Here we go again: Another government closure is near

Once again Congress is finding it impossible to pass spending bills — and time is running out. The federal government appropriates money and runs its programs from October 1st through the end of September. The House and the Senate are supposed to enact appropriations and then pass on that legislation to the president for his signature.

That is how it is supposed to work.

But the entire process is chaotic. Think of Congress this way. There are really three-parties in the House and in the Senate; Republicans (the party in charge), Democrats and Tea Party supporters. It’s this third group who are holding up the budget by saying “no.” Congress could get out of this by letting Republicans work with Democrats on moderate spending bills — something that does happen in state Legislatures from time to time. And that might be the smartest route ahead. (It would likely mean the political career of Speaker John Boehner would be over. But it’s not a bad legacy to step out by doing the right thing.)

There are several issues dividing Congress ranging from the amount of debt the country has (think of a credit card limit) to how much money flows from government checks to Planned Parenthood.

That last item is the big one. Some conservative members of Congress say they will not support any budget that includes Planned Parenthood after a series of videos that purported to show the selling of baby parts.

But Planned Parenthood does many other things — such as distribution of birth control pills — and federal money already cannot be used for abortion. So it’s unlikely the president will agree to any budget that doesn’t continue funding women’s health programs and that includes Planned Parenthood. What’s more the whole controversy has been one-sided, there a case to be made that Planned Parenthood’s actions save lives. The issue is far more about abortion politics than it is about fetal tissue.

Back to the shutdown. Pretty much everyone in Washington says they do not want a government shutdown. But there is really no incentive to get beyond those words. Budget expert Stan Collender recently wrote in Politico magazine that there is a seventy-five percent chance of a shutdown. “First and foremost, there is not enough time to reach a deal. Not only have none of the fiscal 2016 appropriations yet been signed into law, none have even passed both the House and Senate. With less than two calendar weeks (and far fewer days of potential legislative work) to go, the only way to keep the government from shutting down will be for Congress and the president to agree on a continuing resolution to fund the government for a short time while a larger deal is negotiated,” he wrote. But then there is that Planned Parenthood debate — and staunch opposition to even a short-term spending bill.

Not only that but a temporary spending bill could cause additional problems. The Center for Budget and Policy Priorities says a Continuing Resolution would lock in spending cuts demanded by the sequestration law. “The only real fix is for policymakers to agree to provide relief from the sequestration cuts now scheduled for 2016, offsetting the cuts with alternate deficit reduction measures, as they did on a bipartisan basis in 2013, and then to enact regular appropriations legislation for 2016 (even if combined into one or more omnibus packages).  As long as the current sequestration limits remain in place, no amount of re-arranging the pieces within an inadequate total will allow for necessary funding levels to reflect new priorities, new conditions, or rising costs,” the Center said.

We know that closing down government, even briefly, is rough.Two years ago the government closed from October 1 through October 16, 2013. Some 800,000 employees were furloughed and another 1.3 million had to work without pay.

Across Indian Country a government shutdown not only impacts federal employees, but it means tribes have less money and have to lay off employees as well. Two years ago, Indian Country Today Media Network reported that Montana’s Crow Tribe had to lay off some 300 people as well as closing essential reservation programs. Even some health clinics (which are supposed to be protected) had to close temporarily.

Native American organizations have been pushing for an idea to fund health, and perhaps tribal schools, a year in advance. That would be smart. Then when Congress cannot do its job, at least Indian Country won’t have to suffer needlessly. But Congress didn’t get around to that idea either.

One thing for sure: Government shutdowns cost a lot of money. The last tab was about $24 billion.

So here we go again with another waste of time and money.

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. For up-to-the-minute posts, download the free Trahant Reports app for your smart phone or tablet.

Alaska says yes, boosts Indian health system by expanding Medicaid

Governor Bill Walker and Health and Social Services Commissioner Valerie Davidson announcing the expansion of Medicaid in Alaska. (Picture from video feed.)
Governor Bill Walker and Health and Social Services Commissioner Valerie Davidson announcing the expansion of Medicaid in Alaska. (Picture from video feed.)

One more state adds “new money” to the Indian health system via Medicaid

MARK TRAHANT

These days “new” money is hard to find. That’s the kind of money that’s added to a budget, money that allows programs to expand, try out new ideas, and look for ways to make life better. Most government budgets are doing the opposite: Shrinking. Calling on program managers and clients alike to do more with less.

That’s why the news from Alaska last week is so exciting: Alaska’s new governor announced the expansion of Medicaid and this will significantly boost money for the Alaska Native medical system. Indeed, the significance of this announcement to the Indian health system was clear when Alaska’s Gov. Bill Walker and Department of Health and Social Services Commissioner Valerie Davidson made the announcement at the Alaska Native Medical Center on July 16. The governor took this action using executive authority because the Alaska legislature had failed to even vote on legislation to accept Medicaid.

The governor says Medicaid expansion would reduce state spending by $6.6 million in the first year, and save over $100 million in state general funds in the first six years. “Every day that we fail to act, Alaska loses out on $400,000,” the governor said. “With a nearly $3 billion budget deficit, it would be foolish for us to pass up that kind of boost to Alaska’s economy.”

“We know Gov. Walker has worked tirelessly to expand Medicaid since he came into office on December first,” Davidson said at the news conference. It was one of the campaign promises made by the independent governor. “He included it in the budget. He introduced a bill both in the House and in the Senate side. It was a subject of both special sessions. And, it’s the right thing do do for Alaska.”

The expansion of Medicaid is one of key components of the Affordable Care Act. It’s critical a tool for the Indian health system because it opens up a revenue channel for clinics and hospitals to bill Medicaid, a third-party insurance, for services and that boosts budgets at the local level. (In a climate where Congress is unlike to spend more money on Indian health.) How big a number? More than a million American Indians and Alaska Natives are now insured by Medicaid. The Kaiser Family Foundation estimated in 2013 that Indian health facilities collected $943 million in third-party payments.  “By far the largest third-party payer is Medicaid, which accounts for $683 million or 70% of total third party revenues, and 13% of total IHS program funding for FY2013,” Kaiser reported. Nearly 150,000 Alaska Natives and American Indians receive health services across the state from tribal and non-profit health organizations funded by the Indian Health Service. By law the IHS-funded clinics must seek third party billing from patients, such as Medicaid, the Veterans Administration or private, employer-based health insurance.

Medicaid is an odd program for Indian Country. Most of us understand the Indian Health Service to be the government’s fulfillment of its treaty obligations. However the IHS has never been fully funded. Medicaid, however, is an unlimited check. If a person is eligible, then the money is there. Yet states, not tribes nor the federal government, determine the rules for Medicaid. And many Republican states have been determined to fight the Affordable Care Act, or Obamacare, at every turn, and that means refusing to accept Medicaid expansion (the Supreme Court ruled in 2012 that states could turn it down).

Alaska’s decision means that the number of states rejecting Medicaid is continuing to shrink. Most recently Montana agreed to expand Medicaid in April. The states with large American Indian and Alaska Native populations that have not expanded Medicaid include Oklahoma, South Dakota, Wisconsin, North Carolina, Maine, Wyoming, and Idaho. Utah is the next state considering an expansion.

The Affordable Care Act continues to evolve — and improve. But more important, steps that states are taking to expand Medicaid are adding real dollars to the Indian health system.

Mark Trahant 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.

Court affirms Affordable Care Act again; good time to step up Indian Country’s participation

President Obama hugs Kristie Canegallo and Vice President Biden hugs Denis McDonough President Barack Obama hugs Kristie Canegallo, Deputy Chief of Staff, and Vice President Joe Biden hugs Chief of Staff Denis McDonough as they celebrate the Supreme Court ruling on Affordable Care Act subsidies in the Oval Office, June 25, 2015. (Official White House Photo by Pete Souza)
President Obama hugs Kristie Canegallo and Vice President Biden hugs Denis McDonough
President Barack Obama hugs Kristie Canegallo, Deputy Chief of Staff, and Vice President Joe Biden hugs Chief of Staff Denis McDonough as they celebrate the Supreme Court ruling on Affordable Care Act subsidies in the Oval Office, June 25, 2015. (Official White House Photo by Pete Souza)

MAKING THE LAW WORK BEYOND MEDICAID EXPANSION

MARK TRAHANT

The Supreme Court once again affirmed the legality of the Affordable Care Act. This time the court’s answer is unambiguous.  As Chief Justice John Roberts wrote: “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them.”

The 6-3 ruling means that people who buy insurance using tax credits as subsidies — some 6.4 million people — will continue to do so regardless of where they live. Thirty-four states have not set up health insurance exchanges and sao consumers must purchase plans through a federal exchange.

At the White House, President Barack Obama said “the Affordable Care Act is here to stay.”

But Congress has other ideas. The House has voted to repeal the Affordable Care Act some fifty times and this is certain to again be an election year issue in 2016. This ruling will also increase the political pressure for conservatives to try and derail the law using the budget, making it much more difficult for the Congress and the Obama administration to reach a deal over federal spending next year.

There is an interesting twist on this case for American Indian and Alaska Native consumers. Early on both supporters in Congress and in the Obama administration decided to play up the portion of the law that exempted Native Americans from the mandatory insurance requirements. The idea was that delivery of health care is seen as a treaty right, so it was impossible to force Native Americans to buy insurance. But the problem is the Indian health system does not have adequate funding — and the best course for improving that revenue stream is to sign up more Native Americans for some kind of insurance through a job, Medicaid, Medicare, Childrens’ Health Insurance Program, or these health insurance exchanges.

According to a report by the Kaiser Family Foundation, nearly one in three American Indians and Alaska Natives is uninsured and most have far less access to employer-based insurance than other Americans.”Less than four in ten American Indians and Alaska Natives have private coverage, compared to 62% of the overall non elderly population,” Kaiser reported. “Medicaid helps fill this gap, covering one in three non-elderly American Indians and Alaska Natives. Medicaid also provides key financing for IHS providers and has special financing rules and protections for American Indians and Alaska Natives. However, nearly one in three nonelderly American Indians and Alaska Natives remains uninsured.”

One way to improve that insurance rate is to encourage more American Indians and Alaska Natives to take advantage of subsidized plans purchased through exchanges. There are, for example, plans for a family of four earning up $70,650 (or $88,300 in Alaska) that have no cost, including deductibles and co-pays. If a family earns more than that amount, an insurance plan purchased through the exchange could still be eligible for no out-of-pocket costs when using the Indian health system. Native Americans can also sign up for the insurance plans every month, instead of during limited open enrollment periods.

Jim Roberts, a policy analyst for the Northwest Portland Area Indian Health Board, said it’s difficult to get data from the federal and state exchanges. However one report, that Roberts said is “suspect,” does have some data showing that approximately 22,000 American Indians and Alaska Natives in the federal exchange Native Americans have received cost-sharing benefits. “What’s interesting about this report is that 41,626 person were determined eligible for cost-sharing reductions, however only 22K were covered by a selected plan.  A very low take up rate despite high eligibility. Indian participation is a real problem,” Roberts said, both in the state and federal exchanges.

Perhaps that should be the outcome of the court’s ruling Thursday: A new emphasis on making certain that American Indians and Alaska Natives take advantage of every dollar eligible under the law. This would be one way of boosting funding for Indian health clinics and hospitals. And this money does not require appropriations from Congress or approval from a state (as is the case with Medicaid).

As he celebrated the court’s ruling Thursday,

President Obama said: “On March 23, 2010, I sat down at a table in the East Room of the White House and signed my name on a law that said, once and for all, that health care would no longer be a privilege for a few. It would be a right for everyone.”

But that right also requires action. Action from the administration informing American Indians and Alaska Natives about the benefits; as well as action from every clinic and patient to make sure we all havel the insurance we’re entitled to receive under the law. Call it, the pre-paid, Treaty Insurance plan.

Mark Trahant 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.

Missed Opportunities: Indian Country’s economic case for Medicaid expansion

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MARK TRAHANT

A new White House report details the economic impact of Medicaid expansion and is sharply critical of the 22 states that have not done so. The report is titled, “Missed Opportunities: The Consequences of State Decisions Not to Expand Medicaid.

I like that: Missed opportunities. Why? Because this Council of Economic Advisers’ 44-page report fails to include any calculation of Indian Country as one of those missed opportunities.

I get that the population of American Indian and Alaska Natives is small, one percent or so. But you cannot build an economic case for Medicaid in Alaska, Oklahoma, Montana, North Dakota, South Dakota, Arizona, New Mexico (and even Washington and Oregon) without at least back of the envelope estimates. This is important because of the way Medicaid is structured; it’s a shared partnership between the states and the federal government. However American Indians and Alaska Natives are eligible for a 100 percent federal match, so the money spent by a state Medicaid program is fully reimbursed by the federal government.

This system, of course, makes no sense. And it’s probably why the White House failed or forgot to include Indian Country. A much sounder approach would be for the Indian health system — whether federal, tribal, urban or nonprofit — to get funding and administrative rules directly from the Centers for Medicare and Medicaid Services. Then Alaska, Oklahoma, or the other states that are currently rejecting Medicaid expansion would lose their say about what happens to American Indian and Alaska Native patients.

Let’s dig deeper into the White House report — then I’ll add numbers and context.

The administration is quite right to hail the Affordable Care Act’s economic success story. “Since the law’s major coverage provisions took effect at the start of 2014, the nation has seen the sharpest reduction in the uninsured rate since the decade following the creation of Medicare and Medicaid in 1965, and … the nation’s uninsured rate now stands at its lowest level ever.”

However 22 States—including many of the states that would benefit most—have not yet expanded Medicaid (although Montana has passed legislation to expand Medicaid and is working with the Centers for Medicare and Medicaid Services to determine the structure of its expansion). These 22 States have seen sharply slower progress in reducing the number of uninsured over the last year and a half, and researchers at the Urban Institute estimate that, if these States do not change course, 4.3 million of their citizens will be deprived of health insurance coverage in 2016.”

In Indian Country, the big three non-expansion states are Alaska, South Dakota and Oklahoma.

The Alaska Legislature recently adjourned without a vote on Medicaid expansion (a measure was proposed by Gov. Bill Walker). But an expansion may be still possible if the governor acts without legislative approval.

The White House report estimates Alaska would gain some $90 million in federal funds by expanding Medicaid. But that number, I believe, misses out the intersection between Medicaid and the Indian health system. The Alaska Native Tribal Health Consortium estimated that 41,500 Alaskans would be eligible for Medicaid — including 15,700 Alaska Natives and American Indians. In other words, more than a third of potential enrollees are eligible for a 100 percent federal reimbursement. Forever.

The numbers are similar and striking in South Dakota and Oklahoma.

The White House report says health insurance also reduces the risk of death. “This analysis estimates that if the 22 states that have not yet expanded Medicaid did so, 5,200 deaths would be avoided annually once expanded coverage was fully in effect. States that have already expanded Medicaid will avoid 5,000 deaths per year,” the report says.

This is a bit complicated, but I doubt if that number includes American Indians and Alaska Natives who are at risk of death because of funding shortages in the Indian health system. What’s now called Purchased and Referred Care is better funded than it has been in recent years, but that budget line still runs out of money for some patients needing specialty care outside of the Indian health system.

But the key point is that the Indian health system is underfunded and as the Kaiser Family Foundation noted “not equally distributed across facilities and they remain insufficient to meet health care needs.”

That unevenness is dangerous for the Indian health system — and it’s states that are limiting dollars by refusing to expand Medicaid.

We are seeing the evidence about how the Indian health system is picking up additional resources in states where there has been Medicaid expansion. In Washington, for example, I recently reported that tribal health facilities have increased their Medicaid funding by nearly 40 percent since expansion. This is new money in an era of austerity and it’s automatic funding that does not require appropriation from Congress.

Of course it would be ideal if the White House was making this case with hard numbers. The Indian health system is a federal obligation — a Treaty right —  that costs states little. Yet it’s the states that are setting the rules; so at the very least our advocate ought to be chronicling that impact. It’s a missed opportunity.

Mark Trahant 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.

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Reversing diabetes in Indian Country

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The next phase in the epidemic: Reducing the rate of growth and other success stories

MARK TRAHANT

Indian Country has long faced the epidemic of diabetes with rates 2.3 times greater than the general population. The toll from this deadly disease was so great that a federal Special Diabetes Program for Indians was launched some thirteen years ago.

Across America diabetes rates are exploding. A recent piece in The Washington Post put it this way: “Diabetes has reached epidemic proportions in the U.S., due to sugary diets and the lack of exercise. If current disease rates continue, one in three Americans will have diabetes by 2050. Over time, the condition can lead to kidney failure, limb amputations and blindness, among other complications.”

The post linked to a blogger, The Data Dude, and a chart that shows diabetes rates increasing in all but a few counties across the nation, a total of 2,992 of counties. Only five counties had rates that stayed the same and only ten counties showed an actual decrease.

Here is the thing. Two of the ten counties showing a decrease in diabetes rates are found on Indian reservations, Fort Peck, Montana, and Rosebud, South Dakota. According to the United States Centers for Disease Control and Prevention, the rate of growth for diabetes in Roosevelt County, Montana, dropped from 13.2 percent to 12.9 percent, a three-tenths decline from 2004 to 2012. And a similar decline occurred in Mellette County, South Dakota, where the rates declined from 13 percent to 12.7 percent.

If these two reservation communities are showing a decline, what do the numbers look like across Indian Country?

Unfortunately the CDC and the Indian Health Service use different data because, of course, the county map is not ideal. The Indian Health Service reported that its data would not be comparable with the county data cited.

However — and this is important — IHS data do indicate a slowing in the rate of rise of the prevalence of diabetes in American Indian and Alaska Native people nationally. From 2001-2005, there was a relative increase in age-adjusted diabetes prevalence in American Indian and Alaska Native adults of 2.2% per year on average. Contrast that with the period between 2006 and 2013 where diabetes prevalence among the same population increased at a rate of 0.8% per year on average.

Another measurement of that trend comes from the United States Renal Data System. The data show that the incidence of end-stage renal disease due to diabetes in American Indian and Alaska Native people decreased by 43 percent between 2000 to 2011. Looking at the numbers another way, between 1995 and 2006, the incident rate of End Stage Renal Disease in American Indians and Alaska Natives with diabetes fell by 27.7 percent—a greater decline than for any other racial or ethnic group.

The IHS says: “This translates into far fewer American Indian and Alaska Native patients with diabetes starting dialysis. Also, obesity rates and diabetes prevalence in American Indian and Alaska Native youth have not increased since 2006.”

What’s working?

In Poplar, Montana, Tessie LeMere, diabetes coordinator for the Fort Peck Tribal Health Department, says a lot of the work is community focused. One important activity encouraging people to drink water instead of sugary soda. “We offer our water system. If you have your own jug, you can bring it in here and we’ll give you clean water. We do home visits. We do community screenings. The community screenings are a big thing because it’s not just for our patients, that’s for everybody just to get the awareness and prevention out there. We have wellness centers. We pay to those so our patients have access. We also have a dialysis program over at tribal health. That I think has brought the awareness more into reality.”

Perhaps that’s it. The success in Indian Country of the diabetes program is about doing everything, reaching out to both patients and those who are at risk for the disease. Again the numbers tell a story. A generation ago, before the Special Diabetes Program for Indians, only about a third of all Indian Health patients had access to diabetes clinics; today that number exceeds two-thirds. And 94 percent of patients have access to diabetes clinical teams, three times more than in 1997. And nearly 100 percent — 99 percent according to IHS — of people in the IHS system have access to diabetes education (up from 36 percent in 1997).

We hear all the time about how bad things are in Indian Country. The story of improving diabetes rates counters that narrative. It shows a lot of things: First, tribally designed programs work, government funding is important and lessons from Indian Country can help the larger nation treat its diabetes epidemic

Mark Trahant 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.

Fort Peck Tribal Health Department is a success story showing how a community can reduce diabetes rates. From left: Janene Padilla, Diabetes Coordinator Tessie LaMere.  Cheryl Bighorn-Savior (RN), and Laurel Cheek.
Fort Peck Tribal Health Department is a success story showing how a community can reduce diabetes rates. From left: Janene Padilla, Diabetes Coordinator Tessie LaMere. Cheryl Bighorn-Savior (RN), and Laurel Cheek.

Congressional budget plan requires deep cuts in Indian programs

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Budget targets $246 million below last year’s committee levels, says Democrat on House Interior Appropriations

MARK TRAHANT / TRAHANTREPORTS.COM

House and Senate negotiators have reached a deal on a budget resolution. That agreement then would go to each House for a vote. (An outcome that is not certain.) But, if it passes, it would be the first budget enacted by Congress in six years.

Let’s be clear about this plan: It would require deep spending cuts in federal Indian programs.

While the budget itself is not law, it sets limits for each of the appropriations committees to follow. According to a report from The Associated Press the draft document adds some $40 billion to military spending and calls for deep cuts to all domestic programs, including the Bureau of Indian Affairs and the Indian Health Service.

“The plan sets broad budget goals but by itself has little teeth; instead, painful follow-up legislation would be required to actually balance the budget,” the AP said. “It also permits the GOP majority to suspend the Senate’s filibuster rule and deliver a special measure known as a reconciliation bill to Obama without the threat of Democratic opposition. Republicans plan to use the special filibuster-proof bill to wage an assault on Obama’s Affordable Care Act rather than try to impose a variety of painful cuts to Medicare, Medicaid, food stamps, student loans, and other so-called mandatory programs over Obama’s opposition.”

The House budget is blunt about the next steps required to balance the budget within a decade, including another repeal of the Affordable Care Act. “None of the reforms proposed in this budget will be able to solve the underlying challenges in our health care system so long as Obamacare remains on the books. Our budget fully repeals Obamacare,” according to the budget plan.

This very notion sets up a debate. President Barack Obama would need to sign any appropriation into law — so a veto threat has merit. But the Congress still must pass a bill to appropriate money that would defy their own budget rules on programs such as the Indian Health Service (because some of that agency’s authorizing legislation is the Affordable Care Act. Remember: The Indian Health Care Improvement Act is a chapter of the ACA.)

So the actual final budget is going to be difficult to resolve.

At the same moment that the Congress is pursuing its latest “repeal” of the Affordable Care Act more states, even states controlled by Republicans, are moving forward with an expansion of Medicaid. This may be the most important part of the Affordable Care Act, especially for Indian Country because it’s adding new dollars to the underfunded health care system. Montana is the latest state to expand Medicaid.

A new report by the Kaiser Family Foundation says hospitals in states with Medicaid expansion are reporting a significant decrease in uncompensated care and a boost from Medicaid revenue. “Overall,” the report said, “hospitals in Medicaid expansion states saw increased Medicaid discharges, increased Medicaid revenue, and decreased cost of care for the poor, while hospitals in non-expansion states saw a very small increase in Medicaid discharges, a decline in Medicaid revenue, and growth in cost of care to the poor.”

In past budget years, American Indian and Alaska Native programs have been able to get support from the appropriations committees, but in this cycle there will be less flexibility because of the instructions in the budget. The ranking Democrat on the House Appropriations Committee, Rep. Nita Lowey from New York, said the “Majority’s allocations, which are based on the House budget resolution that passed on a party-line vote, are insufficient and fundamentally flawed.”

She said: “The Interior bill’s allocation paints a similar picture with an allocation that is $246 million below the FY 2015 enacted level. We will still have to cover the increased costs to combat deadly wild fires, provide contract support costs in the Indian Health Services, and prepare for Centennial anniversary of the National Park Service, all from an allocation below last year.”

This budget resolution would cut deeper than even the sequester. As Lowey said in a press release, “I think my colleagues on the other side generally agree that sequestration was a failure, and a return to those sequester-level caps threatens important defense and non-defense priorities alike.”

The Republicans have yet to identify specific spending numbers based on their budget targets.

No Democratic votes are required in either the House or the Senate to enact this budget resolution. The president does not need to sign the resolution, but he will need to sign into law any future appropriations based on the spending plan.

Mark Trahant serves as 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.

Writing day.


Working on post about Congress’ budget and potential impact on Indian health programs that are linked to Affordable Care Act.

Budget resolution does not require Democrats nor the signature of President Obama.

Op-Ed post: Medicaid expansion will boost Montana’s economy, people

Montanans love to talk about how special our state is. For those from some place other than Montana, you may think that we mean our beautiful mountains, the vast golden prairies, and incredible blue sky that never seems to end. And you would be right – we do mean that. But what really makes Montana special is the people.

The people of our state are kind and generous. We are the type of people who celebrate together during the good times, and look out for each other when times get tough.

Montana is particularly lucky because the people can dramatically change the direction and future of our state. Over the last few months, it was clear that the people of our state stepped up and did just that. They talked and our legislature listened. Late last week, the Montana Legislature passed the Health and Economic Livelihood Partnership (HELP) Act (SB 405). This bill is compromise legislation to extend health care coverage to low-income Montanans who need it, and the Governor has indicated that he will sign it as soon as it reaches his desk.

We are a group of organizations that have spent the past two and a half years working to expand access to affordable health care for the lowest-income Montanans. And we will forever be grateful to you, the people of Montana, for making your voices heard.

It was you who made more than 10,000 calls and emails to your legislators in support of Medicaid expansion. More than 150 of you submitted letters to the editor and opinion editorials. More than 300 of you came to the Capitol to testify. You kept the conversation going on social media. Hundreds of you came to rally on the Capitol steps or walk the halls talking to your legislators. It was you who passed Medicaid expansion.

Montana will be a better place because you made your voices heard. This legislation will help create thousands of new jobs. Montanans will be healthier and more productive because when people have health care, medical problems are more likely to be treated earlier and illnesses are less likely to affect one’s ability to work. Our rural hospitals will be able to keep their doors open because more people will have insurance to cover medical expenses. Montana tax dollars will come back to our state to boost our economy. And most importantly, tens of thousands of Montanans will be able to get the health care they need and deserve.

Never forget that when you talk – and sometimes it has to be loud and often – but if you talk loud and often enough, your elected representatives will listen.

Montana thanks you.

Sincerely,

Montana Women Vote, Montana Human Rights Network, Montana Budget and Policy Center, Montana Primary Care Association, American Cancer Society Cancer Action Network, Montana Organizing Project, Planned Parenthood Advocates of Montana, Western Native Voice, SEIU 775, MHA…An Association of Montana Health Care Providers, and AARP Montana.