an easy no. Again.

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

 

 

 

 

 

Humor day in the Senate; Scary single payer & a halt to Alaska energy projects

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Single payer? A vote today on an amendment that Montana Sen. Steve Daines hopes will pout Democrats on record for such a scary idea. (YouTube photo)

Mark Trahant / Trahant Reports

Today is humor day in the Senate. But at least the healthcare debate will go on and on without a conclusion. And no matter what happens today and Friday there is still a long way to go.

The Senate has at least ten more hours of official debate on a House bill that’s been substituted with language that neither we nor senators have yet seen. (Leading to great theatrics by the Senate Democrats who said they’d offer no more amendments until there was an actual bill with, you know, like words in it.) But even without an actual bill Democrats sent the framework of the so-called “Skinny Repeal” to the Congressional Budget Office for a score and the answer is more of the same, the number of uninsured would increase from 28 million to 44 million in a decade.

Nonetheless by Friday there will be some sort of proposal that’s designed to get 50 votes so the legislation will go to a conference committee with the House. This Skinny Repeal strips the individual mandate (causing a mess in insurance) but leaves Medicaid alone. For now. Basically this means the House will get its way and senators will be forced to vote for that approach or nothing. It’s a risky strategy when the Republican majority is so slim. Actually in both houses.

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Via a Tweet from Pat Bagley, editorial cartoonist at The Salt Lake Tribune.

Today the Senate will consider a proposal for universal health care, Medicare for all. Consider is not the right word here because the proposal is already doomed. But Montana Sen. Steve Daines wants Democrats on record voting for this scary, scary idea. But as Pat Bagley, the cartoonist for The Salt Lake Tribune tweeted yesterday, not one country that’s gone down the single payer path has reversed course. It’s the United States that is the outlier with our incomprehensible health care “system.” Even Bernie Sanders, who is for Medicare for All, said he won’t vote for this amendment because it’s a ruse.

Daines won’t be voting for his own amendment either. That’s not the point. Daines told the Helena Independent Record Wednesday night “It’s time for every senator to go on the record on whether or not they support a single-payer system.”

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So, while we are at it, let’s be clear about what Single Payer could do for the Indian health system. Indian Health Service funding would jump by at least 40 percent in a Medicare for all approach. The agency (and the tribal and nonprofit operations) would be equal with other healthcare providers; getting paid for every patient instead of worrying about appropriations or tracking down insurance payments from companies, Medicaid, and other third-party payers. So it would be a financial boom. Big time.

But as I said: Medicare for all is really not on the table. The Senate vote is just supposed to frighten Democrats. So. Be careful. Or Congress will give you health care. Aye.

Speaking of bad jokes, I laughed at the Trump administration’s threats to Alaska Sen. Lisa Murkowski. According to the Alaska Dispatch News, Interior Secretary Ryan Zinke warned Murkowski that Alaska energy projects could suffer because of her vote (and her leadership) against the GOP health care proposals. (I do think she could lose her Energy Committee chairmanship, but that, too is a silly move by Republicans in a narrowly divided Senate.)

So the Trump administration that wants Energy for All is telling a Senator who’s pro-energy that Alaska development is in trouble because she’s against their destruction of health care. Now that’s some weighty logic. Nonetheless Alaska Senator, Dan Sullivan reported this threat with a straight face. He told the Alaska Dispatch News that it’s a “troubling message … I’m not going to go into the details, but I fear that the strong economic growth, pro-energy, pro-mining, pro-jobs and personnel from Alaska who are part of those policies are going to stop.”

So oil companies be warned. You could be punished. As will we all. Be afraid. And remember universal care for all is up today.  So keep the children away from the Senate TV.

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

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

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Quick note before today’s vote

Good morning.
No post this morning, but a couple of thoughts before the House vote on the plan to repeal & replace the Affordable Care Act.
President Trump has made this an either, or vote for House members. With the president or not? Are they more worried about a primary from Trump supporters or their own constituents? As I wrote yesterday, Alaska’s Rep. Don Young will be worth watching on that score. This bill is terrible for Alaska. And a “yes” vote will be risky come election time. Or will Trump supporters use this an opportunity to take on Young in the primary?
Second point (and future stories) If this is end of repeal and replace, then the action will shift (as it already has) to the rule making process. Secretary Tom Price has a lot of power to make deals with the states on how ACA is implemented (and for that matter, Medicaid).
Third. It’s really interesting to see the new round of leaks coming from the White House. They were against this whole thing from the beginning, see. Blame is directed to Paul Ryan. (Trump’s news favorite Brietbart even calls this bill RyanCare.) So the question is what does this do to Ryan’s speakership going forward (if he continues in office)? As I wrote the budget divisions ahead are even greater than those that surfaced in the health care policy debate.
That’s it for now. Working on something not-Trump-related for the weekend. — Mark

#NativeVote16 – Driving turnout, early votes from Alaska to North Dakota

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Selfies: A get out the vote rally in New Town, North Dakota. Facebook photo via North Segment of the Three Affiliated Tribes.

Mark Trahant / Trahant Reports

Across Indian Country there are rallies, phone banks, forums, and social media pitches that are repeating one message, vote. Native American voters can make the difference in key states from the presidential race to county commissions.

And what does it matter? In a paragraph: One presidential candidate, Donald Trump, favors completion of the the Dakota Access Pipeline as well as resurrecting the Keystone XL Pipeline. He would support legislation to repeal the Affordable Care Act, a law that includes increased funding for the Indian Health System as well as the Indian Health Care Improvement Act. Clinton, on the other hand, would be more of the same. She generally supports President Obama’s policies on energy, climate, and on federal-tribal relations. (Previous: Native Vote tips the Electoral College.)

And this election there are so many talented Native American candidates whose very presence makes this country better. This is why we need to vote. This is why we vote.

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Denise Juneau’s Montana get out the vote tour started on the Confederated Salish and Kootenai Tribal Nation. (Photo via Twitter)

In Montana, Democrats, including congressional candidate Denise Juneau, include tribal nations in that last minute push. The five-day, statewide tour stretched from the Confederated Salish and Kootenai Tribal Nation to across the state to Wolf Point and the Fort Peck Assiniboine Sioux Tribes. Juneau told Montana Public Radio: “We are on this swing around the state, 17 communities we’ll be hitting all across Montana to talk to voters to know that what we stand for and know our records and that we are going to really talk about the future of this state and what it looks like and draw the stark contrasts that are necessary. I plan to hold my opponent accountable to his lack of a non-record of looking out for Montana, and win over the voters of Montana, and that’s really the excitement around this last push across the state with all these statewide candidates. We’re going to work really hard to get out the vote and make sure that when we wake up after election day the headlines read that we win.”

 

Juneau also picked up another newspaper endorsement, The Missoulian. “Montanans need a strong voice in the U.S. House who is focused on serving her constituents,” the paper said. “Let’s see what Denise Juneau can do for Montana – for our economy, our public lands and our access to health care – as our U.S. representative.”

Elections were once about turnout on at the polls. But in this era most people will vote early and that changes the focus. Juneau said she already voted and is encouraging everyone in the state to vote early. “You never know what’s going to be happening on Election Day.”

Juneau, of course, is a member of the Mandan Hidatsa Tribes (and Blackfeet). The Three Affiliated Tribes have a lot going on this election with candidates running across the country. Another tribal member, Laurel Deegan-Fricke, is in a tight state senate race in North Carolina. And closer to home, citizens Ruth Buffalo is on the ballot for State Insurance Commissioner and Cesar Alvarez is a candidate for the state House of Representatives.

A Thursday rally in New Town included Buffalo, Alvarez, and a broad section of North Dakota candidates, including Chase Iron Eyes, Marlo Hunte-Beaubrun, as well as other candidates for state, regional and tribal offices.

The outreach to Native Voters in North Dakota also included stops at the United Tribes Technical College and Fort Yates. Iron Eyes and Hunte-Beaubrun are Standing Rock Sioux tribal members.

Iron Eyes posted on Facebook: “I feel good about our campaign. I love being the underdog. North Dakota is about underdogs. We are all looked over and counted out. We all meet challenges head on. We all #FaceTheStorm. Only the strong survive. I ask for the strength to Walk Without Fear. We don’t win unless you vote! It’s that simple.”

The Native Vote is critical in Arizona both in the presidential race and in the U.S. Senate race. Jamescita Peshlakai, who is running for the Arizona state Senate, posted on Facebook that “our next US Senator, Ann Kirkpatrick, is talking Navajo on KTNN. Wow. 2 years ago President Obama ended his campaign commercial with “Ahehee!” Our language can be learned by non-Navajos. If there is a will, there is a way.”

On Saturday the Inter Tribal Council of Arizona is doing a phone bank with the goal of reaching 10,000 Native voters before the election.

There is also a Native Vote rally scheduled for Election Day starting at 11:30 am in Tempe on the campus of Arizona State University.

And in Alaska the early vote is breaking records. The Alaska Dispatch News reports that 22,114 early votes have already been cast, five days before Election Day. “Early in-person votes go right into the ballot box and are counted on Tuesday, along with ones turned in at the polls,” the Alaska Dispatch News said.”Since the ballots aren’t tallied until Tuesday, there’s no real way to tell how people are voting. And it’s not entirely clear what’s driving the increased early turnout.”

On the Facebook page, Get Out the Native Vote-Interior Alaska, there is this remarkable story posted by Wilmina Daisy Stevens: “When it comes to voting, I always have to think of my mother, Hannah Paul Solomon. On the very last day that she was with us, my sister told her that she had received her GwichyaaZhee Corporation ballot. She wanted to vote it and she did. She never told anyone how she voted but she knew how important it was to vote. My sister sealed the envelope and we watched for the mailman. Once the mailman came, I said ‘The mailman just picked up your ballot, Mom. Your vote is counted.’ She had a smile on her face. Three hours later, my mom passed away. I vote because my Mom showed me how important it is to vote whether its Tribal, Corporations, City, Village, School Boards, or National: Please exercise your rights to vote. Its the only way to voice your opinion. Mahsi’ Mahsi Choo Shalak Nai.”

Five days to go.

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